More important than the infrastructure, it is essential to know if the hospital has a documented process for its healthcare activities. Patient care not only involves the core clinical care, but also other support activities like requisition of tests, medicines, nurse doctor coordination, infection control practices, training, and so on. These need to run seamlessly in the background to provide the best experience to the patient and the relatives.
A quality-conscious hospital should define all such activities internally, document the same, and impart necessary training to the staff. These documented activities include detailed job responsibilities, work instructions, checklists and quality indicators for the staff to follow.
So how will the patient know about these processes? He is not expected to inquire with the hospital whether they have these processes laid down. And how many processes could he check even if allowed to?
Accreditation is the key
Organisations like the Quality Council of India [QCI] and its National Accreditation Board for Hospitals and Healthcare providers [NABH] have designed an exhaustive healthcare standard for hospitals and healthcare providers. This standard consists of stringent 500 plus objective elements for the hospital to achieve in order to get the NABH accreditation.
To comply with these standard elements, the hospital will need to have a process-driven approach in all aspects of hospital activities – from registration, admission, pre-surgery, peri-surgery and post-surgery protocols, discharge from the hospital to follow-up with the hospital after discharge.
NABH accreditation criteria
To give an idea what NABH standard comprises of, some of the 500-plus objective elements are listed here. The requirements have been grouped for easy understanding.
Information to patients
- The patients and/or family members are explained about the proposed care.
- The patients and/or family members are explained about the expected results.
- The patients and/or family members are explained about the possible complications.
- The patients and/or family members are explained about the expected costs.
Rights of the patient and family
- Respect for personal dignity and privacy during examination, procedures and treatment.
- Right to refusal of treatment.
- Informed consent before anaesthesia, blood and blood product transfusions and any invasive or high-risk procedures.
- Information on how to voice a complaint.
- Access to his / her clinical records.
Quality in investigations
- Adequately qualified and trained personnel perform and/or supervise the lab investigations.
- Policies and procedures guide collection, identification, handling, safe transportation and disposal of lab specimens.
- Laboratory and imaging results are available within a defined time frame.
- Critical results are intimated immediately to the concerned personnel.
- The lab and imaging quality programme addresses verification and validation of test methods.
- The lab and imaging quality programme includes periodic calibration and maintenance of all equipments.
- The lab and imaging programme includes the documentation of corrective and preventive actions.
- Surgical patients have a pre-operative assessment and a provisional diagnosis, documented prior to surgery.
- Documented policies and procedures exist to prevent adverse events like wrong site, wrong patient and wrong surgery.
- The operating surgeon documents the post-operative plan of care.
- There is a documented policy and procedure for the administration of anaesthesia.
- All patients for anaesthesia have a pre-anaesthesia assessment by a qualified individual.
- During anaesthesia, monitoring includes regular and periodic recording of heart rate, cardiac rhythm, respiratory rate, blood pressure, oxygen saturation, airway security and level of anaesthesia.
- Documented policies and procedures exist for prescription of medications.
- The organisation defines a list of high-risk medication.
- High-risk medication orders are verified prior to dispensing.
- The hospital has an infection control team.
- The hospital has designated and qualified infection control nurse[s] for this activity.
- Hand-washing facilities in all patient care areas are accessible to health care providers.
- Compliance regarding proper washing of hands is monitored regularly.
- Isolation/ barrier nursing facilities are available.
- Adequate gloves, masks, soaps, and disinfectants are available and used correctly.
Facility and infrastructure maintenance
- The organisation's environment and facilities operate to ensure safety of patients, staff and visitors
- There is a documented operational and maintenance [preventive and breakdown] plan.
- Up-to-date drawings are maintained which detail the site layout, floor plans and fire escape routes.
- The provision of space shall be in accordance with the available literature on good practices [Indian or International Standards] and directives from government agencies.
- There are designated individuals responsible for the maintenance of all the facilities.
- Maintenance staff is contactable round the clock for emergency repairs.
- Response times are monitored from reporting to inspection and implementation of corrective actions.
- Defined procedures for situation of bed shortages are followed.
- Ambulance[s] is appropriately equipped.
- Ambulance[s] is manned by trained personnel.
- There is a checklist of all equipment and emergency medications in the ambulance.
How NABH accreditation helps patients
In an NABH accredited hospital, there is a strong focus on the following:
- Patient rights and benefits
- Patient safety
- Control and prevention of infections
- Practicing good patient-care protocols e.g. special care for vulnerable groups, critically ill patients
- Better and controlled clinical outcome.
NABH now is a member of the International Society for Quality in Health Care [ISQua] and thus NABH standard is at the threshold of being recognised globally.
So, if a hospital is NABH accredited, the patient can rest assured that the hospital follows stringent standards as laid down by the accreditation body for providing best in patient care comparable to any international hospital of repute.
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