Dr. Rajashekar Y L
Head, Shekhar Hospital,
Bengaluru
Ophthalmology as a specialty and medical science has been at the fore front of innovation, improvisations and implementations. People in India have been greatly benefitted by these measures and quality of eye care in improving each day.
Quality in all aspects of medical science is a nonnegotiable entity and more so in Ophthalmology. Uniqueness about ophthalmology is the variety it has, be it the size of practice or sub specializations it offers.
An ophthalmic practice can be a single doctor practice, group practice, a chain of hospitals, an institution or even a part of multi-specialty hospital. Ownership models too vary. The country being so wide and diversity being so vast, it is but natural to expect this variety. By and large, all these facilities are delivering decent levels of care with quality in mind.
This alone is not sufficient to ensure a predictable and progressive medical care for the people. There is a need to have common minimum standards to guide, follow and implement across the country. These parameters have to be measurable and should help the practice to bring in quality of care.
NABH is a very good initiative by the Govt of India. The objective of NABH is to ensure that a medical facility adheres to the expected range and degree of infrastructure,processes,facilities, expertise,objectives and compliances. The ideal is kept in mind while formulating the guidelines. This has always been the case in our country right from the size of the constitution or legal system. We, as people, have followed these with an allowance of ‘practicality’. Medical profession being a noble one, there is no tolerance for falling short of standards. This comes as a challenge when it comes to adhering to NABH guidelines and implementation of quality in toto.
There is a need to understand and be aware of this new dimension to practice. Quality is a must and it should be as per the nationally (and even internationally) acceptable norms. This is what humanity expects from the field of medicine irrespective of geography and affordability.
Quality comes with a cost. All medical facilities should make budget provisions for this and embrace the change. This also mandates engaging hitherto ‘optional’ services like HR,Finance consultants,Cost consultants, environmentalists, energy consultants, legal experts, Information technology etc. This is new to many small and mid size ophthalmology practices and the cost burden can be reduced is associations like AIOS and state level bodies bring in consultants at group level. Over all, the facility with NABH will enjoy better patient satisfaction,good clinical outcome,employee retention,cost effectiveness and growth of practice in the long run.
NABH, with all its 300 plus objective elements spread over 10 chapters, throws up expectations ranging from easy, moderate and tough to follow situations. Infrastructure related clauses are the toughest to follow given the standards with which the buildings have been allowed to be constructed in our country in the past. Applying stringent building laws all of a sudden looks like an unfair enforcement. we loose the argument since medical facility is noble and beyond excuses. This is a pill we all have to swallow in the short term to take the practice of ophthalmology to greater heights.
Apart from this, still there is a scope to review certain objective elements to suit ophthalmology needs even in the new standards published for eye care. The fee set by GOI for NABH accreditation can also be reduced or even hospitals embracing NABH be rewarded with cash incentives by the Govt. This kind of measures will be in tune with making medical facilities more affordable while making them accountable.