industry standards become indispensable because it directly involves human
lives. Medindia discussed healthcare standards in India with Ms.
Rama Venugopal, Executive Director, Value Added Corporate Services
corporate consultancy firm based in Chennai, South India, that closely works
leading hospitals and diagnostic centers in South India
Q. Tell us the role your company plays in
establishing high standards in healthcare industry?
consulting organization we facilitate organizations in the health-care industry
to implement and establish best clinical and administrative practices. Over the
years we have facilitated a number of hospitals, laboratories, imaging centers,
blood banks to implement and establish systems and practices conforming to
national/international standards like NABH, ACHSI, CAP, NABL leading to quality
patient care services. We facilitate organizations to set highest level of
quality that is required to meet the international standards. We do that by
educating and training staff on the importance of quality and effectiveness in
implementation of international standards.
you tell us about the awareness levels on standards in India and willingness
levels to implement these standards in hospitals & diagnostic centers?
Awareness level on the standards has increased drastically over the last couple
of years due to demand for standards from bodies like Central Government
Health Scheme (CGHS) and the Insurance sector
.Nowadays healthcare organizations are keen on implementing the
standards. Public awareness level is high as the knowledge regarding national
and international standards are more commonly projected in media now than
before. Also the current boom in medical tourism has increased the
foreign patient population and the organizations are competing to provide high
standards and quality care.
Also it provides opportunity to benchmark
with the best.
Why are standards very necessary for
Quality is important in any industry and it is even more critical in the
healthcare industry considering the margin for error is absent. In a country like India we have an unusual
problem. Over the years, the average age of an individual, at birth, has gone
up to 69 years from about 63 years. The Healthy Adjusted Life Expectancy (HALE)
has remained static at about 53 years.
Comparable peers have HALE in excess of 65 years. While this by itself
does not mean that healthcare standards are poor, it indicates the opportunity
that is available. Medication errors one of a nation's leading causes of death
and injury. Good practices in healthcare delivery will definitely make an
impact in the long run.
2006 study in Indian council for research on international economic relations
in India, the estimated loss in India's national income as a result of heart
diseases, stroke and diabetes in 2005 was US$9 billion, and this is projected
to exceed US$200 billion over the next 10 years. Firms lose approximately 14
percent of their annual working days due to sickness.
valid and clinically relevant performance measures have the potential to significantly improve the quality and
efficiency of patient care across the nation. The goal in assessing performance
is to create a system that promotes the best clinical standards and ensures the
highest quality of patient care through transparency, accountability, and
credibility. The adoption of appropriate quality-improvement strategies will,
if done right, result in increased patient and physician satisfaction.
Q. How do hospitals/diagnostic centers
benefit through standards?
Implementing well defined systems and processes in accordance
with international benchmarks ensure that we bring consistency in healthcare
delivery. It will minimize the scope and opportunities for errors/mistakes
through the medium of continuous monitoring as well as greater awareness
created through training programs. Hospitals/diagnostic centers benefit through
standards by Reducing error rates, rework and waste, customer dissatisfaction.
By following standards, hospitals/diagnostic centers can increase their
yield, capacity and improve their delivery performance. A well defined system
will involve all the people in the healthcare delivery which includes patients,
doctors, nursing staff, paramedics, bio-medical engineering and administration to
name a few. In the long run once the
standards gets internalized the benefits will become more pronounced and even
effective commercially. In that context
implementing standards should be seen as an investment and not a cost.
these standards in a health care organization stimulates continuous improvement
and enables the organization in demonstrating commitment to quality care. It
has the potential to improve the community confidence in the services provided
by the health care organization as it facilitates access to reliable and
certified information on facilities, infrastructure and level of care. It would also go a long way in the hospitals
getting international recognition also. This will provide boost to medical
standards provide framework for quality assurance and quality improvement for
hospitals, focus on patient safety and quality of care, make available a system
of continuous monitoring of sentinel events and comprehensive corrective action
plan which lead to building of quality culture at all levels and across all the
How does a common man benefit through standards?
The common man will get high quality of care and safety and
services by expert medical staff. Rights of patients are respected and protected.
Evaluation of Patient satisfaction
is done regularly. Since the
hospitals following standards will have high quality of services and care, the
patient gets very good care at an affordable cost.
Some of the key tangible benefits
would include factors like:
diagnosis and cure
Return to work
as early as possible
Treatment -that is, to be treated with empathy, respect and concern
Q. What is infection control?
Infection control practices control/eliminate sources of infection and help protect
patients and health care providers from disease
. A patient entering
health care setting is at risk for acquiring infections because of lowered
resistance to infectious microorganisms, increased exposure to numbers and
types of disease-causing organisms and invasive procedures. The hospital
environment plays a major role in the transmission of microorganisms.
potential sources of hospital cross infections are doctors' white coats,
nurses' uniforms, contaminated hands, hospital garments, privacy drapes,
stethoscopes, bed rails, and biomedical waste among others. Patients undergoing
hospital treatment frequently become infected. These infections arise from many
different sources and are usually associated with operative or other invasive
procedures carried out in operating theatres, wards, X-ray departments and
clinics. Doctors, nurses and other healthcare personnel come into contact with
a variety of microorganisms and must practice infection control and techniques
to avoid spreading them to patients. In order to achieve reduction in infection
rates among patients and staff, an infection control program has to be
developed with a clear and firm organizational structure. Without proper
infection control, recovery of patient slows down leading to increase in cost
of treatment and prolonged stay in hospital. Thus these factors contribute to
high morbidity and increase the death rate.
Q. What is the scope of infection control? Is
it restricted to Labs, Operating Theatres & ICUs?
India, one in five patients admitted to hospital acquired Healthcare Associated
Infections (HAI) a decade ago. HAI includes urinary tract infections,
ventilator associated pneumonia and centraline related blood screen infections.
It is believed to cause complications between 3.5% and 16.6% patients
worldwide. Most common types of HAIs are surgical wounds and lower
respiratory tract infections that are found among patients admitted to ICUs,
labour rooms and among patients undergoing invasive procedures or those on
So the scope is of wide range.
Since Labs, OT
and ICU's are critical/high risk areas the monitoring will be more. It can be
expanded to CSSD (Central sterile supply dept,) Blood bank, HDU (High
dependency unit) etc based on the scope of HCO.
Q. What are the types of standards that
help in infection control?
All national and international standards promote infection control and emphasis
its importance. For example the National Accreditation Board for Hospitals and
healthcare providers (NABH) standard in India focuses on this aspect through a
separate chapter Hospital Infection Control (HIC). It covers various issues
related to infection control like introducing dedicated HIC team to monitor
hand hygiene/ hand washing, cleaning/disinfection/sterilization, vaccination,
18001 (Occupational Safety & Health management systems)
framework for a safe and healthy working environment. The benefits are:
safe working environment
Delivers cost savings by minimizing risks to employees
Improved operational efficiency
Q. How do these standards help in infection
Infection control is gaining widespread attention in all healthcare settings.
Incorporating an infection control program is essential to minimizing the
incidence of infection and patient revisits.
As a part of
implementing these standards the health care organization will start monitoring
the infection control aspects such as hand hygiene, biomedical waste
management, infection rate surveillance etc. It will support hospitals in
reducing the risk of health-care-associated infections. Health Care
Organization (HCO) will also introduce the best infection control practices
through international guidelines such as CDC,
(Centre for Disease Control)
guidelines for infection control, WHO
(World Health Organization)
As a part of
these environmental control methods,
reporting of communicable diseases, attention to employee heath, infection
surveillance, isolation practices, validation of sterilization practices will
usage in India is very high
, and no regulatory mechanism has been put
in place. Since the standards clearly say about Antibiotic policy, the indiscriminate
use of Antibiotics will be curtailed and monitored.
Monitoring of needle stick injury rates will help in
preventing the spread of blood borne disease to health care workers and can
reduce those incidents by vaccination and training them in safe practices.