RE: NABH query on ICU design / Infection control

Please see my reply below.

 

Sincerely,

Dr Akash S Rajpal,

 

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From: Ashwini Ranade [mailto:ashwini.ranade@completewellbeing.com]
Sent: 18 June 2010 12:00
To: Dr.Akash S Rajpal; 'Akash Rajpal'
Subject: NABH query

Dear Dr Akash,

 

Kindly answer the below queries on NABH.

 

 

1. I'm doing my project work on NABH with Apollo hosp. I'm said to make unit binders so far. Can you guide me how to proceed further?  ; Kindly eloborate 

 

2. I’m doing my internship on NABH. Can you provide me basic guideline how to make a project report.  : You may do a gap analysis on standard requirement and evidence seen. I wonder how long you would be doing your internship. Standard internships are for one to three months. In that it will be difficult to do a complete gap analysis. You may choose few departments or chapters from NABH to make the report/case study. For interpretation of standards you would have to refer to the NABH guidebook. 

 

3. respected sir/madam
i would like to know what are the standards which are to be maintained according to NABH while handling patient in ICU. basically to control nosocomial infections since i am from non-medical background i would request you to please guide me just regarding hand washing procedure, proper waste disposal technique, wen to use gloves, how to enter in icu i.e. dress-up. 

You may refer to international standards design books , CDC or WHO websitez or refer to http://www.isccm.org (Indian Society of Critical Care Medicine) which has good knowledge base for the same. 

 

Stay Well
Ashwini

 

NABH queries & responses - 2

RESPONSE TO AN EMAIL QUERY ON NABH STANDARDS RELATED TO QUALIFICATIONS OF NURSES.
(All are requested to post the queries via this blog for a larger sharing of knowledge)


Sir,

NABH says you need to comply to statutory requirements. So the qualifications will be as per states/regions requirement. If you have anything out of norm you should have evidence in writing from the local authority that its allowed.
Normally nurses registered with state nursing council are required. Also check NMMCs (your local hospital registration authority) guidelines of registration which mentions this.You should also refer to the Bombay Nursing home acts (http://www.maha-arogya.gov.in/actsrules/nursing/BombayNursingHome.pdf) page 8-point 8 & page 5-point 15 for better understanding. Depending on region/accessibility various liberties are provided by state keeping in mind difficulty in availability of medical staff. For example a recent gazette of GOI allows certain AUYSH practitioners to practice allopathy.
 
Bottom line: NABH does not specify specific qualifications.
You can also refer to NABH standard HRM11 to outline a policy which state which qualified staff will do what at what course of treatment. This way you could have a optimised mix of qualified staff doing certain aspects of plan of care and non qualified staff doing certain aspects keeping in mind criticality of care.

I would compile Internet links to various acts concerning health care ASAP which could benefit the fraternity at large.

Sincerely,
Dr Akash S Rajpal

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On Thu, May 6, 2010 at 9:39 PM, ramani brahma wrote:

Does NABH Specify any minimum qualifications for nursing staff/lab technicians and X- ray technicians? Thanks regards Dr. Ramani

NABH queries & responses

I refer to a email where this gentleman enquired whether NABH prescribes
standards for staffing (quantity).
My response is mentioned below with a copy of the email.
I hope the same would help any concerned on the said aspect of HR
planning.

Best wishes,
Dr Akash S Rajpal.
--------------------------------------------------
Sir,

Kindly refer to the below mentioned NABH standard.
NABH does not lay down staffing quantity specifications and it is upto
the organisation to decide what is suitable.
What NABH would look at would be the efficacy of operations and human
resource planning. If you are able to comply to various standards
related to patient records effectively even with one staff they would
appreciate it, and if you cant even with 10 staff then a non compliance
would be made depending on the severity of the problem. Therefore it is
important to assess how much staff is required to carry out the assigned
tasks in specified shifts by way of HR planning followed by continuous
monitoring for efficiency of staffing & errors for improvement &
training needs.

HRM.1: The organization has a documented system of human resource
planning
A.The organization maintains an adequate number and mix of staff to meet
the care, treatment and service needs of the patient

Sincerely,

Dr Akash S Rajpal,
-----Original Message-----
From: Alex Roy
Sent: 04 May 2010 07:02
To: Dr.Akash S Rajpal
Subject: NABH Standards

Dear Sir,

I just have one question about the NABH Standards.

According to NABH standards, is there any specific number of staff
(strength of staff) in a medical record department for a 1000 bedded
hospital.

I would be thankfull at your response.

Have A Blessed Day
Carol Peter

Mission & its influence on staff performance.

The challenge we administrators always face is to retain the
satisfaction levels of our customers - the patients.
All would agree, that while its very difficult to attract new patients,
its so easy to loose them.
A major reason for the same is often the lack of good communication by
various categories of personnel including the front office, Nursing and
even the doctors.

So how to counter this problem?
I think the most essential element missing in various training sessions
or the approach by various staff while handling patients is that the
mission statement of the organization is never on the conscious level of
any staff's mind.
Actually a training session to orient staff on importance of Mission
statement and how each and every staff including the housekeeping
personnel can contribute in achieving the Mission Statement, is hardly
conducted.

I remember, during our audits, one of the housekeeping boys was
interviewed by an external auditor to assess if he was aware about the
Mission statement. The auditor hardly expected a positive reply.
The Housekeeping not only explained the interpretation in the local
language about the Mission Statement, but further explained (when asked)
how he contributed to achieve the same.
He confidently replied that his good cleaning practices of the toilets
and other floor areas would create good impression of the hospital,
would impress upon the users including doctors and patients and thus
influence the patients and doctors to like the hospital.
It would be an understatement that the external auditors were surprised
to hear that response.

The ingraining of mission statement I feel is the most essential
component of training, and should be "made to understand" for better
delivery of services.

In my next blog as a continuation to the introduction of this blog, I
would write about certain areas which can be looked into for better
customer satisfaction.


Sincerely,

Dr Akash S Rajpal,
AGM Operations,
Dr L H Hiranandani Hospital, Powai.
NABH Accredited Hospital.
ISO 9001:2000 Certified (DAR & NABCB accredited)
"IMC Ramkrishna Bajaj National Quality Award" Winning Hospital.

Insurance Claims Process - The future?

What started off as a query from Arijit M - Insurance Professional -
Manager Claims (National Level) at Reliance General Ins Co. Ltd on
Linked-in with the topic 'How can we use the mobile technology in Claims
servicing, Health top, renewals, premium quote' actually made me think
of a possible ideal future of the claims processing process between the
service provider & the back office of TPA/insurance.

Except for premium alerts, notices, and status update of the claim
stage, mobile technology is of not much use as a large amount of work is
done with interaction with personnel from provider and payer.

So how can technology & IT help in faster claims processing, the biggest
grouse of every stake holder including the provider, payer, and the
claimant (patient)?

I feel a web based service instead can be used for live claim
processing, input of data and attachment of scanned medical records by
the service provider for faster processing. Digital signatures can be
used to authenticate the files.

A network among all TPA/insurance back offices can prevent duplication
of claims for which original documents are sought from patients (which I
feel is waste of paper and time) on lines of CIBIL rating for loan
processing.

There were thoughts whether an integrated system which captures real
time data information like condition of the patient, proposed/final line
of treatment, day to day billing will bring about faster turn around
times in claim processing?

But then how will this real time capture of EMR bring in value and
expedite the claims process?

The medical treatment is not always as per the proposed line of care.

In India still the consultants have a 'problem' of data entry when it
comes to using computers (it's still better than the US where clinical
EMR penetration is very low).

Capturing of EMR (Forget real time) cannot happen until the application
and data entry is standardised across all insurance network hospitals.

Standardisation even if willing (by hospitals) will be a problem because
various software's would have various programming intricacies built in
to their existing software's which would make the modification &
integration difficult and leading to unnecessary cost overloads.

So what is the possible ideal future for the claims processing?
I could only think of this: I would propose an online simple web based
claim process form where all necessary claim related fields are filled,
and scanned copies of medical records are attached by the service
provider. But this should not follow a sending of hard copy as that
would mean duplication.

A CIBIL (Credit Information Bureau (India) Limited) like network would
prevent duplicate submissions where all claim processing back offices of
TPA/Insurance can log in & check the insurance history of patients akin
to the loan/credit history of the borrower. Patients can log in and see
how they fare & make appropriate amendments.

Sincerely,

Dr Akash S Rajpal,
AGM Operations,
Dr L H Hiranandani Hospital, Powai.
NABH Accredited Hospital.
ISO 9001:2000 Certified (DAR & NABCB accredited)
"IMC Ramkrishna Bajaj National Quality Award" Winning Hospital.

Active Versus Proactive Operations

All of us hospital administrators have to face customer/patient complaints almost on a daily basis.

In best of our abilities the operational planning is done to ensure that the customer leaves the premises satisfied, however that’s a wishful thinking.

I am yet to design a plan which delivers 100% customer satisfaction.

However I have already moved on to the aspect of 'proactive' operational planning as opposed to the 'active' coordination which we do normally to ensure the time oriented end result.

 

To cite an example:

 

1. Discharge Process:

Almost every hospital has a similar discharge process:

Doctors write the discharge note, which follows a series of events (which if patient comes to know of he would probably no feel dissatisfied).

After the discharge note is written, the discharge summary is prepared, unused medicines are returned, additional prescriptions are indented, missing reports are collated, billing service postings are validated and so on.

 

Any bottleneck above would be 'actively' corrected by persuasion & interdepartmental coordination.

 

However as almost every discharge request would accumulate for the day in a concentrated manner, the resources deployed always seem to be deficient in numbers as well as efficiency.

 

Our recent approach (I am sure other likeminded people may have already embarked on the same) has been (or striving to be) 'proactive' as follows:

 

'Predict' the discharges for the next day.

Ensure all necessary reports/return of medicines/indent of new medicines are made in advance.

Billing is almost ready.

Discharge summary is already prepared, except minor changes if may be required.

All necessary interdepartmental coordination & 'persuasion' now can happen any time of the day or middle of the night as and when the human resources available and not bogged down by 'peak' volume demands.

 

This would lead to a 'quick' discharge of the patient the next day.

Yes, there would be exceptions, change of orders, change of decision by doctor even patient, but a majority would be covered in the predictive proactive preparation and better customer satisfaction.

Sincerely,

Dr Akash S Rajpal,
AGM Operations,
Dr L H Hiranandani Hospital, Powai.
NABH Accredited Hospital.
ISO 9001:2000 Certified (DAR & NABCB accredited)
"IMC Ramkrishna Bajaj National Quality Award" Winning Hospital.

Sharing knowledge

Dear all,
Starting today I would try and interact with all desirous of sharing knowledge specifically pertaining to the domain of healthcare & quality.
There have been many queries on NABH, ISO, and Malcolm Baldrige from the hospital management trainees, and peers which I have been replying to, but this will make the interaction archived for the benefit of all who came in late.
I would post from time to time my thoughts on problems related to hospital operations, quality and so can you vice a versa.
I hope this blog opens up a great knowledge pool for every one to dive in.

Best Wishes,
Dr Akash S Rajpal