The debate seems never ending when it comes to define and unfold the word Quality. Dilemma still exists regarding quality being subjective or objective, directly or indirectly associated with performance, and cost incurring or cost saving. It is also not very clearly understood that whether it is a responsibility of management or clinicians, and whether it is reactive or proactive in approach. Whatever the understanding may be in the industry, however it differs from place to place. One thing is for sure that Quality is major and decisive factor in almost each and every aspect of hospital performance. You name it and quality is there to make a difference. Aspects like patient care, better outcome, for patient, family and visitors, marketing of the hospital, workforce satisfaction, financial betterment and the list goes on when we try to assess the contribution of Quality in hospital functioning. For a second if we look beyond health sector, we are bound to find quality as a single most factor that helps organizations to stand apart and deliver the best with better performance from all aspects including operational performance and financial performance of an organization.
We would try to understand the things under following headings:-
1. Quality Journey of USA & India
2. Present scenario of quality in healthcare
3. Visualization of future with regard to quality
Quality Journey of USA
‘Improving quality will reduce expenses while increasing productivity and market share’. These words uttered by Deming while delivering lecture at the Mt. Hakone Conference Center in August 1950 changed the outlook towards quality. It started the never ending journey in the arena of quality. Japanese, in 1950s and after, indentified and reacted in a positive manner against the principles suggested by Deming and in his home country America it was Ford in 1980s that identified and implemented Deming’s principle in the business and got the competitive edge against GM and Chrysler. From this fundamental and thought provoking work, US secretary of commerce of the Reagan government, took personal interest during the difficult times of economic slowdown and came out with the Quality Improvement Act of 1987. Malcom Baldrige National Quality Award honours the contribution of the visionary towards high end performance via the medium of quality.
Currently Agency for Healthcare Research and Quality (AHRQ) of the US department of health and human services (HHS) is the main agency to develop, implement and monitor aspects of healthcare quality in US at national level. AHRQ's mission is to improve the quality, safety, efficiency and effectiveness of healthcare for Americans. Also JCI, ASQ NAHQ and many more are non-government agencies that are contributing in building quality framework of US healthcare organizations.
Quality Journey of India
We had private sector as a major health care provider since beginning, yet we lagged behind in providing quality care. Two landmark years I would like to highlight here is 1983 and 2006. First Apollo group of hospitals came into existence at Chennai in 1983 and NABH became constituted body of QCI in 2006. IMC RBNQA (Ramkrishna Bajaj National Quality Award), adopted from Malcom Baldrige National Quality Award, was established in 1996. But RBNQA gave little importance to the healthcare sector until in 2008 when P. D. Hinduja Hospital won the RBNQA as a first Indian healthcare organization immediately followed by the L H Hiranandani Hospital very next year. As of now total 188 hospitals including public, charitable and corporate hospitals are NABH accredited. Still many applications awaiting the response from NABH body to assess the hospital. This can be described as a good response but it represents only a minute fraction (1.37%) of total hospitals in India (Total number of hospitals in India are 12760 as per CBHI). Indian counter part of Malcom Baldrige, IMC RBNQA is striving to achieve performance excellence through the medium of quality which can be assured by committed leadership, operations and workforce focus, strategic planning, knowledge management, patient centred approach and focus on overall results.
Present Scenario of Quality in Healthcare
It is high and good time that we have started to view quality from an organizational viewpoint. It no longer remains a departmental activity but now it seeks to have commitment from each and every individual to contribute towards quality. It has transformed from retrospective to prospective approach and cyclic to process approach. Days are gone when quality improvement was fault finding and exercise for blaming, it is now a way of continuous quality improvement. It has altogether taken a new road map by aligning quality with the statistical progress. Now it has been widely and aptly accepted that things that we can’t measure, we can’t improve. Quality improvement is now more scientific way of achieving better results but yet not mandatory. Awards and reorganization still remains the major way of driving organization to work towards the quality improvement. It is well established that organization incorporating the quality aspect and showing commitment from top management are bound to perform well in the industry.
Unfolding Future Opportunities
A lot lies in the future with regard to quality in healthcare. Still somewhere we got to understand that we can directly as well as indirectly contribute to the quality. But time has come where we need to see each and every activity or process in the hospital has direct impact on quality. There won’t be anything like indirect when it comes to quality in healthcare. Quality dimensions range from leadership to customer focus, micro to macro level and so on. An era will come when we will establish linkage between effect of community, government, educational institute, socioeconomic culture and quality. We have to understand that it is not only the internal environment that will decide the quality but external environment will have the same impact in shaping the culture of quality. What I believe in is that the next generation will strive to shape the workforce in order to achieve the quality and better healthcare outcomes. No longer will it be viewed as a marketing tool but it will become a decisive tool for sustained business and business improvement. This can be achieved by the fabricating, embodying, internalizing in the culture of an organization what we can call as culture of quality. Quality culture will be the fabric of the organization which will be binding gel of an organization.
An era will come when price will no longer be a differentiating feature. No longer it will offer competitive edge or affect the choice of healthcare facility. At such juncture, quality will offer the competitive edge to the organization which can, not only ensure quality but communicate the same to the customer. Educated lot of customer won’t look at only the numbers or indicators to decide the level of quality care in the hospital, but they will look at and relate to the way organization will offer quality care. Next generation hospitals have to have unique roadmap in order to ensure better patient care experience and to have better outcome. So let us all strive not for destination, but for the journey called quality to win the care taker and care giver and each and every stakeholder or an organization.
Dr. Biren Chauhan
MHA-Hospital Administration
2012-2014 Batch
TISS, Mumbai
birenc15@gmail.com
We would try to understand the things under following headings:-
1. Quality Journey of USA & India
2. Present scenario of quality in healthcare
3. Visualization of future with regard to quality
Quality Journey of USA
‘Improving quality will reduce expenses while increasing productivity and market share’. These words uttered by Deming while delivering lecture at the Mt. Hakone Conference Center in August 1950 changed the outlook towards quality. It started the never ending journey in the arena of quality. Japanese, in 1950s and after, indentified and reacted in a positive manner against the principles suggested by Deming and in his home country America it was Ford in 1980s that identified and implemented Deming’s principle in the business and got the competitive edge against GM and Chrysler. From this fundamental and thought provoking work, US secretary of commerce of the Reagan government, took personal interest during the difficult times of economic slowdown and came out with the Quality Improvement Act of 1987. Malcom Baldrige National Quality Award honours the contribution of the visionary towards high end performance via the medium of quality.
Currently Agency for Healthcare Research and Quality (AHRQ) of the US department of health and human services (HHS) is the main agency to develop, implement and monitor aspects of healthcare quality in US at national level. AHRQ's mission is to improve the quality, safety, efficiency and effectiveness of healthcare for Americans. Also JCI, ASQ NAHQ and many more are non-government agencies that are contributing in building quality framework of US healthcare organizations.
Quality Journey of India
We had private sector as a major health care provider since beginning, yet we lagged behind in providing quality care. Two landmark years I would like to highlight here is 1983 and 2006. First Apollo group of hospitals came into existence at Chennai in 1983 and NABH became constituted body of QCI in 2006. IMC RBNQA (Ramkrishna Bajaj National Quality Award), adopted from Malcom Baldrige National Quality Award, was established in 1996. But RBNQA gave little importance to the healthcare sector until in 2008 when P. D. Hinduja Hospital won the RBNQA as a first Indian healthcare organization immediately followed by the L H Hiranandani Hospital very next year. As of now total 188 hospitals including public, charitable and corporate hospitals are NABH accredited. Still many applications awaiting the response from NABH body to assess the hospital. This can be described as a good response but it represents only a minute fraction (1.37%) of total hospitals in India (Total number of hospitals in India are 12760 as per CBHI). Indian counter part of Malcom Baldrige, IMC RBNQA is striving to achieve performance excellence through the medium of quality which can be assured by committed leadership, operations and workforce focus, strategic planning, knowledge management, patient centred approach and focus on overall results.
Present Scenario of Quality in Healthcare
It is high and good time that we have started to view quality from an organizational viewpoint. It no longer remains a departmental activity but now it seeks to have commitment from each and every individual to contribute towards quality. It has transformed from retrospective to prospective approach and cyclic to process approach. Days are gone when quality improvement was fault finding and exercise for blaming, it is now a way of continuous quality improvement. It has altogether taken a new road map by aligning quality with the statistical progress. Now it has been widely and aptly accepted that things that we can’t measure, we can’t improve. Quality improvement is now more scientific way of achieving better results but yet not mandatory. Awards and reorganization still remains the major way of driving organization to work towards the quality improvement. It is well established that organization incorporating the quality aspect and showing commitment from top management are bound to perform well in the industry.
Unfolding Future Opportunities
A lot lies in the future with regard to quality in healthcare. Still somewhere we got to understand that we can directly as well as indirectly contribute to the quality. But time has come where we need to see each and every activity or process in the hospital has direct impact on quality. There won’t be anything like indirect when it comes to quality in healthcare. Quality dimensions range from leadership to customer focus, micro to macro level and so on. An era will come when we will establish linkage between effect of community, government, educational institute, socioeconomic culture and quality. We have to understand that it is not only the internal environment that will decide the quality but external environment will have the same impact in shaping the culture of quality. What I believe in is that the next generation will strive to shape the workforce in order to achieve the quality and better healthcare outcomes. No longer will it be viewed as a marketing tool but it will become a decisive tool for sustained business and business improvement. This can be achieved by the fabricating, embodying, internalizing in the culture of an organization what we can call as culture of quality. Quality culture will be the fabric of the organization which will be binding gel of an organization.
An era will come when price will no longer be a differentiating feature. No longer it will offer competitive edge or affect the choice of healthcare facility. At such juncture, quality will offer the competitive edge to the organization which can, not only ensure quality but communicate the same to the customer. Educated lot of customer won’t look at only the numbers or indicators to decide the level of quality care in the hospital, but they will look at and relate to the way organization will offer quality care. Next generation hospitals have to have unique roadmap in order to ensure better patient care experience and to have better outcome. So let us all strive not for destination, but for the journey called quality to win the care taker and care giver and each and every stakeholder or an organization.
Dr. Biren Chauhan
MHA-Hospital Administration
2012-2014 Batch
TISS, Mumbai
birenc15@gmail.com
