THE RURAL HOMOEOPATHIC HOSPITAL EMBARKS ON A JOURNEY OF QUALITY:
THE RAMKRISHNA BAJAJ NATIONAL QUALITY AWARD
Dr. Anoop Nigwekar, MD (Hom), MBA* & Dr Anand Kapse, MD (Hom), MBA**
*Director, Projects and Administration, MLD Trust,
Member – Technical committee – AYUSH – NABH,
Certified Assessor – IMC-RBNQA
**Director, Rural Homoeopathic Hospital, Palghar
The ABC of NABH
The Rural Homoeopathic Hospital (RHH), Palghar has achieved the rare distinction of being the first hospital in India to have received NABH Accreditation under AYUSH (Homeopathy) on the 18th of February 2018 and NABH Pre entry Level Accreditation (Allopathy) on the 1st of March 2019. The accreditation ensures that the RHH is following a set of systems in the services it delivers to the patients who call on it. The systems are so set that they ensure the safety of patients and at the same time deliver service with a defined quality. We also manage an integrated set-up in which all have experienced the scope and advantages of offering a basket of secondary care with Allopathy, as it is also a need of the local community. These two accreditations establish that the services offered are of high quality, as NABH offers accreditation to a certain defined scope of services. The accreditation is mandatory for those hospitals who wish to seek various government schemes on health care – like the AYUSHMAN BHARAT, which enables the Hospital to provide service to the disadvantaged section of the population. Accreditation also confers an additional advantage when it comes to Cashless Mediclaim services and costs that we are permitted to seek from patients.
NABH: An opportunity to map services and grow for the benefit of all
Professional management demands a systems approach, which needs that certain fundamental processes must be in place. Most of us are averse to be monitored and being told to comply, especially when the process is voluntary. Hence most of the institutes keep away from systems management. For us to seek the NABH accreditation required a huge team effort of the entire staff organized under a team of supervisors.
How did we go about it?
Our supervisors sat together regularly for 4 hours every week for 52 weeks a year! The end of the tunnel came after 3 years during which time even the team configuration changed. The peculiar element of the team was that their coordination was their own responsibility!!! Dr. Prakash Gudsoorkar, Dr. Tejashree Junagade, Ms. Sunita Jayawant, Mr. Atul Chinchkar, Mrs. Nirmala Kulkarni, and Mr. Jaiprakash Patil were the supervisors. The NABH STANDARDS were read and the sections applicable to us were identified. A champion for each standard was chosen who sought support from a colleague champion if the standard demanded cross-departmental work. The team soon realized that they achieve more when all work together. This avoids tug of war or one-up-man-ship. The champions then identified those who actually work on the floor and face patients, their relatives, the doctors, nurses and students.
This champion and his defined team created the standard operating procedures (SOPs) for their areas of operations. NABH sent a team for pre-assessment, after which the final assessment was done. We got our accreditation after a concerted effort lasting 18 months. However, we benefitted in many more ways:
- Our team unity was stronger than ever.
- We stopped becoming anxious for assessments.
- We were confident in doing what we write and writing what we do.
- We were now keen to improve on what we had already done.
- Our patients started observing the change in us.
NABH: The costs and the gains
A thought comes to mind: Does compliance with NABH standards demand a huge financial investment? This thought itself is misguided. NABH demands a safe environment for treating patients and caring for them. This is otherwise ignored under the guise of saving costs. NABH processes help to improve transparency and communication with patients through bilingual signage and standardized consent forms. It also encourages our partners and well-wishers, e.g. canteen contractor, pharmacy and various vendors, to come together on a common platform. Additionally, an institution that has regular training programmes for employees and networking with volunteers from corporate employees enhances the morale and visibility of the organization. Cost-cutting measures and authentic documentation are then introduced, which automatically streamlines costs.
A number of green initiatives enabled contributions through the CSR route to set up solar electrification of the campus and set up a sewage treatment plant, both of which were not compulsory for the NABH accreditation. However, due to all the above changes, the services offered are of a high quality, which will ensure happy patients, happy staff, happy management, and happy relatives. We all desire to get the best of services in life for ourselves, but when it comes to providing best quality service to others, questions arise and we do not appreciate the cost we will pay for not addressing the quality of care. This effort helped us to transcend this common human tendency.
Embarking on a Journey of Quality: IMC’s RBNQA
Once the systems were in place and we were confident of monitoring them, we decided to get ourselves assessed again, through a different agency. We decided to apply for the Indian Merchant Chamber’s (IMC) RAMKRISHNA BAJAJ NATIONAL QUALITY AWARD (RBNQA) in the health-care category. This assessment is based on the concept of the MALCOLM BALRIDGE BALANCE SCORE CARD, an international system that assesses quality in all fields. The process mapping is similar to that followed in NABH, but after a point, the road takes a different turn. There is 55% weightage for process and 45% weightage for results, with marking out of 1000.
The advantage sought was getting feedback for the organisation in areas of improvement that are very much in the IMC scope. The more an organisation works on these suggestions, the better it can map its processes and measure their outcomes through results. Hence, this was a different method altogether. Dr. Prakash Gudsoorkar, Head, Quality Care and Infection control, was the leader of this effort. He was ably supported by the team of supervisors who had already helped us get NABH accreditation. We had to prepare a 60-page submission as per the criteria guidelines set by the National Quality Award Committee. This is followed by a face-to-face meeting at the IMC with the team of assessors appointed by the IMC Awards Committee, which comprised highly experienced people from various sectors across industries, well trained and qualified to undertake the quality award assessment process. You have to make a presentation and offer clarifications in about 15 minutes (it actually continued for 2 hours!). They share with us the site visit issues where they seek to clarify their doubts or carry out a verification of what we have stated in our submissions. The site visit allows the team to assess and submit their report. The final decision is by a jury who are exceptionally qualified and experienced people from India coming from diverse backgrounds. This year, we were finally assessed by a jury headed by Shri Mohandas Pai of Infosys fame. We received the Commendation Certificate, the only NGO in Health Care to receive it in 2018. The most important thing was the summary of the assessors – an actual eye opener for the RHH.
Third party assessment of the RHH
If the RHH desires to grow further the areas of improvement identified are given below:
“The most significant opportunities, concerns, or vulnerabilities in area of process are as follows:
- A culture of collecting relevant data documenting and analyzing it to form action plans that can be measured and reviewed for improvement needs to be developed for management by fact. This will ensure smooth operations, revenue generation, regular donations, and will give us a market edge against existing and upcoming competition.
- A focus towards continuous improvement and innovation, involving all stakeholders could help in further cost control, simplifying processes for customer satisfaction and organizational sustainability.
- By linking strategies with work systems and key processes and aligning existing resources to improve overall performance, the Institute could increase focus on a system-driven approach (against person-dependent) for continuity of operations and improve profitability.
Considering the Applicant’s key business factors, the most significant strengths, opportunities, vulnerabilities, and/or gaps (related to data, comparisons, linkages) found in its response to Results Items are as follows:
- The Institute could aim to capture and analyze healthcare outcomes, service quality, and values that lead to patient and stakeholder satisfaction and engagement by focusing and integrating:
- a) Operational data
- b) Target-based outcomes
- c) Comparative data and trends
- d) Competitive data and Benchmarking
Learnings from treading the journey of Quality
- We need to harbour within us the quest for improvement and nurture a need to create for the community a better quality of life than the one we experienced.
- We need to function as a team that commits itself to the Vision, Mission, and Values of the organization.
- We need to involve every last man and woman in the organization in this effort. Continuous training and motivation are crucial.
- It is a journey that is tough but enjoyable, since it is a collective journey. It appears effortless, but only when we are at the end of the road! This is because we have been constantly learning and changing.
- Accreditations and awards demand that we have key performance indicators and continuous quality improvement parameters. This implies that the journey is not over; it has just begun.