In the current era of heightened fiscal responsibility, transparency, accountability, and escalating health care complexity and risk, accreditation contributes to ensuring that care meets the highest standards of health care decision-making and provision. In the recent times demand for quality in healthcare services has risen due to various market forces such as insurance, medical tourism, corporate growth and competition. As a result of these the expectations of the consumer for best in quality has also risen, which has indeed lead to the introduction of national and international accreditation bodies to act as a quality assurance mechanism, thus enhancing customers access to better healthcare services. Hospital Accreditation as a public recognition by a national or international healthcare accreditation body, of the achievement of accreditation standards by a healthcare organization, demonstrated through an independent external peer assessment of that organizations level of performance in relation to the standards.
• Better identify strengths and weaknesses
• Promote transparency
• Improve management processes
• Stimulate quality improvement and performance management
• Increased accountability to community members, stakeholders, and policymakers
• Improved communication with the govt. bodies & policy makers
• Be more competitive in funding opportunities
• Provides a framework to help create and implement systems and processes that improve operational effectiveness and advance positive health outcomes.
• Improves communication and collaboration internally and with external stakeholders
• Strengthens interdisciplinary team effectiveness
• Demonstrates credibility and a commitment to quality and accountability
• Decreases liability costs; identifies areas for additional funding for health care organizations and provides a platform for negotiating this funding
• Mitigates the risk of adverse events
• Sustains improvements in quality and organizational performance
• Supports the efficient and effective use of resources in health care services
• Enables on-going self-analysis of performance in relation to standards
• Ensures an acceptable level of quality among health care providers
• Enhances the organization’s understanding of the continuum of care
• Improves the organization’s reputation among end-users and enhances their awareness and perception of quality care
• Promotes capacity-building, professional development, and organizational learning • Promotes the use of ethical frameworks
• Decreases variances in practice among health care providers and decision-makers
• Provides health care organizations with a well-defined vision for sustainable quality improvement initiatives
• Stimulates sustainable quality improvement efforts and continuously raises the bar with regard to quality improvement initiatives, policies, and processes
• Increases health care organizations’ compliance with quality and safety standards
• Provides a team-building opportunity for staff and improves their understanding of their coworkers’ functions
• Promotes an understanding of how each person’s job contributes to the health care organization’s mission and services
• Contributes to increased job satisfaction among physicians, nurses, and other providers
• Highlights practices that are working well
• Promotes the sharing of policies, procedures, and best practices among health care organizations
• Promotes a quality and safety culture
In India NABH was set up to establish and operate accreditation programme for healthcare organizations with the objective of enhancing healthcare delivery system and promoting continuous quality improvement and patient safety. Regardless of ownership, legal status, size and degree of independence it provides accreditation to hospitals in a non-discriminatory manner. The standards laid by NABH are accredited by International Society for Quality in Healthcare (ISQua). This shows that the accredited hospital will also get international recognition.
• Hospitals - Pre Entry-level Certification – SHCO (<50 BEDS) & HCO (>50 BEDS)
• Hospitals - Progressive-level Certification – SHCO (<50 BEDS) & HCO (>50 BEDS)
• Hospitals - Full Accreditation – SHCO (<50 BEDS) & HCO (>50 BEDS)
• Medical Imaging Services
• Medical Laboratory programme
• Nursing excellence
• Emergency departments
• Blood Banks & Storage centers
• Ayush Hospitals
• PHC’s, CHC’s, Clinics
• Dental clinics
• Eye care organizations etc.
The primary goal of the accreditation is to ensure that the hospitals not only perform evidence based practices but also give importance to access, affordability, efficiency, quality and effectiveness of healthcare.
It is quite evident that many regulations made by the government are not followed in most states and hence the quality of healthcare remains poor and unattended. Since accreditation is voluntary, it challenges the medical regulations laid down by the government both at state and central level. Accreditation fills the gaps or removes the areas of deficiency and ultimately establishes optimum standards, professional accountability and clinical excellence. Even the Government has acknowledged that accreditation should be performed by a way of independent assessment programmes and with incentives both for secondary and tertiary level of hospitals to ensure patient safety and quality of care.
Variety of benefits can be availed by the healthcare organization on being certified by NABH. The biggest beneficiaries are the patients, since they are serviced by the credential medical staff. It also provides opportunity to the hospital to benchmark with the best in the industry. Since accreditation ensures continuous learning, leadership, good working environment and ownership of clinical process, the hospital staff feels more satisfied and contented at work. It provides an opportunity to get empanelled by various insurance companies and other third parties. Lastly, it provides access to reliable and certified information on facilities, infrastructure and level of care.
To conclude, accreditation is a transparent system of control over the accredited hospital which assures that the hospital will constantly fulfill the accreditation criteria. The on-site survey of the hospital and staff by the experienced accreditation assessment team encourages them to establish educational and performance improvement goals. The best part is that it gives the opportunity to the patients to give a feedback on the services they availed during their stay in the hospital and also to complain if they were dissatisfied. Finally it ensures that hospitals, whether public or private, national or expatriate, play there expected roles in national health system.
In the USA, Joint Commission International (JCI) in the best known accrediting body whose standards of quality assurance and rigorous quality evaluation process is well known all over the world. As this concept is not new to the healthcare industry, other countries like Australia, Canada and UK also have their own models of hospital accreditation.
Health System in India is very dynamic and operates in an environment with rapid social, economical and technical changes. In the past there have been numerous instances of poor patient care, negligence, inadequate resources with inefficient facilities, lack of information and unwanted medical interventions. On the other hand it consists of different types of healthcare organizations and institutions delivering different levels of care not only to the local population but also to foreigners who visit India for medical treatment (Medical Tourism). Such being the case, assuring quality in healthcare services becomes a mandate and receiving an accreditation is the only answer to it. It is the single most approach for improving the current standards of the hospitals. JCI Accreditation is a long-term process that demands commitment. There is a great deal of preparatory work leading up to a survey and then subsequent performance and improvement work is done to ensure those accreditation standards are maintained. Organizations that achieve and maintain JCI accreditation are dedicated to providing their patients the best level of care possible.
JCI standards and evaluation methods stand alone in the world as unique tools designed to drive positive change. Its standards and evaluation methods are:
• Designed to stimulate and support sustained quality improvement
• Created to reduce risk
• Focused on building a culture of patient safety
• Developed by health care experts from around the world—and tested in every world region
• Developed by health professionals specifically for the health care sector
• Applicable to individual health care organizations and national health care systems
JCI accreditation is viewed as the gold standard in the global health care community. A health care organization that has met JCI’s exacting standards can proudly display the Gold Seal of Approval® as a sign of this distinctive accomplishment.
Joint Commission International accredits eight types of health care programs: hospitals, academic medical center hospitals, ambulatory care facilities, clinical laboratories, home care facilities, long term care facilities, medical transport organizations, and primary care centers. Here are more details about some of these accreditation categories.
JCI defines an academic medical center hospital as any of the following:
• A medical facility that is integrated with a medical school
• The principal site for the education of medical students and residents from the medical school
• A site that conducts academic and/or commercial clinical research trials
JCI defines an ambulatory care facility as any of the following:
• Free-standing medical, dental, and surgical facilities
• Dialysis facilities
• Diagnostic radiology centers
• Outpatient chronic care management facilities
• Acute care centers
JCI standards address best practices for care within a patient’s home, including end-of-life care. Measurable elements of performance cover:
• All patient-centered care and interactions
• Safety of the environment
• Staff qualifications and education
JCI long term care standards address quality improvement issues for non-acute settings such as:
• Assisted living facilities
• Rehabilitation centers
• Chronic care facilities
JCI standards address all aspects of emergency and nonemergency transport of patients and apply to public and community-based medical transport organizations associated with hospitals. JCI standards evaluate multiple transport modes including:
• Emergency treatment and transport services
• Nonemergency transport services
• Public and private ambulance services
• Air and water medical transport
• Fire brigade emergency services
JCI primary care standards focus on:
• Community integration
• Health promotion
• Disease prevention
• First-contact medical services
• Linkages to other parts of the health care system
NABL stands for National Accreditation Board For Testing And Calibration Laboratories. NABL has agreements with ILAC (International Laboratory Accreditation Conference) and APLAC (Asia Pacific Laboratory Accreditation Cooperation). These are especially valuable for International recognition and mutual acceptance of test results. In short accreditation has worldwide acceptance.
NABL is an autonomous body under the aegis of Department of Science & Technology, Government of India, and is registered under the Societies Act. It is only one of its kinds that assess laboratories in India for quality and consistency in the results. The concept of Laboratory Accreditation was developed to provide a means for third-party certification of the competence of laboratories to perform specific type(s) of testing.
NABL follows ISO 15189:2007, which is specific ISO followed world wide for medical laboratories. This standard is used by APLAC (Asia Pacific Laboratory Accreditation Cooperation) and ILAC (International Laboratory Accreditation Co-operation) etc.
NABLaccreditation is based on evaluation of technical competence whereas ISO certification is based upon verification of proper documentation. Though documentation forms an essential and important part of NABL, it lays down great emphasis on quality and the lab can be denied accreditation if one does not comply with the quality standards.
NABL has established its Accreditation System in accordance with ISO/IEC 17011:2004, which is followed internationally. In addition NABL has to also comply with the requirements of APLAC (Asia Pacific Laboratory Accreditation Cooperation) MR001 which it satisfies. For each inspection, there is one lead assessor and other technical assessors for assessing different departments of the laboratory. These are qualified people from government, semi government and private organizations who have got special training from NABL.
It means that your lab is continuously striving for quality and this will further progress our cause of providing quality services. Laboratory Accreditation provides formal recognition of competent laboratories like ours, thus providing a ready means for customers to find reliable testing services in order to meet the demands.
Laboratory testing is an essential component of improved health care for patients in resource-limited settings.4 Accurate and rapid diagnostic tests are required to diagnose illness, identify causative factors, monitor the effectiveness of treatment, and perform surveillance for key diseases. Reliable and actionable test results are often a prerequisite to the delivery of high-quality patient care. Historically, laboratories in developing settings have been underresourced and marked by poor performance. This has fostered distrust in laboratory data among clinicians and helped to reinforce cycles of underinvestment in laboratory systems. Nevertheless, the demand for diagnostics in developing settings has increased substantially in recent years to meet the needs of expanded treatment and prevention programs for HIV and other major diseases, and there has been significant recent investment in improving access to testing.5–8 Expanded test menus are now available at even the lowest level of health care facility.9
Laboratory results are required for making a large proportion of medical decisions. In developed countries, an estimated 60% to 80% of patient management decisions are based on laboratory data. Laboratory investigations are often more sensitive and specific than clinical decision criteria alone. Diagnostics and clinical patient management have an interdependent relationship; laboratory data provide justification for clinical decision making, while clinical signs or the clinical management protocol often prompt laboratory testing.
Laboratories that achieve accreditation are recognized for superior test reliability, operational performance, quality management, and competence. A functional national laboratory accreditation initiative within a country requires at least 3 elements: a laboratory policy framework that makes accreditation a requirement for laboratories, designated quality standards against which laboratories can be assessed, and accrediting bodies (local or international) authorized to assess laboratories and certify their performance against the designated quality standards.
Accreditation is most effective when it is rooted in a policy framework for evaluating laboratory quality and patient safety. In some countries, accreditation is a mandatory requirement for testing operations, while in other countries, accreditation is voluntary and driven by market incentives. Governments may stipulate that laboratories functioning below the accreditation standard be required to submit detailed improvement plans and take timely action to demonstrate compliance, with continued failure to comply resulting in penalties, service limitations, and prohibitions against further testing. To set up a national laboratory policy in-country may require new laws or an update of existing legislation
The College of American Pathologists (CAP's) Laboratory Accreditation Program accredits the entire spectrum of laboratory test disciplines with the most scientifically rigorous customized checklist requirements.
The CAP's peer-based inspector model provides a unique balance of regulatory and educational coaching supported by the most respected worldwide pathology organization.
The Laboratory Accreditation Program inspects a variety of laboratory settings from complex university medical centers to physician office laboratories, and covers a complete array of disciplines and testing procedures.