Abstract

The article discusses the importance of quality in hospitals, particularly in the context of e-patients who have high expectations and are vocal about their experiences on social media. It also highlights the challenges that hospitals face, including avoidable harm, clinical variations in care, increased length of stay, and staffing problems, and how these issues can negatively impact the bottom line. It also emphasizes the importance of patient safety and the need for effective technology to improve the quality of care and prevent errors. The use of electronic quality management systems is proposed as a solution to shift the focus from merely collecting data to improving the quality of healthcare. Integrating various IT software and hardware is necessary to make the system effective, and adopting incident reporting tools is also crucial.

Why does quality matter?

The importance of quality in hospitals has been emphasized numerous times, especially in the current scenario. Hospitals are facing challenges with the emergence of e-patients, who are educated, empowered, and electronically savvy. These patients have high expectations and are used to on-demand services such as ordering food or teleconsultation through apps. They are vocal about their expectations and are quick to share negative experiences on social media platforms. Therefore, quality in hospitals is crucial for meeting the expectations of these New Age consumers.

Although less than 10% of hospitals in India have voluntarily gone for accreditation, there is a growing interest among them to adopt accreditation, as seen by the increasing number of applications received by NABH for entry-level accreditations.

The government is taking proactive measures to move towards value-based care through programs like Ayushman Bharat, the Digital Health Commission, and the National Health Authority. Under this model, beneficiaries will be reimbursed based on the outcomes of care rather than the number of services they receive, making it crucial to measure outcomes and patient experience.

The National Health Authority has requested input from stakeholders on implementing value-based care, so it seems that implementation is imminent, especially with the Ayushman Bharat initiative. Hospitals have realized that poor quality is negatively impacting their bottom line, and they are now acknowledging the importance of accreditation and quality improvement efforts. They have recognized that the cost of implementing these measures is far less than the cost of poor quality, which leads to negative patient experiences, longer hospital stays, increased use of consumables, and wasteful expenditures. Despite the challenges and financial considerations involved, hospitals are beginning to prioritize quality and invest in improving patient safety.

Patient Safety

When we consider patient safety, the situation is just as concerning now as it was in the 1990s, and research indicates that patients are experiencing more harm today than they were back then. Despite significant technological advancements and a wealth of research, preventable harm remains a leading cause of death, highlighting the enormity of the problem and the fact that not much progress has been made in this area despite decades of experience and efforts.

The reason why patients are still being harmed in hospitals despite recent technological advancements is that hospitals have been slow to adopt technology to improve the quality of care and patient safety. Simply digitizing certain aspects of the hospital, such as HR, EMR, or remote monitoring systems, is not enough. What is needed is a seamless integration of all these systems on an interoperable platform where information can be shared and AI and ML platforms can generate actionable insights for care providers in real-time. The lack of effective technology is a major obstacle to implementing quality and safety measures in hospitals. Many incident and error reporting systems are paper-based or rely on rudimentary electronic systems, making them ineffective, according to studies.

Although the aim is to have a culture that focuses on improvement rather than blame, there is still a fear among healthcare workers that reporting incidents may result in negative consequences. A study conducted in US hospitals in 2020 revealed that 46% of healthcare workers are afraid to report an incident due to fear of repercussions, and around 35% to 40% of them do not report incidents at all. This is a serious problem because underreporting poses a significant threat to patient safety.

Where is the loophole?

Using a manual system for data collection in healthcare is like an archaeological approach where valuable information is unearthed. However, in healthcare, this approach is not effective. Nurses fill out forms, and the data is presented in a PPT by a quality manager to the hospital leadership committee, which can take up to 30 to 45 days from the time the incident occurred. This is a significant issue where healthcare workers lack simple tools to report incidents in real-time and receive feedback on how the incident was addressed. Moreover, quality managers lack the resources to analyze the data and draw meaningful conclusions from it.

Why adopt eQMS?

The focus needs to be shifted from merely collecting data to improving the quality of healthcare. Electronic quality management systems play a crucial role in this shift. Hospitals that haven’t yet adopted such systems are missing out on important information that could help prevent errors from occurring.

Without data, there can be no improvement. We need real-time data to track the effectiveness of the practices we adopt and to ensure that improvement strategies are working. Failure to report events accurately and promptly can result in harm to patients and burnout for healthcare workers. This ultimately increases costs and represents a wasteful expenditure for hospitals. Therefore, it is crucial to address this issue and adopt electronic quality management systems to improve patient safety, prevent errors, and reduce costs.

Integration

An easy solution does not exist because having only an e-quality management system is not enough. It needs to be integrated with other IT software and hardware to be effective. For example, the quality management system should be able to draw data from the laboratory information system to alert staff about potential infections or from the radiology information system to alert them about errors in X-rays. Without systems that communicate with each other and provide real-time alerts, it will not be effective. Therefore, we need to focus on developing integrated and interoperable systems.

Adopting incident reporting tools

One crucial aspect of quality is the incident reporting system, and it’s vital to move towards digital systems. Currently, about 86% of events are not recorded, and staff are not always aware of incident definitions. Digital tools can make it easier for care providers to report incidents across devices and in real time. With automated trigger systems, incident information can be collected, analyzed, and used for root cause analysis to identify preventive and corrective actions. Paper-based reporting can result in confusion and increased documentation, taking time away from quality improvement efforts. Digital tools can streamline the audit process by providing access to worldwide checklists and predictive analysis for real-time auditing.

Infection Control & Surveillance System

Digital surveillance has had a significant impact on infection control, especially with trigger tools that draw information from the laboratory information system to detect possible infection scenarios and alert care providers.

This creates a safety net for patients who may acquire infections in the hospital. By analyzing breach data, audits, and checklist compliance, the root cause of infections can be identified and prevented from happening again. Infection controllers can use tablets to monitor trigger alerts in real time across the hospital, ensuring that all processes are tracked and audited. Digitally tracking quality metrics and indicators are essential to reducing hospital-acquired infections by up to 90% and improving compliance with care bundles and ethics.

Conclusion

Quality indicators become crucial in meeting accreditation requirements, particularly for hospitals with multiple accreditation systems that must capture numerous quality indicators. Therefore, it is necessary to use digital tools and examine how much of these projects can be performed online, and tracking incidents is essential. Digital tools allow for clearly presenting data using dashboards, which is beneficial to leadership that values time and attention. Digital tracking of data is comparable to asset liability and equity, where assets represent strategies undertaken by the hospital, liabilities represent the cost of poor quality, and equity represents the hospital’s long-term bandwidth due to quality initiatives, such as an improved brand image and net promoter scores. Therefore, hospitals should take the initiative to adopt digital tools to make life easier for the quality team. It is a simple, scalable, seamless, safe, and smart approach to quality management.