Indraprastha Apollo Hospitals actively participates in numerous quality improvement initiatives to improve the delivery of care, increase patient satisfaction and improve the overall patient experience. Here's a partial listing:
Patient Feedback System
Patient satisfaction surveys help a great deal in identifying ways of improving a hospital’s services. Ultimately, that translates into better care and happier patients. Moreover, it shows the staff and the community that the hospital is serious about quality and is looking for ways to improve. Voice Of Customer is a Customer Feedback Programme being run by Indraprastha Apollo Hospitals. Indraprastha Apollo hospital utilizes the Voice of Customer (VOC) tool as a feedback mechanism for judging the patient satisfaction pertaining to various departments and services in the hospital.
Fighting hospital-acquired infections
As part of its quality improvement program, Indraprastha Apollo Hospitals places a major focus on reducing all types of hospital-acquired infections. The infection control programmes at our hospital has matured into one of the best programmes in this country. The rates continue to compare with the best in the world for urinary catheter related Urinary Tract Infection (UTI), Central Line Related Blood Stream Infections (CRBSI) and Ventilator Associated Pneumonia (VAP). This has largely been possible through ongoing meticulous implementation of bundles of measures for CRBSI,VAP and UTI -the latest technical measures including stringent hand hygiene routines, adopted in the world by nursing and the doctors and because of the intensive drives carried out through out.
Employee safety and infection prevention was addressed by educational drives, measures undertaken and augmenting personal protective equipment to prevent exposure inoculation injuries and provision of pre and post exposure prophylaxis. Vaccination of appropriate staff for various preventable infections including Hepatitis B is an ongoing phenomenon. Care was also taken to maintain environment to acceptable standards to contain infective exposures.
Apollo Clinical Excellence (ACE@25)
is a clinical balanced scorecard focusing on clinical excellence, incorporates parameters, which are mission critical for the clinical milieu of our organization. This balanced scorecard focuses on providing evidence based quality care and a safe environment to our patients and strengthening the functional efficiency of our hospital, stimulating quality improvement while reducing variations. To authenticate the data, an ACE@25 audit team comprising the members from other Apollo Group hospitals, audits the records of the hospital. ACE @ 25 incorporates 25 clinical quality parameters involving complication rates, mortality rates, one year survival rates and average length of stay after major procedures like liver and renal transplant, CABG, TKR, THR, TURP, PTCA, endoscopy, large bowel resection and MRM covering all major specialties. Also included are hospital acquired infection rates, pain satisfaction and medication errors. Benchmarks have been chosen from the world’s best hospitals including Cleveland Clinic, Mayo Clinic, National Healthcare Safety Network, Massachusetts General Hospital, AHRQ US, Columbia University Medical Center and US Census Bureau.
Clinical Practice Guidelines
"Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Institute of Medicine, 1990). They define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. The statements contain recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature. Apollo Hospitals has developed Clinical Practice Guidelines for treatment of various diagnoses in consultation with it's consultants in the respective specialty. Adherence to CPGs by the various treating physicians is monitored on a continuous basis through closed file audits by the quality teams. Acute Myocardial Infarction, Fulminant Hepatic Failure, Seizure management, LSCS, Hysterectomy, Renal Transplants are examples of diagnoses where Clinical Practice Guidelines are followed. CPGs are reviewed on a periodic basis for incorporating newer developments.
Clinical pathways are one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. Their implementation reduces the variability in clinical practice and improves outcomes. Clinical pathways promote organized and efficient patient care based on the evidence based practice and optimize outcomes. Apollo Hospitals has implemented clinical pathways for various surgical procedures and other diagnosis in consensus with consultants of the specialty. Clinical Pathways are reviewed on a periodic basis for incorporating newer developments. CABG, laparoscopic cholecystectomy, TURP, total abdominal hysterectomy, stroke, and total knee replacement are some of the clinical pathways implemented by the Apollo Hospitals. An initiative to customize the clinical pathways across the entire Apollo Group is being undertaken.
A project on reducing hospital ALOS was taken up on a high priority basis to reduce the turnaround time and improve our patient satisfaction levels. The objective was to reduce the Average Length of Stay from the existing level of 5.09 to 4.8 days. Key specialties, diagnosis, system issues, individual consultant and patient behaviors leading to an increased LOS were identified and international best practices in reducing ALOS addressing each of these issues were studied and indigenized to suit our system. The initiatives resulted in reduction of ALOS to the target level of 4.8 days within two months.
Performance Indicators are parameters used to measure outcomes of various consultants on defined parameters in their specialty. They are monitored on a monthly basis and their annual means form the basis of the consultant annual appraisals. Stroke readmission rate, ALOS post TKR, operating time in laparoscopic cholecystectomy, endoscopy complication rate, UTI in renal transplants, craniotomy re exploration rates, remission rates in ALL and recovery room delays are some examples of performance indicators in various specialties. Individual averages and departmental averages are analyzed and compared.
Apollo Way Initiative
Apollo Way Initiative is an initiative to achieve planned outcomes through improved processes, operational excellence and productivity through a structured methodology of diagnostics, issue identification, Root Cause Analysis, problem solving, solution design & implementation followed by Dashboard setting and monitoring. Apollo way aims at Enhancing patient experience, Improve operational excellence and Improve financial accruals.
Prevention of needle prick injuries
The hospital conducts mandatory in-house training programs for all staff to prevent needle prick injuries.
Information technology initiatives
The hospital has invested in a number of IT solutions that not only resulted in better management but also resulted in substantial savings.
- PACS : The X-Rays and CT scans went filmless leading to easier access to the images and reducing consumption of films in the process leading to substantial savings.
- Interfacing Medical equipments : A number of equipments in the Laboratories were interfaced with the Hospital Information System. Final calibration and validation is now in progress.
- Social Media : Indraprastha Apollo Hospitals was the first to have a website of its own and in keeping with changing times, the Hospital has now got connected with its patrons over social networking websites Facebook and Twitter to reach out to those who want to know more about us on this medium.
- Web Applications : A Visitor Management system using touch screen kiosks, an online Key Management system to improve the security and handling of hospital keys and a web based application for Wage & Salary administration were introduced. An e-based Leave Management Module was also implemented, thus saving considerable man-hours and stationery costs.
Apollo Quality Workshop and Apollo Quality Program (AQP)
A Group Quality Workshop was held at Indraprastha Apollo Hospitals, Delhi in October 2010. The workshop developed the Apollo Quality Program, a plan for the implementation of standardized methodologies for clinical handovers, international patient safety goals; surgical care improvement, zero medication errors, standardization of medical records, diagnosis and procedure codes and promoting innovation in quality improvement. A pilot for the program was started in December 2010 and final implementation along with reporting of the measurable dashboard on compliance to the program shall start from April 2011.
5S at Apollo
5S is a Japanese concept of workplace organization, which has very important application in healthcare; 5S improves operational efficiency by visual management and an organized workplace. Apollo began implementation of 5S from January 2010. Apollo has developed its own customized, healthcare specific 5S handbook, which is available in 7 Languages – English, Hindi, Kanada, Telugu, Tamil, Gujarati and Bengali. This ensures a comprehensive knowledge base for our staff across our Group.
5S provides the following benefits:
- A cleaner workplace for enhanced safety and reduced clutter
- An organized, efficient workplace for increased productivity and patient safety
- An always-ready environment that fosters and promotes compliance with regulatory standards including JCI
- The reduction of inventory and supply costs
- The recapture of valuable space and minimizing overhead costs
- The impact of “how we feel” about our workplace, organization, and ourselves