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December 15, 2018 Saturday 02:21:59 PM IST


Health Monitor

"Quality is never an accident, it is always the result of intelligent effort” (John Ruskin)

Quality may be defined as:

a. meeting customer expectations

b. adherence to certain standards

c. doing it right every time

d. freedom from errors


Every patient who visits a hospital expects the highest level of care and safety.  Every hospital should continuously strive to ensure that the  patients receive the highest level of care and safety.  It is this thought that should be weighed by the top management to plan for the best facilities, processes and practices even before the commissioning of a hospital. The management’s vision to excel in quality of services could begin with developing systems and processes which adhere to National Accreditation Board for Hospitals & Healthcare Providers  (NABH) standards and Joint Commission International  (JCI) standards.

An Accreditation is defined as "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 relation to the standards".


Accreditation is an external review of quality with four principal components:

Ø It is based on written and published standards

Ø Reviews are conducted by professional peers

Ø The accreditation process is administered by an independent body

Ø The aim of accreditation is to encourage organizational development

The key objective of any accreditation is ensuring ‘quality of care’ and ‘patient safety’.  The standards are applicable to clinical as well as non-clinical departments and have a direct impact on delivery of care and patient safety. 

The margin of error allowed in healthcare is zero.  Mistakes cannot be tolerated when dealing with patient lives.  Every time we treat a patient, a hundred things could go wrong.  There are so many evidences and news articles about how medical errors have resulted in physical and mental trauma, disability or even loss of life. The financial burden of medical treatment is in itself a huge challenge for many patients, let alone facing such adverse events.

The only way to prevent such errors is to follow evidence based practices.  The objective of getting an accreditation is not merely a branding for the hospital but to inculcate a culture of safety and continuous improvement within the institution.  This can be achieved only by adopting a preventive approach to all errors or potential errors and learning from mistakes to improve existing practices.

For this, the support of the top management is utmost essential and the culture of safety needs to percolate through all rungs of the organization.  For any doctor/staff who enters the organization, there could be an elaborate induction training session which imparts knowledge on the safety culture of the organization.  This could be followed by department specific training and competency assessment to ensure that they are well versed in the best practices and to adhere to the standards during routine work.

Continuous improvement, popularly known as ‘kaizen’ could be followed. The Japanese term refers to activities that continuously improve all functions and involve all employees from the CEO to the ground level staff.  The kaizen philosophy could be adopted across a hospital where every staff and department head are encouraged to participate in the quality improvement process.  Measuring and monitoring of Key Performance Indicators in terms of processes and outcomes, setting targets/benchmarks to be achieved, and developing and implementing strategies to achieve them are all part of the quality improvement process.

The patient satisfaction index is the best tool for measuring the outcome of the services.  Every patient visiting the hospital could be given an opportunity to provide their feedback.  On collecting this, a detailed analysis should be followed and the response to every service provided could be recorded.  The concerned department heads need to be informed on a daily basis in case of any complaints or suggestions and remedial measures should be ensured. The complete analysis is presented to the top management every month and a multi-disciplinary team should review areas with scope for improvement and ways by which this could be achieved.

A similar approach is followed for all departments where their Key Performance Indicators are monitored and analysed periodically and improvements made wherever required.  Transparency coupled with collaborative decision-making is the key to maintaining a safe and ethical culture in the hospital.


Quality is a journey and not a destination.  Hence, we cannot stop with just one accreditation.  The journey continues and the accolades or recognitions received are only milestones in this journey.  The focus should be on developing every department as a centre for excellence.  This would ensure that the best standards are practised even when no one is looking or monitoring.  This is achieved by constant training, reinforcements, quality audits, clinical audits, monitoring and surveillance of practices, reporting of incidents/errors, quality improvement programmes and initiatives involving all staff.

Reporting of errors and near misses is another good practice which plays an important role in learning from mistakes/potential mistakes.  The focus is always on “why” and “how” it happened than “who”.  The strength of a good system lies in identifying the weakest link and re-engineering the process/system to ensure that there is no room for error. 

Aristotle rightly said, “Quality is not an act, it is a habit”. The management, Quality team, doctors, nurses and all staff need to work together as a team with due diligence and focus on making quality and patients’ safety a habit which is interwoven in their daily routines, thoughts and actions.  Our ultimate goal should be  to ensure that all the patients and their families are given the best treatment which includes cure and care. We should continue to strive for excellence and continuously raise the bar, hoping and believing that we can and will do better. 

Dr. Anna George

The writer is GM-Quality, Rajagiri Hospital, Aluva

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