Quality of Health Care services for
RSBY Network Hospitals in the State
of Gujarat district______
Quality in medicine
WHO- DALY, LE
Long term
outcomes
-1 yr mortality/ visitation
Short term outcomes
- Hospital mortally.
Process indicators
-Response time etc.
Structural quality
- Availability as per norms
26th September 2012
Quality of health care in RSBY : Pilot in the
State of Haryana- Ambala
2
3
Introduction
• Almost 4 years completed by RSBY in state.
• 28.1 lakh families (approx. 54 lakh
population) covered.
• 29 hospitals (Public-1 and Private-28)
empanelled as RSBY network hospitals.
• No consistent nationally applicable quality
improvement process.
• Introduction of Quality Management System
for RSBY Empanelled Hospitals.
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
26th September 2012
Objectives
4
– To enable the provision and coordination of health
services which are:
–
–
–
–
–
–
Equitable
Patient centered
Safe
Effective
Integrated
Efficient
– To maintain continuous improvement in quality of
services provided.
– To encourage hospitals to achieve levels of quality over
a period of time.
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
26th September 2012
Operational Plan
Empanelment
cum grading
criteria
5 Point grading scale (E to A
Grade)
Comprehensive Quality
Criteria Check list provided
by Ministry of Labor and
Employment
Admittance level is “E” Grade
Grading
mechanism
Districts chosen for Pilot
(____)
Quality Criteria Form
Hospitals visited and assessed
Analysis and Grade given
after assessment
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
26th September 2012
5
Grading criteria
6
Grade-E
– Basic Empanelment criteria and entry level.
– Includes 10-medical beds, 24 hours drinking water
supply, one toilet for every 12 in-patient beds, basic
system and internet connectivity.
– Medical officer with qualified nursing staff, OT
sterilization, PNDT Act followed, clean bed sheet,
mattresses, bedpans etc, IPD records, Labor room
requirements.
– Hospitals not fulfilling Grade-E will be given 3
months time to upgrade to acceptable level.
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
26th September 2012
Grading criteria-2
7
Grade-D
– Grade D is accepted level in RSBY
– Includes patient mobility within hospital like ramp,
an information provider, documented evaluation and
management of patient, informed consent, providing
discharge summary and other documents to patient.
– OT specifications fulfilling, mopping of all areas of
hospital, emergency power back up.
– System of registration of patient, provision of
privacy, female attendant.
– Privacy of patient and emergency power back up etc.
– Will be motivated to attain to C Level.
26th September 2012
Quality of health care in RSBY : Pilot in the
State of Haryana- Ambala
Grading criteria-3
8
Grade-C
– Augmenting supportive services.
– Dietary services, laboratory, radiological services.
– Proper nursing units managed by registered
qualified and experienced nurse.
– Patient care by medical and nursing professionals,
documented rounds, pre-post operative care of
patients, arrangements to meet emergency.
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
26th September 2012
Grading criteria-4
9
Grade-B
– Included Intensive Care Unit .
– Blood Bank, documented infection control
practices, proper radiology services, mortuary
services,
– Zoning of OT complex.
– AMC of major medical equipments etc.
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
26th September 2012
Grading criteria-5
10
Grade-A
– 24x7 emergency services.
– 24x7 pharmacy facility.
– Qualified anesthesiologist to attend ICU.
– Hospital management system in place.
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
26th September 2012
Grading criteria-6
•Test
results should
be
•Pre
admission
physical
•The Labour
•Mopping
room/OT
of
should
all
areas
have
at
least
Delivery
table
•The•The
services
waste
and
disposal
facilities
is in
satisfy
accordance
statutory
recorded
in
the
Lab
examination
and
medical
history
•The
health
facility
has
Anesthetic
twice
machine
a day
with
with
emergency
disinfectant
requirements
with
the
Biomedical
under
the
PNDT
waste
Act
•All•There
emergency
is
•10
adequate
inpatient
telephone
provision
medical
numbers
for
beds
patient
concerned
for privacy
with
registers,
requisition
slip
•OTsupplies
sterilisation
facilities
functional.
taken
written
informed
consent
isdrugs
mechanisms
in
place
for
oxygen
Shredders
resuscitation
/
needle
destroyers
equipment
are
and
•Fresh
•Designated
clean
bedsheets
airthe
conditioned
and
changed
space
•Test
management
results
should
&
be
handling
recorded
rules
not in
only
in
Health
in•Adequate
the
and
form
inpatient
Safety
oflights
screens
are
health
displayed
and
curtains
etc
and
on
OPD
card
•Maintaining
ofcare.
medical
record
and
Air
conditioning
each
taken
•1
medical
officer
&
1
nurse
at
all
adequate
quantity
of
blood
for
infants
available
and
adults
infor
allfire
clinical
areas
when
•Standard
required
ICU
bed
the
equipment
patient.
for
the
the x-ray
1998
•Pictograms
•Rights
and
•Availability
indicating
responsibility
of
24
exits
of
hours
the
and
patients/
drinking
escape
•A
system
for
registration
of
all routes
•Documented
lines
of
•Maintaining
of
necessary
records
as
OT
•A
copy
of
the
Discharge
times
without
loss
of
time.
•There
is
a
•Mechanisms
suitably
experienced
to
ensure
and
toilet
qualified
•Bed
constant
mattresses
monitoring
of
thefor
for
patients
vitals
emergency
are
in card
registers,
•The
health
requisition
facility
slip
has
and
a valid
the
OPD
license
areInformation
properly
water
displayed
supply
investigations
identification
responsibility
required
and
providing
necessary
records
of
•Height
adjustable
OT
Table,
shadowless
lamp
summary
/
Death
Summary
is
•1information
provider
at
all
times
•Storage
center
meets
the
doctor
responsible
sanitation
for
(duty
the
roasters
day
to
day
for
management
good
crash
shape
cart,
defibrillator
ventilators,
•Female
from
attendant
the
PCB
to
accompany
female
•Relevant
forthe
patient
safety
•One
education
information
toilet
for
are
every
displayed
isqualified
available
12
at
including
•Written,
dated
and
signed
•Management
system
inin-patient
place
insured
patient
to
the
Insurer
orand/or
hisfor its
•The
operating
theatre
fully
equipped
provided
to
the
patient/attendant
•Registered
nurse
licensing
requirement
of
the
Drugs
of
the
unit.
sweepers)
•Clean
suction
bedpans
pumps,
and
bedside
urinal
oxygen
pans
and
facility
patients
•Availability
during
radiological
of
colour
coded
procedures
Bin Agency
in
Safety
prominent
regulations,Fire
beds
precautions,
AIDS/HIV/Other
procedures
for
the
•Written
and
dated
job
representative
/ Government
/ Nodal
purpose
•IPD
patients
are
evaluated
at birth.
experienced
per
ward
and
Cosmetic
Act
and
Supreme
•A
trained
•Documented
mid-wife/nurse
Infection
is
present
control
at
every
dustbin
•Anesthesiologist-Intensivist
areward
•Arrangements
each
are
in place
for
dealing with
guidelines
places
in
•Adequate
the
health
facility.
privacy
inandPre-operative
OPD
collection,
reception,
handling,
descriptions
as
and
when
required.
•Informed
patient
concern
least
twice
a
day
•There
is
a
system
for
calling
Court
rules
•Records
kept
protocols
after
inB.Sc
place
include
available
•Nursing
.Staff:
Nursing/Diploma:
out
of
•Collection
hours
ordischarge
of
emergency
waste
done
requests.
asmaternity
per
•Hospitals
•The
facilities
records
•Running
available
should
tap
water
and
be
maintained
services
is
facility
provided
hospital
on all
abeled,
storage,
•Written
agreement
with
working
•There
is
evidence
that
the
hospital
has
a
care
•After
examining
the
course
of
specialists
in
an
emergency
•Blood
collected
is
labeled
notes
and
•Regular
birth
registration
documented
autoclaving
•Dietary
have
2
years
services
of
ICU
are
care
made
of
available
Ratio
1:
or
to
2:1
•There
is anpower
in-charge
in also
wards,
radiology/
orand
Accidents,Errors,
and
theguidelines
charges
•Warm
Incidents,Near
are
water
for
prominently
winter
misses
months.
displayed
transportation
and
disposal
oftheViolent
Doctors
documented
policy
on
creation
and
•Emergency
supply
for
OT
action
on
the
OPD
card
is
•Emergency
department
have
appropriately
with
the
donors
•The
hospital
of
instruments
hasSigns
24
hour
on-site
cover
from
patients.
radiologist
OPD,OT,
labour
IN &
LOCAL
room.
LANGUAGE
warning
episodes.
•There
is
•Access
adequate
to
provision
road
allowing
for
patient
to
privacy
samples
•Regular
monitoring
and
review
maintenance
of
•Zoning
of
OT
endorsed
MBBS
24x7
basis
name,
registration
number,
blood
qualified
medical
linen
doctors
(including
•Hygine
delivery
in place
to
the
women
•Waste
of
childbearing
treated
with
age
bleach
hasIPDs
dangers
or
of
• There
inmedical
the
should
form
Ambulance
of
be
screens
evidence
and
ofpracticed
curtains
management
etc
•All
laboratory
equipment
istoany action
meeting
records
which
is
•AMC
for
all
major
equipments.
•If
patients
are
transferred
group,
date
and
time
of
collection
anesthesiologist
•Carbolisation
An
emergency
of
the
OT,
power
Labor
system
Laundary
system
in
place
radiation
solution
in
pregnancy.
before
disposal
arising
•There
from
is
•Hospital
evidence
incident
accessible
reporting
that
there
i.e.
by
is awheelchair;
each
documented
case is
subject
to
a planned
•Sterilabels
used
for
autoclaving
another
hospital
copies
and
date
of
expiry,
tests
carried
provides
heat
Room
and
after
light
every
in
the
event
of
a
mains
•The protection
of
staff
conforms
to
individually
grievance
Ramp
investigated,
redressal
mechanism
evaluated
which
and
acted
isthe BARC
upon.
inspection,
and
calibration
of
their
clinical
notes
accompany
out.
power
failure.
procedure
guidelines
practised
•Reception
desk Emergency
electric
•Staff
are offered
appropriate
them
•A qualifiedsupply.
pediatrician to attend Newborn.
immunisations
Quality of health care in RSBY : Pilot in the State of
26th September 2012Haryana- Ambala
17 Sub criteria
ACCESS
AND
Radiology
Infection
Control
Access
Hospital
Patient
Health
Support
Medical
to
Rights
Waste
and
Blood
Evaluation
Availability
Operating
and
of
Laboratory
Management
Labor
Room
Diagnostic
Services
PHYSICAL
FACILITIES
Practices
and
Management
Services
Records
Safety
Education
Bank
Care
Department
of
Staff
Patients
services
ICU
11
Grading -7
Criteria
Count
Access and facilities
23
Management
8
Availability of Staff
5
Evaluation and care of inpatient
8
Anesthesia
4
Operating departments
10
Laboratory services
10
Radiology services
13
Infection control Quality of health care in RSBY : Pilot in the 7
26th September 2012
State of Haryana- Ambala
12
Grading-8
Criteria
Hospital waste management
Support services
Access to blood bank
Patient rights and education
Medical records
Health and safety
Labour room if available
Intensive care unit
26th September 2012
Quality of health care in RSBY : Pilot in the
State of Haryana- Ambala
Count
7
7
6
8
3
9
6
4
13
Grading mechanism
Hospitals
visited and
assessed
Districts for
Pilot Study
26th September 2012
• Empanelment
cum grading
criteria filled1
• Infrastructure
and services
assessed
Quality of health care in RSBY : Pilot in the
State of Haryana- Ambala
Analysis and
grade given
after
assessment
• Grade from E
to A
14
Grading Criteria
Grade
Benchmark
Below E
less than 15 (the hospital will not be meeting in
any of given criteria properly.
Grade E
15 or less than 50% of D
Grade D
E (>15) + < 14 of D + 25 % of C
Grade C
E + D + 80 % of C + 80% of B
Grade B
E + D + 80 % of C + 80% of B + 50 % of A
Grade A
E +D + C + B+A
E-19,D-32,C-32, B-31, A-24
26th September 2012
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
15
Follow up
16
a) Hospitals not meeting detailed empanelment criteria
will be given time to improve or would be deempanelled
b) Hospitals meeting just the revised empanelment
criteria will be placed in the lowest grade E. These
hospitals would continue to be empanelled providers
but would be advised to work towards achieving next
higher grade within next 3 months failing which it
will be de-empanelled.
c) Hospitals meeting and exceeding the empanelment
criteria would be graded from Grade D-A.
(
26th September 2012
Quality of health care in RSBY : Pilot in the State of Haryana- Ambala
17
Thanks for kind attention
More details on:
www.rsby.gov.in
Or
Dr K Madan Gopal
madan.kavuru@giz.de
kmadangopal@gmail.com
9717773732
26th September 2012
Quality of health care in RSBY : Pilot in the
State of Haryana- Ambala