ASSIGNMENT ON

“Quality Assurance in Healthcare”

COURSE CODE: HLT607

SUBMITTED TO : Dr. MRIDULA MISHRA

SUBMITTED BY: Pankaj Devrari

11809316

Max. Marks: 40 Date of Allotment: 30th May Date of Submission: 6th June

MITTAL SCHOOL OF BUSINESS LOVELY PROFESSIONAL UNIVERSITY PUNJAB 144401

1. Assume that you are working in the hospital run by the NGO and you were asked to

prepare the report to apply for Accreditation. You need to choose one of the Accreditation

agency which you believe is the best for your hospital with your recommendation for the

chosen accreditation agency

National Accreditation Board for Hospitals & Healthcare Providers (NABH) could be a constituent board of
Quality Council of India, founded to determine and operate accreditation programme for healthcare
organisations. the board is structured to cater to much desired needs of the consumers and to
line benchmarks for progress of health industry. The board while being supported by all stakeholders including
industry, consumers, government, have full functional autonomy in its operation.

International Linkage
NABH is an Institutional Member yet as a member of the International Society for Quality in Health Care
(lSQua).
NABH could be a member of the Accreditation Council of International Society for Quality in Health Care
(ISQua).
NABH is on board of Asian Society for Quality in Healthcare (ASQua).

Vision
To be the apex national healthcare accreditation and quality improvement body, engaging at par with global
benchmarks.

Mission
To operate accreditation and allied programs unitedly with stakeholders that specialize in patient safety and
quality of healthcare based upon national/international standards, through process of self and external
evaluation.

Values
Credibility: Provide credible and value addition services
Responsiveness: Willingness to concentrate and continuously improving service
Transparency: Openness in communication and freedom of data to its stakeholders
Innovation: Incorporating change, creativity, continuous learning and new ideas to enhance the services being
provided

Scope of NABH /Objectives

Accreditation of healthcare facilities
Quality promotion: initiatives like Safe-I, Nursing Excellence, Laboratory certification programs (not limited to
these)
IEC activities: lecture, advertisement, workshops/ seminars
Education and Training for Quality & Patient Safety
Recognition: Endorsement of varied healthcare quality courses/ workshops.

NABH STRUCTURE

Benefits of Accreditation

"A public recognition of the achievement of accreditation standards by a healthcare organisation,

demonstrated through an independent external peer assessment of that organisation's level of performance
in regard to the standards".

Accreditation benefits all stake holders. Patients are the most important beneficiary. Accreditation ends up
in prime quality of care and patient safety. The patients get services by credential medical staff. Rights of
patients are respected and guarded. Patient satisfaction is often evaluated.

The staff in an exceedingly accredited health care organisation are satisfied lot because it provides for
continuous learning, good working environment, leadership and specially ownership of clinical processes.

Accreditation to a health care organisation stimulates continuous improvement. It enables the organisation in
demonstrating commitment to quality care. It raises community confidence within the services provided by
the health care organisation. It also provides opportunity to healthcare unit to benchmark with the simplest.

Finally, accreditation provides an objective system of empanelment by insurance and other third parties.
Accreditation provides access to reliable and licensed information on facilities, infrastructure and level of care.

With the turn of the century, competition in most industries has gone up by several notches and
each participant has had to innovate and maintain high standards to remain within the race. With evolving
technology, increasing talent and more available avenues in business, there can only be such a
lot variation within the standard of various products and services in direct competition with one another. to
line oneself apart, attention to quality and customer orientation would wish to incline utmost priority.

Healthcare isn't any different. The demand for quality in healthcare services has risen because
of various economic process like medical tourism, insurance, corporate growth and competition. With
investment set to grow in healthcare, both from the private and public sector, stakes are high and every
one participants will want to make sure that this investment is put to the simplest use possible. Customers of
healthcare facilities, both internal (participant doctors, clinical and non clinical staff)) and external (patients),
will want to make sure that they're an element of an establishment that's recognized for the standard and
high standard of their services. Therefore, it's imperative that healthcare facilities strive for excellence in
quality. Accreditation bodies like NABH act as a top quality assurance mechanism.
Advantages of Hospital Accreditation

Listed below are a number of the key advantages:

Patients
NABH standards facilitate patient safety and reduction in errors
Improved quality of care and importance to patient rights leads to a greater patient satisfaction rate
Accreditation helps improve the boldness of the community towards the services provided by the hospital
Recommended For You >> Learn to plug Your Hospital Services

Staff
Results in greater staff satisfaction because it provides a chance for continuous learning, good working
environment and ownership of clinical processes
It also helps recruitment activities because the staff prefers to figure with an accredited organization over a
non- accredited organization
It ensures staff efficiency, accountability and adherence to plain Operating Procedures
Accreditation bodies provide continuous support and training to accredited organization

Insurance and TPA

Accreditation has now become a prerequisite to be eligible for sure insurance reimbursement, participation in
managed care plans andbidding on contracts

Marketing
An accreditation status provides marketing advantage in acompetitive health care marketplace and
improves the power to secure new business
It provides a chance for the hospital to benchmark its services with the simplest and successively helps
promote footfalls together with medical tourism

Hospital
In addition to the above, an accreditation helps the organization streamline its processes and ensure
adherence thereto
It also provides a framework for putting in quality improvement plans
Helps in risk management
The quality of healthcare imparted to patients in several hospitals in India come short of standards of care and
healing. One can only hope that a mixture of realization by these hospitals to enhance and also the passing of
a law to create quality accreditation mandatory will eventually result in quality healthcare in its truest sense.

2. Discuss the challenges faced by the Wellness Centers in the European contraries.

1. Harnessing Advanced Health Technology

In the current tech landscape, dynamics of both hardware and software is changing. as an
example, per the united kingdom Center for Health Solution report, 48 percent of medical devices are
connected through IoT, which is predicted to rise to 68 percent within the next five years. Research
firm MarketsandMarkets also reveals that the connected medical device market is predicted to witness
a three-fold rise from 2017 to 2022.

Even the software applications utilized in hospitals, like Appointment Management System, Patient
Administration System, and Laboratory Information Management System are now getting powered by
advance techs like AI and machine learning.

To harness the potential of healthcare technology to remodel the health systems and develop a
connected healthcare environment, healthcare leaders and clinicians must forge closer ties with
medical manufacturers and software application development companies. they will share information
and develop new business models and scenarios that may improve the adoption of recent technology
in healthcare.

2. Information and Integrated Health Services

Use of connected medical devices and AI-integrated software application can provide an
enormous amount of knowledge to the healthcare companies which they will use to come up
with information.

This data may be of various types like administrative data, patient medical records, connected device
data, transcript & clinical notes, and patient surveys.

However, most care providers, even top healthcare companies, lack advanced architecture and data
management systems to manage data collected from multiple sources.

The problem is use of relational databases that can't efficiently manage unstructured data collected
from multiple sources, means the worth of the knowledge they're getting isn't absolute.

A transition from relational to the non-relational database could help healthcare service providers
handle large and unstructured data. because the company grows and therefore the flow of
knowledge increases, the database’s architecture may be scaled to form room for the new data.

Healthcare companies must plan all models for all the management layers—operational, tactical, and
strategic, and partner with reliable integrator having mature service management process to support
integrated health systems.

3. Cybersecurity
Connected medical devices and a greater must keep the records of patient information attract the
eye of malicious hackers to healthcare providers. As you'll see, healthcare data breach statistics clearly
reveal an upward trend in data breaches from 2009—2018.

Those breaches have resulted in theft/exposure of 189,945,874 healthcare records. That equates
to over 59% of the population of the u. s..

If we analyze the health records exposed every year, we are going to see an enormous increase in
2015, but matters has improved since 2015 with successive falls within the number of exposed records.

These attacks necessitate a strong system for cybersecurity in healthcare, which could prevent data
theft and loss of data and customers’ conviction.

Even in 2014, most large health networks fell victim to cyber breaches with 20-percent of these attacks
costing over a million dollars in recovery expenses.

Influenced by the impact of technology in healthcare, Healthcare companies are moving ahead with
their digitization plans. Although they have to be very careful and take proper measures to take care
of healthcare cybersecurity, such as:

Limit connected medical equipment access to trusted users

Structure proprietary networks and spend on segregating external and internal medical devices on
enterprise networks
Follow application development security protocols
Build a centralized system to manage information
And if they're outsourcing their IT processes to health technology companies, which include sensitive
information like patients’ personal information or transactional details, they ought to only depend on a
HITRUST-certified third-party provider.

4. Rising Healthcare Costs

The cost crisis in healthcare isn't new. There are many stakeholders who play a key role in
determining the price of healthcare services, starting from device manufacturers to medical drug
manufacturing companies and payers to contract providers.

Conflict is natural when numerous stakeholders are involved. And developing a consensus requires
strategic planning and time.

The rising cost of healthcare directly impacts the revenue of the healthcare companies, as increased
cost discourages patients in some ways, from taking lab tests to doing regular follow-ups post visit,
which ultimately results in poor patient outcome.

According to Martin Gaynor, an economics professor at Carnegie Mellon University, “Health care
spending is high, and it's ultimately unsustainable.”
Here are some things healthcare providers can do to cut back the healthcare costs for patients:

Provide local price variations to patients, either by healthcare providers or insurers

Empower patients to settle on high-value plans per their wallets
Reduce the quantity of medical tests for patients. per a study mentioned by Dr. Atul Gawande, a
surgeon, writer, public health researcher, 42% of patients received unnecessary tests in one year.
Negotiate pharmaceuticals costs for consumers
Some other internal measures can be taken by healthcare companies are reliance on healthcare
information technology and developing a consensus with pharmaceutical companies.

Investment in IT healthcare
A study from Health Affairs reveals that US healthcare systems can depend on more “frugal
innovations” or say “good enough” products that are economically feasible and not technically
inferior still.

For example, a report from Science Direct states that investment in IT healthcare like revenue cycle
management software has been proven to cut back the operational cost. per the author, “The usage of
economic management systems is related to lower hospital operating expenses.”

Besides, it's also the actual fact that administrative costs of u. s. account for or around 8% of their
overall healthcare costs and therefore the country could save $175 billion in healthcare costs by
halving administrative costs—Jama Network.

5. Payment Processing and Invoicing

According to the KF health tracking poll, although most of the people confirmed that they will afford
their treatment, but one out of 4 faced difficulty in affording their medicin

A combined effort from healthcare companies, insures, and benefactors can help curb the rising cost of
healthcare and thus help to resolve one in all the foremost challenges in healthcare.

This effort results in the event of effective medical billing processes and procedures model, under
which financial incentives can be related to patient outcomes instead of service quantities. The new
payment model could also address the priority of Dr. Gawande for unnecessary medical tests.
Many patient advocates are now pushing for the new model that delivers quality over quantity, which
could play a key role in improving patient outcomes at a lower cost. Healthcare service providers can
create different versions of healthcare payment processing models, including invoicing and payment
model looking on their business structure.

One of the successful models is 1ACO (Accountable Care Organization) wherein healthcare groups take
responsibility for improving patient outcomes at a reduced cost.

Besides, healthcare companies can break the entire payment into small chunks to
assist patients/payers better plan their finances and mode of payment.

Again, they will collaborate with medical billing companies to develop healthcare billing systems with
powerful features like flexible invoice management dashboard, advance collection and adjustment,
separate OP and IP billing queue screen can help healthcare providers offer patient-centric solution
and combat healthcare industry challenges more efficiently.

6. Pressure on Pharmaceutical Prices

At the start of the year 2019, RX Savings Solutions report revealed that around three dozen
drugmakers have raised prices on over 250 pharmaceuticals. It means the typical price of the drugs are
going to be increased by 6.3%. against this, the rate of inflation within the US for the past 12 months
through November has been just 2.2%.

Increase in prescription prices has led to the slow growth of prescription spending

The rise in pharmacy prescription prices is one in all the foremost healthcare challenges for both
healthcare enterprise and patients. per Michael Rea, CEO of the Rx Saving Solutions, “The reason it can
keep happening is there's no market check, not a soul or entity to bring reason to determining drug
prices.”

An industry-based regulatory body may be formed including all the representatives of all the
stakeholders of healthcare and pharmaceutical industries to a minimum of control the hike in prices.
7. Healthcare Regulatory Changes
Regulatory challenges affect healthcare companies in two ways: one is it drives up the price of
healthcare services and second is it creates confusion among the final public, which is required to be
addressed in a very precise and proper manner to avoid lawsuits.

Timely reforms in healthcare laws and regulations are necessary, but the matter is that companies are
often not read to handle the challenges that they bring about.
For example, Trump administration is now engaged on regulating Medicare and Medicaid eligible
healthcare providers. Research reveals that these laws and regulations in healthcare industry will
burden the healthcare providers to satisfy new reporting requirements and accommodates a variety of
revised standards including:

Health Insurance Portability and Accountability Act (HIPAA)

Centers for Medicare and Medicaid Services (CMS)
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
A lack of effort by healthcare service providers may lead to entanglement in complex lawsuit and
penalty. To effectively combat these healthcare challenges, healthcare providers must create a
platform to lift awareness and share information quickly with all the bodies.

8. Healthcare Staffing Shortages

Many industry groups have predicted a shortage of around 100,000 doctors by 2030. Here, technology
can help in some ways like the utilization of telehealth can help in a very big way. Live streaming, store-
and-forward imaging, remote patient diagnostics can improve access to healthcare even in remote
regions.

According to the Bureau of Labor Statistics’ Employment Projections 2016-2026, also projects the
requirement for an extra 203,700 new RNs every year through 2026 to fill newly created positions
and to switch retiring nurses.
However, professional development on an everyday basis and improvement in infrastructure are the
key to reducing staffing shortages in healthcare.
The influx of technology within the healthcare industry has completely changed the way training and
education is imparted within the healthcare sector. A shift from a conventional clinical interview with a
spotlight on acute illness to involving patients and better staff communication may be seen,
 which could be a good check in terms of professional development and efficient healthcare workforce
shortage solutions.

9. External Market Disruption

There are many external forces that have made tentative inroads into healthcare, causing disruptive
innovation in healthcare. Increased use of smartphones and therefore the rise of mobile apps and
ecommerce platforms have drastically changed the way businesses interact with their customers.

Healthcare consumers aren't any different. In fact, they're emotionally and physically vulnerable and
then more sensitive to the standard of services.

According to Bain & Company, there are 5 key disruptors, which can cause disruptive innovation in
healthcare and set the healthcare trends. They are:
These disruptors open up doors for brand spanking new players outside the healthcare industry, resulting
in increased competition and healthcare industry challenges. Companies like JPMorgan Chase, Amazon,
and Berkshire Hathaway have announced last year to deliver healthcare to their employees in yet-
unspecified ways.

Amazon has also acquired wholesale pharmaceutical distribution licenses in several u. s.. Besides, there
are other non-traditional players like Apple, Samsung, Alibaba, and Tencent have entered into the market.

These companies, powered by technology, have introduced digital disruption in healthcare and
consumerism into the healthcare industry, which rings the alarum for existing players to investment Digital
Transformation and other emerging technologies like AI, Machine Learning, and IoT.

10. The Opioid Crisis

In 2017, the the big apple Times reported that drug overdoses are the leading reason for death for
Americans under 50. The report created an alarm for policymakers and healthcare providers that firm
action is required to combat one in all these latest challenges in healthcare.

Although, there's still a scarcity of consensus or regulatory body that checks the utilization of opioids, a
category of medication which is out there legally by prescription.

Misuse of pharmaceuticals is gradually gaining recognition in America. it's important that healthcare
enterprises and pharmaceutical companies move to propagate tighter laws and restrict the misuse
of pharmaceuticals by the final public.

3. Write the essay on importance and use of Self-assessment tool kits significance in the

hospitals.

The tool consists of 106 questions assessing adoption of the PAI recommendations at the hospital level.
Upon completing the questions, the tool will allow the user to develop an inventory of priorities (an
"Action List") individualized to their own hospital/health system. Hospitals also will have the chance to
get reports comparing their data with aggregated data collected from similar hospitals within and across
their state. an inventory of resources also will be provided to help hospitals in implementing change in
their institution.

Quality accreditation can provide a sustainable competitive advantage to healthcare businesses if they
build their strategy around creating infrastructure, policies and processes compliant with the Indian
National Accreditation Board for Hospitals & Healthcare Providers (NABH ) standards. The standards
promote adherence to global best practices of health care delivery, and there are detailed guidelines on
measuring performance of hospitals on pre-defined quality indicators (nabh.co/standard.aspx).
Accreditation requires an organisational culture change, which must be sustained for a extended period of
your time. A culture developed on the bedrock of quality care and patient safety will provide utmost
quality assurance to patients and also the community. Patients became more privy to accreditation, and
that they are basing their choice of hospital on whether the hospital is accredited or not.

NABH Standards for Hospitals

The 10 chapters reflect two major aspects of health care delivery, ie patient-centred functions (Chapters 1-
5) and healthcare organisation-centred functions (Chapter 6-10), as follows:

Patient-Centred Standards

Access, assessment and continuity of care (AAC);

Care of patients (COP );
Management of medication (MOM);
Patient rights and education (PRE );
Hospital infection control (HIC);
Organisation-Centred Standards

Continuous quality improvement (CQI);

Responsibilities of management (ROM);
Facility management and safety (FMS);
Human resource management (HRM);
Information management system (IMS).
Aim

This project aimed to conduct self-assessment against NABH accreditation standards, gap analysis and
action planning at a number one multispeciality corporate hospital of north India. Secondary objectives
were to:

Study the efficient functioning of the Hospital, area-wise and department-wise to determine that the
quality operating procedures are being followed in an accurate and effective manner.
 Ascertain the organisation’s preparedness and commitment to quality goals and conformance to
accreditation standards.
Understand the effectiveness of employee satisfaction indicators on implementing NABH processes.
Suggest effective solutions through action planning that the hospital can adopt to bridge such gaps.
Methods

This was an observational study that involved collection of primary data via structured observation tools,
staff and patient interviews, studying the quality operating procedures (SOP s) of the department and
putting the observations on the audit tool. The areas that were considered and studied empirically were:

Patient care areas: outpatient department (OPD ), inpatient department (IPD ), day care centre, operating
theatres, medical aid units.
Support areas: nursing stations, diagnostics (laboratory and radiology), pharmacy;
Ancillary service areas: central sterile supply department (CSSD ), food and beverage, laundry, engineering
services, biomedical engineering, medical gases, biomedical waste management (BMWM) and medical
records department (MRD );
Administrative areas: executive offices and other nonrevenue generating units;

Scoring Pattern

▪ Score 10/10: 100% compliance to the requirement.

▪ Score 5/10: Partial compliance to the requirement (if any of the sample is found to be non-compliant
out of total samples selected).
▪ Score 0/10: Non-compliance to the requirement.
▪ NA : Not applicable.
4. Discuss the Pareto and Fish Bone Analysis purpose and significance in the various

hospitals.

Pareto analysis could be a formal technique useful where many possible courses of action are competing
for attention. In essence, the problem-solver estimates the benefit delivered by each action, then
selects variety of the foremost effective actions that deliver a complete benefit reasonably near the
maximal possible one.

Pareto analysis could be a creative way of observing causes of problems because it helps stimulate
thinking and organize thoughts. However, it is limited by its exclusion of possibly important
problems which can be small initially, but which grow with time. It should be combined with other
analytical tools like failure mode and effects analysis and fault tree analysis as an example

This technique helps to spot the highest portion of causes that require to be addressed to resolve the
bulk of problems. Once the predominant causes are identified, then tools just like the Ishikawa diagram or
Fish-bone Analysis is wont to identify the basis causes of the issues. While it's common to consult
with pareto as "80/20" rule, under the idea that, altogether situations, 20% of causes determine 80% of
problems, this ratio is just a convenient rule of thumb and isn't nor should or not it's considered an
immutable law of nature.

The application of the Pareto analysis in risk management allows management to specialize in those risks
that have the foremost impact on the project.

Steps to spot the important causes using 80/20 rule

 Main article: 80/20 rule
Form a frequency of occurrences as a percentage
Arrange the rows in decreasing order of importance of the causes (i.e., the foremost important cause first)
Add a cumulative percentage column to the table, then plot the data
Plot (#1) a curve with causes on x- and cumulative percentage on y-axis
Plot (#2) a bar chart with causes on x- and percent frequency on y-axis
Draw a horizontal line at 80% from the y-axis to intersect the curve. Then draw a vertical line from the
purpose of intersection to the x-axis. The vertical line separates the important causes (on the left) and
trivial causes (on the right)
Explicitly review the chart to make sure that causes for a minimum of 80% of the issues are captured

The fishbone diagram or Ishikawa diagram may be a cause-and-effect diagram that helps managers to
trace down the explanations for imperfections, variations, defects, or failures.

The diagram looks a bit like a fish’s skeleton with the matter at its head and also the causes for the
matter feeding into the spine. Once all the causes that underlie the matter are identified, managers can
start searching for solutions to make sure that the matter doesn’t become a recurring one.

can also be employed in development. Having a problem-solving product will make sure that your new
development are going to be popular – provided people care about the matter you’re trying to resolve. The
fishbone diagram strives to pinpoint everything that’s wrong with current market offerings so you'll be able
to develop an innovation that doesn’t have these problems.

Finally, the fishbone diagram is additionally a good thanks to hunt for and forestall quality problems before
they ever arise. Use it to troubleshoot before there's trouble, and you'll be able to overcome all or most of
your teething troubles when introducing something new.