An Exploratory Study on the Benefits of Quality Accreditation: Financial Impact and Chief Executive Officer Perspectives
Alexander Thomas, Subramanyam Raghunath, Bhupendra K Rana, Somil Nagpal
Citation Information :
Thomas A, Raghunath S, Rana BK, Nagpal S. An Exploratory Study on the Benefits of Quality Accreditation: Financial Impact and Chief Executive Officer Perspectives. Int J Res Foundation Hosp Healthc Adm 2017; 5 (2):60-67.
Little systematic evidence exists in published literature about the net financial impact of the process of quality accreditation on hospitals that have undergone the process. This exploratory study aims to explore the financial impact of undergoing National Accreditation Board for Hospitals & Health Care Providers (NABH) accreditation in Indian hospitals, based on chief executive officers (CEOs’) perspectives and the financial outcomes perceived by them. The attempt has been to provide a qualitative assessment of the costs and benefits of NABH accreditation on the financial health of the organization. As there were no leading studies to reference that could emulate the data available in the Indian context, the study team developed a set of financial indicators that could be collected from NABH-accredited hospitals. A total of 14 hospitals in Delhi, Ahmedabad, Mumbai, Bengaluru, Mysuru, Surat, and Chennai were included in the study. The CEOs of participating hospitals perceived that the NABH accreditation has been beneficial to their organization and that the overall quality of care for patients within their organizations has improved. In addition, they also confirmed improved awareness of statutory compliances, and of staff responses to emergencies, such as fire and cardiopulmonary resuscitation, and that data and evidence-based decision-making have helped in managing the facility better. The study suggests that the delivery of health care was positively influenced by NABH accreditation. The exploratory study also highlights the factors that may contribute to positive financial outcomes for hospitals. Specifically in terms of financial outcomes, the study has found that the income per used bed shows an increasing trend after the accreditation period. This may suggest medium- to long-term financial benefits to hospitals undergoing NABH accreditation.
National Health Mission. Indian Public Health Standards, 2013. India: National Health Mission; 2013 [cited 2016 Jul]. Available from: http://nrhm.gov.in/nhm/nrhm/guidelines/indian-public-health-standards.html.
Ministry of Health and Family Welfare. Framework for implementation national health mission. India: Ministry of Health and Family Welfare, Government of India; 2012-2017. Available from: http://nrhm.gov.in/images/pdf/about-nrhm/nrhm-framework-implementation/nrhm-framework-latest.pdf.
WHO. WHO global health expenditure atlas. Geneva: WHO; 2014 [cited 2014 Sep]. Available from: http://www.who.int/health-accounts/atlas2014.pdf.
Nagarajan G, Sheriff JK. Novel healthcare (hospitals)—creation an Indian perspective. IJMFSMR 2013 Apr;2(4):89-98.
Fitch Group. Health care earning drivers intact, capex to continue. New York: Fitch Group 2014 Outlook, Fitch Group, India Ratings and Research; 2014 [cited 2014 Jan]. Available from: https://www.indiaratings.co.in/upload/research/specialReports/2014/1/31/indra31Health.pdf.
Indian Healthcare Sector. Healthcare industry in India. India: Indian Healthcare Sector, Services; 2014 [cited 2014 Mar]. Available from: http://www.ibef.org/industry/healthcare-india.aspx.
La Forgia G, Nagpal S. Government-sponsored health insurance in India: are you covered? Directions in development. Washington (DC): World Bank.
Guidelines on Standardization in Health Insurance, IRDA/HLT/REG/CIR/146/07/2016 available online, p. 23.
Balamurugan E, Little Flower J. A study on patient safety culture among nurses in a tertiary care hospital of Puducherry. Int J Basic Appl Med Sci 2014;4(2):93-98.
Landefeld J, Sivaraman R, Arora NK. Barriers to improving patient safety in India: focus groups with providers in the southern state of Kerala. Indian J Community Med 2015;40(2):116-120.
deLorimier AA, Tierney DF, Parker HR. Hypoplastic lungs in fetal lambs with surgically produced congenital diaphragmatic hernia. Surgery 1967;62:12.
Finegold MJ, Katzew H, Genieser NB, et al. Lung structure in thoracic dystrophy. Am J Dis Child 1971;122:153.
Johnson VP, Keppen LD, Carpenter MS. New syndrome of spondylospinal thoracic dysostosis with multiple pterygia and arthrogryposis. Am J Med Genet 1997;69:73.
Thibeault DW, Pettett G, Mabry SM, et al. Osteogenesis imperfecta Type IIA and pulmonary hypoplasia with normal alveolar development. Pediatr Pulmonol 1995;20:301.
Goldstein JD, Reid LM. Pulmonary hypoplasia resulting from phrenic nerve agenesis and diaphragmatic amyoplasia. J Pediatr 1980;97:282.
Argyle JC. Pulmonary hypoplasia in infants in giant abdominal wall defects. Pediatr Pathol 1987;9:43.
Liggins GC, Vilos GA, Campos GA, et al. The effect of bilateral thoracoplasty on lung development in fetal sheep. J Dev Physiol 1981;3:275.
Harris GR, Stone MH, O'bryant HS, Proulx CM, Johnson RL. Short-term performance effects of high power, high force, or combined weight-training methods. J Strength Cond Res 2000;14: 14-20.
Kotzamanidis, Chatzopoulos CD, Michailidis C, Papaiakovou G, Patikas D. The effect of a combined high-intensity strength and speed training program on the running and jumping ability of soccer players. J Strength Cond Res 2005;19:369-375.
Adams K, O'shea JP, O'shea KL, Climstein M. The effect of six weeks of squat, plyometric and squat-plyometric training on power production. J Strength Cond Res 1992;6:36-41.
Fatouros I, Jamurtas A, Leontsini D, Taxildaris K, Aggelousis G, Kostopoulos N, Buckenmeyer P. Evaluation of plyometric exercise training, weight training, and their combination on vertical jumping performance and leg strength. J Strength Cond Res 2000;14:470-476.
Toji H, Suei K, Kaneko M. Effects of combined training loads on relations among force, velocity, and power development. Can J Appl Physiol 1997;22:328-336.
Newton RU, Kraemer WJ, Häkkinen K. Effects of ballistic training on preseason preparation of elite volleyball players. Med Sci Sports Exerc 1999;31:323-330.
Gil SM, Gil J, Ruiz F, Irazusta A, Irazusta J. Physiological and anthropometric characteristics of young soccer players according to their playing position: relevance for the selection process. J Strength Cond Res 2007;21:438-445.
Castagna C, Impellizzeri FM, Chamari K, Carlomagno D, Rampinini E. Aerobic fitness and Yo-Yo continuous and intermittent tests performances in soccer players: A correlation study. J Strength Cond Res 2006;20:320-325.
Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974;32(1):77-97.
Sandhu JS, Thakur K, Shweta S, Ravi S. Concentric hip muscle function and quadricps: Hamstring in athlets with and without oatellofemoral pain syndrome. Ibnosina Journal of Medicine and Biomedical Sciences 2012;4(1):20-27.
Wong P, Chamari K, Dellal A, Wisloff U. Relationship between anthropometric and physiological characteristics in youth soccer players. J Strength Cond Res 2009;23(4):1204-1210.
Amiri-Khorasani M, Sahebozamani M, Tabrizi KG, Yusof AB. Acute effect of different stretching methods on illinois agility test in soccer players. The Journal of Strength and Conditioning Research 2010;24(10):2698-2704.
Brughelli M, Cronin J, Levin G, Chaouachi A. Understanding change of direction ability in sport. Sports Medicine 2008;38(12), 1045-1063.
Miller MG, Herniman JJ, Ricard MD, Cheatham CC, Michael TJ. The effects of a 6-week plyometric training program on agility. Journal of Sports Science and Medicine 2006;5:459-465.
Raven PB, Gettman LR, Pollock ML, Cooper KH. A physiological evaluation of professional soccer players. British Journal of Sports Medicine 1976;10(4):209-216.
Paavolainen L, Hakkinen K, Hamalainen I, Nummela A, Rusko H. Explosive-strength training improves 5 km running time by improving running economy and muscle power. J Appl Physiol 1999;86:1527-1533.
Kyrolainen H, Avela J, Mcbride JM, Koskinen S, Andersen JL, Sipila S, Takala TE, Komi PV. Effects of power training on muscle structure and neuromuscular performance. Scand J Med Sci Sports 2005;15:58-64.
Chu D. Jumping into plyometrics. Champaign: Human Kinetics, 1992.
Potach DH, Chu DA. Plyometric training. In: Essentials of strength training and conditioning (2nd ed). Baechle TR Earle RW, editors. Human Kinetics 2000;427-470.
Sale DG. Neural adaptation to resistance training. Med Sci Sports Exerc 1988;20:S135-S145.
Plisk SS. Speed, agility and speed endurance development. Essentials of strength training and conditioning, (2nd ed). In: Baechle TR, Earle RW, editors. Human Kinetics, 2000;427-470.
Mayhew JL, Piper FC, Schewgler TM, Ball TE. Contributions of speed, agility and body composition to anaerobic power measurements in college football players. J Appl Sport Sci Res 1989;3:101-106.
Negrete R, Brophy J. The relationship between isokinetic open and closed chain lower extremity strength and functional performance. J Sport Rehabil 2000;9:46-61.
Young WB, James R, Montgomery I. Is muscle power related to running speed with changes of direction? J Sports Med Phys Fitness 2002;42:282-288.
Rutherford OM, Jones DA. The role of learning and coordination in strength training. Eur J Appl Physiol Occup Physiol 1986 55:100-105.
Vonk-Noordegraaf A, Haddad F, Chin KM, Forfia PR, Kawut SM, Lumens J, Naeije R, Newman J, Oudiz RJ, Provencher S, et al. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J Am Coll Cardiol 2013 Dec;62(25 Suppl):D22-D33.
Weyman, AE. Principles and practices of echocardiography Philadelphia (PA): Lea & Febiger; 1994. pp. 914-915.
Otto, CM. Textbook of clinical echocardiography. Philadelphia (PA): WB Saunders; 2000. pp. 120-122.
Karas MG, Kizer JR. Echocardiographic assessment of the right ventricle and associated hemodynamics. Prog Cardiovasc Dis 2012 Sep-Oct;55(2):144-160.
Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, Chamera E, Corretti MC, Champion HC, Abraham TP, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 2006 Nov;174(9):1034-1041.
Koestenberger M, Nagel B, Ravekes W, Urlesberger B, Raith W, Avian A, Halb V, Cvirn G, Fritsch P, Gamillscheg A. Systolic right ventricular function in preterm and term neonates: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 258 patients and calculation of Z-score values. Neonatology 2011 Jan;100(1):85-92.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015 Jan;28(1):1.e14-39.e14.
Brierre G, Blot-Souletie N, Degano B, Têtu L, Bongard V, Carrié D. New echocardiographic prognostic factors for mortality in pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging 2010 Jul;11(6):516-522.
Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zacà V, Ballo P, D'Andrea A, Muraru D, Losi M, et al. Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med 2011 Jan;30(1):71-83.
Cioffi G, de Simone G, Mureddu G, Tarantini L, Stefenelli C. Right atrial size and function in patients with pulmonary hypertension associated with disorders of respiratory system or hypoxemia. Eur Heart J Cardiovasc Imaging 2007 Oct;8(5):322-331.
Hammerstingl C, Schueler R, Bors L, Momcilovic D, Pabst S, Nickenig G, Skowasch D. Diagnostic value of echocardiography in the diagnosis of pulmonary hypertension. PLoS One 2012 Jun;7(6):e38519.
Schmidt NF, Missan SR, Tarbet WJ. The correlation between organoleptic mouth-odor ratings and levels of volatile sulfur compounds. Oral Surg 1978;45:560–67.
Kostelc JG, Zelson PR, Preti G, et al. Quantitative differences in volatiles from healthy mouths and mouths with periodontitis. Clin Chem 1981;27:842–45.
Yaegaki K, Suetaka T. Fractionation of the salivary cellular elements by Percoll density gradient centrifugation and the distribution of oral malodor precursors. Shigaku 1989;77:269–75.
Fronterre A, Portesani GP. Epikeratoplasty for pellucid marginal corneal degeneration. Cornea 1991 Sep;10(5):450-453.
Ramez Barbara J, Barbara R, Zadok D, et al. Collagen Corneal Cross-Linking followed by Intac Implantation in a Case of Post-PRK Ectasia. Int J Keratoco Ectatic Corneal Dis 2012;1(1):68-72.
Yeung SN, Ku JYF, Lichtinger A, Low SAW, Kim P, Rootman DS. Efficacy of single or paired intrastromal corneal ring segment implantation combined with collagen crosslinking in keratoconus. J Cataract Refract Surg 2013 Aug;39(8):1146-1151.
Kiliç A, Kamburoglu G, Akinci A. Riboflavin injection into the corneal channel for combined collagen crosslinking and intrastromal corneal ring segment implantation. J Cataract Refract Surg 2012 May;38(5):878-883.
Ferenczy PA, Dalcegio M, Koehler M, Pereira TS, Moreira H, Bugmann ML. Femtosecond-assisted intrastromal corneal ring implantation for keratoconus treatment: a comparison with crosslinking combination. Arq Bras Oftalmol 2015 Mar-Apr;78(2):76-81.
Baikoff G, Joly P. Comparison of minus power anterior chamber intraocular lenses and myopic epikeratoplasty in phakic eyes. Refract Corneal Surg 1990 Jul-Aug;6(4):252-260.
Baikoff G. Phakic anterior chamber intraocular lenses. Int Ophthalmol Clin 1991 Winter;31(1):75-86.
Fechner PU, Worst JG. A new concave intraocular lens for the correction of myopia. Eur J Implant Refract Surg 1989 Mar;1(1):41-43.
Brauweiler PH, Wehler T, Busin M. High incidence of cataract formation after implantation of a silicone posterior chamber lens in phakic, highly myopic eyes. Ophthalmology 1999 Sep;106(9):1651-1655.
Zhang X, Tao X-C, Li Z-W, Zhou W-Y, Ma P, Zhang C-X, Wang Y-M, Mu G-Y. Combining corneal crosslinking and phakic toric implantable collamer lenses for the treatment of keratectasia: a case report. Exp Ther Med 2016 Sep;12(3):1495-1498.
Cakir H, Utine CA. Combined kerarings and Artisan/Artiflex IOLs in keratectasia. J Refract Surg 2011 Feb;27(2):119-126.
Moshirfar M, Fenzl CR, Meyer JJ, Neuffer MC, Espandar L, Mifflin MD. Simultaneous and sequential implantation of Intacs and verisyse phakic intraocular lens for refractive improvement in keratectasia. Cornea 2011 Feb;30(2):158-163.
Thompson RW Jr, Price MO, Bowers PJ, Price FW Jr. Long-term graft survival after penetrating keratoplasty. Ophthalmology 2003 Jul;110(7):1396-1402.
McAllum PJ, Segev F, Herzig S, Rootman DS. Deep anterior lamellar keratoplasty for post-LASIK ectasia. Cornea 2007 May;26(4):507-511.
Villarrubia A, Perez-Santonja JJ, Palacin E, Rodriguez-Ausin PP, Hidalgo A. Deep anterior lamellar keratoplasty in post-laser in situ keratomileusis keratectasia. J Cataract Refract Surg 2007 May;33(5):773-778.
Grewal S, Laibson PR, Cohen EJ, Rapuano CJ. Acute hydrops in the corneal ectasias: Associated factors and outcomes. Trans Am Ophthalmol Soc 1999;97:187-98.
Koenig SB, Smith RW. Keratoconus and corneal hydrops associated with compulsive eye rubbing. Refract Corneal Surg 1993;9:383-84.
Mashor RS, Kumar NL, Ritenour RJ, Rootman DS. Keratoconus caused by eye rubbing in patients with Tourette syndrome. Can J Ophthalmol 2011;46:83-86.
Kandarakis A, Karampelas M, Soumplis V, et al. A case of bilateral self-induced keratoconus in a patient with Tourette syndrome associated with compulsive eye rubbing: Case report. BMC Ophthalmol 2011;11:28.
Coyle JT. Keratoconus and eye rubbing. Am J Ophthalmol 1984;97:527-28.
Gritz DC, McDonnell PJ. Keratoconus and ocular massage. Am J Ophthalmol 1988;106:757-58.
Rahi A, Davies P, Ruben M, et al. Keratoconus and coexisting atopic disease. Br J Ophthalmol 1977;61:761-64.
Besancon G, Baikoff G, Deneux A, et al. Preliminary note on the psychological and mental status of patients with keratoconus. Bull Soc Ophtalmol Fr 1980;80:441-43.
Copeman PW. Eczema and keratoconus. Br Med J 1965;2: 977-79.
Mannis MJ, Morrison TL, Zadnik K, et al. Personality trends in keratoconus. An analysis. Arch Ophthalmol 1987;105:798-800.
Swartz NG, Cohen EJ, Scott DG, et al. Personality and keratoconus. CLAO J 1990;16:62-64.
Gasset AR, Hinson WA, Frias JL. Keratoconus and atopic diseases. Ann Ophthalmol 1978;10:991-94.
Kaya V, Karakaya M, Utine CA, et al. Evaluation of the corneal topographic characteristics of keratoconus with orbscan II in patients with and without atopy. Cornea 2007;26:945-48.
Galin MA, Berger R. Atopy and keratoconus. Am J Ophthalmol 1958;45:904-06.
Roth HL, Keirland RR. The natural history of atopic dermatitis. A 20-year follow-up study. Arch Dermatol 1964;89:209-14.
Lowell FC, Carroll JM. A study of the occurrence of atopic traits in patients with keratoconus. J Allergy 1970;46:32-39.
Nemet AY, Vinker S, Bahar I, Kaiserman I. The association of keratoconus with immune disorders. Cornea 2010;29:1261-64.
Buddi R, Lin B, Atilano SR, et al. Evidence of oxidative stress in human corneal diseases. J Histochem Cytochem 2002;50: 341-51.
Kenney MC, Brown DJ. The cascade hypothesis of keratoconus. Cont Lens Anterior Eye 2003;26(3):139-46.
Behndig A, Karlsson K, Johansson BO, et al. Superoxide dismutase isoenzymes in the normal and diseased human cornea. Invest Ophthalmol Vis Sci 2001;42:2293-96.
Podskochy A, Fagerholm P. The expression of Fas ligand protein in ultraviolet-exposed rabbit corneas. Cornea 2002;21:91-94.
Newkirk KM, Chandler HL, Parent AE, et al. Ultraviolet radiation-induced corneal degeneration in 129 mice. Toxicol Pathol 2007;35:819-26.
Pettenati MJ, Sweatt AJ, Lantz P, et al. The human cornea has a high incidence of acquired chromosome abnormalities. Hum Genet 1997;101:26-29.
Snibson GR. Collagen cross-linking: A new treatment paradigm in corneal disease—a review. Clin Experiment Ophthalmol 2010;38:141-53.
Spoerl E, Raiskup-Wolf F, Kuhlisch E, Pillunat LE. Cigarette smoking is negatively associated with keratoconus. J Refract Surg 2008;24:S737-40.
Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology 1993;100:181-86.
Goodrich DW, Lee WH. The molecular genetics of retinoblastoma. Cancer Surv 1990;9:529-54.
Moodaley LC, Woodward EG, Liu CS, Buckley RJ. Life expectancy in keratoconus. Br J Ophthalmol 1992;76:590-91.
Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, et al. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017 Jan 3;317(1):59-68.
Chervenak FA, Jeanty P, Cantraine F, Chitkara U, Venus I, Berkowitz RL, Hobbins JC. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984 Jul 1;149(5):512-517.
Papageorghiou AT, Thilaganathan B, Bilardo CM, Ngu A, Malinger G, Herrera M, Salomon LJ, Riley LE, Copel JA. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016 Apr;47(4):530-532.
Chibueze EC, Parsons AJ, Lopes KD, Yo T, Swa T, Nagata C, Horita N, Morisaki N, Balogun OO, Dagvadorj A, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017 May 23;7(1):2310.
Cordeiro MT. Zika virus: laboratory diagnosis. In: Zika in focus. Springer International Publishing; 2017. pp. 59-62.
Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, et al. Zika virus associated with microcephaly. N Engl J Med 2016 Mar 10;374(10):951-958.
Zare Mehrjardi M, Keshavarz E, Poretti A, Hazin AN. Neuroimaging findings of Zika virus infection: a review article. Jpn J Radiol 2016 Dec;34(12):765-770.
Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016 Jan;47(1):6-7.
Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016 Dec 15;375(24):2321-2334.