About : Neeraj Lal (Cluster Head and
Vice President - Rainbow Children’s Hospitals, Bangalore and Karnataka Region)
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| Mr. Neeraj Lal |
A post-graduate in
Hospital Administration from the renowned Tata Institute of Social Sciences
(TISS), Mumbai, he holds a degree in Medical Sciences from PGI
Chandigarh. Young and dynamic healthcare
leader with eye for quality detailing, he is one among the four Indian
individual members of the International Society for Quality in Healthcare
(ISQua) based out of Dublin. He is also
an approved Surveyor for ISQua’s International Accreditation Programme.
He is an executive
member of Quality Council of India, Asian Society for Quality in Health Care
and Indian Hospital Association. He is a visiting faculty in almost seven
institutes in India.
He was previously
the Group Chief Operating Officer of the Sunshine Global Group of Hospitals
based out of South Gujarat. He has held senior positions in various Indian
Hospitals including Shalby and Sterling Hospitals for a number of years. He has won numerous awards and has
prestigious positions to his credit. He
has received the Award of Excellence for “Outstanding Contribution in
Healthcare Sector” by North Gujarat University, Patan, Gujarat. He was the winner of the Prestigious
"Aikat Memorial Gold Memorial Gold Medal" for the Best Outgoing
Student of P.G.I. Chandigarh. Received the Healthcare Leadership Award 2019 and
Healthcare Excellence Award for exemplary work in healthcare by elets Technomedia
Pvt Ltd in New Delhi. Awarded the ‘Most
Promising Healthcare Personality of the year 2020” by Medgate Today in Mumbai. He is a healthcare expert with New York based
On Frontiers in operations, quality, business and management of hospitals and
medical institutions. He likes mentoring start-ups and help them understand the
detailing of healthcare.
His family consists of
wife Neha Lal who is Senior General Manager with GCS Medical College,
Hospital & Research Centre in Ahmedabad and 12 year-old son Rudra.
Neeraj likes to spend
off-duty time playing badminton, reading business magazines and listening to
all-time hits of Kishore Kumar.
Neeraj, it’s my absolute privilege to be doing this interview with you and I am sure we will have a good discussion today.
CC.1 How is the Rainbow Group of Hospitals coping up with the COVID19 situation. Please mention about innovations and creative solutions that your team has come up with.
NL: Rainbow Initiatives for Covid-19:
Video Consultation - During the lock-down period, Rainbow has started the online video consultation platform “Hello Doctor”. Rainbow cares for the patients even in this tough time. By this platform, the hospital has provided the video consultation for all the patients, with non-emergent situation, who cannot come to hospital. All the consultants are available for the video consultation.
Online ANC & Yoga Sessions - Rainbow Children’s Hospital, Bangalore has conducted around five Ante--natal sessions “Bundle of Joy” in which Gynecologist, Neonatologist, Anesthetist, Lactation Consultant and Nutrition Expert prepare the expecting mothers and their families to welcome their newborns. The Gynecologist talks about the ante-natal and labour experience. In this session the Lactation Consultant will discuss about the lactation preparation during pregnancy and how to resolve lactation issues after delivery. The pain management during pregnancy is discussed by the anesthetist and Neonatologist focuses on care of the health of the baby.
Facebook Live - Rainbow conducts Facebook live sessions with different Consultants regarding their expertise in their concerned departments. There were few Facebook live sessions on different topics like ‘Safe pregnancy tips during COVID 19’, ‘Prevention & Safety Measures for Kidney Patients during Covid-19’: ‘Caring for Children at Home during Covid-19 Pandemic and ‘Importance of Vaccinations at COVID19’.
Online CME - In order to keep the doctors updated about the current scenario, Rainbow has conducted online sessions with doctors from different parts of Bangalore. The topic for CME was “Practicing Pediatric in Pandemic”. Around 80 doctors from all over Bangalore have joined the session.
Distribution of Masks & Sanitizers - Rainbow has donated medical supplies to BBMP office in Bengaluru and has also distributed around 50,000 masks to the police personnel who are ensuring strict lock down is followed across the city.
Organization of Blood Donation Camp - Rainbow Children’s Hospitals, Marathahalli, Bengaluru is making every action count during these testing times. The team recently collaborated with the Rotary Club TTK Blood Bank to organize an in-house blood donation drive in the hospital premises to help save more lives.
Online ANC & Yoga Sessions - Rainbow Children’s Hospital, Bangalore has conducted around five Ante--natal sessions “Bundle of Joy” in which Gynecologist, Neonatologist, Anesthetist, Lactation Consultant and Nutrition Expert prepare the expecting mothers and their families to welcome their newborns. The Gynecologist talks about the ante-natal and labour experience. In this session the Lactation Consultant will discuss about the lactation preparation during pregnancy and how to resolve lactation issues after delivery. The pain management during pregnancy is discussed by the anesthetist and Neonatologist focuses on care of the health of the baby.
Facebook Live - Rainbow conducts Facebook live sessions with different Consultants regarding their expertise in their concerned departments. There were few Facebook live sessions on different topics like ‘Safe pregnancy tips during COVID 19’, ‘Prevention & Safety Measures for Kidney Patients during Covid-19’: ‘Caring for Children at Home during Covid-19 Pandemic and ‘Importance of Vaccinations at COVID19’.
Online CME - In order to keep the doctors updated about the current scenario, Rainbow has conducted online sessions with doctors from different parts of Bangalore. The topic for CME was “Practicing Pediatric in Pandemic”. Around 80 doctors from all over Bangalore have joined the session.
Distribution of Masks & Sanitizers - Rainbow has donated medical supplies to BBMP office in Bengaluru and has also distributed around 50,000 masks to the police personnel who are ensuring strict lock down is followed across the city.
Organization of Blood Donation Camp - Rainbow Children’s Hospitals, Marathahalli, Bengaluru is making every action count during these testing times. The team recently collaborated with the Rotary Club TTK Blood Bank to organize an in-house blood donation drive in the hospital premises to help save more lives.
A total of 61 blood donations were enabled through the drive. During Covid-19 pandemic, blood bank across the country are facing shortages of life-saving blood products due to a halt on blood donation activities. All protocols as per the recent Ministry of health & Family Welfare Guidelines like precautions related to social distancing, Infection control and biomedical waste management were strictly followed.
CC.2 The COVID19 pandemic has compelled hospitals to focus on Infection Control. How do you see the new focus affecting the healthcare services?
NL: Hospital-related infections have been widely reported during the ongoing corona virus outbreak, with healthcare professionals bearing a disproportionate risk. Due to the outbreak of Corona Virus, the hospitals have started focusing more on the infection control practices.
NL: Hospital-related infections have been widely reported during the ongoing corona virus outbreak, with healthcare professionals bearing a disproportionate risk. Due to the outbreak of Corona Virus, the hospitals have started focusing more on the infection control practices.
Previously, there was not much emphasis on the infection control practices like wearing PPE, hand washing, etc. But now all the hospitals are giving the priority to train the staff in the hand hygiene practices as well as the use of personal protective equipment like gloves, mask, gowns, etc.
This will have a tremendous impact on the healthcare services as it will reduce the number of the nosocomial infections and improve the quality of care. The hospital associated infection rate will reduce and there will be less chances of occurrence of certain infections like VAP (Ventilator Associated Pneumonia), CLABSI (Central Line Associated Blood Stream Infection), CAUTI (Catheter Associated Urinary Tract Infection) & SSI (Surgical Site Infection).
CC.3 You have been associated with healthcare quality and are closely working with the key drivers – ISQua, AsQua, QCI. What vision has been set out for India with respect to Healthcare Quality?
NL: As India is moving towards a journey for universal health coverage with Ayushman Bharat PMJAY, we should improve the quality of the healthcare. This can be achieved by
CC.3 You have been associated with healthcare quality and are closely working with the key drivers – ISQua, AsQua, QCI. What vision has been set out for India with respect to Healthcare Quality?
NL: As India is moving towards a journey for universal health coverage with Ayushman Bharat PMJAY, we should improve the quality of the healthcare. This can be achieved by
The individuals who excel in accomplishing the quality improvement must be recognized. In order to diffuse the quality improvement experience, the hub and spoke model can be used to create an institutional structure.
CC.4 Small Nursing Homes and Hospitals are diffident about the need for implementing QMS in their set-ups. Please comment.
NL: The managers of the small nursing homes feel it difficult to balance budget and quality & safety work in the organization. But Retrenchment in the budgets should not come at the expense of services. Employees of these organizations have to do extra tasks in addition to their regular work. They have less time to spend with patients and a reduction in the quality of health services. Due to lack of the time, there is inadequate incident reporting practice. Let me give you one simple example, when all workers are busy, the staff in the small nursing homes are not eager to take the time after their shift to complete the reporting.
CC.4 Small Nursing Homes and Hospitals are diffident about the need for implementing QMS in their set-ups. Please comment.
NL: The managers of the small nursing homes feel it difficult to balance budget and quality & safety work in the organization. But Retrenchment in the budgets should not come at the expense of services. Employees of these organizations have to do extra tasks in addition to their regular work. They have less time to spend with patients and a reduction in the quality of health services. Due to lack of the time, there is inadequate incident reporting practice. Let me give you one simple example, when all workers are busy, the staff in the small nursing homes are not eager to take the time after their shift to complete the reporting.
Other reasons are fear of reporting colleagues, and that the manager would ask why mistakes had been made. These are some of the prominent reasons that the incidents are not reported in these organizations.
Approximately 50,000 Health care organizations are functioning in our country out of which significant number fall under the Small Nursing homes. Lack of knowledge and staff training, poor insurance coverage and challenges faced by the Small Nursing homes for accreditation, are the road blocks for enhancing the level of quality care across the country.
To be more inclusive and encourage Small Nursing homes to join quality journey, NABH has developed Entry Level standards, in consultation with various stakeholders in the country, as a stepping-stone for enhancing the quality of patient care and safety.
CC.5 The condition of facilities in the public healthcare system, which is utilized by a majority of the poor and underprivileged population, leaves a lot to be desired. What should be the government’s priority then?
NL: India needs to set appropriate goals and reform the public health care sector’s governance and management systems so that they are able to deliver against the healthcare goals. The government should prioritize expanding and effectively delivering those aspects of health that fall under the definition of “public goods” for example, vaccination, health education, sanitation, public health, primary care and screening, family planning through empowering women, and reproductive and child health.
CC.5 The condition of facilities in the public healthcare system, which is utilized by a majority of the poor and underprivileged population, leaves a lot to be desired. What should be the government’s priority then?
NL: India needs to set appropriate goals and reform the public health care sector’s governance and management systems so that they are able to deliver against the healthcare goals. The government should prioritize expanding and effectively delivering those aspects of health that fall under the definition of “public goods” for example, vaccination, health education, sanitation, public health, primary care and screening, family planning through empowering women, and reproductive and child health.
The government’s regulatory mechanism will need to address issues of information asymmetry between doctors and patients which can be achieved by Hospital accreditation, increased importance for patient safety standards and guidelines, and Electronic Medical Records.
Proper distribution of the healthcare workers including the doctors should be done in the rural areas. Government can play a vital role in healthcare financing also.
CC.6 Awareness of the need to access Quality Healthcare Providers, even amongst the educated urban elite population remains very poor. The middle class and poor do not understand Quality Healthcare Services. How can this be improved?
NL: My observation is that most hospitals display the JCI or NABH Accreditation certificate but do nothing to create awareness among patients about it. The patients can be provided with the education material at the time of admission. Those who are not able to read should be explained about the rights and responsibilities. The rights & responsibilities should be displayed in the patient care areas in the dual language (English & Local language).
CC.7 What is your personal vision for healthcare, especially in India, in an ideal situation?
NL: India is facing a huge challenge of affordability and accessibility to provide the quality healthcare services. These issues can be resolved by allocation of higher budget to the national healthcare expenditure.
CC.6 Awareness of the need to access Quality Healthcare Providers, even amongst the educated urban elite population remains very poor. The middle class and poor do not understand Quality Healthcare Services. How can this be improved?
NL: My observation is that most hospitals display the JCI or NABH Accreditation certificate but do nothing to create awareness among patients about it. The patients can be provided with the education material at the time of admission. Those who are not able to read should be explained about the rights and responsibilities. The rights & responsibilities should be displayed in the patient care areas in the dual language (English & Local language).
CC.7 What is your personal vision for healthcare, especially in India, in an ideal situation?
NL: India is facing a huge challenge of affordability and accessibility to provide the quality healthcare services. These issues can be resolved by allocation of higher budget to the national healthcare expenditure.
The integration of the primary care with the higher level of care can reduce the burden at secondary and tertiary level of care. We should strengthen the primary healthcare centres with quality infrastructure, qualified medical practitioners and more access to drugs. We have to strengthen our low cost drug delivery program.
There should be a regular supply of drugs at public healthcare facilities. There should be proper distribution of the healthcare workers including the doctors in the rural areas. Technology can play a key role in improving the healthcare.
Better equipment can enable the medical professionals to provide more comprehensive care. With accurate government policies, India can provide better healthcare which in turn can improve the quality of life.
CC.8 How has Accreditation (NABH and NABL) helped to change the situation, especially with the IRDA mandate in place, making it mandatory for healthcare providers to seek at least Pre-Accreditation Entry Level Certification?
NL: The level of confidence and faith of the people in hospitals can be increased through accreditation since it ensures that the accredited healthcare organization practices and delivers continuous quality services and also functions in the best interests of all patient’s.
CC.8 How has Accreditation (NABH and NABL) helped to change the situation, especially with the IRDA mandate in place, making it mandatory for healthcare providers to seek at least Pre-Accreditation Entry Level Certification?
NL: The level of confidence and faith of the people in hospitals can be increased through accreditation since it ensures that the accredited healthcare organization practices and delivers continuous quality services and also functions in the best interests of all patient’s.
The primary goal of the accreditation is to ensure that the hospitals not only perform evidence based practices but also give importance to access, affordability, efficiency, quality and effectiveness of healthcare. It is quite evident that many regulations made by the government are not followed in most states and hence the quality of healthcare remains poor and unattended. Since accreditation is voluntary, it challenges the medical regulations laid down by the government both at state and central level.
Accreditation fills the gaps or removes the areas of deficiency and ultimately establishes optimum standards, professional accountability and clinical excellence. Even the Government has acknowledged that accreditation should be performed by a way of independent assessment programme and with incentives both for secondary and tertiary level of hospitals to ensure patient safety and quality of care.
CC.9 Currently only hospitals have a kind of compulsion to seek Accreditation or Certification and the rest of the value chain does not have any incentive or motivation to seek Accreditation. For how long should this continue and what is the way forward?
NL: Accreditation is the process in which certification of competency, authority, or credibility is presented. The process allows for organizations to learn best practices to better serve its client base. Currently, the accreditation is required for hospitals, SHCO (Small Healthcare Organizations), blood bank, blood storage center, MIS (Medical Imaging Services), Dental Clinics, OST (Oral Substitution Therapy) center, Allopathic Clinics, Ayush hospitals, Wellness centers, Clinical trial, Panchkarma clinic, Eye care organization and IRCA (Integrated Rehabilitation Centres for Addicts). But in my opinion, there should be accreditation for the rest of the value chain also.
CC.9 Currently only hospitals have a kind of compulsion to seek Accreditation or Certification and the rest of the value chain does not have any incentive or motivation to seek Accreditation. For how long should this continue and what is the way forward?
NL: Accreditation is the process in which certification of competency, authority, or credibility is presented. The process allows for organizations to learn best practices to better serve its client base. Currently, the accreditation is required for hospitals, SHCO (Small Healthcare Organizations), blood bank, blood storage center, MIS (Medical Imaging Services), Dental Clinics, OST (Oral Substitution Therapy) center, Allopathic Clinics, Ayush hospitals, Wellness centers, Clinical trial, Panchkarma clinic, Eye care organization and IRCA (Integrated Rehabilitation Centres for Addicts). But in my opinion, there should be accreditation for the rest of the value chain also.
The pharmacy companies, the medical supply vendors and the companies providing the medical devices should also be accredited. As they will go for accreditation, they will follow the particular set of guidelines which will lead them to focus on the best practices and provision of the quality materials.
CC.10 If you had to make certain changes in the way healthcare quality is being viewed and managed, what would they be?
NL: Improving the quality of health care at the system level requires a focus on governance issues, including improving public-sector management, building institutional capacity, and promoting a culture of data-driven policies. Efforts to improve the quality of health care in India and attempts to evaluate the impact of these efforts invariably face challenges because of the lack of reliable administrative data. It is critical for governments, implementing agencies, and researchers working in India to collaborate on evidence-based approaches to improve the quality of health care and health outcomes.
CC.10 If you had to make certain changes in the way healthcare quality is being viewed and managed, what would they be?
NL: Improving the quality of health care at the system level requires a focus on governance issues, including improving public-sector management, building institutional capacity, and promoting a culture of data-driven policies. Efforts to improve the quality of health care in India and attempts to evaluate the impact of these efforts invariably face challenges because of the lack of reliable administrative data. It is critical for governments, implementing agencies, and researchers working in India to collaborate on evidence-based approaches to improve the quality of health care and health outcomes.
Of the three categories of measures of the quality of health care (structure, process, and outcomes), structural measures have traditionally received the most attention in the form of government surveys of health facilities and record keeping to track the availability of resources such as numbers of hospital beds and personnel and quantities of supplies.
Measuring the quality of the process of delivering health care and the resulting health outcomes is especially challenging, requiring methods and approaches that go beyond standard service statistics and facility surveys.
CC.11 (a) Where does healthcare Quality and Accreditation go from here, and; (b) how can it be expedited, including addressing the shortage of Assessors?
NL: The healthcare sector in India has witnessed marked changes over the past few years. There is a growing demand for quality healthcare services. That has called for a closer look at the healthcare delivery systems and the necessity to introduce quality assurance mechanisms.
CC.11 (a) Where does healthcare Quality and Accreditation go from here, and; (b) how can it be expedited, including addressing the shortage of Assessors?
NL: The healthcare sector in India has witnessed marked changes over the past few years. There is a growing demand for quality healthcare services. That has called for a closer look at the healthcare delivery systems and the necessity to introduce quality assurance mechanisms.
The accreditation of hospitals assumes particular significance in this context. Accreditation relies on establishing technical competence of healthcare organizations in terms of certain standards in delivering services. Hospital accreditation remains a cornerstone for ensuring at least a basic level of quality, at least for things that the health care system assesses. Patients want to know that a hospital provides safe and effective care, and accreditation, if done right, can be a powerful tool to offer that assurance.
The Accreditation process should be given more importance and there should be training programs to include more and more assessors.
CC.12 Tell our readers about your association with On Frontiers, the New York based organization and their work?
NL: They have specific health care projects which are coming up in India. I used to support and advise them on real scenarios to operate in Indian health care environment based on my experience working in different healthcare facilities.
CC.13 You mentioned that you like working with healthcare start-ups. As a mentor, how do you coach and engage with them and what has been your experiences so far?
NL: The goal of every health tech startup is to provide better and affordable healthcare to those who need it. Majority of Indian healthcare tech startups are focused on preventive cure, convenient services & health management among many others. But there are certain health tech startup challenges that are stopping them from achieving their goals easily.
CC.12 Tell our readers about your association with On Frontiers, the New York based organization and their work?
NL: They have specific health care projects which are coming up in India. I used to support and advise them on real scenarios to operate in Indian health care environment based on my experience working in different healthcare facilities.
CC.13 You mentioned that you like working with healthcare start-ups. As a mentor, how do you coach and engage with them and what has been your experiences so far?
NL: The goal of every health tech startup is to provide better and affordable healthcare to those who need it. Majority of Indian healthcare tech startups are focused on preventive cure, convenient services & health management among many others. But there are certain health tech startup challenges that are stopping them from achieving their goals easily.
Some of these challenges include slow growth, complex healthcare industry, funding, and lack of healthcare mentors and need to connect to healthcare technology. Formulation of time bound, flexible, decentralized strategy having an appropriate mix of aforesaid measures is urgently required for optimizing the survival and growth of Startups in India, in today's difficult economic/ employment environment.
CC.14 Any parting words and advice to: (a) medical practitioners; (b) Nursing Professionals; (c) Healthcare Administrators, and (d) NABH Assessors with regard to providing qualitative healthcare?
NL: Of course delivering a high standard of care is a professional responsibility but professionalism must also encompass a commitment to continuously striving for better ways of working. In addition to influencing patients and populations, doctors will need to influence the systems within which care is provided.
CC.14 Any parting words and advice to: (a) medical practitioners; (b) Nursing Professionals; (c) Healthcare Administrators, and (d) NABH Assessors with regard to providing qualitative healthcare?
NL: Of course delivering a high standard of care is a professional responsibility but professionalism must also encompass a commitment to continuously striving for better ways of working. In addition to influencing patients and populations, doctors will need to influence the systems within which care is provided.
As the delivery of healthcare becomes more complex and the role of doctors within the system evolves, the medical practitioners should focus on the quality of the care they provide to the patients. In the future, it will not be possible to be an effective clinician without having a theoretical and a practical understanding of the science of quality improvement.
The role of professional nurses in quality improvement is very important. They carry out interdisciplinary processes to meet organizational Quality Improvement goals and to measure, improve, and control nursing-sensitive indicators affecting patient outcomes specific to nursing practices. All levels of nurses, from the direct care bedside nurse to the chief nursing officer, play a part in promoting Quality Improvement within the healthcare provider organization.
Managers in healthcare have a legal and moral obligation to ensure a high quality of patient care and to strive to improve care. These managers are in a prime position to mandate policy, systems, procedures and organizational climates.
Accreditation Assessors also play a vital role in providing the qualitative healthcare. Assessors should audit the healthcare organizations carefully in order to check whether the organization is actually following the quality practice or they are just doing it to clear the audit.
About the above photograph: Celebrating Children’s Day in Rainbow Children’s Hospital with India’s two most popular cartoons characters Chota Bheem and Chutki
Neeraj, I thank you for sharing your thoughts and radical ideas, which I am sure many Hospitals and healthcare workers in the system will benefit from and the appropriate government authorities will take note of your recommendations.
Thanking you once again.
Sarfaraz Lakhani
Calibre Creators
Note: The views expressed by Mr. Neeraj Lal are his personal and do not represent the view of the organisation he is associated with.
Calibre Creators
Note: The views expressed by Mr. Neeraj Lal are his personal and do not represent the view of the organisation he is associated with.
Nice article.
ReplyDeleteIncluding beneficiary feedback and setting up a system of complaints redressal can be useful to further improve quality of services.
Best wishes,
Very good suggestions, DR. Sundar.
ReplyDeletePractical view and suggestive ideas ! Good read
ReplyDeleteI'm pretty impressed with your article and exited too..
ReplyDeleteWe need senior level professionals and administrative health care service mentors for improving quality health care system in India.
Nice read and well articulated.
ReplyDeleteImpressive write up and some good suggestions
ReplyDeleteA very well articulated interview with insightful suggestions by Dr.Lal. Thank you Mr.Lakhani.
ReplyDeleteThe questions putforth portrayed the concerns of the Indian healthcare systems taking into consideration the Covid-19 scenario as a trigger towards quality healthcare in India. Also, the suggestions provided by Dr.Lal seemed realistic and implementable taking Indian healthcare systems ahead with this pandemic.
ReplyDelete