Joint Commission International (JCI) recently held an event in India for encouraging healthcare organisations to pursue accreditation. M Neelam Kachhap spoke to Paula Wilson, President and CEO, JCI and Prabhu Vinayagam, Asia-Pacific MD, JCI to understand its working and plans for India
Tell us about JCI in India?
Prabhu Vinayagam: Currently, there are 22 organisations that have JCI accreditation; out of which 19 are hospitals and three are specialty centres. Besides, quite a few of them are going for accreditation this year. Now, India has a lot of opportunity coming up as a lot of private investments are going into hospitals and as I go around the country I see many new hospitals coming up. So, there is a lot more opportunity for JCI in this country to work more closely.
India already has a national accreditation body called NABH, why then do we need JCI?
Paula Wilson: We are somewhat familiar with NABH, it’s a government accreditation body and is very important to India. We don’t mean to substitute NABH but see JCI as a compliment to it.
NABH is a stepping process to get themselves (hospitals) to the country level benchmark, then they can look at international benchmark.
If somebody has NABH accreditation will they find it easier to get JCI?
Prabhu Vinayagam: No I’m not saying that. As international standards are different there would be still some more policies to be added. What I’m saying is that the moment they become NABH-accredited the thought process of the organisation is already getting into safety and quality. Hospitals then find it easier to change their culture to suit international standards. If they start from scratch, with no accreditation in place, then it is much more harder to come into a process so I’m seeing NABH in a supporting role here.
JCI first started off in India in 2005 and today out of 20,000 hospitals only 19 are accredited by JCI. Why is that?
Paula Wilson: We are evaluating it (India as a market) very closely now and we think we want to have a bigger presence here.
Prabhu Vinayagam: Earlier, India was not part of the Asia-Pacific from JCI’s point of view, it was part of the Middle East (ME). Till last year, ME has been a very strong growth market for us. A lot of new hospitals are coming up in the ME area so our focus was not on India. But now I’m on board and India is back in the Asia Pacific group. So there is renewed focus on this region.
What is your plan for India?
Paula Wilson: We are a not-for-profit company that is small in size, but we are growing very well. However, we don’t want to do too many things at the same time. Middle East was our focus for the last couple of years but now we want to have a bigger presence in a large and important country like India. We definitely have plans for India. We want to grow both in accreditation and education.
Prabhu Vinayagam: Our intention is not to give accreditation to all the hospitals. We intend to look at which hospitals are pro-actively working on quality and safety. And accreditation is a journey, it’s not a one-off process where a hospital applies and gets accredited. You have to go through a complete improvement process which takes a longer time. On an average, we have seen that from the time a hospital decides to go for accreditation until they get accredited, on an average, it takes about 18-24 months. This is because there are a lot of policy changes needed. Lot of standards need to be implemented and training needs to be conducted for the entire staff.
Will you be focusing more on the private sector or both the private and public sector?
Paula Wilson: We focus on organisations that come to us voluntarily. We have actually accredited three public hospitals. In fact, we accreditate public hospitals in other parts of the world but the public healthcare systems differ from one country to another. We certainly wish every hospital in India gets accredited.
Prabhu Vinayagam: We have had a couple of rounds of discussions with the healthcare ministry in the last five to six months. We met the Ex-health minister Dr Harsh Vardhan and submitted a proposal to look at choosing one public hospital as a pilot project for international accreditation.Then it can become a centre of excellence for other government hospitals to learn and understand how accreditation works. This will help not only government hospitals to grow, it will also put pressure on the private system to continuously raise the bar and that will help improve overall healthcare of the country. As there is a new minister we have to work the system again. We have also met the Director General of Health Services and put in our proposal. Once we get a clearance from there we will take it up.
Indian healthcare has a number of traditional medicine practitioners and some of them even have healthcare centres like the Ayurveda hospitals. NABH gives accreditation to these organisations, will JCI also accreditate them?
Prabhu Vinayagam: That’s not the prerogative of JCI at the moment because we are focused on scientific-based allopathy medicine. We do get inquires from China and Korea who also have a strong traditional medicine practice but we have not taken any decision on that as yet. We haven’t thought about it.
We don’t have the bandwidth for it. We have a lot of work in allopathy so alternative is not in our radar.
Accreditation is a costly affair. Do you think you will have India-specific pricing for JCI accreditation.
Paula Wilson: Accreditation by itself is not very expensive nor is the survey process expensive. What does cost money is the change that any hospital has to implement in its present structure to align with JCI standards. I’m aware that India is a very cost-sensitive market and we are trying to accommodate that to some extent.
Prabhu Vinayagam: Well, cost depends on a lot of factors. Accreditation is not very expensive from the overall perspective. Compared to the cost of errors happening at hospitals accreditation cost is hardly anything. Accreditation is not expensive. I always say accreditation cost will bring in profitability. The moment you standardise; you bring in efficiency it immediately impacts your (hospital’s) profitability. So it’s an investment which has got huge returns.
Do existing customers agree?
Prabhu Vinayagam: I’m not sure if they have done the maths for themselves, but this is an accepted theory. We have enough case studies from around the world that concur with this theory. But, we are yet to produce a case study from India. Surely, we will go ahead and do that.
Do you work with patients to make them seek safer hospital environment?
Paula Wilson: We work mostly on the hospital side. We don’t really engage much with the patients. It’s not really central to our mission. We make sure that the hospital leadership understands how important safety is. We engage with the leadership and staff to make hospital environment safe. But I think it is good that the patient be aware of the risks of healthcare.
Prabhu Vinayagam: We just finished our strategy discussion and India featured high in our discussion. In the future we would go to the patients to create awareness so that they can decide which hospital to go to. Today, they rely on other patients’ experience or recommendations but don’t look at a hospital’s performance. So, we will create awareness among the patients to have a criteria to choose which hospital is best. Accreditation is voluntary in most of the countries so it becomes a challenge for us to show hospitals how safety and quality works and the only solution is awareness.
mneelam.kachhap@expressindia.com