1. Need for Self regulation Accreditation framework, patient satisfaction Dr Ketan Parikh Consultant Paed Surgeon & Paed Laparoscopist; Jaslok, Nanavati, Hiranandani Hospitals Tara Neo-Surg Hospital,Mumbai, INDIA. Past President: AMC; Convenor HCAC.

2.  Indicate a society which is marching ahead in all fields and we the ‘cream of the society’ cannot be far behind, should not be far behind. India – a global power India Shining

3. Health – a priority social need  Health care is an important part of social needs and alongwith education, possibly falls in the 2 nd list of high priority issues of the society after ‘roti, kapda aur makaan’.  the society also has a right to a quality health care institutions for their health care needs.  The initiatives to address quality of health care have become a world wide phenomenon and India cannot remain far behind.

4.  Health care is a very specialised field where quality standards need to go far beyond just granite flooring and marble windows.

5. Aspects of health care -The doctor - qualified/ unqualified - MBBS or specialist - which field of specialisation. Whereas India can boast of top quality medical expertise, it is necessary that the medical institutions complement this medical expertise.

6. Aspects of health care  The hospital:the other staff –qualified or else?  The infrastructure-investigative, support services like blood bank, canteen etc. (star rating of hotels )  The equipment?  The capability of handling emergencies.

7.  Safety is priceless.  Levels of Perfectionism have no limits but every level has its price.  And some one has to pay this price.

8.  Standards of care vary according to the speciality.  In a country where 60% of the population seeks health care from private sector and where almost 90% of this self-financed,  expenses on standards and safety have to be judicious and need based

9.  In practical terms, a laminar flow disinfection is desirable in every surgical O.T. but very important in theatres for joint replacement, neurosurgery and cardiac surgery.  A bacillocid hand disinfection may be desirable on every patient cot in ICU but may become very expensive for routine general ward patients.

10.  As a group of highly qualified and respected institution, the medical professionals are likely to be averse to standards being set by some external agencies.  This brings us to the concept of self- regulation or accreditation.  This regulation should aim to bring quality health care within the reach of all.

11. Accreditation  It is a process of external peer review for determining compliance with a set of standards which are higher than the minimum standards or the licensing process.  Its approach has to be based on the belief that hospitals should be safe places in which professionals should practise and patients should be cared for.

12.  A process by which a patient has the confidence that he is in a setup which can adequately take care of his condition without paying for superficialities which he cannot afford.  In simple words, it should be value for money.

13.  The self regulation system which we should devise has to be tailored for the needs of the country and the society rather than imitate a system prevalent in the west.  It needs to be designed and defined by the local medical professionals.

14.  Unfortunate that the Indian govt which is for the people, by the people and of the people of India, has promoted a health accreditation system for the non- Indians since the NABH accreditation system is aimed at making our hospitals capable of handling medical tourism.

15. A desirable accreditation process:  Should be voluntary  Should be self-governed by a peer population.  In a country like India where cost matters, it should have levels or grades.even the US accreditation system went through the 2 earlier phases of minimal and then optimal standards.  It should be dynamic  It should aim to give quality health care to the INDIAN population.

16.  Every institution has a front panel which is easily seen by the patients and a back panel which is possibly more important for ensuring quality care.  The accreditation process should identify the essential and desirable aspects of this back panel and recognises the same when present.

17. Accrediation process needs to ensure the following: –Safety mechanisms e.g. adequate emergency measures –Adherence to essential systems e.g. autoclaving, fumgation etc. –Adequacy and appropriateness of staff.

18. Miscellaneous aspects  Patient satisfaction  Transparency of billing system and charges  Recognition of patient rights  Adherence of public health norms.  Encouragement to patient and public health education.

19. Advantages of accreditation  Ensures quality of health care.  Permits the patient to choose his level of care.  Identifies quality adherence in an institution.  Stimulates an environment of improving quality standards both for the society and the health care industry

20. Advantages…  Recognises quality  Justifies costing  Protects from over-expectation.  Medico-legal guidelines.  Stimulated improvement in quality standards.

21. Win - win situation  Accreditation would thus protect the consumer and the provider.  It would provide the judiciary with a benchmark to base its judgements.  It would also facilitate the insurance sector to stratify their liabilities.

22. Thank You.  Only when the medical profession takes an active and purposeful initiative towards self –control and setting standards, would we be justified in rejecting the non-essential standards set by other agencies.