Special Issue
International Accreditation Day
‘Competence is the core of accreditation delivery’
Speakers at the second International Accreditation Day celebrations emphasised the need for promotion of better standards and monitoring/auditing practices to ensure credibility of the accreditation processes and systems. A report.

he second International Accreditation Day celebration was organised by National Accreditation Board for Certification Bodies (NABCB), Quality Council of India (QCI) and National Accreditation Board for Laboratories (NABL) on June 9, 2009. The theme of the celebration this year was ‘Competence’, a core principle of what accreditation delivers.

Accreditation provides an independent and authoritative attestation of the competence, impartiality and integrity of conformity assessment bodies (CABs).

Speakers on the occasion emphasised that accreditation should be internationally accepted and meet international standards, thereby providing confidence in the accuracy and reliability of testing, inspection and certification.

Standards and accreditation play an increasingly important role in improving the operations of the marketplace and promoting growth and trade. Many factors have contributed to this, such as mass production, a growing demand for interchangeable parts, globalisation, manufacturers’ concerns about litigation, demand for cheaper and cheaper goods, public demand for product safety and concerns about technical compatibility between products. In such a complex and highly competitive market, a level of confidence is required when procuring products or services. Such reassurance is underpinned by accreditation.

Specifiers, like government regulators, have come to appreciate the importance of credible accreditation programmes that are based on internationally-recognised standards. With restricted budgets, many regulators can no longer do it all themselves, and increasingly, they must rely on third-party organisations to support their regulatory efforts. When they do so, they need a fair and meaningful basis for identifying qualified and competent providers. Accreditation provides this declaration of competence.

The programme started with Mr Anil Jauhri, QCI, extending a warm welcome to the invited guests, the delegates and the speakers. He also read out the messages from International Accreditation Forum (IAF), International Laboratory Accreditation Cooperation (ILAC) and International Organisation for Standardisation (ISO).

Lt Gen H Lal, Chairman, NABCB, in his opening remarks, stressed on the objective of accreditation and need for enhancing the credibility of accreditation. While sharing the experience and thoughts of certification bodies, Mr A Venkataram, Managing Director, BSI India Pvt Ltd, highlighted that there is a need for setting qualification and experience criteria for auditors above the requirements outlined in ISO 19011 standards, which are bare minimum. He elaborated the need to focus on the lead auditor training process imparted to the individual for attending the minimum required qualification for auditors.

Stringent methods of evaluation during the lead auditor training course should be in place so that the individual undergoing the course understands the rigours of a good auditing process. Mr Venkataram also suggested that there should be a system of refresher course for the existing auditors and their re-qualification after every three or four years.

Dr Aparna Dhawan from NABL shared her views on competence issues in laboratories’ accreditation. She said that laboratories’ accreditation provides formal recognition to competent laboratories, providing a ready means for customers to identify and select reliable testing, measurement and calibration services. She suggested that more focus was needed to monitor and calibrate the clinical laboratories involved in pathological testing. Dr Dhawan also suggested that the public complaint handling mechanism should be enhanced and public awareness in this respect should be created.

Mr Anil Jauhri, Advisor, NABCB, highlighted the competence issues of accreditation bodies. He shared his views on how the competency of the certification bodies and their assessors should be monitored. He further explained how the competency of the accreditation body assessor is evaluated and enhanced through regular (twice a year) assessor calibration.

“The Regulations in medical devices field” was the subject of discussion by Mr Rajesh Gur, BD India Pvt Ltd. He discussed components design development and control, compliance to requirements / standards, capability of resources, regulatory compliance and sterilisation. Lt Gen Lal, in his concluding remarks, stated that, though competence was a very tricky and serious issue, it was at the same time quite subjective and therefore needed to be closely monitored and verified on a regular basis.

Finally, Mr Mrutunjay Jena, Deputy Director, NABCB proposed a vote of thanks to the Chairman, all speakers on the stage and all delegates for sharing their experience and thoughts on the occasion.

First assessors
conclave charts
   roadmap for

n an effort to improve the assessment process by bringing harmonisation of practices, the first Assessors Conclave was held on June 27, 2009 in New Delhi. About 40 experienced assessors, including principal assessors, attended the conclave, which proved to be a forum for exchange of experiences and feedback.

Dr P K Dave, Chairman, NABH, in his inaugural speech, expressed his satisfaction at the organisation of the event and emphasised the need for promotion of quality practices, which he stressed should be followed uniformly. He also touched upon the importance of soft skills of assessors. Dr G J Gyani, Secretary General, QCI, in his welcome remarks, observed that this event had been long due and it was time now to learn from past experiences and strengthen the assessment process. He emphasised that an assessor can make or break the credibility of an accreditation programme because he is the one in the field, working for NABH.

His technical competence may not be justified if his personal attributes are not as expected, said Dr Gyani, adding that “thinking and working as a team should be the key to achieving the uniformity as stressed by Dr Dave.”

The programme covered multiple technical sessions on assessment activity (with the objective of minimising perceptual differences) and assessment reports (uniformity in report writing, formats to be used). Presentations were made by assessors on these topics using case studies from the last assessments conducted.

Dr Pawan Kapoor, Chair, Technical Committee, addressed the importance of soft skills in assessments and uniform system for surveillance. Dr B K Rana, Deputy Director, NABH, briefed delegates on the feedback mechanism used for monitoring and evaluating assessor performance. He also shared his experience from ISQua international surveys.

The participation of the delegates, many of whom shared their experiences, was noteworthy. The deliberations of the programme will be used to improve the accreditation standards, as well as the entire accreditation programme. The feedback received during and after the event endorses the productivity of the conclave.

NABH contribution to ISQua programme

The ISQua Accreditation Council’s mid-year meeting was held in Kuala Lumpur in June. Dissemination of WHO patient safety solutions, improving present IAP methodology and surveyor competencies were some of the various points discussed at the meeting.

Representatives from Malaysia, Australia, Jordan, The Netherlands, France, United States, India and ISQua attended the meeting to review the International Accreditation Programme’s (IAP) current activity and to plan future directions. Ms Helen Crisp of CHKS, UK, resigned as a member and Vice-Chair of the Accreditation Council. Dr B K Rana, Deputy Director, NABH, was elected as new Vice-Chair of the Accreditation Council.

Council members also participated in a conference “Global Trends in Accreditation of Healthcare Facilities and Services”, hosted by Malaysian Society for Quality in Health. Meanwhile, Dr Rana led the ISQua survey team for evaluation of an accreditation body ‘Global-Mark’, based in Sydney, during June 9-12, 2009.
Accreditation & quality are interlinked: Dr Gyani
CII charts out a five-point agenda to drive quality in healthcare. Participants at a recent seminar on accreditation of hospitals underlined that accreditation is the key to improved patient safety.
The healthcare sector has been witnessing phenomenal growth and the demand, as quality healthcare services has been rising. This calls for an immediate look at the healthcare delivery systems, and the necessity to introduce quality assurance mechanisms.

One of the most prominent components of quality healthcare is the accreditation of hospitals, which is still in its nascent stages in the country. To have a closer look at the current status of hospital accreditation and its processes, the Confederation of Indian Industry (CII), in collaboration with Quality Council of India (QCI)/National Accreditation Board for Hospitals and Healthcare Providers (NABH), organised a seminar, “Accreditation of Hospitals”, in New Delhi.

The seminar was an opportunity to get comprehensive information and insights into the matter of accreditation of hospitals and issues related to it. The programme, especially designed to address the accreditation needs of hospitals, smaller hospitals and nursing homes, was attended by doctors, healthcare professionals and senior managers from various hospitals and nursing homes.

Participating in the seminar, leading healthcare and quality professionals suggested that mandatory accreditation of hospitals was becoming increasingly necessary as healthcare providers faced greater competition. Delegates at the seminar agreed that once accreditation became widespread, the need to differentiate and establish a favourable price equation would emerge as a prime imperative for hospitals. They stressed on the benefits that accreditation would bring to the hospitals, in terms of improved care and increased consumer confidence.

Appreciating that the concept was still confined to metros, Prof Ranjit Roy Chaudhury, Chairman, CII Healthcare Sub-Committee on Standardisation and Quality, said it was now necessary to look at steps that would carry the process further in semiurban and rural areas.

The CII recently conducted a study on “Accreditation of Hospitals in India”, under the aegis of the CII Healthcare Sub-Committee on Standardisation and Quality.

Based on the study, the CII brought out a set of recommendations which it claims will serve to expedite the accreditation process. The five-point agenda outlined by CII for this includes the need for creating awareness among healthcare providers about the benefits of accreditation, greater role of the government in accreditation of public hospitals, pre-packaged accreditation programmes to facilitate cost-effective implementation and the necessity of grading.

Accreditation and quality are two sides of the same coin, said Dr Girdhar J Gyani, Secretary-General, Quality Council of India (QCI). Speaking at the start of the seminar, Dr Gyani appreciated the recent move by the Government to start accreditation of diagnostic laboratories by NABL for empanelment with the Central Government Health Scheme (CGHS). The Secretary General of QCI mentioned that the process of framing accreditation standards was not simple. “We started work on the accreditation process and framed the standards with the help of experts. In February 2006, we launched the accreditation process, having completed all the necessary steps in 10 months,” said Dr Gyani.
THE BIG PLAYERS: Dr S P S Grewal, CEO, Grewal Eye Institute, Chandigarh; Dr Mahesh Sharma, CMD, Kailash Hospital: Mr Parvez Ahmad, CEO, Max Healthcare; Mr Ajit K Nagpal, Chairman, Batra Hospitals; Mr Suyash Borar, COO, BM Birla Heart Inst. Kolkata and Dr K K Kalra, Medical Superintendent, Chacha Nehru Bal Chikitsalaya, Delhi; Mr Deepak Venugopal, Centre Head, Wockhardt Hospital, Rajkot at the CII seminar.
The standards that were set were at par with ISQua. In short, they almost comply with global benchmarks, stated Dr Gyani. One of the basic reasons for bringing about accreditation was “our quest to bring about the same kind of benchmarks that hospitals in developed countries have,” said Dr Gyani. He reasoned that if our doctors were at par with doctors around the world, why could the hospitals not be at par with others? He pointed out that accreditation was basically creating discipline around the doctors in a hospital. Once that was done, everything else would follow.

The CII has proposed that the Health and Family Welfare Ministry can act as a key facilitator to popularise the concept of accreditation. “The Central Government Health Scheme empanelment could serve as a main driver propelling accreditation of hospitals. An incentive to public hospitals may be considered in the form of the hospitals being allowed to levy user charges and thereafter utilising the proceeds for better hospital services,” the CII noted. The study has also looked into the role of the industry, packaged programmes for accreditation and grading for healthcare sector in the country.

Dr Anupam Sibal, Group Medical Director, Apollo Hospitals, described accreditation as a risk reduction strategy. He said as consumer awareness grew, hospitals would not only have to demonstrate a commitment to quality care but also provide comparisons with other hospitals. Accreditation would not only improve care but stimulate continuous improvement, he said. Dr Ajit K Nagpal, Chairman, CII Healthcare Sub-committee on PPP and Chairman, Batra Hospital, asserted that medicine was ‘a credence good’. Accreditation was, therefore, required to measure a product that was based on credibility in the marketplace. He said the lead role taken by CII would go a long way in setting high standards for healthcare.

The seminar also highlighted the processes required for accreditation. The discussions enabled delegates from the healthcare industry to draw up a checklist to further quality standards in their institutions. The seminar also dwelt on the need for accreditation of hospitals due to the inflow of medical tourists. In addition, rising consumer awareness, entry of big corporate players and overseas healthcare providers to India, and the development of the health insurance market have been the forces propelling accreditation in the country.
Journey towards accreditation goals
The Quality Council of India has taken the initiative to usher in quality healthcare at the primary level. A recent workshop of stakeholders from the government highlighted the work that has been done by the states in the field of quality healthcare, while discussing the problems and the means to overcome them. A report.
The Quality Council of India’s bold move to initiate a Quality Improvement Programme in various states for the adoption of NABH/NABL standards in Government Hospitals, Blood Banks and Medical Labs
was applauded at a recent one-day programme on Quality Assurance and Accreditation for Public Healthcare in Delhi.

Various state government officials came together and shared their experiences, concerns and suggestions to carry forward this initiative. There were participants from the Department of Health and Family Welfare from Delhi, Gujarat, Haryana, Himachal Pradesh, Jammu & Kashmir, Maharashtra, Orissa, Punjab, Rajasthan, Uttar Pradesh, Uttaranchal.

The workshop began with a rundown by Dr Aarti Verma, Chief, Medical Excellence Programme, Max Devki Devi Hospital. NABH, said Dr Verma, has set the milestones and the medical fraternity has to reach those and move forward towards evolving quality healthcare standards.
International Accreditation Day
Focus on accreditation to deliver competence

The Sri Lanka Accreditation Board (SLAB), in association with the Federation of Chamber of Commerce (FCCISL), organised a seminar on the theme “Accreditation delivers competence and credibility” to mark the International Accreditation Day on June 9, 2009, at Colombo, Sri Lanka.

The occasion was utilised to raise awareness about accreditation and conformity assessment among all stakeholders, including administrators, regulators and the industry. The celebrations were part of the SAARC regional workshop on

Sri Lankan Minister of Science and Technology Prof Tissa Vitarana was the chief guest. Dr Thomas Facklam, Chairman, International Accreditation Forum (IAF), delivered the keynote address. He spoke about the strategic initiatives of the IAF, which related directly to ensuring a credible mechanism of mutual recognition of accredited certification and testing. He said that the ultimate goal was “one certificate/one test report — accepted everywhere”.

In the technical session, papers on various topics related to competence, accreditation and trade facilitation were
presented, among others, by Dr L N Senaweera, Director General, Sri Lankan Standards Institution; Mr B Venkataraman, NABCB, India; Mr Rajesh Maheshwari, NABL, India, Mr Sanath Mendis, Director & CEO, Sri Lankan Accreditation Board.

Around 100 delegates, including representatives of accreditation bodies/nodal agencies from Afghanistan, Bangladesh, Bhutan, India, Mauritius, Nepal and Pakistan, participated in the seminar.

Quality in healthcare, she reminded her listeners, has gained interest in the last 20 years and today, healthcare has become a dominant part of government policies in every nation: from the United States and the United Kingdom to India. Despite these advances, however, a lot of mistakes continue to be committed in the delivery of healthcare. Though these errors — sometimes fatal — are never intentional, the time has come to not only bring about norms but to ensure that they are followed, she emphasised.

Today, “our consumers,” said Dr Verma, “are not health literate.” Change, however, is happening. With more than 10,000 projects in healthcare undertaken every year around the world, the time is not far when quality healthcare will not remain a dream for the common Indian. She pointed out that the dream would be fulfilled by NABH, which she termed as “a miracle and a path to address all problems in healthcare.”

Dr Girdhar J Gyani, Secretary General, Quality Council of India, enumerated how the QCI was geared to provide support to raise quality standards in Government Hospitals, Blood Banks and Medical Laboratories. He mentioned that though private hospitals had brought about a sea change in healthcare, 75 per cent of the bed capacity, as far as primary healthcare was concerned, still remained with the government.

Agreeing that the National Rural Health Mission, which was flagged off in 2005, had not been able to bring about qualitative changes in the kind of healthcare available in rural primary health centres, Dr Gyani said that the healthcare sector in the country had witnessed marked changes over the past few years. There has been a growing demand for quality healthcare services, which in turn has called for a closer look at the healthcare delivery systems and the necessity to introduce quality assurance mechanisms, he noted.

The accreditation of hospitals, therefore, assumes particular significance in this context. Accreditation relies on establishing technical competence of healthcare organisations in terms of certain standards in delivering services. However, there is a lot of confusion on standards. The BIS (Bureau of Indian Standards) and the IPHS (Indian Public Health Standards) are often confused with quality standards, Dr Gyani pointed out. “These are infrastructure-related standards. They do not mention Processes, Protocols or Outcomes. All these come under accreditation standards,” he explained.

The Secretary General then elaborated on the work done by a number of government hospitals in the field of quality healthcare. “Everybody thought that government hospitals would not come up to world levels, but those in Gujarat are a success story.” He detailed some other examples: the Chacha Nehru Bal Chikitsalaya in Delhi — the first to receive accreditation — and the Ram Manohar Lohia Hospital in Lucknow, UP. “Both hospitals had done extraordinary work to raise standards and change the delivery of healthcare services to patients.

Other states too have got into the act and are progressing rapidly,” he said. Dr Gyani emphasised to the stakeholders present at the workshop that QCI was there to facilitate the process. It was up to the hospitals and their staff to inculcate the desire to bring in quality healthcare and subsequently go in for accreditation. Delivering the keynote address at the workshop, Dr J P Singh, Principal Secretary, Health and Family Welfare Department, Government of Delhi, said that healthcare should be of quality, but it should also be accessible and affordable.

Pointing out that hospitals in Delhi had taken up the move to bring in quality and accreditation as a mission, he said that eight hospitals had been identified, of which the CNBC had already received accreditation. Dr Singh also informed that other secondary hospitals in the city had been identified and the Delhi government had tied up with German GTZ, an international cooperation enterprise for sustainable development with worldwide operations, to customise the manuals and standards that have to be followed on the journey to accreditation.

Dr Singh advised stakeholders to set up Quality Circles to make the process towards accreditation a more exciting one. As for the Primary Health Centres in the capital, the Delhi government has set up a team of doctors who would devise infrastructure standards. Highlighting the work done by the QCI, Dr Singh said that “the Quality Council of India helped us to integrate the infrastructure standards into our own protocols.”

To bring in the desired changes in the healthcare sector, a well-defined partnership between the government and the private sector was essential. A Public-Private Partnership (PPP) framework would enable capitalisation of governmental resources while ensuring private sector efficiencies in delivery. Currently, the private sector tends to concentrate on curative care of middle and upper income families in urban areas.

QCI spreads awareness through counselling
Training of qualified quality professionals is a key focus area of QCI. A report.

Realising the growing need to develop trained professionals in the field of Applied Statistics and Quality Management in the globally competitive environment of today, the Quality Council of India has initiated a special programme to spread awareness.

The programme, aimed at providing youngsters with the extra edge required to face the competition lying ahead, is an initiative of the National Board for Quality Promotion (NBQP), set up by QCI.

The QCI has always been conscious of the fact that there is a need to spread awareness on quality among all sections of the society, thereby leading to overall improvement in the quality of products and services. As part of its initiative, a series of Counselling Sessions are being organised to create awareness among the young and
fresh graduates and post-graduates regarding lucrative opportunities and career options available in the field of quality management, as applicable to various sectors of industries.

With the advent of knowledge-based industries and advances made in the field of computation technology, the demand for trained personnel in the area of Quality Management and Applied Statistics & Data Management is growing. The application of Statistical Tools and Techniques for the management of available data, and that of Quality Management Technology, are the two emerging areas where the industries are facing problems in getting trained personnel at various levels. The need in these areas is for trained personnel who can deliver in terms of quality management of products, processes and services, and also manage data analysis, besides providing solutions to the intricate problems related to the concerned

It was during World War-II that the need for quality control and its management was felt due to urgent and unforeseen demand of a variety of goods required for the armed forces in the war period and thereafter. Great quality exponents like Dr Juran and Dr Deming of the United States helped countries like Japan, which were almost destroyed, to stand on their own feet again through application of techniques of Statistical Quality Control (SQC) and Statistical Process Control (SPC) etc,.

In this arduous journey of management of quality of products and processes to quality of service, from ‘Zero Quality’ to ‘Zero Defects’, Indians have played a very important role, and as such India has been able to contribute greatly to the development of quality management as an academic discipline.

Although the subject of quality management was initially introduced with focus on quality of material products, and hence was found quite useful for the manufacturing sector, it now finds use in almost every sector. In India, there is a rising demand for quality professionals from all sectors of economy, be it manufacturing, BPO/ITes, software, education, healthcare, hospitality or public services. While there is an increasing demand for trained/qualified professionals in the country, and consequently there is a great scope of employment opportunities in these areas, not many students are aware of the career opportunities that exist in the specialised field of quality.

Today, there are courses run by national level institutes like Indian Statistical Institute, universities like Lucknow University and others, which offer students an opportunity to prepare themselves to get qualified in the field of quality. There are also professional bodies like Institute of Applied and Statistics Management (IASQM), Lucknow, and some others which also run courses in quality management and related topics.

The National Accreditation Board of Education and Training (NABET) of Quality Council of India recently approved a few courses in the area of quality management, being conducted by IASQM. The approval indicates that the curriculum, facilities and administration have passed the stringent quality standards set by NABET.

PPPs can help expand the private sector involvement to include curative/ preventive care for low-income people in rural and urban slum areas. This would make a significant improvement in public healthcare.

Dr Singh informed that two hospitals were ready with the infrastructure and super-specialty departments could be started with Public-Private participation. Most importantly, he said, there should be an element of gradation in nursing homes and private hospitals. After all, the consumer must know what kind of treatment he will get from these places.

He also informed that the healthcare sector sees a spend of around Rs 1,000 crores every year and it is time that a regulatory authority is set up to ensure maximum utilisation of the funds. “The journey towards accreditation must be exciting,” Dr Singh emphasised. Above all, he advised, all stakeholders must be on board for the groundwork of the accreditation process and beyond.

Among the other participants at the workshop were Dr Y P Bhatia, Ex-Chairman, NABH Accreditation Committee, Dr Nabajyoti Choudhary, Chairman, Technical Committee for NABH Accreditaiton of Blood Banks, Dr Bidhan Das, Chairman, Technical Committee for
NABH Accreditaiton of PHC and CHC, Dr Thuppil Venkatesh, Principal Advisor, QCI, Dr Amarjit Singh, Commissioner, Health, Gujarat, Dr K K Kalra, Medical Superintendent, CNBC, Delhi, Dr J L Meena, State Quality Assurance Officer, Gujarat, Dr R S Dubey, Medical Superintendent, Ram Manohar Lohia Hospital, Lucknow, Dr Harish Nadkarni, Chairman, Technical Committee for NABH Accreditaiton of Health and Wellness Centres, Dr Murli Srinivasan, Member, Technical Committee for NABH Accreditaiton of Hospitals and Dr Zainab Zaidi from QCI.