Wockhardt, excelling behind new quality assurance infrastructure, eyes accreditation

The Indian health care industry is undergoing a period of transformation, marked by increased competition, a heightened focus on quality and performance improvement, and the rapid growth of the private health care sector. Wockhardt Hospitals, Ltd. has already established itself as one of the leading health care organizations in India, but now, with help from HMI, Wockhardt’s leadership have set their sights on establishing a strong reputation internationally.

“Since HMI first began working with Wockhardt to establish new hospitals, we have been operating with the view that quality management needed to be one of the key components,” said Dr. Harvey Makadon, HMI vice president for health systems. “Wockhardt wants to be the first hospital in India to be accredited by Joint Commission International (JCI), but beyond that, and perhaps more importantly, the leadership have a real commitment to quality of care and excellence in customer service.”

The Mulund facility staff is using a new health information system to track patient data.

Wockhardt Heart Hospital in Mulund (Mumbai), which opened in July 2002, is the scene of the organization’s efforts to gain international accreditation. HMI and Wockhardt are continuing a process begun in May 2003, when the partners initiated the development of a Performance Improvement Plan designed to help create a sustainable quality improvement model for the hospital that was aligned with the vision and values of Wockhardt. A Care and Quality Improvement Council made up of representatives from various areas of the hospital is driving the implementation of the plan. Committees have been formed to focus on different aspects of quality and patient care, such as infection control, health information management, patient safety, and clinical quality performance indicators.

Sharon Kleefield, HMI director of health care quality, said the leadership of Wockhardt have made considerable progress implementing the Performance Improvement Plan and its associated committees and project teams. “They are focused on defining the processes and specific outcome measures for care of patients as they move throughout the various departmental functions of the hospital, and on establishing a process for reviewing these processes and measures in order to address shortcomings in the quality management system.”

It should be emphasized that instituting these measures is about more than simply imposing a system and playing according to its rules—systemic changes are, first and foremost, changes in behavior and attitude. Wockhardt is taking major steps toward empowering its staff to take active roles in the hospital’s progress, with the Performance Improvement Plan serving merely as the mechanism to support dialogue about what changes are in order, help the staff to develop an approach to driving change, and provide a structure to guide the implementation of changes.

Dr. Lloyd Nazareth, general manager of Wockhardt Heart Hospital, has been a champion of Wockhardt’s quality improvement efforts since the beginning. “Today’s Indian health care consumer is more knowledgeable and discerning than ever before. We believe that in the next decade these consumers will determine the success or failure of our hospitals,” he said. “Quality will be the single most important differentiator of our services. Quality and performance improvement initiatives will also help us to control costs, thereby making our services as affordable as possible for more people.”

Immediate improvements—and a course for sustainable progress

Nurses play a key role in the quality management efforts at Mulund.

An HMI team visited the Mulund hospital in January and came away impressed by the level of enthusiasm and commitment of the Wockhardt staff. Although the hospital has increased its volume, staff, and clinical specialties over the past year, it is still small and manageable enough to allow the leadership to shape hospital practices for the long term. HMI and Wockhardt see the performance improvement work being undertaken at Mulund as the model for other Wockhardt hospitals, including facilities in Bangalore and Kolkata. “We envision a consistent network approach for continuously improving patient care,” said Kleefield.

HMI is helping Wockhardt to measure its performance improvements—and the related quality control mechanisms—against the very detailed and comprehensive standards established by the JCI, the world’s most recognized international accreditor of hospitals (see sidebar). This process involves not only understanding the standards and putting these criteria in place in the hospital, but also communicating new quality management protocols across the organization, providing appropriate training to enable not only dailyimprovement but also continuous review, and ensuring that the right outcome indicators are in place to measure success.

“Using the JCI standards to guide improvements in the Wockhardt hospitals makes sense, not only because of the immediate progress it allows, but also because the standards provide a context for ongoing education for the leadership and staff about how to achieve the highest level of patient care,” said Makadon. “However, because JCI accreditation is a lengthy process, we have to recognize the value of prioritizing the different metrics of performance improvement in order to improve care today. HMI and our colleagues at Wockhardt are continually putting our heads together to answer some important time-sensitive questions: What needs to be addressed now? What mechanisms need to be created? Where do gaps exist in the process?”

Quality and safety in the operating room is just one focus of the Care and Quality Improvement Council.

A committed team effort
For Nazareth and his staff, the first task was to unite the core management and clinical teams around the goal of building the quality infrastructure. It’s a time-intensive program that demands a lot from the staff, but as Nazareth pointed out, this group is now very motivated to make JCI accreditation—and the benefits of high-quality patient care—a reality. “JCI accreditation would, first of all, put a stamp of approval on all of our efforts over the last two years to build an institution that does not compromise on quality, safety, and ethics,” he said. “We hope to be ready for a mock drill by the end of the year, and then we should be ready for the actual accreditation by the middle of 2005. This will mean a lot of work for all the members of our staff, particularly the core group of 25 Quality Champions we have trained.”

Over the next few months, the Mulund quality team will be working to establish patient safety systems in areas like medication, infection control, and emergency medicine. They are also designing a formal competency assessment system for all staff, as well as a training program to support ongoing professional development.

A group of Quality Champions will initiate patient education and information initiatives, and the hospital will continue training all staff in patient relationship management and customer service skills. “Our medium term goal is to be recognized as the best provider of quality health care in Mulund by the end of 2005,” said Nazareth.