Roadmap to attaining quality in public healthcare centers through accreditation

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11www.gujhealth.gov.in Health & Family Welfare, Govt of Gujarat
Quality Improvement Programme
(Toward Excellence Health center for the Community)
“Roadmap to attaining Quality in Public
Healthcare Centers through Accreditation"
Dr. J. L. Meena
State Quality Assurance Officer
Commissionerate of Health & FW
Government of Gujarat
Email:- sqipgujarat@gmail.com
Web:- www.gujhealth.gov.in/quality-assurance-program.htm
Dr. J. L. Meena

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Quality is very Sweet for speak,
but difficult to implement.
because
Quality is Never Improved
without accepting facts.
Dr. J. L. Meena

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Old Scenario of Health Centers.
Building maintenance was
extremely unsatisfactory –
Leaking roof, eroded floors,
over flowing toilets, broken
doors, No patient safety, No
safe drinking water facilities.
no employee safety, poor
lighting and no ventilation
sign.
Dr. J. L. Meena

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• Poor sanitation and
cleanliness.
• Very poor Drainage facility.
• Poor housekeeping service.
• Very poor Biomedical
waste & infection control
practice.
• No cattle guard.
Dr. J. L. Meena

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• Non sterile suction
tube & oxygen mask?
• Empty Oxygen
Cylinders.
• Instrument with rust
& Non sterile.
Dr. J. L. Meena

HOW TO ACHIEVE EXCELLENCE IN
HEALTH IN TRIBAL AREA
TQM-

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Health centers is committed to provide quality
healthcare services.
To provide the treatment as per the national and
international standards.
To provide treatment with the latest technology.
To conduct trainings and workshops on regular
intervals for skill development of the staffs.
To improve the quality on continuous basis.
To improve the quality of treatment as per the
patient satisfaction survey.
Quality Policy
Dr. J. L. Meena

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Quality Objectives
To achieve standards as per IPHS & NABH.
To provide 24X7 quality services to the community.
To implement and monitor all the national programs
running in the district.
To provide right treatment through latest
technology.
To ensure safety of employee.
To ensure safety of patient.
To manage Human Resources for enhancing
productivity.
Dr. J. L. Meena

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A Case Study
JOURNEY TOWARDS QUALITY
Cont….

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A Case Study
JOURNEY TOWARDS QUALITY
Dr. J. L. Meena

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Outcomes…..
Dr. J. L. Meena

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5 Years Back Today
Lack of standards NABH Standards for Health Centers
No Gap analysis report in standard format. Gaps identified and addressed.
Lack of Statutory requirements (e.g. Licenses,
Acts, Rules & Certificates).
Statutory requirements fulfilled
Absence of written policies & procedures. Written policies & procedures available.
Poor sanitation, cleanliness & infection control
practices.
Hygienic, Clean & Green Hospital environment with
infection control audit.
Staff shortage so very poor specialist service. Recruitment of staff as per workload through RKS and
take specialist service outsource.
Lack of trained health care staff for emergency
(resuscitation) services and patient care service.
Staff trained in Basic Life Support and Advanced
Cardiac Life Support
No concept of internal audits (medical audit,
clinical audit & death audit etc).
Staff trained as internal auditors, audits conducted to
find out non conformances, corrective & preventive
measures taken to rectify it
Journey of Quality Improvement
(Cont)…
Dr. J. L. Meena

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Journey of Quality Improvement (Cont)
…
5 Years Back Today
Inadequate infrastructure for handling
biomedical waste and infection control safety
practices
All required practices in place
No Blood storage, CSSD, no separate OT for Eye
& Gynec., Patients attendant launch facilities.
Blood storage, CSSD, separate OT for Eye & Gynec,
Patients attendant launch facilities are available.
Damaged and poor condition of building &
Staff Quarters.
Repairing & renovation done gynecology
No Calibration system of Instruments for
Quality check.
Calibration system of Instruments for Quality check
are available.
Shortage of equipments and proper
ambulances (transport vehicle) .
Sufficient equipments and ambulances with regular
monitoring by a responsible person.
Lack of accountability & planning. Policy and processes for care of the patients in place
Absence of quality standards. Quality standards e.g. medical audit, management of
medication, care of patients etc practiced
No participation in EQAS/ inter laboratory
comparisons
Participation in EQAS / inter laboratory comparison
and achieving good scores in it.
Dr. J. L. Meena

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(Cont)…
5 Years Back Today
Poor signage system. Well developed signage and displays for patient
information.
Absence of Patient & Employees’ satisfaction. Established.
No measurable parameter for patient safety. Measurable parameters for patient safety are
available.
No realization of problems and weaknesses. A clear understanding of what is lacking and what
needs to be done.
No monitoring or reporting of adverse events,
needle stick injury, Sentinel events etc.
These are being reported and are monitored.
Practically non-existent security arrangement Availability of well trained security guards
Non Implementation of Different Codes in the
facilities.
RED for FIRE,
YELLOW for EXTERNAL CALAMITIES,
BLUE for CARDIAC ARREST,
BLACK for BOMB THREAT,
PINK for CHILD ABDUCTION
Dr. J. L. Meena

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(Cont)…
5 Years Back Today
No team work, only Individual approach rather
then team . Unidentified role and responsibility
of staffs.
Team work is available, role and responsibility of all
staff is cleanly mention.
No Evaluation and monitoring system by PRI
members (3rd
party evaluation).
3rd
Party evaluation & monitoring system by PRI
members.
Poor publicity of available services in the
villages and in the community.
All the service which are provide by the healthcare
centre are display in the community and emergency
contact number also display.
No monitoring of Up time & down time of the
instruments.
Proper monitoring of Up time, down time &
utilization of the instrument & equipment.
No responsibility of referred patients . Progress of the referred patient also monitoring by
the health centre on regular basis.( Bi directional
referral service).
No display of the Right and responsibly of the
patients and employees in the facilities.
Proper display of Right and responsibly of the
patients and employees in the facilities.
Dr. J. L. Meena

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Achievement:
India’s 1st
NABH / NABL Accredited Govt.
Facilities:-
•Dist. General Hospital Gandhinagar
•Primary Health Centre Gadboriad, Dist:
Vadodara
•Medical College Hospital Labs Bhavanagar
•Blood Bank (BJMC Ahmadabad)
•Food & Drug laboratory Badodara
•Mental Hospital Badodara
Community Health Center, Bardoli-Surat
Dr. J. L. Meena

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India’s 1st
& 2nd
NABH Accredited PHC
Dr. J. L. Meena

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India’s 1st
NABH Accredited CHC
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A Success Story
Quality Improvement Programme:- Gujarat
Name of the Facility Total Facility
Under
NABH /NABL
Total Facility Under
NABH /NABL which
catering Tribal
population
Total
Accredited
facilities
Total Accredited
facilities which
catering tribal
population
District Hospitals 23 11 2 0
Medical college Hospitals 6 2 0 0
Medical college, Blood banks 6 2 5 2
Medical college, Laboratories 6 2 4 2
Mental Hospitals 2 1 2 1
Dental Hospitals 2 0 0 0
Paraplegia Hospital,
Ahmedabad
1 1 0 0
Primary Health Centers (PHCs) 29 14 12 6
Community Health Centers
(CHCs)
26 11 1 1
NABL Food & Drug Laboratories 2 1 2 1
Total 103 45 28 13
Dr. J. L. Meena

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Benefits to PatientsBenefits to Patients
Availability of Health services with High quality of
care.
Dedicated and sincere medical staff
Access to a quality focused organization
Rights respected and protected
Patient Satisfaction evaluated
Involvement in care process
Patient safety
Pain management
Safe transport
Continuity of care
Dr. J. L. Meena

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Availability of Services at PHC level
Sr Name of service Day Time
1 OPD Services Daily ( Except
holidays)
Morning: 9.00 to 13.00
Evening: 16.00 to 18.00
2 Certificates of age, fitness and sickness ,, ,,
3 Lab services ,, ,,
4 Homeopathic treatment ,, ,,
5 Indoor services Daily 24 hours
6 Delivery ,, ,,
7 Emergency services ,, ,,
8 Vehicle for referral ,, ,,
9 Medico legal services ,, ,,
10 MAMTA Clinic ( Immunization, medical checkup,
treatment, IEC & Family planning services for
expectant mothers, children & adolescent)
Monday 9.00 to 14.00
11 NSV, Abdominal tubectomy , MTP & Hydrocele
operatipon
Tuesday & Friday 9.00 to 16.00
12 All National Programme Daily ( Except
holidays)
Morning: 9AM to 1 PM
Evening: 4 to 6 PM
Dr. J. L. Meena

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List of Laboratory Services Available at PHC
Sr No Name of test Availability
1 Hb Yes
2 Blood Group Yes
3 Sickeling Test Yes
4 H.I.V. Yes
5 Leptospirosis strip test Yes
6 Pregnancy test Yes
7 Blood Malaria Parasite (BMP) Yes
8 AFB Yes
9 Urine Sugar /Alb. Yes
10 Routine urine Yes
11 Bleeding Time/ Clotting Time Yes
12 TC,DC,ESR Yes
13 Syphilis Yes
14 Typhoid Yes
15 Water quality Yes
16 Hb Electrophoresis Yes
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List of services Outsourced at PHC
Proper Net working of
ambulances with 108 for safe
referral service.
X -RAY
Sonography
Gynaecologist services on call.
Pediatric Services on call.
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High Quality of Care cont…High Quality of Care cont…
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Provided baby kits to new born for
prevent Infection & hypothermia
Dr. J. L. Meena

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Dr. J. L. Meena

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Qualitative Laboratory services…Qualitative Laboratory services…
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Management of Medicine…Management of Medicine…

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Change the Scenario…….
Safety of patients & employees…
Before After
Dr. J. L. Meena

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Before After
Change the Scenario….
Biomedical waste practice…
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Change the Scenario……
Safe drinking water……
Before After
RO plant provided
by TSP Grant
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Quality food services to patients & attendantsQuality food services to patients & attendants……
CHC Bardoli, which catering Tribal Population

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Recreational & skill development
Dr. J. L. Meena

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Dr. J. L. Meena

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Occupational Therapy Unit
Behavior modification
training.
Social skill training.
Vocational Training.
Day care services
Job placement wherever
possible.
Dr. J. L. Meena

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Dr. J. L. Meena

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Vocational therapy
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NO. OF DELIVERY AT PHC
PHC:- Salun, Dist:- Kheda

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Adverse Donor Reaction
Blood Bank:- Civil Hospital Ahmedabad

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Issue of Components
Blood Bank:- Civil Hospital Ahmedabad

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Specimen Analysis
Biochemistry Lab:- Sir T Bhavnagar

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Critical value reporting
Biochemistry Lab:- Sir T Bhavnagar

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Surgical Site Infection (SSI)
Dist Hospital:- Gandhinagar

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Benefits to Staff
Professional staff development
Provides education on laid down standards
Provides leadership for quality
improvement within medicine and nursing
Increases satisfaction with continuous
learning, good working environment,
leadership and ownership
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% of film wasted in radiology
department
Dist Hospital:- Gandhinagar

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Professional staff development
Managerial / Administrative
training to MO / Head.
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Induction training to staff at
all levels.
Job based skills training.
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Special clinical skill training on minor
surgical procedure, obstetrics care, new
born care, basic life support and local
anesthesia block.
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NABH ACCREDITATION AWARD FUNCTION BY
GOVT. OF GUJARAT & QCI, NEW DELHI
Dr. J. L. Meena

Award for NABH Accredited PHC :- Primary Health Center - Kandolpada, Navsari-Gujarat, Govt of Gujarat
given by Shri Jaynarayan Vyas, Hon’ble Health Minister, Government of Gujarat

Award for NABH Accredited PHC :- Primary Health Center - Tankal, Navsari-Gujarat, Govt of Gujarat
given by Shri Jaynarayan Vyas, Hon’ble Health Minister, Government of Gujarat

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Improves care
Brings in Corporate Governance
Stimulates continuous improvement
Demonstrates commitment to quality care
Raises community confidence
Opportunity to benchmark with the best
Benefits to Hospital
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Main entrance should be easily identifiable,
welcoming, well lit and with mattress.
PHC Mahuwas, Tribal area PHC
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Welcoming infrastructure……
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District Hospital Godhara (Tribal area)
DH Godhara, which catering Tribal Population
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FICCI Healthcare Excellence Award to
India’s 1st
NABH PHC:- Gadboriayad
Dr. J. L. Meena

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Quality revolution
Disaster preparedness
- Epidemics
- Physical
Access to comparative database
Benefits to Community
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All the Services provided by PHC Gadboriad
are displayed in all the villages & roadside
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Mock drill and training for disaster
management
Ambulance provided
by TSP Grant
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management
PHC Tankal, Kandolpada & Mahuwas, Navsari
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management
PHC Tankal, Kandolpada & Mahuwas,
Navsari
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Involvement in National Programme…Involvement in National Programme…
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Involvement in National Programme…Involvement in National Programme…

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Malnutrition awareness…Malnutrition awareness…

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AIDS awareness programme…AIDS awareness programme…
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PRI Monitoring & Evaluation of CHC
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Quality Healthcare Service to
Poorest of the Poor.
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Efficiency of Government hospitals as key
contributors for building trust and confidence for
the hospitals in the hearts of the citizens of the
State through actively pursuing quality
improvement programme in various facilities.
Given a sense of pride to the government for
ensuring quality services to the poorest of the
poor.
Confidence has been restored of the
community in Govt hospitals
Benefits to the Government
Dr. J. L. Meena

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Award received by Government of Gujarat
for Quality Improvement
Appreciation awarded by QCI to Ministry of Health and Family Welfare
Government
of Gujarat for establishing Quality Assurance framework in providing quality
healthcare to the people of Gujarat in 5th
National Quality Conclave, New Delhi.
Appreciation awarded to Department of Health and Family
Welfare Government of Gujarat for their pioneering effort to
spearhead the Quality and Accreditation Programme in health
care organization. In 3rd
International Health Care Quality
Conclave
FICCI Health care Excellence Award to Dist Hospital Gandhinagar & PHC
Gadboriad, Govt of Gujarat in FICCI Heal 2010, New Delhi Date: 6th
Sept
2010
FICCI Health care Excellence Award to Dist Hospital
Gandhinagar, Govt of Gujarat in FICCI Heal 2011,
New Delhi Date: 8th
Sept 2011
Dr. J. L. Meena

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Strategies Adopted for
sustainability:
•Appointment of Quality Assurance officers at State level, District level,
Assistant Hospital Administrator (AHA) at facility level. We are designated
NABH Coordinators & NABL Directors at Facility level.
•NABH lead assessor training (Total trained persons 290 for hospitals & PHC /
CHC) & NABL Internal audit training (Total trained persons221) to
administrators, clinicians, paramedical & staff nurses etc.
•Post Graduation Certificate Course in Quality Management and Accreditation
of Health care Organization (PGQM & AHO) to the Additional Directors,
Superintendents, Chief District Medical Officers, Clinicians and District Quality
Assurance Officers (Total trained persons186) etc.
•Other training as per requirement of NABH / NABL standards and mock drills
are being conducted.
•New posts of clinicians, paramedical and other are sanction by Government of
Gujarat as per requirement.
•Extra budget as per requirement of NABH / NABL are sanction from 13th
finance commission, Government of Gujarat and NRHM.
•Formation of the state level review committee under the Chairmanship of
Commissioner of Health, Medical Service & Medical Education and Member
secretary is State Quality Assurance Officer.
Dr. J. L. Meena

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Challenges & Solution
Challenges Solution done by Govt. of Gujarat
Infrastructure Separate Project Implementation Unit (PIU) formed
under the Commissioner of Health.
Manpower :- lack of Section posts Regular New posts (About 2200) are sanction by Govt.
of Gujarat
Manpower:- Vacant posts Campus Interview started in surrounding state e.g.
Rajasthan, MP, Maharashtra etc.
6 New Medical College start.
Fund Section through Govt. of Gujarat, TSP, NRHM & Public
private partner though donation etc.
Behavior & Motivation of the
staffs
Regular skill development training & Award ceremony
Monitoring & Evaluation Regular Video conference, Meeting & Hospital
Information Management System (HIMS)
Medical college Try to accredited Blood bank, laboratories & Radiology
Dept. first for there motivation & confidence.
Dr. J. L. Meena

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Road Ahead
To create a Quality culture based
on various standards which is
sustainable, affordable, equitable
& reliable having state of art
technology and which can be easy
to follow and replicate.
Dr. J. L. Meena

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It has been a quality revolution which is a “rewarding experience”.
The National delegates (Teams from Rajasthan, Bihar, Delhi, Madhya
Pradesh, Kerala, Maharashtra, Chhattishghadh, Andhra Pradesh,
Orissa, Karnataka etc) and International delegates
(Nigeria, WHO, Ireland etc ) visited the organizations, observed
tremendous changes and have commendable remarks “which were
thought to be unattainable in public sector. thus setting up an
example for Health Care Organizations to deliver best health care
services to masses”.

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Quality Improvement Programme:- Gujarat
Dr. J. L. Meena

CoH
www.gujhealth.gov.in
Email:- drjlmeena@gmail.com
Mobile No:- 09099075162
Dr. J. L. Meena

Roadmap to attaining quality in public healthcare centers through accreditation

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Roadmap to attaining quality in public healthcare centers through accreditation