1

A Success Story

Quality Improvement Programme- Gujarat, India

(Year 2005 -2012)

“An attempt to improve health services in public healthcare centers”

Government of Gujarat is the first state in India which initiated for actively pursuing quality improvements in

the public healthcare facilities through the network of Primary Health Centers (PHCs), Community Health

Centers (CHCs), District Hospitals & Medical Colleges. In order to institutionalize Quality Assurance, Gujarat

is the only state which has been set up the District Quality Assurance cell & State Quality Assurance cell for

implementation of this programme. Quality improvement programme primarily focused on Reproductive Child

Healthcare services with the following components:-

Quality Assurance - components

The Quality Assurance is made up of two main components:

Quality Assessment

Quality Improvement

Quality assessment helps Supervisors to identify the gaps in performance of PHC/CHC MOs and other staff.

Quality improvement helps in reducing the identified performance gaps.

FRAMEWORK of Quality Assessment of RH services

RH Services to be

assessed

INPUTS PROCESS OUTPUTS

Examples

Family Planning 1. Building Infra-structure

2. Equipment

3. Personnel-training

4. Supplies

1. Clinic-wide

procedures e.g.-Schedules,

Hygiene, Asepsis

2. Technical competence

3. Client Provider interaction

FP method mix

Complications and follow-up etc

Maternal and

Newborn Care

ANC/PNC

Normal Deliveries

Complications managed

RTI/STI

& VCT

Lab tests

Cases treatment and follow-ups

QIP Implementation Process in Gujarat

QIP One Day Orientation workshop for State, Regional & District level officers.

QIP Two Day Orientation workshop for ADHO and BHOs

District Level QIP Two Day Orientation workshop for District QA Team and Block QA Team

District Level QIP One Day Orientation workshop for MO PHC & CHC Superintendents

Select Facilities & Prepared visit plan by District QA Team & Block QA Team

District QA Team Visit CHCs & FP Camps Block QA Team Visit PHCs

Prepared Action Taken Report & MIS Report

QAG Group Meeting with CDHO & DDO and finalized the Action Taken Report of District

and Send to the Region and the State

Note:- Total Number of Batches trained:- 60 & Total participants trained:- 2294

2

After success of the Quality Improvement Programme in PHC & CHC which is mainly focused on

Reproductive and child health care (RCH). Government of Gujarat decide for implement total quality

management system in Public Healthcare Centers (Medical Colleges, District Hospitals, Community Health

Centers, Primary Health Centers, Blood banks, Laboratories, Mental Hospitals and Dental Hospitals etc.) as per

National Accreditation Board for Hospitals and Health Care Providers (NABH) and National Accreditation

Board for Testing and Calibration Laboratories (NABL) Standards and Gujarat is the first state to implement

NABH / NABL in public healthcare centers.

MISSION:

To enhance the patients’ quality of life by providing specialized medical treatment and preventive healthcare at

free / affordable cost.

VISION:

To be the network of finest public healthcare institutions in the state of Gujarat, providing quality medical care

services with the state of art technology with easy accessibility, affordability & equity to the people of Gujarat

& beyond.

PROJECT OBJECTIVES:-

Implementation of safety and quality practices.

Incorporation of management tools

Building sustainability

Benchmarking the indicators

Continuous Quality Improvement

Strategies adopted /mode of transformation with details of role of various stakeholders:

Sensitization of state government towards importance of quality healthcare services.

Policy framework for NABH accreditation of public hospitals and health centers.

Approval and sanction of budget for NABH & NABL accreditation / certification.

MOU signed between Government of Gujarat and Quality Council of India, New Delhi on 7th

July, 2007.

Involvement of staffs (by Skill Mapping & Motivation)

State & Hospital authorities were tour to NABH / NABL accredited hospitals & Labs.

Study Mission to Nonmember Countries on the Application of Quality Management in Healthcare to USA.

Nomination of qualified District Quality Assurance Officers at district level, Assistant Hospital

Administrator (AHAs), NABH / NABL consultants and Nomination of NABH & NABL Coordinator at

facility level.

Development, Review and Implementation of policies and procedures for implementation of Quality

Management system (NABH / NABL).

Development of committee with scope of work as per requirement (e.g. Quality Assurance Committee

(NABH Chapter Ref: CQI, ROM -02, HRM -10, 12), Medical Audit Committee (NABH Chapter Ref:

IMS, CQI -05), Hospital Infection Control Committee (NABH Chapter Ref: HIC), Drugs & Therapeutic

Committee (NABH Chapter Ref: MOM), Grievance Redressal Committee (NABH Chapter Ref: HRM

07), Disaster Management Committee (NABH Chapter Ref: FMS 07), Hospital Ethics Committee

3

(NABH Standard Ref: ROM, PRE, FMS – 01, HRM), Biomedical Equipment & Medical Gases

Management Committee (NABH Standard Ref: FMS 03, AAC), at facility level.

Objective oriented role and responsibility of all committee and groups as defined.

On-site study to analyze the prevalent status and practices to identify gaps (Infrastructure, Equipment,

Documentation, Processes and Practices) were executed.

NABH lead assessor training & NABL Internal audit training to administrators, clinicians, paramedical &

staff nurses etc.

Distance learning Post Graduation Certificate Course in Quality Management and Accreditation of Health

care Organization (PGQM & AHO) to the Additional Directors, Superintendents, Chief District Medical

Officers, Clinicians and District Quality Assurance Officers etc.

Other training as per requirement of NABH / NABL standards and mock drills.

Development, Review and Implementation of policies and procedures.

Defining, monitoring & evaluating the Quality Indicators

Development of Quality Management System (e.g. Patient / Employee Satisfaction, Clinical Record

Indicators and quality indicators etc )

Up gradation of facility as per requirement e.g. Infrastructure, Human resource, equipments & training.

Calibration and testing of medical equipments.

Required civil construction work / structural re-allocation of health departments was done by program

implementation unit (PIU), hired architect along with the assistance of NABH/NABL consultants.

Hospital compliance to the license, statutory acts & regulatory norms of the state.

Intensive & continuous trainings

Regular Process Monitoring

Internal assessment by quality team and fulfilled the identified gaps.

Application for Pre – assessment to NABH / NABL.

Pre-assessment done by the NABH / NABL assessors form NABH / NABL Board.

Gaps identified during NABH / NABL pre – assessment are fulfilled.

Application for Final – assessment to NABH / NABL.

Final audit done by NABH / NABL assessor form NABH / NABL Board.

Gaps identified during NABH / NABL Final – assessment is fulfilled and reports send to NABH / NABL

Boards & NABH / NABL assessor.

Review the report in NABH / NABL board meeting and finally give the accreditation after discussion on the

report.

Accreditation of the facility as per NABH / NABL standards.

Achievement:

India’s 1st NABH / NABL Accredited Govt. Facilities:-

• Dist. General Hospital Gandhinagar

• Primary Health Centre Gadboriad, Dist: Vadodara

• Medical College Hospital Labs Bhavanagar

• Blood Bank (BJMC Ahmadabad)

• Food & Drug laboratory Badodara

• Mental Hospital Badodara

• Community Health Center, Bardoli-Surat

India’s 2nd

NABH / NABL Accredited Govt. Facilities:-

• Primary Health Centre Mahuwas, Dist: Navsari

4

• Govt. Medical College lab (BJMC Ahmadabad)

• Civil Hospital Sola, Ahmedabad (Progressive)

• Blood Bank (Government Medical College Surat)

• Mental Hospital Ahmedabad

• Food & Drug laboratory Kutch

Other NABH / NABL Accredited Govt. Facilities in Gujarat:-

• Blood Bank SSG Medical College Badodara.

• Blood Bank Medical College Bhavanagar.

• Blood Bank Medical College Jamnagar

• Primary Health Center Sokhada, Dist:- Badodara.

• Primary Health Center Salun, Dist:- Kheda.

• Primary Health Center Jetalpur, Dist:- Ahmadabad.

• Primary Health Center Dabhoda, Dist:- Gandhinagar.

• Primary Health Center Jamvanthali Dist:- Jamnagar.

• Primary Health Center Khirasara, Dist:- Rajkot.

• Medical College Laboratory Surat

• Primary Health Center Hadiyol, Dist:- Sabarkantha.

• Primary Health Center Kandolpada, Dist:- Navsari.

• Primary Health Center Tankal Dist:- Navsari.

• Medical College Laboratory Badodara

• Medical College Laboratory Jamnagar

S.N Name of the Facility Total

Facility

Under

NABH

/NABL

Total

Accredited

facilities

Final

Assessment

done

Pre

Assessment

done

Facilities

under

Process

for

NABH/

NABL

1 District Hospitals 23 2 3 4 14

2 Medical college

Hospitals

6 0 0 0 6

3 Medical college,

Blood banks

6 5 0 0 1

4 Medical college,

Laboratories

6 4 0 1 1

5 Mental Hospitals 2 2 0 0 0

5

6 Dental Hospitals 2 0 0 0 2

7 Paraplegia Hospital,

Ahmedabad

1 0 0 1 0

8 Primary Health

Centers (PHCs)

29 12 0 3 14

9 Community Health

Centers (CHCs)

26 1 0 0 25

10 NABL Food & Drug

Laboratories

2 2 0 0 0

Total 103 28 3 9 63

Award received by Government of Gujarat from National/ International organization:-

A. Appreciation awarded by QCI to Ministry of Health and Family Welfare Government of Gujarat for

establishing Quality Assurance framework in providing quality healthcare to the people of Gujarat in 5th

National Quality Conclave, New Delhi.

B. Appreciation awarded to Department of Health and Family Welfare Government of Gujarat for their

pioneering effort to spearhead the Quality and Accreditation Programme in health care organization. In 3rd

International Health Care Quality Conclave on “Role of Quality in Globalization of Indian Healthcare”.

Place: - Gurgaon, Hariyana Date: 30th

August 2010.

C. FICCI Health care Excellence Award to Dist Hospital Gandhinagar & PHC Gadboriad, Govt of Gujarat in

FICCI Heal 2010, New Delhi Date: 6th

Sept 2010

D. FICCI Health care Excellence Award to Dist Hospital Gandhinagar, Govt of Gujarat in FICCI Heal 2011,

New Delhi Date: 8th

Sept 2011

Strategies Adopted for sustainability:-

• Appointment of Quality Assurance officers at State level, District level, Assistant Hospital Administrator

(AHA) at facility level. We are designated NABH Coordinators & NABL Directors at Facility level.

• NABH lead assessor training (Total trained persons 290 for hospitals & PHC / CHC) & NABL Internal

audit training (Total trained persons 238) to administrators, clinicians, paramedical & staff nurses etc.

• Quality Improvement Programme (NABH, BMW, Kaizen, HOPE, fire & Non fire emergency, Radiation

Safety, Cleanliness) Training Total 114 to administrators, clinicians & staff nurses etc.

• Post Graduation Certificate Course in Quality Management and Accreditation of Health care Organization

(PGQM & AHO) to the Additional Directors, Superintendents, Chief District Medical Officers, Clinicians

and District Quality Assurance Officers (Total trained persons194) etc.

• Training to the whole staff (Medical officers, staff nurse, class -4 etc.) regarding Various Codes like code blue, red,

orange, pink; disaster management training (Fire & Non Fire emergencies), sentinel events, Bio Medical Waste

Management, Infection control practices, new born care training, post martum.

• Training of atleast 3-4 medical officers & 3-4 Staff nurse in all healthcare institutes for ACLS (Advance care life

support) and training of whole staff for BLS (Basic Life Support). • New posts (About 2000) of clinicians, paramedical and other are sanction by Government of Gujarat as per

requirement.

• Extra budgets (about Rs. 237 carores) as per requirement of NABH / NABL are sanction from 13th

finance

commission, Government of Gujarat and NRHM.

6

• Formation of the state level review committee under the Chairmanship of Commissioner of Health, Medical

Service & Medical Education and Member secretary is State Quality Assurance Officer.

Next five year (2012-2017) plan:-

To get the total 172 facilities (Medical Colleges, District Hospitals, Blood Banks, Laboratories, Primary Health

Centers & Community Health Centers) across the State accredited by NABH/ NABL in a phased manner.

Dr J L Meena State Quality Assurance Officer

Commissionerate of Health & Family Welfare

Government of Gujarat, Gandhinagar

Phone No. 079-23257356, Fex No. 079-23253304

Mobile No: 09099075162

Email:- drjlmeena@gmail.com, sqipgujarat@yahoo.com Web:- www.gujhealth.gov.in/quality-assurance-program.htm