Need for NABH Accreditation

Dr Usha Manjunath, Director IIHMR Bangalore explains the significance of NABH accreditation and its benefits to healthcare providers.

Accreditation of hospitals and healthcare organisations in India have come a long way, yet have a very long way to go. In the 1980s, need for accreditation was not felt overtly and “Doctor knows the ‘best’” mindset ruled the scene. In the 1990s, the need for the same was felt, but we were not sure at that time if it would work for us. Slowly, the scene changed, many started accepting the fact that “Accreditation is good for setting up standard systems and processes, and that hospitals will benefit. The doctor still knows the ‘best’ but it must be documented. Quality to be improved must be measured. As the famous Russian proverb goes ‘Trust but verify.’

The hospital sector in India is growing rapidly, with private sector having more infrastructure than the public sector. The current landscape of the sector is very fragmented, and regulating the same has been a tall task. National Accreditation Board for Hospitals and Healthcare Providers (NABH) was set up under Quality Council of India which became operational in 2005-2006. At present, accreditation for hospitals, small healthcare organisations, blood banks, blood storage centres, MIS, OST centre, allopathic clinics, ayurveda hospitals, CHC, PHC, wellness centres clinical trials (Ethics Committee), panchakarma clinics, eye care hospitals and IRCAs standards have been accredited by ISQua (International Society for Quality in Healthcare and NABH is also one of the founder members of newly emerging Asian Society for Quality in Healthcare (ASQua). Therefore, there is international acceptance and recognition for these institutes.

NABH provides a great opportunity for healthcare organisations to establish standards, procedures and improve reliability of service operations. Accreditation is very useful to all stakeholders of a hospital, benefiting patients the most. For a hospital, it stimulates continuous improvement in governance, operations and functions (clinical and administrative). A sense of ownership and clinical excellence is instilled among staff. Accreditation is voluntary in nature and in the competitive market, hospitals are getting increasingly interested in demonstrating their quality of service delivery. Presently, nearly 600-700 hospitals are accredited which form a small percentage of hospitals in India (there are about 79,000 hospitals in private and public sector in the country). In 2017, about 119 hospitals (out of 4000 hospitals) across Karnataka have NABH recognition.

Primary motivation for NABH is obviously two-fold: patient rights and safety and provider rights and safety. Insurance Regulatory & Development Authority of India (IRDAI) through its notification no.: IRDA/HLT/REG/CIR/146/07/2016 dated 29.07.2016 has suggested all healthcare units providing cashless services to go for NABH Accreditation within two years’ time of its notification. This has mandated 33,000 hospitals to be empaneled.

Further, the acceleration of universal health coverage (UHC) through insurance (Government financing/social insurance schemes) is accelerating the process. CGHS and ECHS Empanelment facilitates hospitals to treat patients under the insurance schemes. Medical tourism has been an attractive proposition economically and capability utilisation wise for Indian hospitals and the recent ‘Medical Value Travel Facilitator(MVTF)’ empanelment launched is expected to give a boost to the sector. Accreditation helps paying and regulatory bodies to access reliable and certified information on facilities, infrastructure, processes, level of care etc.

Full NABH 4th edition released in 2015 is divided into 10 chapters (5 patient centred and 5 organisation centred) with 105 standards and 683 objective elements incorporated in them. 70 hospital performance indicators are defined for measurement and improvement. Many hospitals in India find it difficult to meet the stringent standards of accreditation and Pre-Accreditation Entry Level Certification (PEH) Certification is a good option to constantly improve quality. PEH is also offered by NABH which when achieved, the HCO can then prepare and move to the next stage – Progressive Level and finally to Full Accreditation status. 423 hospitals across various parts of India have PEH Certification as per NABH website. Hospitals which are being newly built are trying to incorporate infrastructure and other facilities based on NABH standards.

Some of the newly introduced standards like Nursing Excellence Programme, Certification of Emergency Department and NABH – I Safe for hospital infection control provides specific direction for patient safety and clinical excellence. The NABH website is an excellent resource for all aspects of accreditation along with several training programme announcements and advocacy. The organisation structure and the team provide supportive supervision and answers queries of hospitals.

Cost of NABH Accreditation and its application to public health facilities is not seen positively by all stakeholders. Standards of IPHS for public health facilities would also be helpful. Many have expressed concerns regarding some private accredited hospitals not following the accreditation procedures in letter and spirit. These are the issues that Indian hospitals must address. Issues of mindset, accepting external peer evaluation, and improving service quality is essential. Top management commitment and ‘quality culture’ is the need of the hour. NABH is quality assurance at the first level. Hospitals must go beyond that and set up strong internal systems for continuous quality improvement to provide optimum quality services to patients, achieve excellence and not only work on ‘survival’ mode. Honest reporting of errors, adverse events and corrective actions based on analysis of data would help hospitals to achieve better clinical outcomes. NABH provides a baseline for further benchmarking and continuous quality improvement.