March Issue 2019


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A Seamless Experience

Quality assurance is nothing but ensuring meeting of customer expectations

By: Dr AK Khandelwal

In the dynamic, competitive, complex, price sensitive and error prone health care ecosystem, high level of quality is essential to sustain, survive and succeed.
Quality assurance is a source of competitive advantage for a private health care organisations and should remain a hallmark of services. High quality is not a brand value, it is a life line of a successful health care organisation.
Changing health care ecosystem with introduction of new regulatory requirements with high penalty and compensation fuelled with mechanism of fast grievance handling and active media trial, has made it imperative for hospitals to focus on quality assurance.
There is also a paradigm shift in the type of customers from individual customer to institutional or insurance customer with expected boost in increasing number of insurance patients after the announcement of Ayushman Bharat. This will also create pressure on health care organisations to adopt quality assurance program.
Quality assurance are planned and systematic activities implemented within the quality system that can be demonstrated to provide confidence that a product or service will fulfill requirements for quality. QA is nothing but ensuring meeting of customer expectations.

Joy Chakraborty

Change agents are individuals entrusted with the duty and concomitant powers necessary to effect change in policy or practice. These individuals may include policy makers, managers within an organisation, and management consultants

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Key drivers

Quality assurance is the responsibility of the quality department. Needless to mention that provision of effective and efficient quality assurance system and counseling and coaching to other operational units should be the mission of quality department.
The quality assurance department must be manned by an adequate number of dedicated and adequately qualified and trained personnel with well-developed interpersonal skills. Skills required from quality personnel include being persuasive, diplomatic, tactful and resilient. It is recommended that the quality assurance department must operate independently from the operational units and it must regularly perform quality review activities (self-inspection audits/internal audits) to ensure compliance within operational units with company quality standards, good working practices [GxPs: current Good Laboratory Practice (GLP), GCP, etc.], and local, national, regional and international legal, ethical and regulatory requirements.

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Problems faced

Lack of top management commitment: The success of quality assurance programme is significantly dependent on top management of the health care organisation. Quality gurus Deming, Juran, Crosby have emphasised in their literature on the importance of leadership in quality assurance. Around 40% of success of quality management is accounted for top management commitment. It is recommended that top management participation should be visible in quality teams, coaching teams, and teaching seminars. Literature mentions that the role of top management commitment in quality management implementation in any organisation is mainly focussed on employee empowerment.
Lack of trained & quality health care providers: There is a huge gap between demand and supply of trained and quality healthcare providers in our country.
Lack of quality managers: There is scarcity of skilled managers in the Indian health care industry. This can be met by providing training to clinical staffs on quality management.
Poor infrastructure: Majority of health care institutions are having less than 30 beds and do not have appropriate infrastructure.
Indifferent attitude of clinicians: It is a fact that the active involvement of all category of staff is an essential requirement for quality assurance in any healthcare organisation. But unfortunately, quality assurance initiatives in India have not generally secured the full engagement of clinicians.
Lack of change leaders: A health care organisation cannot think of implementing any quality assurance initiatives without change leaders. Change leaders at all levels of the health care organisation can steer the journey towards goal successfully. Around 70% of change process initiated fail to reach goal in absence of change leaders.

Rising cost of technology

Rising cost of technology is a major barrier for small health care organisations to implement quality assurance programmes.

Lack of engagement of employees

Most of the private health care organisations in India are proprietor or family run organisation and lack a culture of shared values and belief and engagement with the organisation goal.

Lack of budget allocation

Manpower training, technology acquisition, process implementation for quality assurance require budget provision. Lack of this budget, especially for small health care organisation is a problem faced during quality assurance implementation.

Intangible benefits

The return on investment (ROI) for quality assurance cannot be calculated readily. It is mainly intangible benefits that come as results from quality assurance and this acts as a deterrent for a health care organisation.

Implementation of Quality Assurance

Preparation for change: All stakeholders of health care organisation should be communicated about reasons, process improvement, regulatory, accreditations, required for the change of existing practices for implementation of QA.
Define the Change: The expected change in the policy, process and procedures should be defined. It is of paramount importance that all stakeholders' roles should be clearly defined so that everyone will understand if and how their roles will change. It is important that all of these stakeholders have shared mission, vision and goals.
Identify the change leaders: Change agents are individuals entrusted with the duty and concomitant powers necessary to effect change in policy or practice. These individuals may include policy makers, managers within an organisation, and management consultants. Change targets refers to those being reorganised within an organisation as part of the change process. These individuals typically include employees within an organisation; however, individuals may also be agents and targets of change simultaneously.
Resistance management: Health care organisation should expect resistance and identify it and manage it by appropriate communication. So, it is very essential that appropriate communication should be made by management to remove/allay their fear and denial. Staffs develop following reactions usually to change: shock, agitation, apathy, numbness, disbelief, withdrawal, activity without getting much done.

Guidelines for communications

1. Why change is needed
2. What is over and how people will be affected
3. What will not change
4. Ask for reactions
5. Listen, listen, listen – pay attention to what you are hearing
6. Show caring and concern
7. Respond to questions, clear up any misunderstandings, and acknowledge objections
8. Acknowledge losses
9. Allow people time to grieve

Training and coaching: These play an important role in supporting all stakeholders through the transition cycle. Expert opine that coaching helps to move employees from a state of resistance, through conscious awareness and the reality of the change, to an informed state of acceptance and involvement.
Sustaining the change: Literature mentions that sustaining the change is a very challenging task. This problem is known as improvement evaporation effect. It means benefits derived from new change diminishes with time. Major factors responsible for increasing sustainability are enthusiasm, reflexive practice, multiple levels of leadership, generation and use of evidence, and performance monitoring.

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About the author

Dr. Ashok Kumar Khandelwal is the VP & Medical Director, Anandaloke Hospital & Neurosciences Centre, West Bengal. He is a trained Assessor from the National Accreditation Board for Hospital and Health Care Provider (NABH). He carries around two decades of experience in the hospital industry and 20 years of experience as a hospital administrator.