Aims & Objectives

To promote awareness of health care among all sections of the Indian people.

To promote awareness among functionaries involved in Health and Hospital Management.

To promote research in the field of Health and Hospital Management. in order to improve the
efficiency of Health Care delivery Systems.

To promote the development of high quality hospital services and community health care.

To promote a forum for the exchange of ideas and information among health and hospital
planners, academicians, administrators, various statutory bodies and the general public for the
improvement of Hospital and Health Care delivery Systems.

To develop norms and standards for accreditation of the Health Care Organization and adopt means
of evaluation of such institutions, so as to improve the quality of health care in the community.

To provide opportunities for training and research in all aspects of Hospital Services Health Care
Delivery System and Health Care Administration.

To update the knowledge and skill of the Health & Hospital Administrators and other personnel
involved in the management of health care organization through continuous education and
research.

To promote and grant recognition to research in the fields of Health and Hospital Management
and to grant awards, scholarship and assistance in other suitable forms to meritorious individuals
and institutions.

To act as Advisory /Consultative Body, in the best interest of community and country, to Central and
State Governments, Public Sector Undertakings, Health Care Delivery Organization, Public Health &
Health System Development, Teaching and Training Organization and any other Health related allied
organization, when need so arises or services are asked for.

To provide Health Care Advocacy for the benefit of health system management and to endeavor to
become a national advisory body for union and state governments.
To publish text books and periodic monographs on current and futuristic trends in health and
hospital management.

To help in preparation of SOPs, Manuals, Literature and Books on Health Care Management, Quality
& Accreditation, Health Care Technology, Health Care Industry related subjects, Text Books for
Health Management Courses for benefit of the Students & Faculty, Hospital and Health Care
Organizations and Academic Institutions.

To undertake Professional Consultancy in the field of Health System Management, Quality &
Accreditation, Health Technology Assessment, Medical Tourism, Disaster Management, Health Care
Delivery Organization, Public Health Facilities & Services for overall improvement of the facilities.

To conduct inter hospital/ Institution awards competition on various parameters to bring

competitiveness for improving healthcare quality & training.

To recognize and felicitate the individuals who have made exceptional and significant contributions
in the field of Health and Hospital Management in general and to the Academy in particular.
Quality management in healthcare.

Clinical governance and better human resource management practices are important planks in the
current health policies emphasizing quality of patient care. There are numerous reasons why it is
important to improve quality of healthcare, including enhancing the accountability of health
practitioners and managers, resource efficiency, identifying, and minimizing medical errors while
maximizing the use of effective care and improving outcomes, and aligning care to what
users/patients want in addition to what they need. "Quality in health is doing the right things for the
right people at the right time, and doing them right first time and every time." Quality can also refer
to the technical quality of care, to nontechnical aspects of service delivery such as clients' waiting
time and staff's attitudes, and to programmatic elements such as policies, infrastructure, access, and
management. In this oration/article quality initiatives like Reproductive and Child Health (RCH) and
National Rural Health Mission (NRHM) of Government of India (GOI), which concentrate on
improving the quality of infrastructure of vast rural health facilities including sub-center, primary
health center, and community health center has been taken into account with focus on improving
quality of health services also. United Nation Population Fund (UNFPA) in collaboration with the GOI
has proposed introducing quality assurance program for accessing and improving the quality of
services at public sector health facilities. It is felt that improving the quality of health services in
public sector will attract the client belonging to low economic strata, and surely will help in achieving
the goal of the NRHM, that is, "Reaching the enriched with quality of health services."
 Commented [C1]: Start

Clinical governance and better human resource management practices are important planks in the
current health policies emphasizing quality of patient care. There are numerous reasons why it is
important to improve quality of healthcare, including enhancing the accountability of health
practitioners and managers, resource efficiency, identifying, and minimizing medical errors while
maximizing the use of effective care and improving outcomes, and aligning care to what
users/patients want in addition to what they need. "Quality in health is doing the right things for the
right people at the right time, and doing them right first time and every time." Quality can also refer
to the technical quality of care, to nontechnical aspects of service delivery such as clients' waiting
time and staff's attitudes, and to programmatic elements such as policies, infrastructure, access, and
management. In this oration/article quality initiatives like Reproductive and Child Health (RCH) and
National Rural Health Mission (NRHM) of Government of India (GOI), which concentrate on
improving the quality of infrastructure of vast rural health facilities including sub-center, primary
health center, and community health center has been taken into account with focus on improving
quality of health services also. United Nation Population Fund (UNFPA) in collaboration with the GOI
has proposed introducing quality assurance program for accessing and improving the quality of
services at public sector health facilities. It is felt that improving the quality of health services in
public sector will attract the client belonging to low economic strata, and surely will help in achieving
the goal of the NRHM, that is, "Reaching the enriched with quality of health services."

Introduction Top

Clinical governance and better human resource management practices are important planks in the
current health policies emphasizing quality of patient care. There are numerous reasons why it is
important to improve quality of healthcare, including enhancing the accountability of health
practitioners and managers, resource efficiency, identifying, and minimizing medical errors while
maximizing the use of effective care and improving outcomes, and aligning care to what
users/patients want in addition to what they need.

Quality management models from industry, demands from providers of professional associations,
increased focus on clients' perspectives and satisfaction, and emphasis on achieving efficiency in
program settings have provided much needed momentum to introducing these interventions.

Rationale for quality improvement

Government, business, and households - the three major sources of healthcare financing are
demanding more accountability from healthcare providers as evidenced in the Consumers
Protection Act.

Financial concern of third parties such as insurance companies.

It costs no more for providers to treat clients with respect, affordable good-quality care, which
means choosing appropriate technology.

Good-quality care helps in avoiding unnecessary costs by preventing injuries, infections, and
unwanted pregnancies, eliminates costly follow-ups to treat clients who have been harmed.

Quality attracts revenue as the improved quality can attract more clients, help programs raise
revenue, and attract donor support.

Finally, good quality can cost less. Costs of poor quality are: Time spent on complaint handling, costs
of claims and legal actions, extra cost of work repeated or wrong work done, duplication, waste, bad
reputation, lost referrals, damaging effect on staff, etc.

What is quality?

Quality in healthcare has been defined in many ways.

"Quality" in healthcare is defined as everything the healthcare organization undertakes to fulfill the
needs of its customer, be it the patient, the payer, the admitting doctor, the employer, or an internal
customer within the organization.

"Quality is doing the right things for the right people at the right time, and doing them right first
time and every time."

Quality can refer to the technical quality of care, to nontechnical aspects of service delivery such as
clients' waiting time and staff's attitudes, and to programmatic elements such as policies,
infrastructure, access, and management.

Quality Management: Quality management is that aspect of the overall management function that
determines and implements the quality policy. It includes strategic planning, allocation of resources,
and other systematic activities for quality, such as quality planning, operations, and evaluations.

Dimensions of quality

Technical performance: The degree to which the tasks carried out by health workers and facilities
meet expectations of technical quality (i.e., adhere to standards).
Effectiveness: The degree to which desired results (outcomes) of care are achieved.

Efficiency: The ratio of the outputs of services to the associated costs of producing those services.

Access: The degree to which healthcare services are unrestricted by geographic, economic, social,
organizational, or linguistic barriers.

Interpersonal relations: Trust, respect, confidentiality, courtesy, responsiveness, empathy, effective

listening, and communication between providers and clients.

Amenities: The physical appearance of the facility, cleanliness, comfort, privacy, and other aspects
that are important to clients.

Relevance: As appropriate and feasible, client choice of provider, insurance plan, or treatment.

Choice: As appropriate and feasible, client choice of provider, insurance plan, or treatment.

Continuous quality improvement

Continuous quality improvement (CQI) is simply a management method. CQI focuses on breaking
down your system into processes, and breaking those processes down into inputs. Every process has
a list of inputs that can be put into five categories: Man, machine, method, material, and
environment.

It views learning as a continual process and provides its members with ongoing professional
development opportunities, and it fosters a favorable working environment.

Total quality management

Total quality management (TQM) incorporates the concepts of product quality, process control,
quality assurance, and quality improvement. Consequently, it is the control of all transformation
processes of an organization to better satisfy customer needs in the most economical way.

Quality assurance process

"Plan-Do-Check-Act" or "PDCA Cycle": It is a work philosophy that emphasizes four phases of activity
[Figure 1]. In the planning phase, people define the problem to be addressed, collect relevant data,
and ascertain the problem's root cause; in the doing phase, people develop and implement a
solution, and decide upon a measurement to gauge its effectiveness; in the checking phase, people
confirm the results through before-and-after data comparison; in the acting phase, people
document their results, inform others about process changes, and make recommendations for the
problem to be addressed in the next PDCA cycle [Figure 2].
 Figure 1: Quality cycle

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Figure 2: Quality assurance process

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Principles for good quality management in healthcare

Principle 1 - Patients focus: Our healthcare organization depends on the patients and therefore should
understand current and future patients' needs, should meet patients' requirements and strive to exceed their
expectations.

Principle 2 - Leadership: Leaders establish unity of purpose and direction of the organization. They should create
and maintain the internal environment in which people can become fully involved in achieving the organization's
objectives.

Principle 3 - Involvement of people (employees): People at all levels are the essence of an organization and their
full involvement enables their abilities to be used for the organization's benefit.

Principle 4 - Process approach: A desired result is achieved more efficiently when activities and related resources
are managed as a process.

Principle 5 - System approach to management: Identifying, understanding, and managing interrelated processes
as a system contributes to the organization's effectiveness and efficiency in achieving its objectives.

Principle 6 - Continual improvement: Continual improvement of the organization's overall performance should be
a permanent objective of the organization.

In routine healthcare delivery, many processes occur simultaneously and involve many professional functions in
the organization. Processes can cause inefficiencies due to problems that occur in the execution or the transition
of one step to the next. Inefficiency in a process often results from unnec essary steps that add complexity, waste,
and extra work to a system, ultimately reducing the overall quality of care.

Building a quality management program

Policies on quality, procedures, and processes are implemented simultaneously, starting at the top and moving
down the organization. It typically begins with a review of standards and specifications, if there are any. This is
followed by an assessment of healthcare and support services. Priority areas for quality improvement can be
identified based on the results of comprehensive monitoring or systems analysis. This approach has three
dimensions:

1. Quality design: Includes setting vision and objectives, allocating resources, and establishing standards
and guidelines to ensure effectiveness and safety, monitoring design, training, team building and
mechanism for maximizing access increasing clients' satisfaction.
2. Quality control: Consists of supervising and continuous monitoring activities and staff performance against
the set standards to ensure that they meet quality objectives.
3. Quality improvement: Seeks to keep raising the level of care - no matter what its current level.
It includes problem identification, priority setting, solution development, implementation, assessment, and
refinement.

Quality design, quality control, quality improvement-form the three sides of the "quality triangle" also called
"Quality management Triad." [Figure 3]

Figure 3: Quality management triad

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Steps of implementation of quality improvement

1. Creating a supportive environment.

2. Focus on the user (of services).
3. Marketing change in the organization.
4. Motivating people in the organization.
5. Building teams: An overview.
6. Data collection and analysis.
7. Problem solving cycle.
i. Identify the problem
ii. Describe the problem
iii. Developing strategies
iv. Planning the solution
v. Defining standards
vi. Implement the solution
vii. Evaluate and monitor the solution
8. Supervision

Quality initiatives in India

The Government of India (GOI), through its Reproductive and Child Health II (RCH-II) and National Rural Health
Mission (NRHM) programs, is committed to improving the quality of RCH services provided through its vast
network of rural health facilities, which includes primary health centers (PHCs), community health centers
(CHCs), sub-centers, and RCH camps. It aims to improve RCH by identifying and filling gaps in the inputs and
processes of RCH service delivery.

The NRHM of the Ministry of Health and Family Welfare (MOHFW), [Figure 4] Population Council, and UNFPA
jointly proposed introducing a quality assurance (QA) program for assessing and improving of the quality of
services at public sector health facilities. In the first round, 89 facilities in Ahmadnagar and 100 facilities in
Tumkur were selected for QA visits. Sixty-four percent were of good quality, about one-third were average, while
a small proportion (6%) were of poor quality.

Figure 4: Structure of QA

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An analysis of all the facilities covered until the end of December 2007 revealed substantial gaps in the
infrastructure and human resources available to provide good quality services, as well as adherence to standards
for providing the services. The analysis of CHC/PHC inputs shows that 75% of facilities in Ahmadnagar and 94%
of facilities in Tumkur were in grade B or C. Regarding the process of service delivery, more than two -thirds of
facilities in Ahmadnagar (67%) and about 45% of the facilities in Tumk ur scored C or D grade. This clearly points
to the existing poor quality services provided by these facilities and need for improvement. The key gaps
identified at facilities in both the districts are similar, including training of different providers, sho rtage of essential
equipment and supplies, general cleanliness, infection prevention practices, repair and maintenance of buildings,
updating of records, poor waste management, availability of protocols and job aids, display of information at
facilities, among others [Table 1].

Table 1: Common observations during QA

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A majority of the facilities in both the districts scored higher grades during the second visit as compared with their
corresponding grades obtained in the first visit [Figure 5]. Average scores of the facilities visited increased by 13
percentage points in Ahmadnagar (from 68% to 81%) and 26 percentage points in Tumkur (from 53% to 79%).
This indicates that QA is making difference in the quality of services [Figure 6].

Figure 5: Change in quality grading of all facilities between fi rst visit and fourth visit

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Figure 6: Changes in quality grades by district

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It was observed that there was an overall improvement of grades of healthcare quality of health institutions from:

Making quality a top priority can require changes in goals, guidelines, attitudes, and activities that are difficult to
make. Organizations typically do not change themselves overnight but rather one step at a time. Internal process
for QA can be successfully driven in large public health systems. It is feasible and effective. It can be supported
financially by the states.

Commitment and persistence are crucial. Traditionally, most healthcare education from undergraduate through to
postgraduate training is offered within specific professional groups. Most training is focused on the care of
individual patients with specific conditions and little attention and time goes to educating healthcare professionals
on wider professional issues such as how patient care depends on contributions of colleagues from other
disciplines; working in teams; organizational behavior and change; and clinical audit or CQI. Nurses and doctors
will therefore learn separately about the care of patients with, for example, diabetes from their own professional
viewpoints, but often do not learn about the organizational aspects of care of people with diabetes. Although
these aspects of care are not about individual people and individual treatments, getting them right impacts on
both the quality and the safety of the care patients receive.

I would like to end the article by quoting the statement of our H'ble Prime Minister, Shri Dr Manmohan Singh.
While inaugurating the NRHM Project in April 2006 he ended his speech by saying that NRHM is m eant for the
poor; we would like to reach the unreachable with quality of health services.