KIRAN SURGICAL SYSTEMS

NABH & NABL Accreditation Assistance

The National Accreditation Board for Hospitals & Healthcare Providers (NABH) Standards

is today the highest benchmark standard for hospital quality in India. Though developed

by the Quality Council of India on the lines of International Accreditation Standards like

the JCI, ACHS and the Canadian Hospital Accreditation Standards, the NABH is however

seen as a more practical set of Standards, topical and very relevant to India’s unique

healthcare system requirements.

Within just 2 years of its launch, the Indian Accreditation Standards, the NABH was

accepted by ISQUa, the International Society for Quality Assurance in Healthcare,

as an International Accreditation on par with the world's best.

Patients are the biggest beneficiaries from the NABH Accreditation, as it results in a high quality of care and patient safety. The patients get services by credential medical staff. Rights of patients are respected and protected. Patient satisfaction is regularly

evaluated. Accreditation also benefits the staff of the hospital as it provides for continuous learning, good working environment, leadership and above all ownership of clinical processes.

NABH Accreditation to a hospital stimulates continuous improvement. It enables the

Hospital in demonstrating commitment to quality care and raises the community

confidence in the services provided by the Hospital. It also provides opportunity to

benchmark with the best.

Finally, the NABH is expected to provide an objective system of empanelment

by Insurance and other Third Parties Administrators. Accreditation provides access

to reliable and certified information on facilities, infrastructure and level of care, a

need being felt increasingly by the Indian Insurance Companies who have recently

come out with a three tier package segmenting hospitals into A,B& C categories

based on which tariffs for cashless hospitalization treatments will be set. The NABH

Accreditation will naturally help Hospital to be in the A Category.

National Accreditation Board for Testing & Calibration Laboratories (NABL), similar

to the NABH, is also an autonomous body, under the Quality Council of India.

The primary objective being to maintain an accreditation system for laboratories

suitable for India, developed in accordance with relevant national and

international standards and guides. The NABL Accreditation is a formal recognition

of the technical competence of a laboratory based on third party assessment and following international guidelines. Trained Assessors taken from institutions all over India, with established credentials in testing and calibration activities carry out the assessment.

D4H is currently the only Consultancy in South India to have been approved by the Quality Council of India, as NABH Consultants. During the last three years since the inception of the NABH, we have been working with over 50 of the leading Private Hospitals in their Accreditation efforts. These hospitals include some of the leading ones in the South like Vydehi Institute of Medical Sciences & Mallya Hospital in Bangalore and the Apollo Hospitals at Mysore, the Apollo Specialty Hospital, Vijaya Hospitals, MIOT Hospitals & Sankara Netralaya (4 of their Units) in Chennai, the Apollo Hospital in Madurai, Kavery Medical Centre in Trichy, GANGA Hospital in Coimbatore, and the Regional Cancer Centre (RCC), Holy Cross Hospital, PVS Hospitals, PRS Hospitals, Dhanalakshmi Hospital, Trichur Heart Hospital and EMS Memorial Hospital in Kerala.

Apart from these Private Hospitals, D4H has also been in the forefront in enabling large Government Hospitals in Tamil Nadu and Kerala in going for the NABH. Of these 18 have till date successfully completed the Pre-Assessment and 4 the final assessment of which 1 has already been awarded the Final Accreditation. These 4 hospitals being incidentally the first set of Government Hospitals in South India to successfully complete the NABH Accreditation process.

Our consulting approach to the NABH Accreditation is unique in that we adopt a very close handholding approach, ensuring that our Consultants become an integral part of the exercise at the Hospital, an agent of the change being brought about. The NABH being an Accreditation Standard requires fundamental changes in the staff attitudes and behaviour if genuine improvement of quality in the delivery of care is to be brought about.

We commence with a comprehensive System Study and Gap Analysis done across the Hospital, covering even the Clinical Areas, especially those having a direct impact on patient care and safety. Our Report detailing the gaps is made with reference to the NABH or the NABL Standards and Clauses. This is followed by several rounds of awareness programs on the NABH Standards, covering different groups of staff and explaining to them those parts of the Standards relevant to their function. For example Nurses would be explained to on the NABH Standards related to Infection Control, Care of Patient, Management of Medication etc, Front Office Staff on Patient Access and Assessment, Information Management Systems, etc.

Once we are clear that a basic level of understanding has been achieved of the NABH requirements in all major departments, we start the system development process, with support of key hospital staff. This approach ensures an in-depth implementation. Based on the progress of implementation, monitored periodically through a series of mock audits and internal audits, the Hospital is prepared for the Assessment.

ISO 9001 Certification for Hospital Quality Management Systems

An ISO 9000 implementation gives a basic road map for integration of all functions

involved in total health care services, for ensuring a better quality of service to

the patients. Developed by the International Organization for Standardization (ISO),

Geneva, the ISO 9001 Certification is recognised worldwide as a hallmark of

professionalism and commitment to quality. The latest version, the ISO 9001:2008,

is especially relevant to the Healthcare Services Sector as it focuses on fulfilling customer

(patient) expectations, improving the quality of an organisation’s business and

management processes, so that when a job is done it is done well, first time, every time.

D4H has been a pioneering consulting firm in applying the ISO 9001 Standards to the

Healthcare Sector. In 1997 in technical collaboration with Thomsun Consulting, a global

quality management consulting major, D4H's foray began into the Healthcare Quality

Sector. Supported by our collaborator's proven track record of success in the healthcare field,

D4H assisted the first hospital in the country to go in for the ISO 9001 Certification, the

Mallya Hospital at Bangalore.

Over the next ten years, D4H went on to work with more than 100 leading Healthcare

Organisations across the country quickly diversifying into Clinical Labs, Nursing Homes,

Emergency and Trauma Care Centres and even some of the leading Ayurveda Hospitals.

D4H now occupies a prominent leadership position in the field of Healthcare Quality,

for applying the International Quality Management Standard, the

ISO 9001 to all healthcare related sectors.

Some minimum attributes that the D4H Consultants work to establish in a

Hospital aspiring for an ISO 9001 Certification are:

Acceptable quality care at affordable prices.
Timely care.
Clear communication to the patients.
Best practices for fixing appointment and service delivery.
Reliable diagnostic and laboratory support.
Reliable support services like canteen, ambulance, pharmacy, etc.
Safe and pleasant environment.
Technical competence, courtesy and attitude of staff.

Our Consultants ensure through a proper implementation of the ISO 9001 the

establishment of a set of good management practices in all areas of the Hospital

that directly or indirectly impact on patient care. These would cover signage at

the entry of the hospital directing the patients to the registration counters

and the right Out Patient Departments, ensuring continuity of care by a good

medical record system, ensuring reliability in the test results for better diagnosis

and care, prompt admission and a reasonably comfortable stay as in-patient

in the hospital and finally timely discharge from the hospital.

Patient Satisfaction Survey Program - D4H PULSE

"D4H’s Patient Satisfaction Survey, the only survey empaneled by the Quality

Council of India to conduct third party patient satisfaction survey for the

Indian Hospitals. As your hospitals takes a step further towards quality we invite

you go through our brochure and to mail us any query on the same

to Kaladaran ambode - Product Manager at kirangroup108@gmail.com.

Patient Satisfaction Surveys are an essential requirement for Hospitals going

in for either the ISO 9001 or the NABH Accreditation. D4H's Consultants

work closely with the Hospital Management to develop and run a PSS Program

that would periodically assess patient responses and thereby monitor the quality

of care the Hospitals provide.

Now D4H is offering to conduct PSS on behalf of Hospitals as an independent

Third Party Agency, as an important quality improvement tool. Based on our

skills built up over the last 10 years in this area, we expect to be able to add

considerable value to the Hospitals by developing and conducting the surveys

in a manner that will help them find out what actually the patients think about

the Hospital. Based on the findings D4H would give a report with a clear roadmap

for improvement.

Our experience has shown that Patient Satisfaction Surveys provide the Hospital with a simple method to improve clinical performance and profitability by identifying the root causes of clinician and patient behaviour and allowing action targeted directly at those root causes. The improvement is thus focused, through a deeper understanding of the patient’s experience in each aspect of care, ensuring critical opportunities for improvement are not missed.

Another huge gain we expect to derive for the Hospitals from Patient Surveys is the opportunity for benchmarking their quality of services against the ‘best practices’ in the sector, in each specialty, area or department, helping in setting targets for improvement and for periodical monitoring.

A properly designed and conducted Survey also help in better Risk Management, through early detection and quick responses, an ‘early warning system" for possible lawsuits. Surveys definitely improve the overall performance across the Hospital.

Essential features of the D4H Patient Surveys:

Results will be reliable and validated. We ensure integrity of the data analysis. Results that you can trust.
Results will come with reports that are actionable, with detailed analysis of the results, bench-marking and guidance on improvement.
Your data will be fully secured with all International Information Security protocols in place.
Surveys conducted by qualified enumerators, well trained to obtain responses from the patients.
Surveys held periodically, to help monitor performance and achieve improvements.
Important patient comments will be highlighted in the Report to enable the Hospital quickly respond to specific customer concerns.
Option available for real-time responses too. Critical issues can be informed to Hospital Management on the same day of the survey.
Survey results will be kept confidential and provided to the concerned hospital only, for internal improvement.

Hospital Project Consultancy

We assist new Hospitals to be set up in full compliance with the NABH and with

the best clinical and non clinical practices in the sector.

Our team today of over 75 in-house qualified and experienced healthcare quality

professionals is the largest in the country today. It comprises Hospital

trained Project Managers, Architects, Planners, Equipment Specialists and HR

Professionals. We are presently assisting new upcoming Hospitals in Chennai,

Bangalore, Mumbai and Udaipur as green field projects that will comply with the

NABH requirements right from commencement of their operations.

Our services include:

1. Market Feasibility Studies

We conduct Market Surveys for establishing the feasibility of putting up Hospitals

in any part of the country. For this we work exclusively with Ms IMRB

International, the leading and most reputed Market Study Group in the country.

2. Architectural Services.

Conceptual Drawings: Based on our understanding of your requirements of

specialties, plot size and layout and other parameters, we will present a conceptual plan for the hospital, showing the proposed structures with block relationships of the departments, area, shape and location within the building.

Detailed Architectural Services: Covering complete design of the building, internal space and facility planning and ancillary support services.

Interior Design: Complete design of the interior spaces, including public areas like lobbies, cafeterias, waiting areas, and semi medical and medical areas like OPD, inpatient wards and special rooms, Operating Theatres, Pathology, etc.

Structural Design: Design of the structural framework for the entire building conforming to the specific needs of the intended space, including the detailed construction drawings for the work to proceed on site.

Design of Services like Electricals, Plumbing systems, HVAC systems, Firefighting systems, Data and Voice Networking, Building Management Systems, UPS systems, Sewage treatment plant and Rain water harvesting

3. Project Report

Preparation of Detailed Project Report (DPR) based on the approved concept. The DPR will comprise proposed Plan, infrastructure development plan, zoning plan, space plan and the human resource plan. We will also provide the financials of the Project covering capital costs, fixed and variable costs and work out the estimated income. Based on this an assessment will be made of the financial viability of the Project.

4. Human Resource Planning & Recruitment

Providing the right manpower for carrying out the various operations at the Hospital. We will work out entire staff matrix of educational qualifications, skills and experience, detailed job specifications and descriptions. We can support in short listing, interviewing and selecting the right staff for professionalizing the services provided by the Hospital.

Food Safety - HACCP & ISO 22000:2005

HACCP - short for Hazard Analysis and Critical Control Point is the most

widely used acronym in discussions about microbial contamination issues,

developed in the early 60’s by Pillsbury and NASA to provide U.S D4hauts

with the greatest assurance of food safety. A faithful implementation of the

HACCP program will assist in the identification, documentation and control of the

impacts of the potential hazards in the entire food process, from raw material

procurement, transportation, pre-storage, cleaning and processing to the final

storage, packing and distribution.

The ISO 22000 is the latest Standard from ISO, specifically developed for Food

Safety, addresses all links in the food chain right from food growers, processors,

transporters, handlers and warehouses, to even food equipment makers.

Implementation of the HACCP or the ISO 22000 in a Hospital ensures that there

are no weak links in the entire Food Supply chain. Right from the procurement

process, to the storing, cleaning, processing, including cooking at the Canteen

and delivery to the patient's bedside, these Standards ensure that the best of

hygiene & food safety practices are followed.

For a Hospital concerned with providing the best level of patient care, it is incumbent that the food provided is of an equally high quality too. While many essential food safety aspects will get addressed during the Quality Management System implementation, a fool proof food safety system will need a dedicated implementation of the HACCP or the ISO 22000.

Hospital Environment, Occupational Health & Safety Management - ISO 14001:2004 & OHSAS 18001:2007

Hospitals are very environmentally sensitive places. This is why environmental

protection is of great importance here. Nearly all materials which flows

through a hospital bear enormous potential for damaging the internal and

external environment, including the health and safety of the people involved.

For example certain wastes generated that have a great ecological effect

are cell poisons (cytostatics), used in cancer therapy, films and developers

for the identification of diseases, as well as radioactive materials in cases

of diagnosis and therapy. Even the excrements of patients can also be

polluted. All these wastes can be safely managed and disposed only

with the means of a comprehensive integrated Environment, Occupational

Health & Safety Management.

As hospitals have to be kept always clean, they use a large amount of cleaning

agents and a larger amount of good water as the cleaning medium. The good

water that enters the hospital system leaves as waste water, which

needs to be treated before being let into the community. This waste water

contains large parts of different types of chemical detergents used for disinfection

and sterilisation and have to be removed.

An EMS or Environment Management System is also very useful in energy savings and management. Hospitals consume huge amounts of energy, which can be effectively managed and reduced using an efficient EMS. The high-end technology used for the identification and treatment of diseases and injuries are also huge energy guzzlers. Similarly, the need for maintaining different temperature zones in a hospital too needs high use of energy. An effective EMS will pay for itself within just months of implementation in a Hospital.

The ISO 14001:2004 - Environment Management System is the most important and internationally reputed Environmental Management System Standard in the world designed to assist any type of organisations to meet its responsibility for securing the future condition of our environment. The Standard is designed to ensure energy and cost savings. While statutory requirements like the Bio-Medical Waste Management Rules ensure a minimum level of compliance, there is rarely any form of recycling taking place thus making the Hospital environmental footprint big, smelly and expensive.

An ISO 14001 Environment Management System enables the Hospital Management to take up the responsibility for ensuring first that a clear environmental policy is developed. Based on this the senior management can realize that the EMS makes sense from a business perspective too and that by reducing the total amount of waste generated, significant savings can be achieved. Also by examining practices associated with waste management, discharges and resource consumption the Hospital can identify inefficiencies, leading to cost reductions.

Hospitals also pose serious occupation related risks to the staff and to the patients. Infection risks by direct contact with sick people, needle and medical equipment punctures where conveying blood-transmitted diseases, all these clubbed with congested layouts, on-going construction related issues and the ingress of outdoor pollutants, make management of hospital environment a necessity.

Thus, while the ISO 14001 helps mitigate the effects of the Hospital’s operations on the external environment, the concerns of the Doctors, Nurses and other staff employed inside the Hospital are addressed by the OHSAS 18001:2007 - Occupational Health and Safety (OHS) System, which is a mandatory requirement in all developed countries, as the ISO 14001.

OHSAS 18001, based on the British Standard - BS 8800 - enables an organisation to control its risks and improve its performance. It requires an organisation to conduct a risk assessment, and develop a system to manage those risks. A planned implementation of the OHSAS will enable an Organisation to manage its health & safety issues effectively and thereby improve productivity, reduce down time and demonstrate good compliance with all applicable legislation.

D4H has helped a number of large manufacturing and service organisations to develop suitable Integrated Management Systems including Quality, Environment, Occupational Health & Safety. Based on this expertise we would be well able to help your Hospital avail the benefits from a similar implementation too.

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