A protocol to study the impact of implementation of National Accreditation Board for Hospitals & Healthcare Providers (NABH) standards among health care workers in a tertiary care hospital in India

Introduction

In light of the enormous social, financial, and technological changes of the 21st century, the Indian medical system is operating in a dynamic environment. Health care is now transforming widely with new technology. The healthcare system includes a variety of medical gadgets, clinical trials, health insurance, medical tourism, and outsourcing programs that have advanced to laudable levels which are more focused on the certification of accredited bodies to improve the services and productivity of the organization.¹ Healthcare workers have an obligation and responsibility to save human lives for which they require skill in their professional aspects as a small error can have very serious consequences on human lives.

The NABH provide the standards and objective elements to improve the structure, process, and outcome of the organization which help to improve the healthcare quality and patient safety. Since the current healthcare system does not impose cost and quality standardization, certification is the only likely method of establishing the dependability and authenticity of a healthcare provider.^1,2

Healthcare accreditation and certification programs have progressed international efforts to raise the standard of healthcare since the 1970s. The accreditation process, which is carried out by qualified external peer reviewers, allows a healthcare organization to be officially recognized for achieving performance standards.^3,4 Accreditation may be considered a way to monitor quality preservation and enhancement, public security, legal protections, risk management, monitoring by the private sector, the adoption of new service settings, addressing issues with the healthcare system, and the creation of leading universities.⁵ It may encourage healthcare workers to be more accountable for their actions and to work collaboratively as a team, help in assessing the long-term impact of NABH accreditation, and help to identify areas where further training is needed, which will help participant development.

This cross sectional study will be conducted for assessing & evaluating the awareness among healthcare workers for NABH guidelines. Records for the assessment will be collected from medical record department (MRD) secondary source of information will be generated from ABVRH hospital Wardha. Ethical permission with hospital regularities will be taken from medical superintendent & medical record department in charge. Confidentiality of the data will be proofed for patient identification.

Questionnaire will be provided for assessment based on adopted questionnaire in use itself in ABVRH.

Post assessment survey will be conducted after 6 months of providing assistant over NABH guidelines among healthcare workers. Data will be gathered by data management team will be analyzed for objectives results considering per protocol basis on minimum sample size required for full analysis data set.

Protocol

Results

In this study we will identify the different impacts of implementation of NABH standards after pre- and post-assessment of 280 staff working in a tertiary care hospital.

Discussion

A cross-sectional study on the effectiveness of implementation of NABH standards among healthcare workers in a tertiary care center in India concluded that more than 80% of participants believe that NABH accreditation has a positive impact on the hospital's services and operational procedures, which have since improved. 85% of participants reported that after post NABH accreditation, their level of job satisfaction had changed. Also, an average of 83.66% think that after NABH accreditation, hospital procedures have improved. It was found that 91.09% of participants believe that hospital processes have improved since NABH accreditation; 85.78% of participants believe that patient satisfaction has improved continuously since NABH accreditation; 82.61% of participants think the training they received on NABH accreditation was valuable; 83.66% believe that systems and processes have become more standardized since NABH accreditation; NABH accreditation; 84.28% of participants believed that following NABH accreditation, the organization provided them with enough support for their contributions to hospital procedures; 79.14% of participants thought that staff complaints were resolved more quickly; and overall, 87.27% of participants said they would refer their family members to this hospital for treatment. 85.55% of participants said it had a favorable effect on employees' morale and job satisfaction.²

A systematic review on Impact of Accreditation on the Quality of Healthcare Services conducted by Abdullah Alkhenizan et al. found that the majority of the 26 studies evaluating the effects of accreditation in their research exhibited broad accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical treatment, infection control, and pain management; and subspecialty accreditation programs to significantly improve the structure and organization of healthcare facilities. According to numerous studies, general accreditation programs considerably improve clinical outcomes and the level of care for these clinical disorders. Furthermore, they demonstrated a significant improvement in clinical outcomes across a number of subspecialties, including sleep medicine, chest pain management, and trauma management, as a result of subspecialty accreditation programs. The studies came to the conclusion that there is consistent evidence that accreditation programs enhance the process of care. Numerous studies revealed that general accreditation programs significantly enhance clinical outcomes and the standard of care for these clinical conditions, and they also demonstrated a significant positive impact of subspecialty accreditation programs in enhancing clinical outcomes in a variety of subspecialties, including sleep medicine, chest pain management, and trauma management. These studies came to the conclusion that there is resounding evidence that accreditation programs enhance the process of care. There is a lot of data to support the claim that accrediting programs enhance clinical outcomes for a variety of clinical diseases. As a tool to raise the caliber of healthcare services, accreditation programs should be encouraged.⁷

An observational study was carried out on every single patient admitted to the ICU for a period of five months (from April to August 2015) in a Hospital at Hubli, in order to know whether the effective application of NABH guidelines was able to control the number of new cases of hospital-acquired infections in their ICU. At first, they conducted an initial evaluation of infection control, and then consistently carried out an evaluation every month about infection control. This study concluded that there was a significantly lower number of new cases that occurred in their ICU which could be, accredited to the application of NABH guidelines.⁸

A cross-sectional, descriptive study conducted by Lallu Joseph et al., received 415 respondents from a conference of healthcare organizations. The survey was done to know the discernment of the frontline workers as well as the administrators of the hospital on accreditation. The study showed that the administrators of various hospitals and not the healthcare workers had a positive response in their perception. It also showed that the long years of experience in accreditation, the weaker their thought was about accreditation. This teaches us that the senior faculty of any hospital should especially be made aware of the benefits of the application of NABH guidelines.⁹

Generalizability

The outcome of the study will help in improving the quality of care and update the policies at institution level.