2. Revision of 4 th edition standards Dr S Murali MD DM Chairman Technical Committee NABH Consultant Neurologist & Chief Clinical Services Manipal Hospital Head Quality MHEPL

3. NABH Trivia….. 2004 – Introduced to the man who revolutionised Healthcare quality in the country June 27 th 2005 NABH was born and the first meeting was held Feb 2005 – First NABH edition Four editions and more than 500 hospitals in a decade

4. Destination fourth edition - Plan Review of International and national literature Feedback from stakeholders (hospitals, assessors and committee members) and other subject matter experts. Analysis of most common NCs raised during assessments. Compilation of feedbacks Deliberations and discussions by Technical Committee members Draft standards are prepared based on above inputs National Accreditation Board for Hospitals and Health Care Providers

5. Destination fourth edition - Plan Draft standards are put up on the public domain (NABH Website) for public and stakeholder feedback Public and stakeholder feedback received on draft standards and analysed Further Deliberation and discussions by Technical Committee on the above feedbacks Final round of discussions with other committee members and feedbacks analysed Final Draft standards prepared Approved by board Final standards to ISQUA National Accreditation Board for Hospitals and Health Care Providers

6. Objectives – 4 th edition – Raise the bar – Address ambiguity and bring in uniformity to the extent possible – Address difficult areas with focus on patient care, clinical excellence and quality of care – Separate Guidebook and standards - 4 th edition of hospital standards. – All the formats of to be revised. They shall be named as ‘Assessment forms’ (AF). – Regulatory to be simplified – In the new formats, provision shall be made for HCO id no and assessors ID no. – To meet ISQUA requirements – Learn from best practices – Strict Timelines National Accreditation Board for Hospitals and Health Care Providers

7. Methodology 1.Feedbacks on existing standards 1.The predesigned questionnaire was distributed to all the Accredited HCOs and Selected team of assessors and feed backs were obtained within a stipulated time period.. Their feedbacks were obtained and analysed. 2.Along with above, daily feedback which is received from HCOs was analysed and most common NCs pattern was seen which was considered while drafting the standards. 2.Reference material : 1. ISQUA guidelines 2.Other International Standards

8. Methodology Best International and National practices Further chapters were divided amongst the members who worked on them keeping the above points in mind and then were deliberated upon in the subsequent meetings. Multiple TC meetings Strict time lines adhered Inputs from domain specialists ( Radiologists)

9. Points considered in new Standards Legal: To focus on mandatory licenses. Undertaking would be obtained from the HCO. Green concept/ Green hospitals Stress on promotion, prevention and education aspect Inclusion of national programmes to some extent(with focus on mother and child) More focus on systems and processes ISQUA requirements

10. Points considered in new Standards End of life care HR requirements Focus to be on Outcome Based Indicators Setting of Patient Safety goals which is appropriate for our Indian system Prescription writing: std prescription should be in BOLD/Capital letters Use of Generic Medicines Re use of devices Blood storage policy

11. Points considered in new Standards Provision should be made for seamless functioning of the hospital and address all aspects of patient care. Interpretations were reworked so as to have better understanding and clarity of the same. Formats to be revised and to be made more standardised Separate guidebook and standard book

12. Special Acknowledgements Assessors and Hospitals for the feedback / inputs Other committee Chairs and members External faculty and Domain experts Chairman and Board Quality Council of India Senior management of NABH – CEO – Director – Joint Director National Accreditation Board for Hospitals and Health Care Providers

13. Special Acknowledgements One and the only TC – all members – Special thanks Secretary 4 th edition – The differentiator Special thanks to the Producer and director National Accreditation Board for Hospitals and Health Care Providers