With a sizable number of accredited and a long list of
applicant hospitals, NABH accreditation is on its way to soon become a norm for
hospital industry in India. Almost all for profit hospitals and a large number of
charitable hospitals in India aspires for accreditation and most of them have either
revamped or in process of revamping their organization in accordance to accreditation
standards.
I have written a long post on 'How to prepare for accreditation', but equally important is also to know, how not to prepare for it. Below, I have covered this topic explaining what could happen if wrong approach is followed for accreditation preparation.
I have written a long post on 'How to prepare for accreditation', but equally important is also to know, how not to prepare for it. Below, I have covered this topic explaining what could happen if wrong approach is followed for accreditation preparation.
Effect of accreditation on workload and complexity
While accreditation standards and systems has been designed to improve quality and safety of healthcare, it was never intended to increase the complexity of hospital functioning and burden of work on employees of the hospitals. On the contrary, well developed and documented policies and processes were expected to make the work-life easier for healthcare and managerial staff in hospitals. However, in my experience many hospitals implementing accreditation have made their systems unnecessarily complex and added a lot of workload on their employees which could have been avoided. For example, to fulfill the requirement of making patients aware about their rights, some hospitals have gone to the extent of asking nurses to read out all rights to each of their patient on admission and mark the completion of this activity on their checklist. While this may sound like an effective way to fulfill the standard’s requirement, it also adds to the workload of already overburdened nurses, many of whom may feel it to be just a mechanical activity holding little value. Instead, display of patient rights and asking nurses to educate those patients whom they think need education on their rights, would give equally good result (if not better). Similarly, adding a lot of forms in every medical record, to be filled by doctors and nurses, to fulfill requirements in ‘COP’ and ‘MOM’ chapters can be done away with, if carefully scrutinized to see if they are actually required, or can the information required in separate forms be integrated or obtained through other simpler ways such as IT systems.
Redundancy is another feature that creeps in while hospital
prepares for accreditation. It’s common to find patient safety related incident
getting captured by doctors in medical records, nurses in their registers and management
executives in their forms. Assessment of HAI in patients gets done by primary
nurse as well as infection control nurse. Redundancy happens usually with activities
arising out of accreditation standards which were previously not done in
hospital and there is no department/designation that can be clearly identified
for performing that activity.
Sometimes inadequate understanding of the intent of
standards leads hospitals in implementing practices that may be totally
unnecessary. For example, some hospitals misunderstand the standard related to
nutritional needs of patient and implements a policy of detailed nutritional assessment of all admitted patients on day one. While nutritional screening of
all admitted patient is a requirement, detailed nutritional assessment should
be done only for those patients who need it and identified through screening. Similarly,
code blue announcement system need not include ICUs, if full-time presence of
ACLS trained staff is already there.
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