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 Table of Contents  
Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 52-55

Study to evaluate change of attitude toward acceptance of NABH guidelines: An intra-institutional experience

Department of Neurosurgery, NASA Brain and Spine Centre, Jalandhar, Punjab, India

Date of Web Publication12-Feb-2015

Correspondence Address:
Dr. Mandeep
NASA Brain and Spine Centre, Jalandhar, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2348-6139.151303

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Background and Objective: The next decade shall see a great change in the health care sector and there is a need for standardization of health care delivery at all levels, which at the moment is lacking in India. The standardization can come if we adopt some sort of uniform accreditation. For proper deliverance of health care, the role of medical staff is significant. This asks for an assessment on the attitude of medical staff toward accreditation and then the knowledge on accrediting standards. This study is conducted with the objectives to identify the attitude level of medical staff on accreditation, as well as their knowledge level on NABH standards.
Research Methodology: The study was conducted on 10 doctors and 40 nurses of the hospital before and 6 months after the start of accreditation process in the hospital. Samples were selected by simple random method. A questionnaire was used to collect the information about the attitude and knowledge of medical staff about NABH accreditation.
Results: The study revealed that medical staff had a positive attitude and improved knowledge about accreditation after 6 months working in a hospital on the way to NABH. The attitude reflected in their positive approach in managing patients under better work atmosphere thus, indirectly reflecting on the benefit to the society as whole.
Conclusion: The sound knowledge and a positive attitude toward NABH accreditation among the medical staff are very important. And the same can be accomplished with proper training and good hospital environment.

Keywords: Accreditation, attitude, Doctors, knowledge, NABH

How to cite this article:
Mandeep, Chitkara N, Goel S. Study to evaluate change of attitude toward acceptance of NABH guidelines: An intra-institutional experience. J Nat Accred Board Hosp Healthcare Providers 2014;1:52-5

How to cite this URL:
Mandeep, Chitkara N, Goel S. Study to evaluate change of attitude toward acceptance of NABH guidelines: An intra-institutional experience. J Nat Accred Board Hosp Healthcare Providers [serial online] 2014 [cited 2020 Sep 22];1:52-5. Available from: http://www.nabh.ind.in/text.asp?2014/1/2/52/151303

  Introduction Top

Since the quality is crucial factor in health care, initiatives to address the quality of health care have become a worldwide phenomenon. A commitment to quality enhancement throughout the whole of health care system involving all professional and service groups is essential to ensure that high quality in the health care is achieved, while minimizing the inherent risks associated with modern health care delivery.

One method that is being proposed is an accreditation system. The focus of accreditation is on continuous improvement in organizational and clinical performance of health services and not just the achievement of certificate or award or merely assuring compliance with minimum acceptable standards.

Accreditation cannot be done without the cooperation of hospital staff especially the medical staff. The medical staff has direct involvement in patient care, and major standards of accreditation are related to them. Hence, there is the need to access the attitude of medical staff on accreditation and to know the knowledge level of staff on accreditation standards. This brings out the need of the topic "Knowledge and Attitude of Medical Staff on NABH Accreditation".

  Research Methodology Top

The study is descriptive in nature. The information about the level of knowledge and attitude of medical staff about NABH was collected by questionnaire. Written consent forms were duly signed. The population consisted of nurses and doctors. The study sample consists of 10 doctors and 40 nursing staffs of the hospital. All the doctors and nurses of the organization with experience more than 6 months were included in the study. The tool and technique adopted for the data collection were questionnaire presented at beginning and 6 months of the start of the accreditation process. A questionnaire was prepared to collect the information on the level of knowledge and attitude of doctors and nurses on NABH accreditation. The pilot study was done to check its validity.

Tool: Questionnaire to doctors and nurses

Section I: Demographic data and general information about the respondents.

Section II: This section assessed the medical staff's attitude towards NABH accreditation and standards.

Section III: This section assessed the effects of accreditation on services.

Section IV: This section assessed the effects of accreditation of patient care.

Section V: This section assessed the attitude of medical staff towards infection control practices.

Section VI: This section assessed the HR management.

Apart from the demographic details the questionnaire consisted of 28 questions under 7 headings, grouped under 4 areas. Attitude level was evaluated using a 4-point rating scale. These items were scored as 1-4 in case of positive statement and 4-1 in case of the negative statement, depending on the agreement. The exposure and knowledge level was assessed using "yes" or "no" format questionnaire.

The investigator obtained the NABH standards from the guide book of NABH standards. Questionnaires were prepared based on that material and distributed among the sample groups of doctors and nursing staff to get feedback about the attitude and knowledge on NABH accreditation.

Inclusion criteria

Doctors and nurses who had working experience for at least 6 months in the particular hospital were only included in the sample group.

Exclusion criteria

  1. Supportive staff.
  2. Staff who had less than 6 months experience.

  Data Analysis Top

Statistical calculation was done using SPSS 15 with the percentage, mean and standard deviation as measures for descriptive analysis.

  Results Top

Medical staff's attitude toward NABH accreditation and standards


Medical staff's attitude and previous exposure to NABH accreditation and standards:

On the first assessment, 20% respondents agreed to the need for accreditation, 40% thought it was name sake, 10% considered it to be beneficial to patients and 10% thought that it would help the health care professionals, whereas post exposure, these figures changed to 90%, 60%, 100% and 80% respectively. 90% of persons agreed that it was not for the benefits of organization alone [Table 1].
Table 1: Need for accredition

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Effects of accreditation on services (positive effects)


Positive effects

On first assessment, 10% considered that accreditation improves the quality of service, 20% considered it is for better outlook about the services, 20%thought that it makes the work systematic, 10% thought it provides good image to the hospital, 10% thought it helps the healthcare professionals to update themselves, whereas postexposure, these figures changed to 100%, 80%, 70%, 96% and 100%, respectively [Table 2].
Table 2: Positive effects

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Effects of accreditation on services (negative effects)


Negative effects

On the first assessment, 30% respondents found that Accreditation increases the workload of the staff, 60% thought it increases the documentation process, 10% found it is an unnecessary management intervention, 20% thought, with accreditation; there is high chance of legal action by patient. 80% agreed it affects the productivity of the staff, none considered it decreases job satisfaction level, whereas, pre exposure, these figures were 80%, 80%, 70%, 70%, 20%, 40% respectively [Table 3].
Table 3: Negative effects

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Effects of accreditation on patient care


Effects of accreditation on patient care

After 6 months, 100% respondents considered that the initial assessment for inpatients must be documented within 2 h, 90% considered that every medical renewal entry should be dated and timed, 90% respondents agreed that medical records should be named and signed 80% wanted care plan to be counter signed by the clinician in-charge of the patient within 24 h. 90% agreed that accreditation improves the results, decreases medical errors and improves patient's rights and satisfaction. This was a significant change noticed compared to pre-exposure figures [Table 4].
Table 4: Medical error

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Section V: Attitude towards infection control policies


Morbidity and mortality outcomes improved due to better implementation of injection control policies. With knowledge, more and more staff started to use better techniques which helped in improving results [Table 5].
Table 5: Infection control practices

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Section VI: HR management


HR management

Majority agreed that introduction of NABH policy improves working condition, gives better job satisfaction and provides a feeling of security [Table 6].
Table 6: HR management

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  Discussion Top

This study proved that the doctors and nurses had a positive attitude towards accreditation after 6 months. The present study was done to find out the level of attitude and knowledge level of medical staff on NABH accreditation in a selected hospital, which are on the way to NABH.

After training on NABH accreditation and standards, the knowledge as well as attitude of the staff toward standardization changed. Doctors and nurses had a positive attitude on accreditation, 6 months later. Both the nurses and doctors were found to be less worried about the negative effects of accreditation.

The knowledge level among medical staff on NABH standards improved and a better compliant and harmonious working atmosphere was created between doctors and nurses. Moreover, patient care also improved. Staff was more satisfied with working environment and their rights and in turn, Management was satisfied because of better results delivered in patient care. No similar study could be found on the web.

  Future Research Top

  • Further studies can be conducted by increasing the sample size.
  • Studies can be conducted by taking staff other than medical staff as the subjects.

  Conclusion Top

The patients in today time are well informed and expect a standardized quality health care from hospitals. [1] Accreditation of hospital is a good way to provide standardization in treatment. [2] Getting the accreditation becomes easier if the efforts to do so are both by management and staff. This study also supports that the attitude and responsibilities of staff improves after their exposure and training of accreditation process.

  References Top

Jyothi G, Bidhan D. Developing national accreditation systems: Needs, challenges and future directions. Express Health Care Management; 2005.  Back to cited text no. 1
Ross MM. Encyclopedia of Health Services Research. USA: SAGE Publications, Inc.; 2009. p. 664.  Back to cited text no. 2


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

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