Dr. Annabel D'Souza Sekar made this wonderful presentation at ASQ Bnagalore's event at Ramaiah Institute of Management on 8 Oct 2011.

1. Quality in Healthcare – Winds of Change Dr Annabel DSouza Sekar MBBS, MBA, DBA (Switzerland) Consultant – Healthcare, ASQ India

2. Present Scenario

3. Indian Healthcare Scenario Unequal distribution of healthcare resources Lack of strict regulation Rising costs Wide inequity in healthcare Gender inequality High cost of imported equipment

4. Indian Healthcare Scenario Change from government sector domination to private sector in the last 20 years Large affordable middle class Medical tourism on the rise

5. Indian Healthcare Scenario Revolution in India over the last decade Increasing public awareness and private investment in healthcare Complicated cases used to go to government teaching hospitals – now to tertiary care private hospitals Achievement in quality in many hospitals on par with western standards

6. The Government Sector Commonwealth countries – British legacy Used to be free – now charge nominal amount for higher end investigations like CT / MRI Health insurance scheme Tamilnadu, Andhra Pradesh, Kerala, Karnataka Acceptance of people – ready to pay for quality healthcare Public private partnership Gujarat, Bihar, Assam, Madhya Pradesh – Fortis Healthcare and Government Hospitals Incentives to medical and paramedical staff Licences to smaller private hospitals to help the government deliver the goods

7. Quality in Healthcare India

8. Quality in Healthcare Today Domain of a select few Corporate hospitals Accreditation – NABH, JCI Other private hospitals ISO certification Quality circles, TQM NABH Accreditation

9. ISO Certification Documentation No perceptible difference before & after Marketing tool or strategy Integrity is a “?” WHO’s stand on ISO for hospitals

10. Primary Health Centres (PHCs) Cornerstone of rural healthcare in India Targeted population around 25,000 Provides promotive, preventive, curative and rehabilitative healthcare Also has Siddha medicine unit with a doctor and pharmacy National Rural Health Mission (NRHM) Indian Public Health Standards (IPHS)

11. Accreditation A self-assessment and external peer assessment process used by healthcare organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve

12. Accreditation NABH Accreditation Joint effort between Ministry of Health and the Confederation of Indian Industry (CII) 105 accredited hospitals 447 applicant hospitals Empanelled assessors, standards, inspection, certification Separate standards for < 50-bedded hospitals > 50-bedded hospitals AYUSH

13. Accreditation JCI Accreditation International accreditation in 1999 Too expensive ($ 250,000) Not practicable in our country Standards are based on US practices, not on Indian practices 19 hospitals accredited as of date

14. Dimensions of Quality Today Infrastructure Hospital acquired infections Audits Reactive rather than being proactive

15. Where we are lagging behind Quality of the processes Quality of the clinical outcomes

16. Quality in healthcare Developed Countries – USA, UK

17. Quality in the Developed Countries Accreditation Quality of the processes Lean Six Sigma Malcolm Baldrige Performance Excellence Programme Quality of clinical outcomes Clinical audits

18. Role of ASQ in India

19. ASQ in India - Healthcare Can help streamline processes in all sectors Merely meeting standards for documentation, training, infrastructure, etc cannot ensure improvement in clinical outcomes Can make use of domain expertise in quality systems such as Lean and Six Sigma that have proven improvement in clinical outcomes Can be implemented in all areas – primary, secondary and tertiary care hospitals

20. Lean in Healthcare Value defined from patient’s perspective Anything that helps treat the patient adds value – anything else is waste ER – cost savings in triage and primary nursing time OT – Better OT utilisation with improved turnover efficiency Nursing station – better organisation leads to prevention of overstocking Medical records – reduction in processing time Laboratory – Improved turn-around time

21. Six Sigma in Healthcare Statistically based process improvement methodology Used to reduce the sources of variation found in any process Billing Physician practices Patient treatment Patient triage Use of technology Laboratory results

22. Six Sigma in Healthcare Reduced blood stream infections following urinary catheterisation in ICU and SICU Improvement in “take-home” baby rate for infertility patients Reduced insulin errors and improved patient safety by implementing tight glycaemic control without inducing hypoglycaemia Reduced incidence of patient falls Reduction in hospital- acquired or nosocomial infections

23. Quality of Outcomes - Patient Definition of quality as given by the Institute of Medicine “The degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge” Desired outcome from the patient’s perspective would be a relief from the disease or better quality of life after treatment

24. Quality of Outcomes - Organisation Outcomes in financial returns patient satisfaction customer retention error rates clearly improved after implementation of various quality systems in healthcare organisations

25. Need of the Hour Deficiencies in quality of care represent neither failure of professional compassion nor lack of resources They result from gaps in knowledge inappropriate applications of available technology inability of organisations to change To improve quality of healthcare Quality must be defined and measured Appropriate steps must be taken to implement quality

26. ASQ and you Healthcare

27. ASQ and You in Healthcare Lean for Healthcare Six Sigma for Healthcare Yellow belt Green belt Malcolm Baldrige Performance Excellence Programme for Healthcare

28. Thank You http://asq.org.in