|
 
 |
| REVIEW ARTICLE |
|
| Year : 2017 | Volume
: 15
| Issue : 3 | Page : 231-236 |
|
National Accreditation Board for Hospitals and Healthcare Providers (NABH) Standards: A review
Samuel N. J. David, Sonia Valas
Department of Hospital Management Studies, Staff Training and Development, Christian Medical College, Vellore, Tamil Nadu, India
| Date of Web Publication | 7-Aug-2017 |
Correspondence Address:
Samuel N. J. David
Department of Hospital Management Studies and Staff Training and Development, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/cmi.cmi_51_17
Quality has become an important buzzword for the current generation of healthcare providers. Most hospitals and healthcare providers are differentiated and evaluated according to their organization performance and quality. National Accreditation Board for Hospitals and Healthcare Providers (NABH) is an integral board of Quality Council of India, established to operate accreditation program for healthcare organizations/institutions. Accreditation is a public recognition awarded to healthcare organizations which fulfill the standards laid by NABH through an independent external assessment conducted by qualified team of assessors.
Keywords: Accreditation, assessment, surveillance
How to cite this article:
David SN, Valas S. National Accreditation Board for Hospitals and Healthcare Providers (NABH) Standards: A review. Curr Med Issues 2017;15:231-6 |
| Introduction | |  |
The word “quality” has become an important buzzword in the health-care industry, and for good reason. However, quality means different things to different organizations/providers. Ideally, quality in hospital encompasses everything it does: how the hospitals care for its patients, how hospitals ensure health and safety of each of its patients and employees, and how it contributes to the overall health and well-being of its communities.[1],[2],[3] Hospital accreditation is being used to guarantee quality and patient safety at developing countries.[4]
| What Is National Accreditation Board for Hospitals and Healthcare Providers? | | |
National Accreditation Board for Hospitals and Healthcare Providers (NABH) is an abbreviation for NABH which is an integral part of Quality Council of India (QCI), set up to establish and operate accreditation program for healthcare organizations. NABH was established in the year 2006.[5] NABH is committed to enhance the development of healthcare quality service in our country for all levels of the population, through various methods and tools, to supplement the efforts of the providers of healthcare service and requirements of the system at various levels.
NABH standards consist of ten chapters which are being divided between patient-centered standards and organization-centered standards. All ten chapters consist of 683 stringent objective elements for the hospital to attain in order to get the NABH accreditation (4th Edition).
To comply with these standard elements, the hospital should have a process-driven approach in all aspects of hospital operations – from display of services, registration, admission, presurgery, perioperative period and postsurgery protocols, discharge from the hospital till follow-up with the hospital after discharge. The standards not only cover clinical aspects but also the governance of the hospital based on clear and transparent policies and protocols. In short, NABH aims to rationalize the entire operations of a hospital.[2]
| History of Accreditation | | |
The term accreditation means the systematic assessment of hospitals against accepted standards. Initially, accreditation was developed for hospitals, but later, it was extended to primary care, blood bank, medical imaging services (MIS), and other healthcare sectors. The origin of the accreditation process was in the United States of America. In 1917, the American College of Surgeons developed a programme of “minimum standards for hospitals” to assess and identify suitable hospitals for surgical training. This developed into a multidisciplinary program of standardization, and in 1951, led to the formation of the independent Joint Commission on Hospital accreditation, now known as the Joint Commission on Accreditation of Healthcare Organizations. All subsequent national programs have been derived from this either directly or indirectly.
As the demand for accreditation grew, the Joint Commission International Accreditation (JCI) was established for this purpose in the USA in the year 1998. The JCI accreditations standards are based on consensus standards developed by healthcare professionals from many countries. An international body known as the International Society for Quality in Health Care (ISQua), was then established as an umbrella organization to provide approval for other accreditation bodies. In 1999, they launched a program called Agenda for Leadership in Programs in Healthcare Accreditation which provides services to various national accreditation bodies to provide and administer standards of healthcare according to international standards.[6]
In India, the NABH system was established in 2006, as a constituent board of the QCI to establish and operate an accreditation program for healthcare organizations. The purpose of the NABH was to design and monitor healthcare standards for hospitals and healthcare providers in accordance with international standards. The first edition of standards was released in 2006 and revised every 3 years. Currently, the 4th edition of NABH standards, released in December 2015, is in use.[5]
NABH is an institutional member of the Accreditation Council of the ISQua. The standards set by NABH have been accredited and approved by ISQua. This means that NABH standards are in alignment with the global benchmarks set by ISQua. Thus, the hospitals accredited by NABH have international recognition.[7],[8]
| Benefits of Accreditation | | |
Accreditation benefits all stakeholders of a healthcare organization, as discussed below:
Patients
Accreditation is most beneficial to patients since it results in high quality of care and patient safety. Patients everywhere, including those in developing countries, have the right to receive high-quality care in a safe environment, and the NABH is a step in that direction.
Patients are made aware of their rights, and these rights are respected and protected. Patient satisfaction is regularly evaluated for quality improvement. Accreditation thus helps to maintain a patient-centric approach in healthcare.[2],[8]
Hospital
Accreditation of a hospital stimulates continuous improvement in its governance, operations, and functions. It enables hospitals to show that they are committed to quality care and patient safety, and this in turn improves the confidence of the community served by the hospital. The accreditation also means that the hospital is at par with the best and may also provide a competitive edge over other organizations.
Staff
Accreditation provides an opportunity for the staff of the hospital to be a part of a continuous learning process and a good working environment with uniformity in policies. It encourages leadership skills in staff, and above all, provides a sense of ownership of the clinical processes. It also facilitates overall professional development of clinicians and paramedical staff.
Empanelment
Accreditation provides an objective system of empanelment by insurance and other third parties. Accreditation provides access to reliable and certified information on facilities, infrastructure, and level of care.[2],[8]
Other benefits
Accreditation also has many other benefits such as establishment of uniform policies, procedures and records, measurement of indicators of performances, management system, and clinical system. Systems are also more transparent and open to change.[2],[8]
| Organizational Structure | | |
The organizational structure is illustrated in [Figure 1] and comprises of the following committees and panels. This information is available online and can be downloaded.[8]
Accreditation committee
The main functions of Accreditation Committee are as follows:[8]
- Recommendation to the board about grant of accreditation or otherwise based on evaluation of assessment reports and other relevant information
- Approval of the major changes in the scope of accreditation including enhancement and reduction, in respect of accredited hospitals
- Recommendation to the board on the launching of new initiatives.
Technical committee
The main functions of Technical Committee are drafting of accreditation standards and guidance documents as well as periodic review of standards.[8]
Appeals committee
The Appeal Committee addresses appeals made by the hospitals against any adverse decision regarding accreditation taken by the NABH. This includes the following:[8]
- Refusal to accept an application
- Refusal to proceed with an assessment
- Corrective action requests
- Changes in accreditation scope
- Decisions to deny, suspend, or withdraw accreditation, and
- Any other action that impedes the attainment of accreditation.
| National Accreditation Board for Hospitals and Healthcare Providers Secretariat | | |
The Secretariat coordinates the entire activities related to NABH accreditation to hospitals and healthcare organizations.[8]
| Panel of Assessors and Experts | | |
NABH has a panel of trained and qualified assessors for assessment of hospitals.
- Principal Assessor: The Principal Assessor is overall responsible for conducting the preassessments and final assessments of the hospitals
- Assessors: NABH has empanelled experts for assessment of hospitals. They are trained by NABH on hospital accreditation and various assessment techniques. The assessors are responsible for evaluating the hospital's compliance with NABH Standards.[7],[8]
| National Accreditation Board for Hospitals and Healthcare Providers Standards | | |
To obtain NABH accreditation, hospitals have to be evaluated against the set of “NABH standards for hospitals” prepared by the Technical Committee. The standards provide a framework for quality of care for patients and quality improvement for hospitals. The standards help to build a quality culture at all levels and across all the functions of hospital.
NABH standards have ten chapters incorporating 105 standards and 683 objective elements. The ten chapters are divided into patient-centered standards and organization-centered standards [Table 1].[8] | Table 1: National Accreditation Board for Hospitals and Healthcare Providers standards
Click here to view |
| Preparing for National Accreditation Board for Hospitals and Healthcare Providers Accreditation | | |
The following steps will help in preparing for the process of application for NABH accreditation:
- Nominate a coordinator
The hospital or healthcare organization should make a definite plan of action for obtaining accreditation. One person must be officially nominated to be responsible for coordination of all activities related to seeking accreditation. This person should be familiar with existing hospital quality assurance system. - Know the standards
The health care organization should get familiar with the prescribed standard and implement them. These are available online.[8] - Self-assessment
The applicant hospital should download the self-assessment toolkit from the NABH official website and self-assess itself against NABH standards. This should be done atleast 3 months before submission of application, and the hospital must ensure that it complies with NABH standards before the application process. - Obtain a copy of application form
- Fill and submit the application
- Pay the accreditation fee .[8]
The process of preparation for NABH accreditation is illustrated in [Figure 2]. | Figure 2: National Accreditation Board for Hospitals and Healthcare Providers accreditation procedure.
Click here to view |
| National Accreditation Board for Hospitals and Healthcare Providers Accreditation and Certification Program | | |
NABH conducts various accreditation and certification programs as mentioned below:
- Hospitals
- Small Health Care Organization (SHCO)
- Blood bank
- Allopathic clinics
- Primary health center
- Dental centers
- MIS
- Eye care organization
- Ayurveda hospital
- Homeopathy hospital
- Siddha hospital
- Unani hospital
- Yoga and naturopathy hospital
- Wellness centers
- Spa centers
- Panchakarma clinic
- Preentry level for hospital
- Preentry level for SHCO
- Nursing excellence program
- Certification of emergency department in hospital
- NABH – I safe – for hospital infection control.
| Assessment Criteria for Hospital Accreditation | | |
The man-days (one person's working time for a day, or the equivalent, used as a measure of how much work or labor is required or consumed to perform some task) given below in [Table 2], for assessment and surveillance are indicative and may change depending on the facilities and size of the hospital [Table 2].[8] The fee structure is given in Appendix 1.
| Accreditation Is an Ongoing Process | | |
NABH accreditation is not a one-time event, and the accreditation is not permanent. Instead, it is an ongoing process. The onus of continuously maintaining standards and continuously monitoring policies and practices falls on the hospital. Once a hospital gets accredited, the accreditation is valid for a defined period and is subject to change based on subsequent surveillance. NABH conducts a regular surveillance of the accredited organization (the first such is usually planned during the 2nd year). The accreditation will have to be renewed once the defined period of accreditation is completed. “Accredited register” could be referred for the list of accredited and applicant organizations under different programs.[8]
| Conclusion | | |
- Accreditation standard for hospitals helps to focus on patient safety and improve quality of healthcare services and processes
- Accreditation is also one of the most frequently used external quality assessment of healthcare organizations to prove its effectiveness and performance [9]
- In the current scenario, the NABH standards is the highest benchmark standard for hospital quality in India
- Patients are the biggest beneficiaries from the NABH accreditation, as it results in a high quality of care and patient safety.
Financial support and sponsorship
Nil.
Conflicts of interets
There are no conflicts of interest.
| References | | |
| 1. | Sanfilippo JS, Bieber EJ, Javitch DG, Siegrist RB. MBA for Healthcare. Oxford, UK: Oxford University Press; 2016.  |
| 2. | Quality Council of India. National Accreditation Board for Hospitals & Healthcare Providers (NABH). Available from: http://www.qcin.org. [Last accessed on 2017 Jun 15]. |
| 3. | Stahl R. Quality is a Way of Life at Wilson Medical Center. The Wilson Times; 15 February, 2017. |
| 4. | Devkaran S, O'Farrell PN. The impact of hospital accreditation on quality measures: An interrupted time series analysis. BMC Health Serv Res 2015;15:137. |
| 5. | National Accreditation Board for Hospitals & Healthcare Providers. Wikipedia the Free Encyclopedia. Available from: http://www.wikipedia.org. [Last accessed on 2017 Jun 15]. |
| 6. | Jovanovic B. Hospital accreditation as method for assessing quality in healthcare. Oncology 2005;13:156-7. |
| 7. | Hittinahalli V, Golia S. NABH Accreditation and its status in the Country. Al Ameen J Med Sci 2013;6:2013. |
| 8. | National Accreditation Board for Hospitals & Healthcare Providers. Available from: http://www.nabh.co. [Last accessed on 2017 Jun 15]. |
| 9. | Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O. A systematic review of hospital accreditation: The challenges of measuring complex intervention effects. BMC Health Serv Res 2015;15:280. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]
|
Search Pubmed for