Promoting Quality Improvements in Indian Hospitals - What Will it Take?
Indian hospitals are a highly heterogeneous sector, in which quality of care has been very variable. On one hand, there are hospitals comparable to the best in the world, while on the other hand there are many that struggle with rudiments of patient safety and infection control. In addition to this, the majority of hospital services are provided by the private sector with very limited regulation and stewardship from the government.
In this context, this RBF Seminar featured two highly renowned figures, Dr Narottam Puri, Chairman of NABH and Dr Nandakumar Jairam, Chairman of Health Insurance Advisory Board of FICCI from the Indian hospital sector, who introduced the context of the Indian hospital sector, presented the recent progress in promoting quality through the lens of the National Accreditation Board for Hospitals & Healthcare Providers (NABH) and illustrated the processes and efforts of one private hospital chain, Columbia Asia Hospitals.
Interestingly, in India the issue of quality of care initially emerged thanks to actors outside healthcare, when the Ministry of Tourism started discussing the need to improve quality of care to support the growing potential of medical tourism. However, quality has increasingly moved from the fringes into a mainstream issue, with regulators, policymakers and payors increasingly recognizing their central role in promoting quality in healthcare to the advantage of the Indian population.
Over the last seven years, India’s National Accreditation Board for Hospitals & Healthcare Providers (NABH) has been operating an ISQua recognized accreditation program for healthcare organizations. Following international trends, quality indicators have moved from the focus on the organizational level to one more closely related to patient safety.
Making improvements in quality of care has become a larger movement and key public and private stakeholders have been working with NABH in these efforts. Several emerging hospital chains, exemplified by the case of ColumbiaAsia, are making their own efforts to enhance quality and patient safety, and have embraced quality improvement as a comprehensive program with strong support from the leaders of the organization.
Several key lessons were highlighted during the presentations and the questions-and-answers session that followed. The staged, step-by-step approach adopted in India to promote quality across the health sector is contributing to closing the divide on quality between the smaller hospitals and the higher-end ones. While accreditation in itself is not a measure of quality, it is an important tool that can be used to promote quality among hospitals.
Discussions also highlighted the role of judicial activism, consumer activism, and increasing awareness in urban India that was strenghtening and broadening the participation of stakeholders in the debate on quality. The rising awareness and participation of payors and insurers has increasingly contributed to this mainstreaming of the emphasis on quality, and the catalytic role of the World Bank in this process was also appreciated in the discussion.