Quality is common sense and not only about learning application of quality models. It is not a myth but proven beyond doubt by "Dabba walas" by getting six sigma for the services provided by them. Similarly, quality is nothing but solving healthcare service problems by sheer intelligence. Healthcare providers should think what they expect themselves if they happen to visit a hospital; would they be satisfied by waiting in a long queue, medication error, wrong lab results and un-homely environment? The concern of patients should be solved because he is paying to meet a desired outcome. If patient's expectations are met, he is satisfied and if it is exceeded, he is delighted. Hence, hospitals should concentrate on patient's delight to create a brand image of the hospital. The concern for the patients should lead to confidence building in society where patients belong. Every healthcare provider wants to improve quality of medical care and each value addition would win the hearts of the patient. A willingness and commitment is required to improve the image of the hospital in the eyes of the community. To make 'step by step' quality improvement, one has to do gap analysis to identify the gaps in the service provided, followed by preparation of manuals and Standing Operating Procedures (SOPs). The manual is a formalization of the process which staff needs to implement after reading these documents. The staff needs to be sensitized by repeated training the various process as per various manual which would subsequently lead to implementation. The process is shown in the following diagram -

Figure - Step by Step Quality Improvement

The step by step improvement of the quality model has been launched by British Standards Institute (BSI) recently, in which hospitals are rated as silver, gold and platinum based on compliance of quality standards laid down by BSI. The platinum rating is equivalent to accreditation. The model has been launched only in India and has not been put into practice elsewhere in the world. This would encourage hospitals to improve quality leading to accreditation and would not frustrate the organization if it is not able to achieve the highest platinum rating. It would help small hospitals to improve quality in a graded manner as 84% of private hospitals in the country are less than 30 bedded. The government hospitals, barring a few, which provides medical care to the masses of India are yet to take off in the journey of quality.

In Thailand, legislation has brought a concept of graded improvement of quality leading to accreditation of all hospitals irrespective of its ownership. All hospitals need to achieve level 1 to 3 grading over a period of time to get accredited, however hospitals can also directly apply and achieve accreditation.

The Government of India is likely to bring 'clinical establishment bill' which would mandate that each hospital and health facility should achieve minimum clinical standards. There is a need for improvement of quality in all health facilities and it is a concern of each stakeholder. The step by step quality improvement is a practical approach and should be considered for implementation as an alternative to accreditation. The hospitals already awarded accreditation could think of further improving quality by adopting European Foundation Quality Management (EFQM) model leading to business excellence. Quality is an unending and continuing journey which by commitment of management can always lead to business excellence. The money invested in achieving quality standard would offset value addition, increase clientele base and achieve confidence of the community.

For more details on how CII-IQ could assist in Healthcare training and consultancy, please contact Surg. Rear Admiral (Retd.) V.K. Singh, VSM, Senior Advisor, (TQM) at v.k.singh@ciionline.org