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ORIGINAL ARTICLE
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 7-12

Level of compliance to quality standards and staff attitude toward adopted practices in a specialty hospital


Department of Onco-Anaesthesia, Clinical Oncology, Delhi State Cancer Institute, Delhi, India

Correspondence Address:
Dr. Surendra Kumar
4/2926 Sri Ram Colony, Bhola Nath Nagar, Shahdara, Delhi - 110 032
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/QAIJ.QAIJ_2_19

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Introduction and Aim: NABH accreditation is seen as an assurance towards quality services and patient safety. We conducted study at a 150 bedded, NABH non-accredited, speciality hospital to identify extent of compliance of practices and policies of the hospital with NABH standards for patient centric activities and to study staff attitude towards practices followed. Materials and Methods: In 5 patient-centered activities chapters of the NABH standards, 61 standards with 403 observable elements were identified applicable to the hospital. The prevalent practices of the staff were observed (each element observed 50 times), relevant records checked to assess compliance with the NABH standards. A sample population of staff (doctors, nurses, technicians) was randomly selected and interviewed on a set of 9 questions to assess awareness of hospital policies and rationale of the practices followed. Results: Compliance to NABH documentation requirements was 37%. Where predefined policies were present, a highly uniform practice (uniform on ≥80% observations) was observed for 96% elements, high uniformity was observed for only 15% elements in cases where no predefined policies were present. The hospital performed best on standards in 'Hospital Infection Control', where documentary compliance was 60%; and 78% elements complied at ≥80% observations with 63% complying at all observed times. The compliance rate was least for standards in 'Patient Rights and Education' where documentations compliance was 14% and only 37% elements complied at ≥80% observed times. Only 50% of the sampled population was aware of all departmental policies while 12% was completely ignorant of the policies. Practices of most of the care providers, 76%, was based on learning by seeing others doing the job, while some (18%) followed verbal instructions. Deviations from established practices were common and gave rise to near misses (66% responders). Most of the care providers, 85%, did not report such events; events not resulting in obvious harm to the patient and consideration that the event was not because of one's own fault were major factors for underreporting. Introduction of checklists and regular training was recognised as a means to prevent such events. Conclusion: The hospital needs to formulate more policies and SOPs. Training and sensitisation of staff regarding work protocols and safety measures were infrequent and inadequate.


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