Healthcare Improvement Through Integration of Quality Initiatives

Abstract

Tata Main Hospital (TMH), Jamshedpur is a 920-bedded hospital of Tata Steel providing free health care to employees and their families. It is a referral centre for others who pay for services. In the past 20 years, the hospital has moved from unstructured, random quality improvement projects to implementing international and national quality standards like ISO and NABH. As part of Tata Steel, the hospital introduced QIP and VE projects in 1992. In 1995, the JN Tata Excellence Model was rolled out. The hospital was certified to ISO 9001: 2008 in 2010. Subsequently, it adopted policy and daily management with formulation of ABP (Annual Business Plan) and cascaded these as departmental KPIs (key performance indicator). NABH standards were implemented in National Accreditation Board for Hospital and Healthcare Providers (NABH) (Accreditation standards for hospitals (3rd ed) 2011). The ISO and NABH standards were integrated with the daily management and healthcare protocols were developed. These were implemented in all work areas, administrative and clinical. To provide a strong base to the integrated system, document control was on LAN. Monitoring was through structured internal audits and a formal review mechanism. TMH achieved ISO certification in 2010 and recertification in 2016. NABH pre-accreditation certification was obtained in April 2016. A total of 42 quality parameters are reviewed through the integrated system and many of these have shown significant improvement over the years (morbidity, wait time, and satisfaction-related data). Through an integrated approach to quality, Tata Main Hospital helped to set up an improvement cycle with focus on patient satisfaction, quality of health care and cost. Improvement has been recorded on all three perspectives.