Full accreditation of hospitals sluggish but demand high for entry-level certification

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Only an estimated 2 percent of India’s hospitals with over 50 beds each have been fully accredited in the 17 years since the National Accreditation Board for Hospitals and Healthcare Providers was set up.

According to the board, 835 hospitals with 50-plus beds each and nearly 800 with a capacity of less than 50 beds each have been accredited so far.

The NABH, which was formed under the commerce ministry’s Quality Council of India in 2005 to establish and operate accreditation programmes for healthcare organisations in India, went into a huddle with representatives of private hospitals recently to brainstorm on how to get more hospitals on board so that patient safety and clinical outcomes are improved.

Accreditation of hospitals is voluntary, but the government incentivises facilities that are accredited through various health insurance schemes.

The NABH assesses hospitals, mostly private, on over 600 parameters that are classified as patient-centred or organisation-centred. To comply with these standards, hospitals need a process-driven approach in all their functions – from patient registration, admission, pre-surgery, peri-surgery and post-surgery protocols, to discharge from hospital and follow-ups after discharge.

In addition, there are infrastructural and human resource-related specifications that hospitals need to meet.

Long way to go

While there is no government data on the number of private hospitals in India, some industry estimates suggest that there are about 45,000 hospitals with over 50 beds each. When smaller nursing homes are included, the number goes up to almost 100,000.

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The NABH chief acknowledged that India has a long way to go when it comes to hospital accreditation.

“You have to see that we are only a 17-year-old organisation, while our equivalent in the US, the Joint Commission International, came into existence in 1952,” said Atul Mohan Kochhar, chief executive officer of the NABH in New Delhi.

According to Kochhar, demand for entry-level accreditation has improved after the NABH revamped the procedure in 2014.

Successful completion of the Healthcare Organisation Platform for Entry Level Certification (HOPE) ensures quality assurance of hospitals across the nation and qualifies them for full accreditation. Kochhar said almost 8,000 hospitals have opted for entry-level certification so far.

“Every month, we receive 370-380 applications from hospitals for our HOPE certification and it shows that hospitals are getting aware about raising their quality standards,” Kochhar told Moneycontrol.

The Insurance Regulatory and Development Authority mandated in July 2016 that all 33,000 hospitals empaneled with the regulator must have entry-level NABH certification.

Alexander Thomas, president of the Association of Healthcare Providers of India, a network of private hospitals, said investments may be needed to receive accreditation but the returns are good.

“NABH is the only reliable accreditation body for hospitals in India and hospitals should opt for it because it raises the quality of facility and clinical standards,” Thomas said. “It’s good that many hospitals are now coming ahead with HOPE and the idea is to push them for full accreditation within 2-3 years.”

Benefits for patients, hospitals

Siddhartha Bhattacharya, secretary general of Nathealth, a network of private healthcare companies, said patients would be the biggest beneficiaries of accreditation.

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“It ensures minimum standards of quality, patient safety and sets the bar for payout on what level of care is purchased,” he said.

From a hospital’s point of view, according to Bhattacharya, it demonstrates commitment to quality care, improving patient outcomes and trust.

“If the hospital is accredited, it enables patients to have confidence that they are being treated by trained medical professionals as per optimal standards,” said Bhattacharya.

NABH accreditation also helps to positively influence healthcare delivery, according to an analysis prepared with funding support from the World Bank in 2018. The findings were based on the assessment of 14 accredited hospitals in tier 1 and 2 towns in India.

The study also highlighted factors that may contribute to positive financial outcomes for hospitals and added that income per used bed shows an increasing trend after the accreditation period.

“This may suggest medium- to long-term financial benefits to hospitals undergoing NABH accreditation,” according to the report, which was co-authored by Thomas.

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