Daily Times

Healthcare standards are advocated as an important means of improving clinical practice and organisational performance. The Punjab Healthcare Commission (PHC) has utilised an open, transparent and inclusive development process to develop standards for a wide range of treatment disciplines being practiced across Punjab. The methodologies adopted by the PHC are effective and efficient at producing standards appropriate for the health industry.

In health accreditation, a standard is “a desired and achievable level of performance against which actual performance is measured.” Standards enable “health service organisations — large and small — to embed practical and effective quality improvement and patient safety initiatives into their daily operations.” External organisational and clinical accreditation standards are considered necessary to promote high quality, reliable and safe products and services. There are over 70 national healthcare accreditation agencies worldwide that develop or apply standards, or both, specifically for health services and organisations.

Quality management has become a major concern in the delivery of healthcare. The rising cost of treatment, coupled with variation in the health delivery practices has necessitated the development of strategies to standardise healthcare delivery. A hospital’s quality system depends on the philosophy, vision and corporate strategies that satisfy patients’ requirements. The PHC has a unique standing in the Pakistan health sector for two reasons. One, it was the first regulatory body to have the power to inspect and regulate Health Care Establishments (HCE). Two, it was the first organisation to develop the Minimum Service Delivery Standards (MSDS) to identify processes sin qua non for the achievement of quality at any HCE. Obtaining a regular license with the PHC is now a hallmark for a HCE providing quality healthcare. In this pursuit of quality, the PHC has shown zero tolerance for quackery.The Commission has operationalised an Anti-Quackery Department to clamp down on unqualified frauds, and has fully-fledged Monitoring and Inspection Departments to assess quality indicators adopted by HCEs registered with the PHC.

Often money budgeted for healthcare has been diverted to politically motivated developmental projects while doctors take advantage of governmental negligence to promote their own private practices. This trend would have to be arrested if the health sector is to produce optimal results

According to health experts, there are six important components of a healthcare system that provide quality care to individuals. One, a safe system for all patients, in all processes and at all times. According to this component a patient’s medical history is neither looked over, nor ignored or misplaced, and the HCE provides consistent care irrespective of any constraints. Two, a system that provides effective care, which means that all possible determinants—preventive service, diagnostic tests, therapy or no intervention — are looked at to produce the best result. Three, a patient-centric system, which comprises respect for patients’ values, preferences, expressed needs, coordination, integration of care and emotional support.  Four, a system that delivers care in a timely manner, wherein care should be dispensed in time without delays because delayed care is not only wasteful but also provokes anxiety among patients and families. Five, an efficient system, a hospital should use resources to obtain best value for the money spent. Six, a healthcare system that is equitable. Care should be based on an individual’s need not on personal characteristics like gender, race or religious affiliation.

Also read: A deeper shade of discrimination

We can assume safely that nearly all health practitioners and the hospital staff have an understanding about the above cited components and the necessity to practice them. However, the quality of healthcare in Pakistan is often sub-optimal and at times alarmingly poor, an indication that quality is compromised and healthcare standards ignored blatantly. It is in this context that the role of the PHC becomes instrumental. The PHC sees to it that the MSDS it has defined are followed through in letter and spirit. Towards this end, it has developed and implemented a stringent licensing process which includes the inspection of HCEs to assess compliance with MSDS.

All said and done, we can write on this all we want but unless the behaviour of people towards quality is changed, the current system and processes will keep churning out old, dated, and rotten practices, because either it suits those benefiting from the status quo or because change demands cost and accountability, which are not liked by many.

Now out of compulsion, many HEC’s have gotten themselves registered with the PHC. They are forced to spend considerable time with the Commission to learn the rudiments of the MSDS for its effective implementation. Unless trained through capacity building workshops, the MSDS cannot be enforced and HCEs will not qualify for a Regular License. For this, the Commission runs a comprehensive capacity building program, training healthcare service providers on implementing the MSDS at their respective facilities.

When PHC began its operations the biggest challenge was posed by the private sector. A natural resistance to law enforcement was expected though, because of years of free hand given to the sector to not only mint money but to flout laws. Another challenge faced by the Commission has been to ensure that government run hospitals abide by the MSDS for it is here that the poorest segments of society access treatment. However, the PHC cannot single handedly change the system. The Government’s spending pattern on the health sector, the quality of education given at the medical colleges, the training doctors receive from seniors, the rules and regulations followed by other medical regulatory bodies such as Pakistan Medical and Dental Council and the weight society gives to ethical work practices collectively determines the character and productivity of the medical sector. Often money budgeted for healthcare has been diverted to politically motivated developmental projects while doctors take advantage of governmental negligence to promote their own private practices. This trend would have to be arrested if the health sector is to produce optimal results.

The writer is a journalist and can be reached at durdananajam1@gmail.com.

Published in Daily Times, August 2^nd 2018.