COVID has taught us the importance of herd quality in healthcare

Dr Atul Mohan Kochhar, CEO, NABH reminisces how the accreditation body coped with the unprecedented challenge of COVID-19, and the lessons learnt on the role of technology and standardization in taking healthcare down to the last mile. 

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When the pandemic struck out of the blue, we were struggling to cope with the sudden surge in patients seeking diagnosis and treatment – from the mildest to the most critical cases. Admittedly, we were used to doing things in a certain way, and suddenly we realized that the old way is not going to work in this unprecedented calamity. So, we had to quickly change, adapt and adopt. And that was the main lesson. 

Another major lesson was that ours is not one country, but 36 countries rolled into one. We are a united federal structure with a very big and diverse population in several aspects. That makes healthcare delivery all the more complex, especially in situations like the COVID-19 pandemic. 

India has been the cradle of technology for the whole world. We are the source partner to US and all the advanced countries. India had already showed the world that it could leapfrog in technology and execution. We witnessed this with the UIDAI or Aadhaar card a few years back. And amidst this pandemic, we have seen India seamlessly deliver 200 crores plus dosages seamlessly, ensuring a 100 crore-plus fully vaccinated population. 

So, this showed that technology was the only answer to bridge the large gap between our health infrastructure deficiencies – lack of doctors, beds, critical care, etc. Like every other organization, NABH decided that we have to put all hands-on deck and do our best for the country and the world. There was a spirit of caring, sharing and collaboration, and we used the already available technology for all our stakeholders. 

For example, it is well known that we provide accreditation certificate and empanelment services to about 14,000 hospitals currently and counting. And these certifications or accreditation also come with a co-linked incentive provided by IRDA. So, for every day we were not working, we were causing economic and financial losses to our stakeholders. 

To tackle this, we deployed available technology – Microsoft Teams, Zoom etc. to continue with patient safety initiatives. We started conducting all assessments online and with very well-defined policies in place. Hospitals also showed that they were willing to step up for this change, and they cooperated with us. 

It was also observed that whichever hospital followed SOPs – whether big or small, whether NABH or JCI, performed better. They could limit morbidity of their patients as well as their staff. Suddenly the very basic tenets of patient safety and quality in health care, such as hand hygiene, surgical safety checklist, mock drills of donning and doffing of PPE, how to wear a mask correctly, became very important. Hospitals already in compliance were already used to following this and performed better, even as guidelines were constantly changing. 

Suddenly the very basic tenets of patient safety and quality in health care, such as hand hygiene, surgical safety checklist, mock drills of donning and doffing of PPE, how to wear a mask correctly, became very important.

So that is a very strong case to institute SOPs in every domain of healthcare, whether they go for NABH certificate or not. The basic framework of patient safety revolves around having process centered care not person specific care. So, one should have a process in their organization. And that process should work for all of us. 

One more important learning from this phase was that we cannot be complacent anymore. New challenges keep coming up, the latest being monkey pox. We cannot get away by creating islands of excellence. It is necessary to empower our tier 2/3/4/5 setups. Otherwise, we are as weak as the weakest link in the chain. India needs to create a culture of quality, which I would like to label as herd quality. This movement should go on to every nook and corner of our big and diverse country. 

Furthermore, I would like to add that we run a very robust AYUSH program. This pandemic showed us that there is no absolute right. Even the most developed countries had some of the worst-case fatality rates. We all have to reinvent and rethink. AYUSH therapies were already there for 5,000 years, and are now looking extremely promising in ensuring holistic healthcare. But now we realize the importance of developing these traditional practices in a very structured way with accreditation, so they are accepted more in Western countries. 

NABH is also very committed in working to empower our stakeholders through Digital Health initiatives. For this, it has joined hands with National Health Authority (NHA) to accredit and rate the Ayushman Bharat Digital Mission (ABDM) integrated healthcare solutions (public and private) on various parameters, that will enable a prospective buyer of the service to make an informed decision. This initiative will help the citizens of India to get better and more timely healthcare and help India to become one of the leaders in digitization of healthcare in the world.

AYUSH therapies were already there for 5,000 years, and are now looking extremely promising in ensuring holistic healthcare. But now we realize the importance of developing these traditional practices in a very structured way with accreditation, so they are accepted more in Western countries. 

India has already become a leading and attractive destination for medical tourism. As the Government is emphasizing on both Heal in India and Heal by India, NABH has collaborated with Ministry of Health & Family Welfare (MoHFW) for “Heal in India” initiative which was launched by our Honourable Prime Minister, Shri. Narendra Modi on 15th August, 2022. This is to promote international medical tourism and cater to more patients for their treatments in India. The government is making a portal, where all big hospitals, especially the NABH Accredited Hospitals and Medical Value Travel Facilitator (MVTF) Empanelled providers will find space and will be registered. Accreditation is mandatory to provide medical care abroad. Thus, India is positioned to achieve the dual vision of Heal in India and Heal by India in the coming years and we are very sure that from 2023, medical tourism will revive in full force.

As I close, I would like to stress that NABH has given the country national standards or desh ka standard, and these are totally Atma Nirbhar. We must build on that and take these standards to every PHC and CHC and district hospital. Only then can we fulfill the idea of a healthy India, because India is at the forefront of Heal in India, Heal by India. And standardization of care is very, very important. NABH is dedicated to take quality to the last man in the line and create an ecosystem of quality in healthcare.

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Dr. Atul Mohan Kochhar obtained his MBBS (1991) and MD (Dermatology-1996) from Delhi University and is a recipient of the University Gold medal for excellence in Dermatology, Venereology and Leprology. He is also a Diplomate of National Board (DNB- Dermatology and Venereology), a Member of the National Academy of Medical Sciences and a Fellow of the American Academy of Dermatology.

Since December 2019, he has taken charge as the Chief Executive Officer of National Accreditation Board for Hospitals and Healthcare providers of India. As CEO of NABH, he has helped draft more than 215 policies on Virtual and hybrid assessment, helped revise various standards, and initiated the popular Quality Connect – Learning with NABH programme to connect with and empower various stakeholders. Promotion of patient safety, quality and taking best healthcare practices to the ‘last in the line’ are his mission in life.