Newer models of healthcare

A few models of healthcare that are likely to emerge in our country in the near future, are:

 1. Public Private Partnership (PPP) 

Various models of PPP between public and  private sectors have come up. These include- joint ventures,  management contract, co-ownership etc . One of the first PPP ventures was the Indraprastha Apollo Hospitals in New Delhi.

2. Low cost healthcare 

With the advent of lowcost healthcare chains such as Vaatsalya Hospitals, Lifespring Hospitals, Glocal Healthcare etc, the era of lowcost healthcare has arrived.  These are asset-light models with minimal operating expenditure.

3. Single Speciality Chains (SSH)

Single speciality hospitals such as Cardiac, Eye (Ophthalmology) , Mother and Child  ( Obs- Gynae and Paediatrics) 

4. Day Care Hospitals

Day care hospitals, which provide services such as Eye surgery, routine ambulatory surgery etc, are being set up.

5. Telemedicine

 Telemedicine is being used to reach out to distant areas, using the hub and spoke model, where the tertiary care hospital is the hub and the smaller centres are the spokes. This has been employed successfully by several hospitals such as Narayana Hrudayalaya, Apollo Hospitals, Care Hospitals etc.

6. Wellness Centres

Health is defined by WHO as a state of “complete physical , mental and psychological wellness and not merely the absence of disease.” Wellness Centres focus on preventive health, health checkups etc. These centres are also being set up across several cities, and provide health checkups as well as diagnostic services.

Hospital CEO Turnover Rate hits 20% in USA

 
The CEO Turnover Rates in hospitals in the USA hit 20% last year, While this is attributable to a number of reasons, such as Private capital/ venture capitalist involvement, Changing role of IT, New health plan partners etc, it is an alarming trend which needs to be arrested.

An article on this phenomenon, and its impact on the healthcare industry :

http://www.healthcaredive.com/news/hospital-ceo-turnover-a-symptom-of-a-greater-sickness/263642/

( Courtesy: Healthcare DIVE)

APIC guidelines for Infection Control

Infection Control is an important part of hospital quality management and hospital management. Presenting  the APIC ( Association for Professionals in Infection Control and Epidemiology)  guidelines for Infection Control :

http://apic.org/Professional-Practice/Implementation-guides

Risk management in hospitals

Hospitals carry a natural amount of risk in their operations: both clinical, and non-clinical risk. While there exist the apparent clinical risks such as infections, wrong medication, wrong surgery etc, there also exist non- clinical risks such as fire, chemical spillage, electrical hazards etc.

Risk management is an important part of Quality Management and Patient Safety activities in hospitals. The US National Library of Medicine’s controlled vocabulary thesaurus,  MeSH, defines Risk Management as “ the process of minimizing risk to an organization by developing systems to identify and analyze potential hazards to prevent accidents, injuries, and other adverse occurrences, and by attempting to handle events and incidents which do occur in such a manner that their effect and cost are minimized. Effective risk management has its greatest benefits in application to insurance in order to avert or minimize financial liability.”

The management of risks require a proactive approach consisting of  Risk identification, Risk assessment, Risk mitigation, Problem Prioritization, Risk reporting , Risk management, Investigation of adverse events and  Establishment of a safe organizational culture.

An incident reporting policy is required. An important part of risk management is the reporting system for incidents such as adverse events , sentinel events and near misses. Sentinel events, which are events not related to the primary illness, resulting in patient death/ permanent loss of function, may include serious injury such as  loss of limb or function. The number of sentinel events are to be  monitored on a monthly basis and reported to the Quality Steering Committee. Patients are assessed at admission for risk of adverse episodes such as falls, and proactive measures are taken accordingly. It is recommended that the incidents are analysed and  analysis is done , including Root Cause Analysis for Sentinel events. This analysis is used to redesign /modify processes or carry out corrective/ preventive steps.

“Safety First” programme is implemented in many hospitals for vulnerable patients

(patients<16 yrs/ >60 yrs, women in labour, critical care patients, patients unable to perform ADL). In addition, the following patients/ processes are high risk and departmental level precautions are to be taken: Patients undergoing surgery, sedation, blood transfusion, chemotherapy, dialysis.

For long-staying patients, medical board is to be held and communication is to be carried out with the patient’s relatives.

Failure Mode and Effects Analysis (FMEA) is a technique used for proactive risk reduction. It consists of the computation of a RPN ( Risk Probability Number) , which is arrived at by multiplying Severity (S), Occurrence (O) and Detection ( D), i.e. S X O X D. It can be used for a variety of problems such as Medication Errors (MEs), Needle Stick Injuries ( NSIs) etc.

According to Hippocrates, the father of modern medicine, the basic principle of medicine should be “ Primum non nociere” , i.e. “ First do no harm.” Keeping this in mind, Risk management is an activity that should be proactively carried out by hospitals.

Data Data Every Where, But Not A Bit Makes Sense

Details of Author:
Name:  Dr. Gunjan Sharma; Age: 29 years; Qualification:  B.D.S (RGUHS) , PGDHM (ASCI)

Experience: 3 years; Presently working at: Fernandez Hospital, Hyderabad; Department: Quality

Designation: Quality Coordinator; Areas of Interest:    Quality aspects in Indian healthcare industry,       Training needs of Indian healthcare workforce,  Auditing,  Data Management 

In today's healthcare industry everyone is talking about high end information systems and technology solutions like HIS, EMR etc. but the ground reality is far more different than these jargons.

Budding generation of Managers and mandatory rules or standards laid down by various governmental and non governmental bodies in India have sparked the process of data collection in hospitals. Lot of data is available in raw and manual form but most of it is of no use as it cannot be processed for obtaining any inferences.
Major concerns in this area are:

Manual Data

In this computer driven era still lot of data is entered manually. Huge piles of manual data are difficult to handle as it first needs to be digitized. Moreover problems like overwriting, corrections and incomplete data sets are spoiling the quality of collected data.

Lack of Staff

I fail to understand the repulsive attitude of Indian hospitals towards the data entry personnel. It might be due to their cost cutting strategies that they find them to be of no use. Hospitals are more keen in utilizing their existing staff in entering data for their concerned department. I think it’s time for them to realize that data entry is an art and the entire life cycle of data depends on its inception. Bad quality data is the horror of any data research scientist.

Transcription Errors

Even if some of the hospitals recruit data entry operators many transcription errors occur while digitizing the data. One of the major reasons for this can be; untrained data entry operators. Majority of data entry operators are recruited from other industries as there is a lack of staff which is specialized in hospital data and understands healthcare terminologies.

Poor HIS

Most of the hospitals are either buying or developing their own HIS. But there is lack of planning in customizing or developing HIS products as the end users are ignorant about their present and future needs. Lack of training and sensitization of hospital staff towards the statistics driven processes has led to this condition. Hence hospitals end up with HIS which is incomplete and is not able to satisfy the requirements of the departments.

Lack of Analysts

Huge sets of data needs the magic touch of an analyst to transform into sense making graphs and trends. Hospital management courses need to focus more stringently in the area of data analysis by introducing subjects like Business Intelligence. But it’s not just the educational institutes, hospitals also need to motivate and provide opportunity to young managers into the less explored Indian woods of healthcare data.

I hope that this miniscule effort of mine will encourage all upcoming managers and administrators in the area of healthcare data management and analysis.  

Launch of NABH pre- accreditation entry level certification standards for healthcare organisations

NABH plans to launch pre- accreditation entry level certification standards for healthcare organisations , in resource- challenged situations, as a preparation for full NABH accreditation.

Details at : http://nabh.co/main/publiccomments/PRE_ACCREDITATION_EL.asp

The standards are open for discussion and comment.]

Comments may be sent to:

Jatin Kumar
Assistant Director
National Accreditation Board for Hospitals and Healthcare Providers (NABH)
Quality Council of India,
6th Floor, ITPI Building, 4A, Ring Road, IP Estate
New Delhi 110 002, India
Tel: +91-11-23323416-20; Fax: +91 11 23323415
Email: jatin@nabh.co