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A QCI Publication QCI

In a slew of initiatives, QCI takes a holistic look at raising and enhancing quality across the country: from the first workshop on clinical audit in the country to training and accreditation of Personal Accreditation Bodies.



Vol V No 3-4 n August-September 2011



10:54 AM

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Dz Č‚   Çł     “An opportunity for companies to showcase and share their success stories in the field of Qualityâ€? The Award The QCI-DL Shah Award has been instituted with a view to establish that bottomline benefits are achieved through quality initiatives. The Award recognises successful projects in the form of case studies of an organisation that have linked quality initiatives to real term financial gains and competitiveness. These awards are given after evaluation of the project(s) submitted by organisations. Awards will be given under different categories. These are: S.N.



Manufacturing General Service (Other than IT/ ITes/ BPO/ Hospitals/ Healthcare/ Financial) IT/ ITes/ BPOs Hospitals/ Healthcare Financial

2. 3. 4. 5.

Category A PSU/ Govt. A1

Category B Large B1

Category C SME* C1




A3 A4 A5

B3 B4 B5

C3 C4 C5

[Note1: *Micro, Small and Medium Units will be as per MSMED Act 2006 Note2: There are no entry/ registration fees for participating in the award.] Applicant can submit more than one project (case study) showing monetary savings from each project separately. Award Presentation The Awards will be presented in the 7th National Quality Conclave scheduled during February 2011 at New Delhi. Details regarding the requirements, terms and conditions and assessment process can be downloaded from QCI website For further details contact:;, The applications for awards (one hard copy and one soft copy)with complete details should reach the following address latest by November 30, 2011. Avik Mitra, Advisor/ Mr. Sunil Jaiswal, Asst. Director, National Board for Quality Promotion (NBQP), Quality Council of India 2nd Floor, Institution of Engineers Building, 2, Bahadur Shah Zafar Marg, New Delhi – 110 002 Tel: + 11 2337 9321, 2337 8056-57, Fax: 2337 9621;;


Quality India EDITORIAL

Quality in Public Services


reads: “For the first time in the country, Madhya Pradesh Public Services Guarantee Act, gives right to the citizens to get 52 public services within a timeframe and also gives them right of appeal in case of delay.” By any account this is a very laudable initiative comF LATE, there has been awakening ing from what was at one time in the category of among the citizens—from the ‘chalta hai’ attitude to BIMARU states (an acronym to describe the bad state of being an empowered lot. Citizens have begun to realise economy in Bihar, Madhya Pradesh, Rajasthan and that they have certain rights provided in the Constitution Uttar Pradesh). If pursued, this can become a trend-setthat had gone out of their minds. The Constitution of ter in the country. We also know of other states in this India as we know is, perhaps, the most comprehensive category i.e. Bihar, which too is actively working for simidocument when compared with other nations. The lar initiatives. Bihar has already become the first state to opposite is the one from UK, which does not have any have adopted QCI standard for Quality Governance of written Constitution, but is known to be one of the most government schools. If this be the trend, then it may effective democracies in the world. As an become another ‘tortoise and hare’ story where the tororganisation/nation attains maturity, it does not really toise (BIMARU) will show the way and may even go on matter whether there to win some of the key are written documents races in providing citior not. What is imporzen-centric services. The tant is that the system is Government of NCT established by way of Delhi also has widely norms and followed in publicised 32 public letter and more in spirit. services, where time limComing back to our its have been set up. It is own case, we have in up to citizens to be proany case a very well writactive and make sure ten-down system, then that initiatives by govwhere is the problem? ernments get institutionObviously, it is in the alised. POWER OF THE PEOPLE: The people of the country have startimplementation. The Performance ed asserting themselves and demanding their rights as was „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„ When an organisation seen in the recent campaign against corruption. Management Division If this be the trend (of lacks maturity, systems are (PMD) under the office of defined to micro levels so as not to leave things to the Cabinet Secretary has also launched guidelines for providing the right to chance. This makes things rigid. Alternatively, systems Resource-Framework Document (RFD). In fact, the citizens to get public can have a bit of flexibility so that they can accommodate outline on “Performance Monitoring & Evaluation Sysservices within a little changes for the overall benefit or at times to suit tem (PMES)” has the approval of the Prime Minister, by unforeseen circumstances. After a good six decades of which each department is required to prepare a RFD, timeframe and also independence, we seem to have learnt to work more on which basically provides a summary of the most imporgiving them the right of this flexibility and use it as a weapon of discretion. We tant results that a department/ministry expects to appeal in case of delay), also seem to believe more in the old saying: “It is safe to achieve during the financial year. It seeks to address three basic questions: (a) What are department’s main then the BIMARU states be in a chaotic organisation.” It seems to have gone to the extent that we consciously create chaos within sysobjectives for the year? (b) What actions are proposed to will show the way and tems to be safe for our selfish gains, without realising its achieve these objectives? (c) How would someone know may even go on to win adverse impact on society of which we too are a part of. at the end of the year the degree of progress made in The liberalisation initiatives in the year 1991 implementing these actions? That is, what are the relesome of the key races in brought magical results. Unfortunately, we have not seen vant success indicators and their targets? PMD is workproviding citizen-centric any more efforts of that kind in the past 20-years. We still ing to institutionalise RFD within the working systems of services. have a vast majority of public services directly under the departments and QCI will be partnering with PMD on government. We need to open out more and more serv- this initiative under National Quality Campaign. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„ ices to the private sector. Where needed, we can have GIRDHAR J. GYANI is the Secretary professional regulatory bodies. We already have good General of the Quality Council of India experience by way of SEBI, IRDA and TRAI. and editor of Quality India. He can be While I am writing this piece, I see full page advercontacted at tisements by the Government of Madhya Pradesh. It GIRDHAR J. GYANI AUGUST-SEPTEMBER 2011 I Quality India I 3




A QCI Publication QCI







Cover story Wanted:500 mn skilled workers by 2022 (June-July, 2011) was interesting to read. It is indeed a big challenge to train 500 million skilled workers by 2022. The country needs to create skilled workers to meet the growing and diverse demands of an ever-expanding market. Poor physical infrastructure, poor quality of incoming trainees, lack of employer involvement and shortage of quality faculty are the major challenges. Skill development should be focus area if India wants to achieve the target. In this regard, the role of National Skill Development Corporation (NSDC) is instrumental as it has got the onerous task to achieving this target. Virender Bhati, Baroda The healthcare industry is going through interesting phase as Accredited practitioners discuss ways to usher in quality healthcare (JuneJuly, 2011) illustrated. Healthcare, being one of the most dynamic and fast-developing fields in the country, has seen tremendous growth. Healthcare infrastructure too has seen phenomenal growth. In this regard, NABH has done exceptional work by creating accreditation programme for healthcare organisations. NABHaccredited hospitals have achieved higher standards in treatment and healthcare. Kamal Rahim, Jodhpur

QCI has taken the onerous task of embedding quality in critical sectors such as healthcare, education, industry and services. With the aim of promoting quality within the country, many initiatives have been taken by QCI. Details in the story.



The first-ever workshop on Clinical Audit ended on a right note with medical practitioners listing out the procedures used for diagnosis, care and treatment for the benefit of the attendees.



Samjhe Seekhe Gunwatta has become the buzzword for improving the quality of school education in the state as Bihar ushered in the NABET standard for Quality Schools Governance.

4 Quality India August-September 2011




National Board for Quality Promotion (NBQP) conducted an interactive workshop in which the methodology of writing projects was discussed while explaining ideal requirements, terms and conditions for the QCI-DL Shah Award applications.

TRAINING ASSESSORS p31 Dr Vijay Krishna from the American National Standards Institute conducted a workshop on how to train assessors. Dr Krishna emphasised the need for personal certification and the credentialing systems in the country.




Vijay K Thadani, Chairman, National Accreditation Board for Education and Training (NABET), talks about the future initiatives of NABET and how the institution is poised to change the education scenario in the country.

Building brand India through Quality (June-July, 2011) story deliberated on some very poignant facts about Quality. CII Institute of Quality has done a good work in instilling the values of quality in the corporate. Philip Crosby had said, "Quality is the result of a carefully constructed cultural environment. It has to be the fabric of the organisation, not part of the fabric." I think, the organisations should take a cue from this statement. Quality should be inherent in the company, not be instilled. Ultimately, it is the quality of people who make quality organisations not the other way around. Ram Sridhar, Chennai Connecting Bihar through quality bridges (June-July, 2011) made a pleasurable reading. Indeed, Bihar's Infrastructure Development has seen a phenomenal change especially to roads and bridges. Bihar was notorious for poor road connectivity as most of the roads were in bad shape. But now, the scenario has totally changed. Roads and bridges have become the hallmark of Bihar development. The credit especially goes to Nitish Kumar, who revived the almost defunct state-owned Bihar Bridge Construction Corporation and empowered it to transform itself into a profit-making venture that rapidly built bridges all over Bihar, which was riddled with rivers and prone to flooding. Gyan Sahay, Patna

Quality Council of India

ECHS will have to obtain recognition from the National Accreditation Board for Hospitals (NABH) within 18 months or face deempanelment. Plus NABET charts out school accreditation programmes and much more. 5 Quality India August-September 2011

Institution of Engineers Bldg., 2 Bahadur Shah Zafar Marg, New Delhi 110 002 Tel / Fax: 011 2337 9321 QCI 011 2337 0567 Designed, printed and published by Newsline Publications Pvt Ltd. D-11 (Basement) Nizamuddin (East) New Delhi -110 013 on behalf of Quality Council of India (QCI) at Nutech Photolithographers, New Delhi 110 020 Editor: Girdhar J. Gyani For private circulation only.

Quality India


NABH conducts first workshop on clinical audit

in India A

THE FIRST OF ITS KIND INTERACTIVE WORKSHOP ON CLINICAL AUDIT SAW EMINENT MEDICAL PRACTITIONERS LISTING OUT THE PROCEDURES USED FOR DIAGNOSIS, CARE AND TREATMENT. udit has acquired different meanings over time in relation to healthcare quality. The definition provided by the Department of Health emphasises the fact that clinical audit can be used to examine all aspects of patient care from assessment to outcomes. Clinical audit involves systematically looking at the procedures used for diagnosis, care and treatment, examining how associated resources are used and investigating the effect of care has on the outcome and quality of life for the patient. In brief, clinical audit provides a method for systematically reflecting on and reviewing practices. It is a very important quality improvement tool. National Accreditation Board


Clinical audit involves looking at the procedures used for diagnosis, care and treatment, examining how associated resources are used and investigating the effect of care has on the quality of life for the patient. Clinical audit provides a method for reflecting on and reviewing practices.

for Hospitals and Healthcare Providers (NABH), a constituent of Quality Council of India (QCI), held the first interactive workshop in the country on Clinical Audit on August 27, 2011 in New Delhi. Dr S Murali, Dr Sanjeev Singh and Dr Anand R, all eminent doctors in their specialised fields, conducted the interactive workshop sessions. The session’s deliberations, that included group activity of participants in each session, were: y An overview of clinical audit international and national. y Identifying a problem or an issue. y Setting criteria and standards. y Observing practice/data collection. y Comparing performance with criteria and standards.

INQUISITIVE MINDS: Dr R Anand answering the question of audiences.


6 I Quality India I AUGUST-SEPTEMBER 2011

y y

Preparing a report. Three case studies, one each medical and surgical related specialities and one in paediatrics. During the workshop the confusion with respect to various terminologies were pointed out. It was emphasised that just going through a medical record and pointing out deficiencies in care related aspects does not constitute a clinical audit. The participants developed the clinical audit as they progressed along the workshop starting from selection of topic to strategies for implementing change and more importantly sustaining change. On clinical audit methods terms often used are: Criteriabased audits, adverse occurrence screening, clinical incident audits,

Quality India

SETTING THE AGENDA: Dr Sanjeev Singh interacting with participants.

peer reviews and case note analysis. These are used inconsistently by different authors and tend to add to the general confusion about the clinical audit process. It is best to ignore this labyrinth of terminology since there is only one clinical audit method — the clinical audit cycle. This involves completing a number of stages and activities. It is essential to understand the importance of clinical audit and why it is an important activity. It helps improve the quality of the service being offered to users and without some form of clinical audit, it is very difficult to know whether hospital staff is practising effectively and even more difficult to demonstrate this to others. The benefits of clinical audit are that it: y Identifies and promotes good practice and can lead to improvements in service delivery and outcomes for users. y Can provide the information one needs to show others that the service is effective (and cost-effective) and thus ensure its development. y Provides opportunities for training and education. y Helps to ensure better use of resources and, therefore, increase efficiency. y Can help working relationship, communication and liaison between staff and service users, and between agencies. The overarching aim of clinical audit is to improve service,

user outcomes by improving professional practice and the general quality of services delivered. There are numerous topics which are available and relevant for clinical audit. Several ways of subdividing clinical audit topic areas have been devised. A useful framework has been provided and classified topics under three heading: ¾ Structure: The availability and organisation of resources and personnel. ¾ Process: The activities undertaken, that is what is done with the service’s resources. ¾ Outcome: The effect of the activities on the ‘health/wellbeing’ of the service user, that is, changes for the individual, which can be attributed to the clinical intervention they received. Now, the question arises how much time is required to do a clinical audit project? The clinical audits have to be precise and hence an audit cannot be weighed against time. For some clinical audit projects, data collection, analysis and action plans can be carried out in an hour or two. Similarly these audit stages can take one or more years to complete. What is important is to design a clinical audit project, which will produce meaningful data and, which can be finished within the budget and time available. The most time consuming element of any clinical audit project is the implementation of required for changes. It is suggest-

ed that projects be kept simple and cover areas in which changes can be achieved. A clinical audit project is more likely to be successful and beneficial to service user if all of the key stakeholders are involved from the outset. These may include: y Clinical and non-clinical staff providing the service. y Service users. y People whose support may be required to implement resulting changes in practice like managers, referrers and trust board members. As many of the above groups as possible should be represented on the clinical audit project team. In fact, the NABH standards mandate that clinicians and nurses be a part of the team. If individuals are unable to attend team meetings, then they will need to be consulted and kept informed about the clinical audit project throughout the process. From the outset a clinical audit project team works together when decisions are being made about what to audit and how to design the audit. Roles and responsibilities within the team will need to be identified, for example audit project lead, data collector. During the proceedings a few participants questioned the need for a clinical audit when a medical audit is already being done. Dr S Murali clarified that clinical audit tends to be used as an umbrella term for any audit conducted by professionals in healthcare and


The overarching aim of clinical audit is to improve service, user outcomes by improving professional practice and the general quality of services delivered. There are numerous topics, which are available and relevant for clinical audit. Several ways of subdividing clinical audit topic areas have been devised. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 7

Quality India


 Clinical audit tends to be used as an umbrella term for any audit conducted by professionals in healthcare and audits conducted by doctors are often referred to as medical audits. Since patient care is a multi-disciplinary approach clinical audits should be done.

Dr S. Murali

SPELLBOUND: Audience listening with rapt attention to the speaker.

audits conducted by doctors are often referred to as medical audits. It is important to stress that very few healthcare procedures involve just one professional discipline and that non-clinical staff such as receptionists, secretaries, porters, managers etc. play a vital role in the quality of the service provided. Clinical audit, therefore, is usually a multi-disciplinary activity. Many clinical audits are also multi-sectoral, that is, they may involve health and social service, primary and acute care providers, education and health. Another question that props up is service evaluation the same as clinical audit? Service evaluation may be defined as “a set of procedures to judge a service’s merit by providing a systematic assessment of its aims, objectives, activities, outputs, outcomes and costs�. There are many different approaches to service evaluation. Whichever method is used, the process should provide practical information, which helps inform the future development of a service.

Clinical audit may be one activity, which takes place during service evaluation, alongside other activities such as routine data gathering, incident reporting, and interviews with staff and service users. In order to conduct an evaluation, services need to consider their aims, objectives and then identify their key evaluation questions. In some quarters, there persists a doubt whether clinical audit is same as research. It has to be affirmed that clinical audit is not research, but it does make use of research methodology in order to assess practice. Although research and clinical audit are two distinct activities with different purposes, they are interrelated in several ways; these are: y Research provides a basis for defining good quality care for clinical audit purposes. y Clinical audit can provide high-quality data for nonexperimental evaluative research. y Research into the effectiveness and cost-effectiveness of clinical audit is needed.

Benefits of NABH Accreditation Benefits HCO y Stimulates continuous improvement. y Enables the HCO in demonstrating commitment to quality of care. y Raises community confi dence in the services provided. y Provides opportunity to benchmark with the best. y Benefits Patients/Customers y Accreditation benefits all stakeholders, patients/customers are the biggest beneficiary. y Results in high quality of care and patients/customer safety. y Patients/customers get services by credentialed staff. y Rights of patients/customers are respected and protected. y Patients/customer satisfaction is regularly evaluated. Benefits Staff y Staff is satisfied as it provides for continuous learning, good working environment, leadership and above all ownership of service processes. y Improves overall professional development of staff and provides leadership for quality improvement in various techniques. Benefits to others y Objective system of evaluation and empanelment by Third Parties y Provides access to reliable and certified information on facilities, infrastructure and level of care.

y y

8 I Quality India I AUGUST-SEPTEMBER 2011

Research needs to be audited to ensure that high-quality work is performed. A study involving (a) collecting information about service users to see whether the service is reaching the target population, and (b) obtaining feedback from service users, referrers and providers about various aspects of the service (such as accessibility, acceptability, effectiveness) in service evaluation. „

Quality India

The quality way to


CLEARING THE DOUBTS: Participants interacting with Prof A K Srivastava and Avik Mitra.


uality awards are aplenty — national and international — starting with Deming, perhaps, the earliest. There is the Malcolm Balridge and there are several Indian quality awards from the Rajiv Gandhi National Quality Award to the Ramkrishna Bajaj National Quality Award.

There is the QCI-DL Shah Award for quality award too. But there are differences between the QCI-DL Shah Award and the others. This award is given to projects and individuals or teams that have exhibited “economics of quality�. The QCIDL Shah award ignites improvement in activities, innovations and thereby creates a culture of quality in an organisation. It is

 DL Shah believed in ‘Quality as a philosophy’ in all spheres of life. A man of vision, an industrialist of repute and a noted philanthropist, he promoted world-class quality culture in the country and envisioned that the ‘Made in India’ label would be a respected brand the world over.

D L Shah Founder, D L Shah Trust

often said that it has not attracted CEOs’ attention because in their perception quality has no direct link to profit. On the contrary, quality has direct impact on profits, shows tangible savings, enhances innovative ideas and spreads quality culture within organisations. Quality Council of India’s (QCI) credo is National WellBeing and that can only be achieved through quality in every facet, however small, in our daily activities. The late DL Shah devoted his lifetime to propagate quality as well as promote it. Today, the DL Shah Trust is carrying forward his dream and the QCI-DL Shah Award is the fructification of that dream. The Sixth QCI National Conclave, held in February this year, saw an increase in the number of entries for the QCI-DL Shah Awards. This in itself was


QCI credo is National Well Being and that can only be achieved through quality in every facet, however small, in our daily activities. The late D L Shah devoted his lifetime to propagate quality as well as promote it. Today, the D L Shah Trust is carrying forward his dream. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 9

Quality India


LEARNING THE ROPES: Participants jotting down important anecdotes in the interactive session.

proof enough that companies and organisations were traversing the quality path. Irrespective of size, big and small, the companies sent several project reports — and many of them were outstanding. Each passing year has seen a rise in the number of participants and this includes several categories. Keeping that in mind, QCI has broadened the canvas of categories. For the Seventh QCI National Quality Conclave (2012) the categories are as under: Over the years it has been observed that entries submitted by organisations — and this is true for many of the award winning ones — lack clarity in projecting their quality activities through project (case study) reports till it is clarified during presentation. There is a methodology in writing, which has to be coherent, cogent and comprehensive and concise in presenting relevant details. What is needed is a methodology and to bring that in the National Board for Quality Promotion (NBQP), a constituent of QCI, conducted a workshop. Unlike others it was an interactive workshop conducted by Prof AK Srivastava and Avik Mitra. In the interactive workshop it was not speakers at one end and the listeners at the other. In addition to describing the methodology of writing projects (case studies) both Srivastava

S.N. Sectors

Category A PSU/ Govt.

Category B Large

Category C SME







General Service




(Other than IT/ ITes/ BPO/ Hospitals/ Healthcare/ Financial)


IT/ ITes/ BPOs





Hospitals/ Healthcare









and Mitra explained requirements, terms and conditions for the QCI-DL Shah Award applications. It spanned from a number of awards, eligibility, assessment criteria and processes, and details to be included in the applications. Number of Awards Under each category there will be a National Award and Commendation Awards. In case when no suitable project (case study) is found to be eligible under a category no award would be given. However, a certificate of appreciation will be given to all those projects which will undergo final site verification. The final decision pertaining to the awards will be taken by the jury. Eligibility for the Award The projects that are eligible to compete for the award must satisfy the following conditions: ¾ The organisation submitting the project has not



been convicted by any Court for any irregularities. The project(s) submitted by the organisation has not won the QCI-DL Shah Award (for the same project) in any previous years. The project details can be verified in India.

Assessment The assessment of the projects will be made on the basis of various parameters, which have been identified by a team of experts from QCI and DL Shah Trust. Emphasis will be placed on: ¾ Monetary savings, which are verifiable. ¾ Impact on product/services. ¾ Diagnostic approach for solving the problem. ¾ Methodology adopted for arriving at solutions. ¾ Sustainability of the approach along with scope of application in other areas. Assessment Process All the applications received shall undergo preliminary evaluation as per the criteria laid down on the basis of information provided by the applicant. Those selected after preliminary evaluation will become eligible for final assessment and factfinding exercises, which will consist of presentation of the project(s) and/or actual site visits to verify the claims on various savings and the quality tools used in the project(s). Details to be included Application pertaining to a project should be typed in double spacing and should not exceed 5,000 words. There is no

10 I Quality India I AUGUST-SEPTEMBER 2011


EXUDING EXCELLENCE: Winners receiving the QCI-DL Shah Award at the 6th National Quality Conclave.

defined format for submitting an application. However, the application should contain the following details: ¾ Brief information about the organisation. ¾ Full contact details of Chief Executive and Project Leader/Coordinator (name, address, Tel/Fax/Mobile numbers

and e-mail details) Executive summary of the project. ¾ Project description, which may include: 1. Details of how the project was identified. 2. Details of diagnostic approach on solving the problem including tools used. ¾

A guide for application *There is no entry/registration fee for participating in the award. *Applicant can submit more than one project (case study) showing monetary savings from each project separately. *The project should also demonstrate applications of right quality tools and techniques. *A team experts will be carrying out the preliminary evaluation and subsequent assessments. *Non-disclosure and confidentiality: The names of the applicants and scoring system developed for the assessment process will be regarded as proprietary and kept confidential. Such information shall be made available only to those individuals who are directly involved in the assessment and administrative process. *One hard copy and one soft copy of the application should be sent before November 30, 2011. *The Awards will be presented in the Seventh National Quality Conclave scheduled during February 2012 at New Delhi. The application(s) may be submitted to: 1. Avik Mitra, Advisor (E-mail: 2. Sunil Jaiswal, Assistant Director (E-mail: Address: National Board for Quality Promotion Quality Council of India 2nd Floor, Institution of Engineer Building 2, Bahadur Shah Zafar Marg New Delhi 110002. Tel: 011-2337 9321/2337 8056/2337 8057 Fax: 011-2337 9621

3. Details of methodology adopted for arriving at solution including validation for effectiveness on action taken. 4. Details of impact on product/services. 5. Details of sustainability of the approach along with scope of application in other areas and future actions. 6. Details of financial gains achieved in tangible terms and improvement of business results. 7. Any other points to provide clarity about the project viz. charts, graphs and photographs. ¾ Certificate from the CEO or Authorised Person stating the following: 1. That the information furnished is correct to the best of his/her knowledge and belief. 2. An authentication of the financial gains from the project. 3. That the project(s) has not received QCI-DL Shah Award in any previous years. 4. That the organisation has not been convicted by any Court for any irregularities. 5. An undertaking allowing QCI the copyright of the project case study (as per the attached form). The last date for submission of application(s) is November 30, 2011. „


Non-disclosure and confidentiality: The names of the applicants and scoring system developed for the assessment process will be regarded as proprietary and kept confidential. Such information shall be made available only to those individuals who are directly involved in the assessment and administrative process. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 11

Quality India

The need for regular

auditing IT IS ESSENTIAL FOR ALL ORGANIZATIONS TO CONDUCT AUDITS REGULARLY, WRITES D N C ATTYGALLE, TO ENSURE THAT SYSTEMS ARE EFFECTIVE AND EFFICIENT. nternal quality audit is a systematic and independent examination conducted by internal staff members. All quality management systems, environment management system requirements or any other system should have internal audits at frequent intervals, to monitor and comply with the implemented system. Audit guidelines are given in ISO 19011:2002 (as guidelines for quality and/or environmental management systems auditing). Conducting internal audit is a must. If any organisation’s systems (such as QMS/EMS/OHSAS, etc.) are operating without internal quality audits, the system is not effective and efficient. Audit is nothing more than fact-finding.


In many organisations, internal audits are neither effective nor used properly by the management. According to our experience after certification, it is found only 50 per cent of the certified organisations carry out internal audits once in three months. In many cases internal audits are conducted more frequently if auditors are given some extra incentive (monetary or recognition) for attending this activity. Audit will give outsiders guide or recommendation, after reviewing the existing processes, work instructions, objectives, non-conformities, corrective actions taken, preventive actions taken, records and the like, while, external audits are done as per the schedule by Certification Body (CB).

Conducting effective Internal Audit It is a general understanding that the auditor should have common sense. It is not a duty of the auditor to say everything as perfect and leave the auditee. When internal auditors have undergone trainings on the basics of auditing, keen on conducting the audits by preparing possible checklists, reviewing procedures and work guidelines before audit, the internal audits then become effective. Any audit starts using simple questions in horizontal plane. Later, questions can be asked to go deeper into the subject. In other words, auditor may conduct audits as vertically or horizontally as need arises. Vertical auditing and horizontal auditing According to our experience, vertical auditing is carried out by the auditors who look into the depth at particular processes/ activities in a department, checking key and support processes. They should have experience on the subject for a longer period. On the other hand, horizontal audits, spread among different departments, are carried out by the auditors at the initial stage. These auditors may follow one process from the start to end and spread among different departments. Questions during audit The option of asking open-ended

12 I Quality India I AUGUST-SEPTEMBER 2011

Quality India Suggestion to Improve cross function, 10%

Suggestion to implement foolproof methods, 5%

Categories of Internal audit results Minor document error Process Reengineering

Suggestion to Eliminate cause, 10%

Process Introduction

Suggestion to eliminate potential problem Suggestion to Eliminate potential problem, 10%

Suggestion to eliminate cause Suggestion to Improve cross function Suggestion to implement fool-proof methods

Process introduction, 5%

Minor document errors, 50% Process Reengineering, 10%

or close-ended questions or both during the audit is the option that an auditor has. Questions are the means to probe the unknown and collect information that is relevant to the purpose of audit. In most busy organisations sometimes process owners take shortcuts. Thus, the auditors are there to remind the correct way of doing things and make sure that anomalies are taken care of. The main purpose of internal audit system is to make sure appropriate planning and corrective action is implemented and monitor its effectiveness. Also ensure non-conformities identified in the system are cleared. The results of any previous audits, importance of function or procedure to the quality of service, familiarity of the function should be taken into account while conducting internal audits. The documents of persons/department being audited are always wary of being questioned. The aim of questioning is not necessarily to find fault but to gather information that could be used, at the end of the audit for corrective steps. Examples of open-ended could be — can you explain what do you do with this report or who has authorised this work or how does document change take place or similar questions so that other person starts talking. In closed-ended questioning the replies normally are yes or no, examples like — have you completed the training form or is this management rep-

resentative’s signature? Based on the observation it is seen that experienced internal auditors always: y Uses a checklist to structure each interview with auditee. y Explains what should be done with the audit results and in what manner the results used to fix problems. y Presents worthwhile findings to be followed. y Knows how to handle remote or antagonistic or reserved personalities. The auditor too has to observe correct protocol and not to seem as an intimidating person. A few useful tips to auditors for smooth audit functioning are: y Always be a good listener (which may entail 70 per cent listening and 30 per cent talking). y Never make assumptions (based on what has been told before the audit) but find facts and seek objective evidence. y Never promise solutions to the auditee. y If need arises record observations for future use/reference. y Keep questions direct and clear, and to the point. y Never be defensive continuously. y Never be derogatory or let down auditee person/ department. y If and when technical jargons are used by the auditee ask for explanation. Auditor also has to deal with results to discover trends and

improvement, highlight difficulties in the process, offer an idea on type of corrective action and ensure results of audits will influence scheduling of future audits. Introspection is an essential quality for an experienced internal auditor. The auditor can assess self at the end of an audit whether: y Are my contributions at satisfactory levels? y Have I helped the auditee to implement a mistake-proof or fool-proof system? y How could I make suggestions to improve existing processes, even in a small way (KAIZEN)? y How I contributed to reengineering processes? y What method have I introduced to ease their work? y Can fact-finding results be used in problem analysis and corrections? y Have my suggestions on traceability established in determining long-term effectiveness. y Always keep in mind methodology to fill the gap between expected and actual situation. For example, if there is a gap in tracaebility, auditor should purpose simple mechanism like checklist, table etc. „ (D N C Attygalle is a senior management consultant and trainer with more than 20 years of experience and a qualified auditor for EMS, QMS, OHSAS, FSMS, Laboratory Management System in Sri Lanka. He is a life member of QCI.)


The option of asking open-ended or closeended questions or both during the audit is the option that an auditor has. Questions are the means to probe the unknown and collect information that is relevant to the purpose of audit. In most busy organisations sometimes process owners take shortcuts. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 13

Quality India

Samjhe Seekhe


BIHAR CHIEF MINISTER NITISH KUMAR’S INITIATIVE TO ADOPT THE NABET STANDARD FOR QUALITY SCHOOLS GOVERNANCE PROMISES TO TAKE THE STATE TO THE TOP POSITION IN THE FIELD OF he NABET Standard for Quality Schools Governance was adopted by the Bihar government as the state’s standards for its schools at an impressive function presided over by Nitish Kumar, Chief Minister of Bihar. He launched a comprehensive programme, “Samjhe Seekhe Gunwatta’ (understandlearn quality) programme in all the districts of Bihar. Under this programme, an eight-minute documentary focusing on how to improve the quality of education for students in the state would be screened in all the schools in the districts. The demand-driven programe was launched in collaboration with UNICEF. The launch


date — September 5 — was significant since it is, Teachers’ Day and birthday of S Radhakrishnan, the country’s first Vice President, who was a great educationist and philosopher. The day was celebrated as Shiksha Diwas and many prominent policy announcements were made by the Chief Minister on that day. Organised by the state HRD department at Patna’s S K Memorial Hall, the ‘Samjhe Seekhe’ programme, the Chief Minister said, would now become a stepping stone for the growth of education in the state. The CM also emphasised: “Our goal is to stop the migration of our children to other states for quality education. For this, we

have made arrangements at preschool levels at various Anganbari centres across the state. The children are given free books and school uniform and are encouraged to stay in school by offering various programmes that keep them interested in education.” He also said that while he would ensure that each school had at least one Urdu and one Sanskrit teacher, he would promote learning of English at all levels. Deputy Chief Minister Sushil Kumar Modi also addressed the gathering. In his speech, he said that in 20112012, the state government had allotted a fund of `10,000 crore for promoting primary, secondary and higher education in the

FOR QUALITY EDUCATION: Anjani Kumar Singh, Principal Secretary, Human Resource Department, Bihar (standing, second from left), discussing some points about the programme with NABET Chairman Vijay Kumar Thadani (extreme left) and Yameen Majumdar, UNICEF chief, Bihar (right)


Bihar Chief Minister Nitish Kumar said that his goal was to stop the migration of children to other states for quality education. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

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Quality India

BOLD STEP: Bihar Chief Minister Nitish Kumar (third from left) with Anjani Kumar Singh, Principal Secretary, Human Resource Department, Bihar (extrme left), P K Sahi, Minister, HRD, on his right and Deputy Chief Minister Sushil Kumar Modi on his left launching the , 'Samjhe Seekhe' programme in Patna on September 5.

state. He also pointed out that “more than `3,000 crore is been allotted for the development of educational system under the ‘Sarva Shiksha Abhiyan’ in the state”. Modi also said that after distributing more than 35 lakh cycles to girl students, Bihar had become the first state for distributing the maximum number of cycles in the country. The function was also addressed by P K Sahi, Minister, HRD Department, Bihar. Speaking about the programme, he said: “This ambitious programme of the state government, ‘Samjhe Seekhe’ is aimed at making quality education available in all government schools. The emphasis will be to take Bihar to the topmost position in the field of education in the next three to four years.” Dr Yameen Mazumdar, Chief of the Bihar field office of UNICEF, was also present at the inauguration of Samjhe-Sikhen. He pointed out: “Samjhe Seekhe is an integrated package focusing on a new paradigm in academic support to schools, renewed focus on community involvement, strong monitoring and supervision system and bringing quality of education as the fulcrum of all future interventions in the system.” The Secretary, Higher Education; Director, Primary; Director, Secondary; Director, Higher Education; Director, SCERT; RDDE, Patna: Project Manager, Bihar Education Quality Mission

and many senior government officials from education department were also present on the occasion. The success of a nation depends on the education of its people. Education has to be at the core of the national development agenda. School education is, perhaps, the most important basic element of the education system as it lays a strong foundation for further learning. QCI compliments Bihar for taking this lead in being the first state in the country to adopt the Standards for Quality School Governance. The progress of the pilot project where 10 schools are working for accreditation is very satisfactory. The support provided by the education department is exemplary. Looking at the lead taken by Bihar, many other states are now approaching QCI to replicate the model. This standard has been developed with a view to defining and implementing systems to: ¾ Provide educational services that aim to enhance satisfaction level of all interested parties, ¾ Provide a basis for assessing and where required, rating the effectiveness of an educational quality management system, ¾ Develop quality consciousness among interested parties involved in school activities. The standard focuses on establishing systems to enable learning, self -development and

improved performance. It encourages schools to pursue continual excellence. The standard can also be adapted: a) As a self-improvement tool, b) For third-party accreditation/certification, and c) By statutory and regulatory authorities. There are three main elements of the standard focusing on the vital aspects of any school: a) School governance; b) Education and support processes; and c) Performance measurement and improvement. A 50-point checklist guides the schools in assessing their progress. The programme also focuses on ethical and moral development of students, teachers’ upgradation, social and career development of students, physical development, their health and safety and many more parameters that contribute towards a holistic education system for children. It involves all stakeholders in preparing and managing a comprehensive school governance model including parents, children, teachers and society at large to make learning enjoyable and knowledgeable for the children. Bihar is now seeking to replicate this model and increase the scope to all districts. QCI/ NABET is gearing to create local capacity in Bihar to support the state initiatives. „


Samjhe Seekhe is aimed at making quality education available in all government schools and take Bihar to the topmost position in education in three or four years „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 15


Quality India

Q: A:

NABET appears to be very different from the other Boards of QCI. In what way is it different and what are the focus areas of NABET? NABET or National Accreditation Board for Education and Training is engaged in the accreditation of education and training programmes and consulting organisations. Historically, NABET was set up to accredit training courses and auditors in the area of conformity assessment. However, QCI adopted the mission of "Quality for National Well Being," the scope of NABET has also enlarged to accredit Quality Schools Governance, Environment Impact Assessment Consultants, Vocational Training, and Skills Certification. Therefore, NABET has five verticals under its banner: ¾ School Governance ¾ Environment Impact Assessment ¾ Skills Certification ¾ Skills Training ¾ Management Systems Training

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Quality India


OUR SOCIETY” VIJAY K. THADANI, CHAIRMAN, NABET, ON THE ORGANISATION'S FOCUS AND ITS FUTURE. NABET is different from other boards as its large canvas of services impacts the basic foundation of our society. The number of people it impacts directly and indirectly is fairly significant. The key operating principles of NABET are: a) Voluntary accreditation While NABET promotes accreditation benefits and conducts awareness programmes, we do not favour mandated accreditation and encourage organisations and entities to go for voluntary accreditation. We strongly believe that adherence to a quality framework is best when it is a voluntary act. b) Globally valid, locally relevant Substantial thought has been invested in designing ISO frameworks such as ISO 17024 for personnel certification bodies and ISO 29990 for non-formal education and training. We believe in leveraging these existing internationally accepted standards and customising them for our local needs versus re-inventing the wheel. c) Cross pollination of best practices We strongly believe that best practices from one industry can be applied to solve similar problems in another industry. Many quality systems have emerged from the manufacturing industry, but have now been successfully adapted for other industries, such as the IT industry.

The demographics of the world have shown that India is going to have a surplus of youth power compared to the other countries. Government and its departments are focusing on formulating policies for harnessing this asset. What would be the role of NABET in these emerging scenarios and what is NABET doing to meet the future challenges? For India, to leverage its demographic dividend in the next decade, we need to ensure quality school education for all and enhance our skill development capacity by an order of magnitude. Any significant increase in scale creates an adverse impact on quality. Subsequently, for us to sustain our demographic advantage we need to have a replicable and continuously improving skill development model. NABET is participating in this process by encouraging various stakeholders, such as the state governments, school management, industry, and vocational training providers to adopt quality frameworks that enable them to meet their quality goals and achieve continual excellence. ‘Fungibility’ of skills is a key challenge in our vocational training system. The two dimensions of fungibility are: a) Consistent quality across institutes At present, the quality of

students differs across institutes. A standardized governance framework across institutes will help ensure more consistent quality. To address this, NABET has developed training programmes, benchmarks, and assessment techniques for vocational training institutes. b) Globally acceptable output Given the increasing global context at workplaces and the manpower surplus that we are predicted to have by 2020, international acceptability of our skilled manpower is another dimension of fungibility. To proactively address this, NABET has already aligned its accreditation mechanism to cover ISO 17024 and ISO 29990 guidelines. This will ensure that the vocational training institutions and skill assessment bodies have procedures that are universally accepted. Trainer quality and trainer productivity are another key challenges of our vocational training system. There is a significant dearth of vocational trainers. The World Bank research shows that in some states trainer vacancies in vocational training institutes are as high as 88 per cent and 76 per cent. To address this, NABET is inviting a number of international bodies to conduct Train the Trainer programmes. We are also establishing accreditation mechanism for Train the Trainer courses. Besides ensuring international compliance, this will ensure minimum quality


NABET has already aligned its accreditation mechanism to cover ISO 17024 and ISO 29990 guidelines. This will ensure that the vocational training institutions and skill assessment bodies have procedures that are universally accepted. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 17

Quality India

Q INTERVIEW standards for trainers and will also support their continual professional development. Also, NABET has developed accreditation criteria for Vocational Training Institutions in conjunction with Directorate General of Employment & Training. The accreditation criteria provide framework for the effective management and delivery of the competency based Vocational Education and Training (VET), aimed at overall development of the students. Environment and education are the two areas of major concern today. Has NABET been contributing in these areas also? What has been the impact so far? Both environment and education are important dimensions of growth. Any conversation on growth includes discussions around the environmental impact of the growth and significance of education to encourage and sustain growth. Both of these are very critical development areas, globally. NABET promotes accreditation in both these areas. Environment: In India, we recently crossed the 1.2 billion population mark. On May 23, 2007, according to researchers at the University of Georgia and North Carolina State, a tipping point was reached. For the first time in history, city-dwellers outnumbered the Earth’s rural population. The high population density in the cities is a great concern for India enhanced even more with the high pollution levels, erosion of green cover, and depletion of natural resources. In addition, to the environmental impact of migration, we are also pursuing growth of our manufacturing sector. The next five-year plan is planning to target 25 per cent growth from the manufacturing sector. NABET has been working closely with Ministry of Environment and Forests (MoEF). Carrying out Environmental Impact Assessment (EIA) is an essential component of most developmental and industrial

activities in our country. This has been adopted to ensure that development and environment protection goes hand-in-hand. To achieve this objective, it is crucial to ensure high quality of EIAs, which help in assessing the environmental impact of activities and in adopting measures for mitigating environmental risks. Many EIAs are unable to meet the objectives largely because of: ¾ Lack of a defined EIA process and scope ¾ Inadequate capability of the consultants ¾ Lack of measures to assess the quality of the EIA outputs ¾ Low quality of the input data In the Environmental Clearance Notification of September, 2006 issued by MoEF, some of the above aspects have been addressed particularly scoping for the EIA (which will now be done by the Ministry). Formats, such as checklist for environmental impacts and guidelines for EIA report’s structure have been defined to standardise the process. With proper scoping, the EIAs are expected to meet the desired objectives. To complement Ministry’s efforts, NABET has developed a system of accreditation of EIA consultant organisations, which provides benchmarks for: ¾ Experts required to prepare quality EIAs - their qualification and experience; ¾ Systems and procedures to be followed to ensure quality of primary data based on which the EIAs are prepared; and, ¾ Facilities needed by an organisation that wants to prepare EIA. The objective is to meaningfully contribute towards improving the quality of EIAs. For EIA accreditation, NABET follows the ISO 14001 framework, which is based on the Plan-do-check-act methodology. Per this methodology, an organisation ‘plans’ by establishing the objectives and processes necessary to deliver results in accordance with the organisa-

18 I Quality India I AUGUST-SEPTEMBER 2011

tion’s environmental policy. It then implements the processes and continuously monitors and measures the processes against the targets. Besides compliance to targets, the objective of ‘check’ is to also ‘act’, i.e. take actions towards continually improving the performance of the environmental management system. NABET accreditation is a public declaration that the accredited organisation is indeed implementing its environment policy. As of date nearly 100 consultant organisations are accredited. This scheme has created a structured mechanism in the market. Information on capabilities of an EIA consultant organisation is now available to project proponents. Also, because of this process a number of incompetent agencies and unskilled operators have been weeded out. Education: Schools across the country, especially in the rural regions suffer from many quality issues, such as inadequate infrastructure and inappropriate teacher-student ratios. In 2007, our past President Dr A P J Abdul Kalam gave a seven-point charter to QCI, wherein he emphasised that besides an existing affiliation system, there was a need for a quality management system based on accreditation mechanism. NABET, since then, has developed an accreditation standard for Quality School Governance. The standard was prepared in consultation with a number of stakeholders including academicians, parents, teachers, and management system experts. This standard was also forwarded to a number of international bodies for their feedback. The standard aims at creating a system for holistic education of the students. It includes many parameters that span areas such as ethical and moral development of the students, their health and safety, their social and career development, and their physical development. It involves all stakeholders

in preparing and managing a comprehensive school governance model, including parents, children, teachers, and society at large, to make learning enjoyable and knowledgeable for the children. The accreditation process followed by NABET involves self-evaluation and analysis by administrators, teachers, and students. This helps create awareness about the quality parameters and encourages schools to pursue continual development. How supportive has the government been to these initiatives? QCI has been set up under the Cabinet decision to support the government initiatives via an accreditation mechanism that is based on the principle of third party assessment. The core activity of QCI is accreditation to support the national initiatives and to bring international parity. The government is increasingly utilising QCI/NABET to not only ensure adherence to the quality parameters but also to build capacity. May last year, in an effort to streamline the system and to involve competent environment professionals in the entire process of preparing and implementing EIA/EMP as per Environment Impact Assessment (EIA) Notification, 2006, MoEF has taken initiative to accredit qualified and experienced consultants through NABET. This accreditation also covers consultants working in public sector undertakings. The Government of Bihar has already made significant progress in preparation of accreditation. These include identifying blocks and champions for each block and customising the 50 measures of QCI as per the statutory requirements of Bihar. Soon, the government will be launching awareness programmes to educate the principals and the teachers on the accreditation process and benefits. Ministry of Micro, Small,

Quality India SPECIAL ISSUE GLOBAL TIE-U UP: Human Resource Development and Telecommunicati on Minister Kapil Sibal unveiling the MoU signed between National Accreditation Board and Training (NABET) and the Scottish Qualifications Authority (SQA). Also seen in the background NABET Chairman Vijay K Thadani.

Medium Enterprises has made it mandatory to use the services of NABET-registered consultants and NABCB-accredited certification bodies to avail of the subsidy provided to a MSME unit for obtaining ISO 9001/ISO 14001 certification. Is any work being done by NABET in states also or it has remained restricted to the central schemes? NABET is working with state governments to build their local capacities in the field of education and vocational training. Various MoUs have been signed with Ministry of Labour and Employment, governments of Karnataka, Bihar and Sikkim. Discussions are in progress with a number of other state governments. The effort is to build a uniform accreditation mechanism throughout the country. NABET is helping these governments build local capacities and make them self-sufficient in resources and soft technologies. The objective is to establish world-class practices in NABET’s areas and to create a mindset of continuous improvement and excellence. Micro, Small and Medium Enterprises are the backbone

of our country. What is NABET doing to support the MSMEs? Truly, MSMEs form the backbone of Indian economy. They provide a significant source of employment for semiskilled workforce. There are about 26 million MSMEs in India and they employ about 60 million people. However, the failure rate of MSMEs is high. Access to adequate and timely credit at a reasonable rate, globally competitive quality, and know how to set up appropriate infrastructure are some of the key challenges that plague the MSME sector in India. A better predictability of the enterprise will reduce the risk perception of the banks, defined and measurable processes will allow for continuous improvement in efficiency and quality, and sharing of best practices within the sector will allow for better diffusion of the best practices. A robust quality system can help achieve all this. NABET has been actively working with various constituent bodies such as MSME, local chapters, and associations in conducting various programmes for this sector. We have trained ITI teachers on quality tools and have conducted 78 programmes that covered 1800 ITI teachers.

NABET has also conducted a survey of ITIs and ITCs to analyse the issues related to covering the needs of Micro, Small and Medium Enterprises. In addition, NABET has been regularly conducting awareness programmes in association with the Ministry of MSME throughout the country for emerging and traditional sectors.

the first phase of implementation. These included Healthcare, Construction, IT, Security and Energy. NABET has mutual recognition arrangements with International Register of Certificated Auditors (IRCA), UK, RABQSA International, Inc, Australia & USA and Scottish Qualifications Authority (SQA), Scotland.

What are the international linkages and what were the reasons for these? What are the future plans for the multilateral agreements? In the coming decade, India has a potential to emerge as the largest provider of skilled manpower in the world. For us to leverage this demographic dividend, our workforce needs to have globally recognised skill standards. International linkages help create global acceptance for our accreditation. Therefore, NABET has been focusing on bilateral agreements with peer bodies. In May 2010, we signed an agreement with American National Standards Institute (ANSI). The agreement is intended to promote and facilitate the development of skill standards, personnel credentialing, and an accreditation system in India. We identified 11 priority sectors to be targeted under

What are the new areas that NABET is gearing up to meet the national and international challenges? NABET is focused at ensuring that its accreditation mechanisms are in line with the international guidelines and address the needs of developing economies. We are therefore actively participating in international forums. The experts working with NABET are regularly exposed to the best international practices. Also, we are continuously upgrading our resources and technical teams. Leveraging technology to deliver our services is another key focus area. The credibility of NABET is evident from the fact that all the bilateral agreements have been signed with worldrenowned bodies that are very selective in aligning themselves with other bodies. „

AUGUST-SEPTEMBER 2011 I Quality India I 19

Quality India

Quality beyond

accreditation QCI IS GENERALLY KNOWN FOR ITS ACCREDITATION RELATED ACTIVITIES. DR GIRDHAR GYANI, SECRETARY GENERAL, QCI, PROVIDES OVERVIEW OF ACTIVITIES, WHICH GO FAR BEYOND ACCREDITATION. tandardisation plays an important role in upgrading products, in sustenance of quality and in technological advancement in manufacturing and allied support sectors. Standards play an equally important role in defining processes and systems leading to quality in organisations. There is a growing worldwide trend towards setting standards, which can facilitate quality and cost competitiveness, not only in manufacturing industry, but also for organisations, services, processes, systems, etc. The standards can be classified into two distinct categories:

S y


One of the main objectives of setting up the Quality Council of India (QCI) was to create an accreditation infrastructure in the country in line with the developments around the world and obtain international acceptance for the conformity assessment i.e. certification, testing and inspection. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„


Those which are mandatory and compulsorily enforced by law, i.e. regulations, and Those which are voluntary in nature and ideally are market driven.

Whether regulations or voluntary standards, implementation of these standards needs measurement either by testing or by inspection or by certification or by any combination thereof. ‘Conformity Assessment’, as these activities are called, has also grown worldwide as a consequence. With increase in demand for conformity assessment, the need arose for assuring its credibility in terms of technical competence and ensuring that its results — the test reports, the inspection reports or certifications like ISO

20 I Quality India I AUGUST-SEPTEMBER 2011

9000 certification — were accepted across borders. Thus, the discipline of ‘accreditation’ evolved, to attest the technical competence of conformity assessment bodies and establish their equivalence across the globe. In order to supplement countrywide enforcement of technical regulations, it is increasingly being practised the world over, to move towards using of accredited conformity assessment bodies for activities such as product certification, inspection, management system certification. The norms for using accredited conformity assessment bodies are to be drawn by the regulators through specific schemes. ESTABLISHMENT OF QCI One of the main objectives of setting up the Quality Council of India (QCI) was to create an accreditation infrastructure in the country in line with the developments around the world and obtain international acceptance for the conformity assessment, i.e. certification, testing and inspection. This was sought to be accomplished through the National Accreditation Board for Certification Bodies (NABCB) and the National Accreditation Board for Testing & Calibration Laboratories (NABL) for certification/inspection bodies and testing/calibration labs respectively. As the scope of accreditation grew beyond the traditional boundaries of conformity

assessment — into fields such as healthcare and education, QCI responded to the developments and market need by initiating accreditation in these areas by establishing the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and National Accreditation Board for Education & Training (NABET). With NABH providing for accreditation services to cover the entire gamut of healthcare services such as hospitals, blood banks, imaging centres, etc, and NABET providing or proposing to provide accreditation services in education where such a programmes does not exist, i.e. Schools, Vocational Training (ITI) and Ayush colleges, QCI is all set to provide framework for evaluation of competence of various types of organisations through its accreditation services. SUPPORTING REGULATIONS

The traditional method of regulation has been that the government/regulator prescribes the standards, and has its own inspection machinery (and labs if needed) to verify compliance. Many of the problems in administering regulations in India can be attributed to this model of regulation. There is a worldwide shift, away from this methodology, and in what could be termed as unbundling of regulations, increasingly, while the regulators are retaining the essential functions like registration of

Quality India

SETTING STANDARDS: QCI Secretary General Dr Girdhar J Gyani (second from left) along with Subodh Kant Sahay (third from left), Union Minister for Tourism unveiling booklet on Accreditation Standards for Wellness Centres.

manufacturers/establishments, market surveillance, prosecution, etc, they are relying for the conformity assessment aspects on independent third party professional bodies whose technical competence has been assessed through accreditation. In the Indian context, the drawbacks of the traditional system like the acute manpower crunch the regulators face and sometimes the inability of the existing machinery to assimilate latest developments like GMP/GHP, etc. in food and drugs sectors, mean that the need for such a shift in India is even greater. A significant development in this regard is the initiative of the European Commission, which has brought out EC Regulation 765/2008 and EC Decision 768/2008 on accreditation and market surveillance, which in turn has pushed the entire EU towards the use of third party evaluation to support the regulations across all sectors. In India, some of the new regulators have embraced the above worldwide trend as follows: ¾ The Petroleum and Natural Gas Regulatory Board (PNGRB), the newly established regulatory body in the oil and gas sector, was the first to decide to rely exclusively on third party conformity assessment system duly accredited by NABCB

and signed an MoU with QCI for providing accreditation services to support its regulations in June, 2008. QCI has helped PNGRB in approving 3rd party inspection bodies initially through a simplified assessment system and ultimately through accreditation to ISO 17020, the international standard for inspection bodies, from NABCB. QCI has provided nearly 15 inspection bodies through its assessment system to PNGRB for their approval and use. ¾ The Food Safety & Standards Authority of India (FSSAI) has taken a decision to rely on NABCB accredited inspection/certification bodies and NABL accredited labs to support enforcement of its regulations. It assigned a project to QCI to design the system for approving inspection/certification bodies and food labs for its purposes based on NABCB/NABL accreditation which has been done and is to be notified shortly. ¾ Similarly, the Warehousing Development and Regulatory Authority (WDRA) is also relying on the QCI system for approving third party agencies for warehouse certification. QCI has already assessed 5 certification bodies for WDRA and these have been approved by WDRA. ¾ QCI is helping the Drugs

Controller General of India in designing a system of ‘notified bodies’ based on accreditation for supporting proposed regulation of medical devices. ¾ The Ministry of Labour has also sought QCI’s help in designing a system of approving safety auditors/auditing organisations to administer the Factories, Act. ¾ Ministry of Environment and Forest (MoEF) has made NABET accreditation of EIA Consultant Organization mandatory. On December 2, 2009, Ministry of Environment and Forests (MOEF) has passed a circular that only those EIA/ EMP reports shall be considered by the Ministry after June 30, 2010, which are being prepared by QCI- NABET accredited consultants. As per latest notification issued on December 31, 2010 by Ministry of Environment and Forest (MoEF) date has been extended up to June 30, 2011. ¾ As member of the National Council for Clinical Establishment Act, QCI is assisting Ministry of Health and Family Welfare (MoHFW), in drafting the Application and registration process under the Clinical Establishment Act, 2010. QCI has been assigned the task of: y Carrying out the survey so as


In the Indian context, the drawbacks of the traditional system like the acute manpower crunch the regulators face and sometimes the inability of the existing machinery to assimilate latest developments like GMP/GHP, etc. in food and drugs sectors, mean that the need for such a shift in India is even greater. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 21

Quality India to study the existing models in the 11 states/UTs where the Clinical Establishment Act would be applicable initially i.e. States of Arunachal Pradesh, Himachal Pradesh, Mizoram and Sikkim and seven Union Territories covering the entire spectrum of healthcare delivery, namely private clinic(s), poly clinics, PHCs, nursing homes, medical colleges, AYUSH clinics, etc. y Analysing the above and drafting the minimum requirements of the said facilities in terms of structure, process and outcomes. The minimal requirement standards once finalised and approved by the MoHFW will form the benchmarks and will be used for registration and regulation. QCI will also draft ideal achievable standards based on the same parameters. These standards should be achievable after a defined timeframe. Once these are formed, further during the review, standards of various grades of services, i.e. benchmarks of various levels of excellence will be developed. HEALTH AGENDA: Eminent doctors expressing their views during the celebration of WHO Day organised by QCI.

VOLUNTARY INITIATIVES While regulations are vital instruments to enforce a minimum standards in areas of health, safe-

ty, environment etc. there are a large number of sectors where quality is driven by voluntary, generally market-driven initiatives. Many ministries/regulators/government organisations, in their quest for promoting quality in their domain areas, are keen on setting up voluntary programmes where the organizations complying with prescribed standards may not only get market recognition but in some cases even financial assistance from the government. QCI has helped them in designing such voluntary systems as follows: 9 The Department of AYUSH was looking for a quality mark on AYUSH products to enhance consumer confidence and tied up with QCI, which has led to the launch of a voluntary product certification scheme for AYUSH products in October 2009. 9 The WHO-GMP certification of Ayush (Herbal) drugmanufacturing unit is mandatory in almost all countries for their export. The Department of AYUSH has in principle agreed to use a process of evaluation of such units by competent and impartial third-party bodies with NABCB/QCI accreditation based on which the (expand)






9 22 I Quality India I AUGUST-SEPTEMBER 2011

COPP certificate will be issued. The Food Safety & Standards Authority of India (FSSAI) sought to launch a system of grading of restaurants based on food safety practices, in which QCI was the knowledge partner in developing the standard which has been adopted by FSSAI. QCI has also created a certification framework for assessing compliance of such a grading system. FSSAI has decided to create a voluntary certification framework for promoting good agricultural practices to provide good quality and safe raw material to the food processing industry in which again QCI is the knowledge partner having developed the India GAP standards for adoption by FSSAI and will create the certification system. Another initiative by FSSAI is to create an HACCP standard for voluntary adoption based on Codex standard, which has been drafted by QCI and provided to FSSAI for adoption. QCI will also create a voluntary certification system for the same that would make available an Indian standard for the purpose and industry would not have to seek certification to foreign standards. The National Medicinal Plants Board had sought QCI’s assistance in preparing a voluntary certification framework for medicinal plants based on good agricultural and field collection practices prescribed by WHO. The voluntary certification scheme has been recently launched. The Ministry of New and Renewable Energy has sought QCI’s help in creating an inspection/certification framework for solar energy service providers and assigned an` one crore project to QCI for designing the same. The National Horticulture

Quality India





i. ii. iii. iv.

Board (NHB) has developed standards for cold storages and QCI is providing competent inspection bodies for the purpose of inspection during construction of cold storages to ensure these follow NHB standards. Infrastructure Projects: The central/state governments are making huge investments in infrastructure projects and monitoring quality in such projects is a key concern. The accreditation of thirdparty inspection bodies specialising in areas such as construction, oil and gas installations, and water supply and power projects provide a ready solution to the need for an independent quality monitoring. In order to provide competent resources, QCI has announced a scheme for approving inspection bodies for infrastructure projects since July, 2009 and 10 inspection bodies have been approved under the system. NABET has a signed Tripartite Agreement along with Edcil India and Department of Elementary Education, Himachal Pradesh for establishing a quality governance framework for government schools. NABET has signed an MOU with Karnataka Vocational Training & Skill Development Corporation Ltd. (KVTSDC), Bengaluru for establishing a quality governance framework for Vocational Training Institutes falling under the jurisdiction of KVTSDC and other state govermnent affiliated VTPs. NABET has signed an MOU with DGE&T to grant accreditation in following areas: Vocational Training Providers ( VTPs) Assessing Bodies (ABs) Industrial Training Institutes/ Centre ( ITIs/ITCs) DGET Field Institutes (ATI, ATI-EPI, RVTI, MITI, CTI, CSTARI, and Apex Hi Tech Institute)

9 Training and Certification of Examiners of Assessing Bodies under Modular Employment Scheme (MES) of DGE&T. 9 NABH has designed a specific programme for accreditation of Oral Substitution Therapy (OST) Centres across the country to support NACO, MoHFW, and GoI. 9 NABH has designed and launched an Accreditation Programme for AYUSH (Ayurveda, Homeopathy, Unani, Siddha and Yoga & Naturopathy) Hospitals, for the Department of AYUSH, Ministry of Health & Family Welfare. It consists of two kinds of standards — Accreditation Standards and Structural Standards. Accreditation standards are based on three components — structure, process and outcome. These standards measure the quality and safety aspects of the care delivered to the patients. Structural standards basically deal with infrastructural requirements to help the organisations to deliver quality of care. For each specialty, i.e. Ayurveda, Homeopathy, Unani, Siddha. Yoga and Naturopathy, there are separate Accreditation and Structural Standards as per the individual system of medicine

and requirements. The first accreditation has been granted to an ayurveda hospital, the AyurVaid Hospital, in Bengaluru. Further, there are eight applications of ayurveda and unani hospitals under processing. 9 Medical laboratories based in PHCs, CHCs and district hospitals in the state of Kerala are undergoing a specially designed programme, named “Compliance to Essential Standards for Medical Laboratories”. About 360 laboratories are preparing to implement QA — program which would have a greater impact on quality of health services in the state. 9 Central Government Health Scheme (CGHS): The Ministry of Health and Family Welfare (MOHFW) asked QCI to help in empanelment of private hospitals and diagnostic centres. QCI has been providing such support to CGHS since 2006. This is an important initiative by the government to provide quality healthcare services to its employees and QCI is a proud partner with the MOHFW. 9 Ex-Servicemen Contributory Health Scheme (ECHS): The Ministry of Defence (MoD) asked QCI to help in

STRAIGHT TALK: One of the speaker putting forth his views during the seminar on Accreditation of Hospitals.

AUGUST-SEPTEMBER 2011 I Quality India I 23

Quality India CORE ISSUE: QCI Secretary General Dr Girdhar J Gyani (third from left) talking to the audience during the national workshop Food Safety & Standards Act — The Step Forward.


QCI initiated a programme of providing technical assistance to the government and its institutions as part of its responsibility as the apex quality facilitation organization in the country and being the custodian of the National Quality Campaign assigned to QCI at the time of its establishment by a Cabinet decision. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

empanelment of hospitals, nursing homes, eye hospitals, dental centres, diagnostic centers and polyclinics. These healthcare facilities are located in Type A, B and C cities. QCI is providing them support in evaluating and recommending to ECHS for their empanelment. For other specialty and super specialty hospitals, MoD has made it mandatory to obtain NABH Accreditation within 18 months. 9 Himachal Pradesh Government has sought QCI’s help on similar lines as for CGHS to empanel private hospitals and diagnostic centres. QCI has been extending such support to HP government since 2008. 9 NABH is providing technical assistance to Government of NCT of Delhi in preparing concessioner agreement for their PPP projects in two of the super specialty hospitals. 9 Quality Council of India has been requested by Ministry of Labour and Employment (MOLE) to launch and run an Accreditation Scheme for Smart Card Providers for empanelment under Rashtriya Swasthya Bima Yojana (RSBY). The scheme is an extension of accreditations being done by NABH for primary hospitals and insurance companies.

24 I Quality India I AUGUST-SEPTEMBER 2011

CAPACITY BUILDING It is realised that many of the services covered under QCI’s accreditation programmes especially in health and education sectors, are provided by the government and its institutions and the challenge is not as much in evaluating these organisations as in motivating them in implementing accreditation standards. Keeping the above in mind, QCI initiated a programme of providing technical assistance to the government and its institutions as part of its responsibility as the apex quality facilitation organisation in the country and being the custodian of the National Quality Campaign assigned to QCI at the time of its establishment by a Cabinet decision. To cite few examples, QCI is providing the following services to the government and its institutions: ƒ QCI is providing service to FSSAI to conduct gap study of their labs to identify gaps vis-à-vis international best practices. The study covers 50 labs including 40 state government labs and 10 potential referral labs. ƒ FSSAI has also assigned a project to implement service standards within the organisation to work towards achieving Sevottam. ƒ The Department of AYUSH had sought similar help from QCI to undertake a gap







study of six state government AYUSH labs in 2009. QCI has been given a project to actually upgrade the Homeopathic Pharmacopeial Lab (HPL) in Ghaziabad belonging to the Department of AYUSH to accreditation standard, ISO 17025. QCI is helping the Delhi Govt’s Food lab in obtaining accreditation to ISO 17025; the lab has been assisted in documentation and upgradation as per ISO 17025 and has filed an application for accreditation with NABL. QCI conducted a study for the Delhi Govt in early 2010 to suggest measures for ensuring food safety during the Commonwealth Games, 2010 MFPI had chosen QCI as the knowledge partner for the Food Safety and Quality year 2008-09 and QCI has conducted number of awareness programmes on food safety sponsored by MFPI since 2008. Provided Hand holding to 11 Navyug Schools so that they come up to expectation level of Accreditation. Out of these, 11 Navyug Schools eight Navyug Schools have been accredited by NABET Providing hand holding to 22 KVS. Out of these 22 KVS, six KVS have been accredited by NABET. Other KVS are in

Quality India HAND-IIN-H HAND: (L-R, on the dais) Dr Vishnukanth S Chatpalli, Executive Director, KVTSDC, H A Keshavmurthy, Deputy General Manager, KVTSDC, Ramesh Zalki, Secretary to the Government, Department of Labour, B N Bachegowda, Labour Minister, Government of Karnataka, Vipin Sahni, Director, NABET. The MoU was signed by Dr Girdhar J Gyani, QCI, Secretary General and S R Umashankar, Commissioner, Department of Employment and Managing Director, Karnataka Vocational Training and Skill Development Corporation Ltd.

different stages of assessment/ preparation ƒ Have signed an MOU with State Council of Education Research and Training, Patna for upgrading the 10 identified schools to the level of Accreditation. ƒ Have signed an MOU with Human Resource Development Department, Government of Sikkim, for upgrading the 10 identified schools to the level of Accreditation. ƒ Eight Schools have been identified by UT Chandigarh under School Health Programme for NABET Accreditation. NABET to help UT Chandigarh in formulating standard focused on health issues in schools. ƒ NABET has conducted survey of 130 ITIs/ ITCs and has submitted its report to DGE&T. The objective of the study is to i) Evaluate performance of affiliated Industrial Training Institutes (ITIs/ITCs) through assessment of a. existing infrastructure, b. resource availability c. effective utilisation ii) Capture feedback from stakeholders (employers) about competency of passed students (employed) and their expectations. A majority of the recommendations made by NABET in this report has been accepted by

DGE&T and action is being initiated by DGE&T on these recommendations. ƒ




Support to NACO: NABH is closely working with NACO to help improving quality of NACO supported blood banks around the country. NABET is conducting awareness programmes for Industry clusters in different parts of country on QMS/ QTT Tools under NMCP Scheme —Enabling Manufacturing Sector to be competitive through Quality Management Systems/ Quality Technology Tools being operated by Ministry of Micro, Small and Medium Enterprises. NABET is also conducting five-day ITI Teachers Training Programmes. The objective of this training programme is to make aware of the concepts related to QMS/QTT Tools and the same could be introduced in ITIs/ITCs. This project is being done under NMCP Scheme being operated by Ministry of Micro, Small and Medium Enterprises. Government hospitals of central government and various state governments sought help from QCI to facilitate NABH accreditation. QCI designed a specific programme to cater to this



need and about 120 hospitals are preparing to attain NABH accreditation in Gujarat, UP, MP, Kerala, AP, Tamil Nadu, Delhi, Assam and Karnataka. Five public hospitals (one in NCT of Delhi, one in Gujarat, one in UP, one in Kerala and one in Tamil Nadu) have already been accredited. QCI is also helping government and its affiliated organisations to do gap study against NABH accreditation standards to help them bridge the gaps related to infrastructure, equipment and man-power. District hospitals are referral destination for PHCs/ CHCs in a district and their accreditation will ensure quality services to a large segment of rural population in the country. QCI is proactively sensitising state governments/PSUs etc through state and nationallevel workshops for improvising their healthcare quality at primary, secondary and tertiary levels. Primary Health Centres (PHCs) and Community Health Centres (CHCs) in the state of Gujarat are also being supported under a unique collaborative programme and five PHCs have achieved accreditation. Seven others are in different stages of Accreditation process. „


NABET is also conducting five-day ITI Teachers Training Programmes. The objective of this training programme is to make aware of the concepts related to QMS/QTT Tools and same could be introduced in ITIs/ITCs. This project is being done under NMCP Scheme „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 25



Quality India

Learning from

mistakes LESSONS LEARNT IN ROOT-CAUSE ANALYSIS ARE CRITICAL SUCCESS FACTORS FOR SOLVING THE PROBLEM, WRITES ARUN HARIHARAN IN THE SECOND PART OF HIS ARTICLE ON ROOT-CAUSE ANALYSIS.* ears of experience applying root-cause analysis (RCA) to dozens of business problems taught us many lessons. We also made quite a few mistakes. Hopefully, we have learned from these too. Listed below are what we found to be critical success factors for RCA to be effective. I have also talked about our mistakes, so that you don’t make them (or, at least, have a good laugh at our expense). 9 Stopping before getting to the rootcause: We saw how, in the lizard story (see the last issue of Quality India), we almost stopped at several stages before getting to the root-cause — once after spraying the air freshner, then after the lizard was found and removed, and again after fixing a hole in the air-conditioning duct. At none of these stages had we actually reached the root-cause, which was the absence of preventive maintenance. We were merely attacking the symptoms instead of getting to the rootcause and eliminating it. This happened in several business problems as well — we sometimes found ourselves almost unwilling to get to the bottom of it. In some cases, we were fortunate to have someone like



The improvement can never be permanent unless the ‘prevention’ of the root-cause is institutionalised. And any institutionalisation means going back to the process. In other words, RCA without process-improvement is meaningless! „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

* The article on root-cause analysis was published and this article is the second part of root-cause analysis published in the June-July 2011 issue of Quality India.

26 I Quality India I AUGUST-SEPTEMBER 2011

Dev who gently pushed us along. In others, we learned the hard way — the defect kept recurring, or customers continued to complain, forcing us to eventually identify the rootcause and eliminate it. 9 “We did the RCA but there is nothing to change in the process”: Time and again, we

found that despite doing the RCA and identifying opportunities for improving the process, there was resistance to actually making the process-change (or introducing a new process where none existed, as in the lizard example). We were happy to take one-time actions like removing the lizard or even fixing the hole in the duct, but

committing to the discipline of following a process repeatedly in future seemed daunting. Or was it the accountability the process would bring that we were secretly afraid of? Unfortunately, as we learned, the improvement could never be permanent unless the ‘prevention’ of the root-cause is institutionalised. And any institutionalisation means going back to the process. In other words, we learned that RCA without process-improvement is meaningless! In fact, we realised from experience with RCA in various businesses, that there seemed to be only two types of how (to eliminate the rootcause) for any problem — process or people (often both). By process, we mean an absent or faulty process. By people, we mean that the process exists on paper, but it was not followed. This, in turn, could be due to lack of either training or discipline. In manufacturing industries, the cause could also be defective machines or parts or raw-materials, but these can also usually be traced back to either a process-issue or a peopleissue. Once the correct rootcause is identified, the solution is either to introduce a process (if no process exists), or improve the process (if it is

Quality India

Tools Used In Root Cause Analysis

faulty), or train/discipline people to follow the process. Wherever possible, ‘poka-yoke’ or mistake-proofing, sometimes with the help of technology, can be used to minimise the chance of human-error. A familiar example of mistake-proofing in computer data-entry is the use of an online calendar to select a date instead of actually typing in a date — which significantly reduces the chances of entering a wrong date. 9 Identify the root-cause, not whom to blame: One of the biggest hurdles on the road to the root-cause is the tendency to mistake the question why for who — as in whodunit? We often found people trying to fix the blame for the problem rather than get to the rootcause. We had to repeatedly tell (and prove to) people that the company was not interested in knowing whose fault it was, but only in preventing the problem from happening again. This has a lot to do with organisational culture. It is senior management’s responsibility to make everybody comfortable with discussing defects and complaints without getting into a blame-game. Companies like Toyota actually encourage employees to make quality problems visible. They even empower workers to stop production, if necessary, as soon as they detect a defect, to fix the problem (immediate correction) as well as for root-cause

analysis for preventive steps. 9 That’s outside our control: This is another common roadblock to root-cause analysis. The moment the ‘why-why’ trail led us outside our own department or our company, we tended to drop it, saying (with a sense of relief), “that’s beyond our control, there’s nothing we can do”. Almost every business problem we encountered involved more than one department within our company, and often, external entities such as vendors, distributors, partners to whom certain types of work was outsourced, and so forth. After months of losing improvement-opportunities on the pretext of ‘third-party dependency’, one day, somebody picked up the courage to ask, “So what?” Why couldn’t we get the relevant ‘outsiders’ (other departments or external ‘third parties’) to work with us in identifying the root-cause and reducing defects? We laughed at the person who suggested this, but let her go ahead and try it anyway (we couldn’t wait to see her get egg on her face). The first time this was tried was with an external company to which some key processes were outsourced. In the past, most customer-complaints used to be blamed (conveniently) on this ‘third-party’. To everybody’s surprise, at our request, this external partner was happy to work with us in reducing defects and customer-

complaints. We knew they were serious when they deputed three of their best people who were experienced with the process they were running for us, as part of the root-cause analysis team. Both companies found that not only did working together help reduce and prevent several types of customercomplaints, but also brought productivity-improvements and cost-savings. Such benefits are shared by both companies, increasing profits for both. 9 But nobody’s complained before: The best time to do RCA and eliminate a defect is as soon as it is first detected. However, often, defects don’t get the attention they deserve till customers start complaining. In some cases, we almost refused to accept the existence of a defect — till customers forced us to. Like Raj in the lizard story, even after complaints started to come, we would sometimes respond, “But nobody’s complained before!” I have seen cases where, despite getting several complaints, each time, our response would be that “nobody’s complained before!” We sometimes needed a flood of complaints to start actually paying heed to a defect. In the process, we lost time, money, and at times, customers. 9 But that’s the standard practice: A common response we get once the root-cause and solution were identified is “but that’s the way it’s always been


The preventive action to eliminate the root-cause to most problems is a process-change or behaviour change — and — as with any other change, there is often resistance. The best way to manage this change is to make sure that the people who actually ‘do’ the process are involved in the RCA. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 27




It is important for the RCA team to have the right attitude of prevention, not blame. The people doing the RCA must never forget that they are trying to identify what can be done to prevent the problem. Blaming someone outside our ‘circle of influence’ may be convenient, but will usually lead to a dead-end. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

Quality India

done”, or “that’s the industrypractice”. The preventive action to eliminate the root-cause to most problems is a processchange or behaviour change — and — as with any other change, there is often resistance. We learned from experience that the best way to manage this change is to make sure that the people who actually ‘do’ the process are involved in the RCA. This way, they are part of the solution rather than the problem. 9 Losing the way (or losing the why)? Have the right attitude. Use the template. Ask the customer. Observe the process: In some cases where RCA was being done, we would discover that we had lost our way or reached a dead-end at one of the whys. There would be no apparent further answer to why, nor would the point we had reached look like a root-cause with a clear preventive action. E.g. an insurance company was getting a number of customer-complaints for errors on policy documents. The company decided to find out the root-cause to help them reduce the errors. The RCA team’s answer to the first why to this problem was that there were errors in some of the application-forms given by the customers in the first place. These errors were carried onto the policy document. The answer to the next why (why were there errors on application forms?) was that customers completed the forms in a hurry (who likes to fill up forms?). Most of the team-members felt there was nothing we could do about customer behaviour. Some of them said that this RCA was getting us nowhere. Errors on some insurance policy documents was a ‘normal industry practice’ that we need to live with, they added. Fortunately, one team-member said, “Wait a minute! Is there really nothing we can do? Is the customer being in a hurry really the reason for errors? After all, the customer is more interested than anybody else in getting an errorfree insurance document, so

28 I Quality India I AUGUST-SEPTEMBER 2011

why would so many of them be hasty and put wrong information on the application form? Why don’t we speak to a few customers who complained and find out what really happened?” When we did this, we realised that we had got the answer to the first why wrong! The customers told us that they had never filled up the application in the first place. The company’s agents who sold them the insurance had asked them to just sign the blank application and collected certain mandatory documents for proof of age and address. The agents had told the customers that they would fill up the details later at the company’s office, to save the customer the trouble. As the agent was usually known to the customer, most customers would agree to this. The RCA team then decided to directly observe what the agents did next. Some of them visited the company’s office and observed agents who were there. Several agents were hurriedly filling up the application forms on behalf of the customer. They would rely on their own knowledge or the documents given by the customer (some of these were barely decipherable photocopies). The agent’s priority, of course, was to hand over the application to the company and collect their commission. The RCA team realised their folly — they had lost their way by answering the first why wrongly. The correct reason for the errors was not that the customer was completing the forms in a hurry, but that the customer was not completing their form at all — it was the agent based on second-hand knowledge who did this on their behalf! Once the real cause was identified, the RCA team realised that there was something the company could do about it. The preventive action was to make it mandatory for agents to get the form completed by the customer and educating all agents about this. The company saw a drastic reduction in the errors and com-

plaints when this was done. We learned from this example that it is important for the RCA team to have the right attitude of prevention, not blame. To arrive at the right answers to each why, the people doing the RCA must never forget that they are trying to identify what can be done to prevent the problem. Blaming someone outside our ‘circle of influence’ may be convenient, but will usually lead to a deadend as in this example. An easy way to avoid this is to pause for a moment after answering each why and ask, “Does this really explain why the previous step happened and is it leading us closer to finding out how to prevent this problem?” Do this before asking the next why. Using a simple template for RCA (see figure) helps a great deal to stay on the right path. We also learned from this experience that two easy ways of arriving at the root-cause or at least remaining on the right path to the root-cause are to ask the complainant for more details and to observe the process as it actually happens. Some of us were at first afraid of speaking to customers who had complained, but we found after talking to several customers, that most of them actually appreciated the fact that the company was taking their complaint seriously and involving them in the prevention efforts. Several customers said that the company’s efforts to eliminate defects from the root gave them more confidence in the company despite their recent bad experience and promised more business in future. „ (The third part of this article will appear in the next issue.) (The author is a Quality, Performance Management and Knowledge Management practitioner and has worked with business leaders in several businesses in strategic Quality and Knowledge Management. He can be contacted at This article was originally published in Quality Digest magazine in April 2011.)

Quality India

ISO 17024 is on personal


ENLIGHTENING THE MINDS: Dr Vijay Krishna, Senior Manager at ANSI, interacting with participants during the workshop.

t was not long ago, perhaps in the mid-1990s, that many Indian companies jumped on the bandwagon of ISO certification, the most popular being the ISO 9001. The rush for the ISO 9001 stamp was more due to commercial compulsion than due to real quality improvement with the companies prominently displaying “An ISO 9001 Company” realising little its implication or its import. It had to do more with the pressures from the World Trade Organisation and importers (mostly the Western countries) that expected exporting countries (the companies exporting goods and services mainly from developing economies) to have an ISO certification. That symbol of an ISO certification seemed more important than the context or content. It has to be admitted at that point in time that India did not


have Assessing Bodies (or Certification Bodies, as these are known in the West). As a result hordes of “Assessing Bodies” set up shops in India for certification. It is a moot point whether certification followed proper protocols and procedures. Realising its importance the Government established the Quality Council of India (QCI), an autonomous, independent body, to set up national standards on quality and also to promote and propagate quality in every sphere in the country — Quality for National Wellbeing, being the motto. The National Accreditation Board for Education and Training (NABET), a constituent of QCI, was tasked to set schemes for accrediting the assessment bodies. ISO 17024: 2003 covers the international requirements for assessment bodies confirming certification of persons. It is the most acceptable standard for personnel certification schemes the

world over. It has been drawn with the objective of achieving and promoting a globally acceptable benchmark, with consensus approval of more than 150 nations, for organisations operating scheme certification of persons. NABET and American National Standard Institute (ANSI), Washington DC, USA, have signed an MoU to cooperate for training and accreditation of Personal Accreditation Bodies. In pursuance of that MoU, Dr Vijay Krishna, Senior Manager at ANSI, was invited to conduct workshops at New Delhi, Mumbai and Bengaluru. At the outset he mentioned, “I am going to talk about theory and you have to relate it to the context in your organisation. Theory is based on context and the context I am going to speak is about the United States and I am here to share the experiences and you have to interpolate it to the Indian context.”


ISO 17024: 2003 covers the international requirements for assessment bodies confirming certification of persons. It is the most acceptable standard for personnel certification schemes the world over. It has been drawn with the objective of achieving and promoting a globally acceptable benchmark. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

AUGUST-SEPTEMBER 2011 I Quality India I 29

Quality India Personal certification and the credentialing systems increase the national human capabilities through focussing on skill development. There is, however, a challenge to re-skill people who lose jobs especially those that took place during and after the economic downturn. The problem is universal and not related to any specific nation. In this context , it is important to re-train and re-skill for alternative jobs. ISO 17024 is not merely about personal certification but, in a larger context, it is about assessing competency of people. The whole personal credentialing system is built around certain foundations to assess the skill of a person and his/her competency in his/her chosen profession. We have still not understood the importance of accreditation though QCI has gone aggressively to propagate and promote principles of accreditation. Let us take the examples in our daily lives: We call a plumber or electrician or carpenter or mason to attend to odd jobs either at home or in the office. Have we ever asked that person about a personal certification? If we do ask, the reply would probably state that the person has been working (in his trade) for the past ten or twenty years. Many

traditional jobs, for example, carpentry or masonry are handed down from one generation to the next. Most of them would have learnt their trade through a handson experience. That being the case what prevents them from obtaining personal certification? There are obviously inhibitions. “There are almost 4,000 certification bodies in the US, covering every kind of profession. Even a Yoga teacher is certified,” mentioned Dr Krishna. Here we seem to pay more attention to academic qualifications and little about the skill required to practice that profession. As a result, students coming out of this educational system do not get a meaningful employment. The need is to bridge this gap through certification. In the Western countries personal certification bridges this gap while we still have a long way to catch up. Dr Krishna said, “The problem confronted in the US is to find how many of these certification bodies is credible or quality certification bodies.” Thus, not only has the assessor to be credible, but the assessing (certification) body too has to be credible. In our context, the assessing bodies need to be accredited first for their competency and credibility before assessors representing

“Assessors must have the required standards” A S Kesai, Deputy Director General, Ministry of Labour and Employment, on the qualities of an assessor. It is now well known that by 2022 we have to have 500 million, skilled manpower. Under our ministry there are a number of schemes of which two major schemes are craftsmen training scheme and apprenticeship training scheme. We have observed that unorganised sector never had the benefit of any of these schemes and also noted that many, almost 92 per cent never attended any scheme. In 2007, based on studies, we developed skill development initiative programme under Modular Development Scheme. When this Scheme was started, one of the key features being assessment by independent

30 I Quality India I AUGUST-SEPTEMBER 2011

assessing bodies. In pursuance we advertised in the papers calling for Assessing Bodies and so far 41 Assessing Bodies have been empanelled. In doing so, we observed that assessors working with the Assessing Bodies did not have required standards. With a view to obviating this anomaly we signed an MoU with Quality Council of India (QCI) for certification of accreditation and ISO 17024 certification. Skills required for employment has to be properly assessed. So, the code of practice for the assessors has to be understood. After signing the MoU we notified assessing bodies to register with QCI and get accredited, which would enable us to maintain the standard in the country and at par with international standards. There is a difference between the job seekers and job and a competent assessor can help the job seekers, through proper assessment, to get a meaningful employment.

them meet the calibre. NABET conducts regular workshops on accreditation processes and the workshop by Dr Krishna was one such in the series concentrating on a ISO 17024, regarding personal certification. It is estimated that by 2022, the requirements for skilled personnel would be around 500 million in the country. Though 17 ministries are engaged in skill development for youth, the largest chunk is under the Ministry for Labour and Employment. In this context the Deputy Director General, A S Kesai remarked, “The importance is not merely in imparting skills. It is also about certifying and we intend to utilise third party assessment bodies for credible certification. We have requested NABET, through a MoU, to accredit assessment bodies.” ISO 17024 is not about certifying products or services but about people. In certifying people, it is about knowledge, skills and attributes. Certification is not simplistic and starts with Assessment Body. The requirements of an Assessment Body are: y Assessment criteria shall be fair and equitable among all candidates. Assessment Body shall follow all applicable criteria. Procedures shall not impede or inhibit access by applicants/candidates. y Policies and procedures for granting, maintaining, renewing, expanding and reducing the scope of the certification, suspending or withdrawing the certification. y Assessment Body shall confine its requirements, evaluation and decision on assessment to those matters specifically related to the scope of the desired assessment. It is of utmost importance that an Assessment Body has a proper organisation structure consisting assessment board, scheme committee, assessment body management personnel and subcontractors, if any. The organisation structure entails: y Assessment Body shall be independent and impartial in relation to its applicants/

Quality India candidates and certified persons, including their employees and their customers and shall take steps for ethical operations. y Assessment Body shall be responsible for its decisions relating to the granting, maintaining, renewing, expanding and reducing the scope. y Assessment Body shall identify the management, which shall have overall responsibility for (a) evaluation, (b) formulation of policies, (c) decisions, (d) implementation of policies, (e) finances and, (f) delegation of authority. y Shall have documents establishing it as a legal entity or part of the legal entity. In addition to the organisation structure, the Assessment Body shall have a documented structure that safeguards impartiality, including provisions to assure the impartiality of the operations of the Assessment Body. This structure shall enable the participation of all parties significantly concerned in the development of policies and principles regarding the content and functioning of the certification system without any particular interest predominating. The Assessment Body shall appoint a scheme committee that fairly and equitably represent the interest of all parties significantly affected without any particular interest predominantly. The Assessment Body shall have financial resources and policies to distinguish other activities so that other activities do not compromise impartiality and confidentiality. In doing so demonstrate training is independent of the evaluation and certification. It shall have policies and procedures for appeals and complaints and employ or contract sufficient people with the necessary education (domain knowledge), training and experience. It is cautioned that following situations should be avoided: y Trainer as an examination item writer. y Trainer as a member of the certification examination

committee. Trainer as an invigilator. Assessment Body shall develop and maintain an assessment (certification) scheme by identifying the core knowledge, critical work functions, job tasks and subtasks, and relevant skills and abilities. In addition it shall prepare representative sampling of current practitioners or job incumbents, content and performance domains to be identified and these to be updated periodically (at least 3 to 5 years, in keeping with technological changes). Evaluation: NABET accredits only organisations (assessment bodies) and not people, not dissimilar to ANSI. Likewise NABET sets national standards. The review of Assessment Bodies entails: y Assessment Body has the capability to deliver requested certification (assessment). y Accommodates any special needs of applicants. y Applicant has required education, experience and training. y Examine competence by written, oral, practical and other means. y All scheme requirements are objectively verified. y Adopt reporting procedures results of evaluation are documented appropriately. What is an assessment scheme? The scheme is related to meet the specific requirement related to academic and skill requirement. NABET has been accrediting academic and technical institutions. These institutions impart academic/technical knowledge to students but that does not necessarily means that individual has acquired the requisite competency. Accreditation is quite different, in a sense, from assessment of personnel. Assessment of a person is about competency, which is a combination of academic knowledge, training, skills, attributes and attitude. This evaluation is carried out by an assessor from an Assessment Body. The assessor ought to have domain knowledge of the subject/topic for conducting impar-


“ANSI sets the norms� American National Standard Institute (ANSI) is the coordinator of the US voluntary standards and conformity assessment system and official US representative to the International Organisation for Standardisation (ISO) and via the US National Committee, the International Electrotechnical Commission (IEC). ANSI is a private, not-forprofit organisation and one of the world's largest accreditation bodies operating the scheme of personal certification. As the voice of the US standards and conformity assessment system, ANSI empowers its members and constituents to strengthen the US marketplace position in the global economy while helping to assure the safety and health of consumers and the protection of environment ANSI oversees the creation, promulgation and use of thousands of norms and guidelines that directly impact businesses in nearly every sector: From acoustical devices to construction equipment, from dairy and livestock production to energy distribution and many more. ANSI is also actively engaged in accrediting programmes that assess conformance to standards including globally recognised cross-sector programmes such as ISO 9000 (quality) and ISO 14000 (environment) management systems. It currently administers two accreditation programmes for personal certification agencies. The first accreditation programme is based on the international standard ANSI/ISO/IEC 17024 and the second is based on the Conference for Food Protection Accreditation Standards for certification agencies that certify food protection managers. The process used by ANSI to accredit certification bodies is based on an international standard (ISO/IEC 17011). Adherence to a rigorous internationally recognised accreditation process ensures that the ANSI process conforms to the highest accreditation standard and represents the best practices in accreditation. ANSI is the only personal certification body in the US to meet nationally accepted practices for accreditation bodies.

tial assessment. On the other side, the Assessment Body, which the assessor represents, should have credibility in carrying out its task. The Assessment Body needs to be accredited to fulfil prescribed national standards. To train and skill 500 million is a humongous task. It is not merely skilling people, but to impart skills appropriate to the jobs in the marketplace. In doing so it is also estimated that India would be having 40-50 million additional skilled personnel while the world (in developed world) will be short of that many skilled personnel. It is an extremely incentive to find jobs elsewhere provided we have skilled, duly-assessed people to fill that vacuum. „ AUGUST-SEPTEMBER 2011 I Quality India I 31

Quality India

Quality in


QUALITY CONTROL: Patient safety should be given foremost priority while adopting best practices in hospitals.

ll of us want goods and services to be of a ‘good quality’ or of a ‘high quality’, if possible. All of us know that to get anything of a ‘high’ quality, more effort needs to be put in and the cost may be a little higher, yet we justify the higher efforts and cost with phrases like ‘No Compromise’, etc. In hospitals, ‘quality’ is a separate department.

A „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

The concept of quality may differ from personto-person and cultureto-culture. The need for quality will also differ for different goods and services. People may accept poor quality in disposable items because ultimately they are to be thrown out. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

What is quality? There are numerous ways of looking at quality. Apart from being ‘Best’, quality may also be thought of as ‘Value for Money’. This means that we get goods or services of a fairly good quality yet the cost is not very high. Naturally, this idea of quality is popular among the consumer, but the supplier will have to bear higher costs to maintain quality

32 I Quality India I AUGUST-SEPTEMBER 2011

and yet offer quality services at a lower cost to be considered ‘Value for Money’. The supplier will benefit by creating value for his business and getting the loyalty of customers. At the basic level, getting ‘quality’ means getting exactly what is promised or offered or named. For example, when we buy a shirt, quality means a garment of fabric, which will last over at least a hundred washes, will not tear or fade, the fit and the stitching will be perfect, the buttons will last till the life of the shirt and will offer protection from heat and cold to the wearer. Do the shirts that we buy offer all the listed items? Does the fabric fade? Does it tear easily? Do the buttons fall off? Is the shirt material too thin and transparent? Answers to such and hundreds of similar questions decide quality.

Cultural background The concept of quality may differ from person-to-person and culture-to-culture. The need for quality will also differ for different goods and services. People may accept poor quality in disposable items because ultimately they are to be thrown out. Yet, the same people might insist on eating the most expensive type of wheat or rice because they are concerned about their food. Some people will accept a cheaper television with fewer features because they cannot afford a costlier piece with the latest hi-tech features. This is not a compromise on quality but a compromise due to necessity. But the same people may spend more when it is a question of medical treatment for a member of the family. Quality in healthcare

Quality India What about quality when it is a question of healthcare? Can we honestly say that a little compromise here and there will not affect the outcome of a medical treatment given to a patient? The answer is a big ‘No’. Any compromise in the healthcare service industry may lead to nasty outcomes. A very unfortunate and sad example is the recent outbreak of hepatitis in Gujarat due to reuse of syringes. It is a standard protocol to discard and destroy disposable needles and syringes. It was not done, the syringes were reused. Syringes used on infected patients were also used on other patients without sterilisation. The result was that the other patients — innocent people — were infected with hepatitis and died. They should never have been infected with hepatitis except for the fatal reuse of syringes that should have been destroyed and burnt after first use. In healthcare, quality has to be taken care of in infrastructure, equipment and services. The actual quality of healthcare no longer depends on how well qualified a doctor is but how adequate his team is and how well equipped his hospital is. Can the doctors and the paramedical staff work as a team to face emergency situations? Does the hospital have life-saving equipment in working condition? An answer of ‘Yes’ to all these questions enables ‘Quality’ in a hospital. Equipment The better the quality of equipment, the better would be the outcome. This is so obvious, but here there is a clash between profit and commitment. The philosophy of the top management of a hospital will decide what equipment the hospital will buy. There are business pressures like competition, business cycles, newer technologies, which dictate what equipment is taken. If a hospital’s equipment is the best in the world, it is, of course, ideal. But if cost constraints do not allow the best,

the equipment should at the least be functional. It must satisfy the needs of the patients. Infrastructure Then comes infrastructure. Is it ideally designed? Do the patients have the least difficulty in reaching the hospital? Once inside the hospital, is the structure safe and solid to hold the number of people that may be expected to come? Are the electrical systems safe? Are there adequate lifts and are they reliable? Has the relevant inspector checked the lifts for safety? Are the lifts certified? How is the building protected against fire? Are there enough fire extinguishers? Is the fire- fighting system checked and certified by the relevant departments? Is a mock fire drill done from time-to-time to train the staff about how to react in case of fire? Is the building dust-free and air-conditioned? A centrally airconditioned building becomes important in infection control. Pathogenic bacteria cannot flourish in cooler temperatures and hence severely-burnt patients, who are prone to infections, are kept in chilled rooms. Also, a centrally air-conditioned building will be relatively dustfree and hence infection-free

because minute dust particles may harbour disease-producing (pathogenic) bacteria. There are hundreds of such questions that need to be addressed correctly before the adjective ‘Quality’ can be applied to a hospital. All the above do not constitute luxury. Most of the above items are necessary basics in a multi-specialty hospital. Service Perhaps, the quality of service is the most crucial component of quality in a hospital. Service includes not only the medical and surgical services, but also each service that a patient or his/her relatives might need during their hospital stay. In the times of nursing, pioneers like Florence Nightingale, the concept of quality did not exist because equipment was rudimentary and the infrastructure was never custom-made for a hospital. Any building was converted into a hospital as and when the need arose. But what made Florence Nightingale a saint amongst nurses was that she dedicated herself to serve patients. Today, she is a cult figure for nurses. Nurses dedicated to nursing think of her as a Godlike figure and follow her precepts.

Healthcare: Shortcomings in Quality (USA) It is but natural to ask what is the necessity of ‘quality’ in hospitals? The question will be answered by the eye-opening data found in the USA-based ‘Institute of Medicine’ (IOM) website ( on the following link: 8089/14980.aspx The IOM is an organisation independent of the US Federal Government. y Between 44,000 and 98,000 Americans die from medical errors annually. y Only 55 per cent of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes and to treat chronic conditions. y Medication-related errors for hospitalized patients cost roughly $2 billion annually. y Forty-one million uninsured Americans exhibit consistently worse clinical outcomes than the

insured, and are at increased risk for dying prematurely. y The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years. y Around 18,000 Americans die each year from heart attacks because they do not receive preventive medications, although they were eligible for them. y Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents. y More than 50 per cent of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately. Most of the above situations could be cured by implementing quality. If the condition of US healthcare is so shabby, it may be assumed that Indian healthcare may not be much better. Except for a few centres in Indian metros, ‘Quality’ is sadly missing from the Indian healthcare scenario.

AUGUST-SEPTEMBER 2011 I Quality India I 33

Quality India What is ‘quality’ in nursing care? A smile as soon as he or she enters a patient’s room (it must be remembered that a nurse means both a male and female nurse). Talking to patients, encouraging them to face their troubles bravely, using light humour to make patients smile, touching them gently, washing and cleaning them with empathy and most important of all, enjoying the work and thinking about nursing work as service to society and God. There are other routine procedural things like being available 24x7, informing patients before any procedure, explaining patients about a procedure if it involves pain or discomfort for the patient and so on.


Better quality in nursing care is achieved through both motivation and training. Training has to be continuous. As new staff is appointed, it needs to be trained to maintain the hospital standards. Older staff needs to be updated about newer medical methods and techniques. „„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„

34 I Quality India I MARCH-APRIL 2011

Training Better quality in nursing care is achieved through both motivation and training. Training has to be continuous. As new staff is appointed, it needs to be trained to maintain the hospital standards. Older staff needs to be updated about newer medical methods and techniques. All staff needs to be reminded about smiling at patients again and again as nursing is a tough profession. What is true for nursing is also true for all other ancillary services in a hospital. Apart from nursing, a hospital has attendants who help patients in personal matters, catering staff, who serve food, Patient Relationship Officers, who are an interface between the patient and his/her needs, Medical Officers, who monitor the patients and so on. If a hospital gives the best service to a patient, and during the discharge process if a billing person behaves rudely, the whole treatment experience may be marred. If the ambulance driver, who drops the patient home or at the airport, demands a tip, again that will reflect very badly on the hospital. Accreditation Ultimately, what are the rewards of Quality? Does investing more money in building an ideal hospital and buying the state-of-the-

art equipment and gathering the best of staff to run the hospital to ensure that the best patients will come to that hospital? Answer may be yes, provided patients come to know about the hospital. How will people know how good a hospital is? Is there any benchmark that shows how good the hospital is? Of course, there is. Just as good quality food items have the ‘AGMARK’, well-maintained hospitals that follow all the good practice procedures and protocols can also apply for and get accreditation from the Quality Council of India through National Accreditation Board for Hospitals and Healthcare Providers (NABH). International bodies like Joint Committee International (JCI) also give accreditation and certification. Corporate tie-ups Such certification makes the hospital known as a good institution. This makes it easier for corporate decision-makers whether to sign a contract with a hospital for the treatment of their employees. Thus, an accredited hospital has a much higher chance of being empanelled by companies that offer free or subsidised medical treatment to their employees. There are a few more areas and departments that must be mentioned. Medical waste management Hospital waste is special because it is a potential source of spreading infection. Hence, first and foremost all hospital waste must be separated in four types of containers, which are colour-coded blue, yellow, black and red. Sharp objects like needles go in one container, soiled cotton wool and gauze in another, food waste has a separate container and so has paper waste. The approximate amount of waste which may be generated by each hospital, is estimated by standard of reckoning. If a hospital generates less waste, the authorities of that hospital may be questioned whether they are

throwing waste into garbage dumps. Operation theatres Also called OTs, these are the most critical rooms in any hospital. After every surgery of a wounded patient the OT will be cleaned and fumigated to prevent transmission of infection from one patient to the other. All OTs will undergo deep cleaning and fumigation once a week. All the instruments used in each and every operation must be first washed and then sterilised as per predefined protocols before the next operation. All the clothes that the surgeons and anesthetists wear during operations must be similarly washed and then sterilised. Infection control This is, perhaps, the most important section of any hospital. The aim is to prevent transmission of infection from one patient to the other. It is best done by preventing any accumulation of dirt anywhere. Toilets, floors, each room and each bed for that matter are kept hyper-clean. Medical insurance Today, most of the time, payments for medical treatment is done through medical insurance. If a patient has a medical insurance he/she needs to claim the cost of the treatment from the insurance company. A good hospital will have a separate cell that helps patients get an approval and payment for treatment from their insurance companies. This eases the burden on the patient. The quality of food served to patients in a hospital needs to be constantly monitored. For environmental conservation, nonrenewable natural resources like water need to be harvested from rain. All possible measures must be taken to avoid the waste of both electricity and water. Thus, Quality in the Healthcare Service Industry is not a onetime investment. It is a person/independent continuous ongoing process. (The writer is Vice PresidentQuality, Shalby Hospitals, Ahmedabad, Gujarat and can be contacted at: or „

Quality India

Q FOCUS Impact of lead

on society A LITTLE KNOWN FACT ABOUT THE MOVE TO MAKE PEOPLE AWARE ABOUT LEAD POISONING IS THE COVERAGE OF KERALA BY THE NRCLPI IN LESS THAN 60 DAYS, WRITES VENKATESH THUPPIL. RCLPI (National Referral Centre for Lead Poisoning in India) and NBQP have joined hands to create LESS (LEad Safe Society) through a nationwide initiative in creating leadawareness among the general public and to make them realise that Lead poisoning is 100 per cent preventable. To date more than 10000 LEaders (Lead educators) throughout the country are playing an important role in creating awareness about the handling of lead in the right way. Perhaps, nowhere in the world has such a massive initiative has been taken to create volunteers in such a big number in a short time. This is one of the efforts to move towards National Well Being. A decade of untiring effort towards "National Well Being" has been taken forward. It was triggered a few years ago when the NRCLPI brought to the notice of QCI about the environmental and health risk associated with the global number one toxic heavy metal: Lead. Data from earlier studies by The George Foundation in 2,000 revealed that over 51 per cent of children below 12 years of age in seven metros in India were found with more than 10 micrograms per deciliter of lead levels in their blood. This was resulting in the reduction of IQ in most of these children. Realising the gravity of the situation and the fact that the country would be


facing environmental pollution and lack of awareness in the area of lead poisoning, QCI initiated much-needed awareness through Lead Educators (LEADer programme) as the flagship programme of the NRCLPI across the country with total support from NBQP. NRCLPI in its lead awareness programme reached around 10,000 school teachers across India in a short period of time covering over ten states including the interiors of Bihar and PRE-E EMPTIVE MEASURES: Craftpersons being sensitised about lead poisining Jharkhand by 2010. This was in LEADer programme. a massive programme supand enable them to share ported by NBQP towards NGOs for the programme. their experience at home, National Well Being. The first phase of the proworkplace, etc.; The National Rural gramme began on June 28 at ¾ In addition through Health Mission (NRHM), a Tiruvanathapuram. The two group discussions make friendly partner, posed a chalsubsequent phases covered the the participants express lenge to cover the whole state rest of the districts by the last their opinion and clarify of Kerala within a short period. week of August 2011. In a their doubts; and, During 2011, recognising the record time of less than 60 ¾ The participants were importance of taking such a days, a full state was covered given DVDs of the presprogramme at the grassroots reaching out to the grassroots' entation and QCI sponlevel, NRCLPI with the suplevel administration in the sored 'Lead and U' docuport of the QCI modified the State of Kerala. A national-levmentary produced by LEADer programe including el faculty under the leadership NRCLPI to enable them hazardous waste management of Professor Shashidhara conto be equipped with suffias desired by the National Rur- ducted the programme in the cient knowledge for conal Health Mission (NRHM). state of Kerala. ducting similar proTaking the message across the The full-day workshop was grammes on their own. entire State of Kerala, the total designed to stimulate the parNRCLPI is now assisting number of 26 Lead awareness ticipants to take it forward in QCI in getting much-needed programme was conducted their respective work areas. In regulation for L ead-safe paints with the full logistics support addition, participants had the for decorative and domestic from NRHM. The proopportunity to: ¾ Arrive at workable solu- usage and eliminate toxic lead gramme was organised in 14 tions by understanding from traditional medicines. districts of Kerala in three the situation and to The much-needed awareness phases. NRHM officials address their local needs; in the remote north east corselected participants from vari¾ Empower participants as ners of our country are replious sector such as Doctors, LEADers by giving them cating the Kerala model to Engineers, Professors, School required information to make people aware of lead poiand College Teachers, Nurses, meet real-life situations soning. „ Panchayat raj activists and AUGUST-SEPTEMBER 2011 I Quality India I 35


Quality India NABH decodes ‘Indian perspective on accreditation’

nternational Forum on quality and safety in healthcare, held in Amsterdam from April 5 to 8 this year, had invited Dr Narottam Puri, Chairman, NABH, to speak on the Indian perspective on accreditation. Dr Puri highlighted the quality improvement measures underway in India and the role of accreditation on improvement. The quality improvement is a process, which encompasses several different parameters. Accreditation is one such tool that may be used for improvement. He focussed on Indian accreditation programme, the services on offer and the progress of the programme. National Accreditation Board for Health Healthcare Providers (NABH) has been a member of International Society for Quality (ISQua) accreditation council since 2007. This council is responsible for International Accreditation Programme (IAP) on behalf of ISQua Board. IAP covers three accreditation programmes — organisation, standard and surveyor training. IAP is operated by accreditation council having 15 members representing different accreditation bodies from across the globe. Council meets at least four times a year including twice face-to-face. ISQua accreditation council mid-year faceto-face meeting was held in Ultrecht, the Netherlands during April 4-5, 2011. Representatives from Australia, Canada, Denmark, France, India, Jordan, Malaysia, South Africa, the Netherlands, the United States of America, the United Kingdom and ISQua international office in Durban attended the meeting to review


GROUP INTERACTION: NABH group members with foreign delegates at Amsterdam, Netherlands.

the products of IAP, surveyor nomination and selection process, board updates, ISQua accreditation promotion and values, role description for council.The last meeting through tele-conferencing was held on June 28, 2011. The next face-to-face meeting is scheduled to be held on September 13, 2011 during ISQua annual conference in Hong Kong. One of the roles of IAP of ISQua is to harmonise healthcare quality standards and push the agenda of quality improvement in healthcare setting. This is achieved through evaluation of standards, surveyor training programmes and healthcare external evalua-

tion organisations by a team of international surveyors. These surveyors are on the panel of accreditation council. One such survey was organised by council recently. Dr BK Rana, Deputy Director (NABH) led this three-member ISQua survey team for the evaluation of Health and Disability Auditing Australia (HDAA), Brisbane during July 11-15, 2011. Other team members were Paul van Ostenberg from JCI and Carsten Engel from IKAS, Denmark. HDAA operates its certification and accreditation programme in the area of disability service provider and diagnostic imaging in line with the requirements of Department of Health, Australia.


mulls accreditation he South Asian Association for Regional Cooperation (SAARC) countries and German National Metrology Institute (PTB) held a workshop on accreditation at Thimphu, Bhutan on July 4 and July 5, 2011. Accreditation provides a framework for establishing equivalence of test results, inspection results and certification and has been referred to in World Trade Organisation (WTO) and Technical Barriers to Trade (TBT) agreements as tool to overcome technical barriers to trade. Above all, it provides a reasonable assurance of acceptability of conformity assessment results when supported by Mutual Recognition Arrangements (MRA) and/or Multilateral Mutual Recognition Arrangements (MLA) as managed by International Laboratory Accreditation Cooperation (ILAC) and International Accreditation Forum (IAF). Hence regional economic integration is closely linked to the question of how a member states effectively cooperate in the field of accreditation. This is particularly relevant for regions with heterogeneous structure in terms of market size, laboratory landscape and status of accreditation systems. In this context a regional approach would


36 I Quality India I AUGUST-SEPTEMBER 2011


help, at least at the initial stage, to share accreditation facilities of MRA signatories in order to facilitate acceptance of conformity assessment carried out in neighbouring countries. In the framework of SAARC-PTB cooperation, four regional accreditation workshops had been realised to date. The Fifth Workshop on regional cooperation in accreditation held on July 4 and 5, 2011 had the following objectives. ¾ The workshop should facilitate a mutual update on developments in accreditation on national, regional and international level. ¾ It is aimed to pursue the establishment of national accreditation focal points within SAARC. ¾ The meeting should provide a forum to follow-up on other agreed regional activities, such as cooperation in proficiency testing and training programmes. ¾ Objective was to follow-up on previous recommendations and pursue, it to their logical conclusions. Seven of the eight SAARC countries had sent nominations for the workshop which was attended in total by 30 participants. Bangladesh,

Quality India

SHARING KNOWLEDGE: Delegates at the Thimphu workshop.

India and Pakistan had nominated two participants each, Maldives, Nepal and Sri Lanka had one nominee each. Additionally SAARC Secretariat was represented by two nominees from accreditation bodies, standard bodies, industry associations and government organisations. Thus participants could represent the views and expectations of key stakeholders in the accreditation process. Manfred Kindler was the chief resource person for PTB and conducted the workshop. Venkataraman Balakrishnan, Chief Executive of National Accreditation Board for Certification Bodies (NABCB), Quality Council of India and Vice Chair of Pacific Accreditation Cooperation (PAC) facilitated the conduct of the workshop as moderator. Other resource persons included Shafquat Haider, Federation of Bangladesh Chambers of Commerce and Industry and Kiran Bhattarai of GIZ (German International Technical Cooperation), Nepal and Stefan Wallerath, Project Coordinator of PTB. The workshop was inaugurated by Yeshey Zimba, Minister for Works and Human Settlement, Government of Bhutan, by delivering the keynote address. Earlier Phuntsho Wangdi, Director, Bhutan Standards Bureau, welcomed the participants. Amrit Lugun, Director, SAARC Secretariat, Kathmandu, in his address touched on the SAARC share on global trade and pointed to very low at intra-regional trade level within the SAARC region. Technical barriers to trade and particularly the lack of harmonised standards and mutually acceptable conformity assessment systems were identified as one of the main bottlenecks. He believed that regional cooperation in accreditation would contribute to the removal of technical barriers to trade in the region. At the conclusion of the workshop, the participants, recognising the importance of standards, metrology and conformity assessment in free trade and any free trade initiatives like South Asia Free Trade Agreement (SAFTA) and in mutual acceptance of conformity assessment results, unanimously recommended the following for consideration by the SAARC Secretariat: ¾ Keeping in view that accreditation and conformity assessment are critical issues for overcoming potential technical barriers within the region and in trade by a member of SAARC outside the region and noting that the constitution of the “Expert Group on Accreditation” was approved within SAARC and that some countries had already nominated experts on this group. The participants requested the SAARC Secretariat to pursue with those SAARC members who are yet to nominate experts and also arrange the first meeting of the SAARC Expert Group on Accreditation latest by mid-2012 and technical support of PTB, Germany. ¾ The workshop discussed the draft of terms of reference (TOR) of the Expert Group on Accreditation and recommends that the attached TOR may be presented to the appropriate forum within SAARC for

their consideration and approval. ¾ Having recognised the need to build competence in accreditation and create a pool of qualified assessors, the workshop recommends that programmes may be organised covering standards such as ISO 17011, ISO 17021, ISO Guide 65, ISO 17025, ISO 15189, ISO 17020, ISO 17024, uncertainty of measurement and traceability and ISO 17043. ¾ The workshop recommends that SAARC Secretariat may consider providing brief information about the Workshop on Regional Cooperation on Accreditation on its website. It was also recommended that the SAARC website may provide contact details on accreditation bodies and national focus points on accreditation on the SAARC website. ¾ The workshop suggests that documents all trade-related issues within SAARC countries that relate to standards and conformity assessment may be uploaded on the relevant section of the website. The workshop felt that over a period of time this information would be valuable in minimising technical barriers to trade within the SAARC region. The workshop also recommends that the web page include information on Proficiency Testing facilities available in the region with inputs from all member countries ¾ Having recognised that a National Focal Point on Accreditation

DELIBERATING ON KEY ISSUES: Yeshey Zimba, Minister for Works and Human Settlement, Government of Bhutan, delivering the keynote address at the Thimphu workshop.

(NAFP) has been established in Bhutan and a draft MoU between NAFP and an established National Accreditation Body (NAB) was being developed, the workshop recommends that this draft template be refined (NABL, India has volunteered to modify the draft MoU and provide the template for other NAB and NAFP). ¾ The workshop also recommends that to develop the technical competence of personnel in NAFP, SAARC Secretariat may facilitate the association of such personnel with established accreditation bodies and PTB, Germany may be approached for funding such a programme. ¾ Having recognised that NAFP would require documentation that would go beyond the documentation of an accreditation body (since activities and responsibilities would be different), the workshop recommends that a model documentation be developed to facilitate functioning of NAFP. ¾ Having noted the progress of proficiency testing (PT) programme in textiles, the workshop recommends that efforts may be made to initiate PT programme in the field of cement testing, pharmaceuticals, food and also in the area of calibration covering temperature, pressure, mass and torque. The recommendations including the TOR for the export group on accreditation would be considered by SAARC Secretariat. AUGUST-SEPTEMBER 2011 I Quality India I 37


Quality India

QCI to assist African countries in food safety ndia and Africa share a 150-year-old hisenvironment and media and communication. ered relationship involving development of tory and today these nations are continumajor sectors such as agriculture, trade and ing their multi-layered partnership activiIndia-Africa Forum Summits industry, peace and security and; governance ties with cooperation and mutual respect. The greatest milestones in the role of India in and information and technology. The Indian Prime Minister, Dr ManmoAfrican development are the India-Africa The 2011 Addis Ababa summit, IAFShan Singh, said at the joint session of two Forum Summits (IAFS). The first summit was II, aimed at broadening the partnership prohouses of Ethiopian Parliament on May 26, held in 2008, followed by the second summit gramme further. The summit was attended 2011 that, “Indian and by 14 leaders of Ethiopia are no African nations and strangers to each oththe India delegation er. Many millennia was led by Dr Manago Africa and India mohan Singh. A tarwere joined as one get of $100 billion landmass. Today we investment by 2014 are separated by (IAFS-III), the next waters of the Indian summit, was set. Ocean but our conIndia’s products and nections are deep. I services are facilitatam conscious that ed with easier entry when one visits into those regions of Ethiopia one visits the Africa which cradle of humankind. demanded them It is a land of great more. Information natural beauty which and communication was home to the most technologies are also ancient kingdom in to be given greater Africa. The sight importance in women with heads expanding the covered and men human resource FORMIDABLE TEAM: Anil Jauhri, Director, NABCB (sitting second from left) along with the participants in wearing turbans are development of Food Safety workshop held at IGNOU strikingly common in Africa. The set of the villages of Ethiopia and India. Hospitaliin 2011 and the third is proposed to be held in seven fields declared at the 2008 summit ty in humble village homes begins with sim2014. where India and African nations would ple offerings and guests are treated as incarThe motto of IAFS-I, held on 8-9 April extend partnership programmes were transnation of gods.” held in New Delhi, was “Dynamic Partnerformed slightly at the Addis Ababa summit. In view of the recent bilateral visits by the ship — Shared Vision”. The 2008 summit Farming is the predominant occupation Indian team to Tanzania and Ethiopia, the highlighted the various perceptions of both in the African countries. However, lack of Indian ties with Africa are being built afresh sides on wide range of affairs. Both convened adequate storage facilities avoidable to continue the 150-year-old shared history a “framework for enhanced cooperation” and wastage of horticulture and farm crops of both nations. The India-Africa tie-up is after duration of two years since the summit occur. In addition, lack of food processing multi-dimensional partnership programme a Joint Action Plan was formulated. IAFS-I facilities and shortage of trained manpower with an objective to bring about mutual focussed on combined efforts to a multi-layin food processing sector is responsible for empowerment and development to both wastage of food grains, fruits, vegetables in nations. In the 21st Century world, if the Africa. African countries and India recogQCI’s motto is Quality for National WellbeIndia-Africa commitment visions are nise that human resource development is ing and through consistent national quality achieved then both nations will mutually benvital to achieve the socio-economic develcampaign has been promoting quality by efit. Africa by rising to become one amongst opmental goals in Africa. Accordingly, India enabling manufacturers and suppliers of the world’s developed nations and India by will cooperate in establishing programmes goods/services to apply quality standards and extending activities worldwide and dominatin capacity building. Amongst the proposals tools, and simultaneously empowering coning over the world superpowers. In all conto be implemented under IAFS-II, four prosumers to demand quality goods/services. texts, the Indian-African relationship is one posals from Ministry of Food Processing The promotion of quality encompasses all alliance which can take India and Africa along Industries have been approved by the Cabisegments including manufacturing, health, with their huge abundance of resources into net and these are: education and public services. greater and higher dimensions. ¾ India-Africa Food Processing Clusters. On food safety QCI, as part of national The Africa-India Forum Summit is ¾ India-Africa Food Testing Laboratories. quality campaign, has conducted 34 one/two intended to consider the modalities to ¾ India-Africa Food Processing Business -day programmes in various cities like New strengthen the cooperation ties between the Incubation Centres (5). Delhi, Noida, Chennai, Patna, Tirupati, two partners in the areas of economic, politi¾ Capacity Building. Varanasi, Shillong, Cuttack etc. and eight cal, science, technology, research and develIn recognition of the competence of short-term courses at New Delhi, Nagpur, opment; social development and capacity Quality Council of India (QCI) in the field, Hissar, Sonepat etc. building, tourism, infrastructure, energy and the Ministry of Food Processing Industries


38 I Quality India I AUGUST-SEPTEMBER 2011

Quality India has assigned QCI to conduct two programmes of two-week duration each year for the next three years for African participants under the capacity building programme. Each batch is expected to have 25 participants from African countries and the training programmes will cover the latest international development in food safety regulation, hygienic practices in food industry, ISO standards applicable to food industry and also various private standards. The programme will also include Good Agriculture Practice (GAP), organic certification and regulations applicable to food industry in India. The programme will also cover industry visits to

SPEAKING THE MIND: Workshop on food safety in progress at IGNOU.

provide the participants gain practical experience of assessing food safety systems and norms. QCI will utilise the services of national and international faculty, from the government and private sectors for the programmes. The first programme is scheduled in November 2011 and the second in February 2012. These programmes will enable participants to understand the needs of the world market in respect of regulations and market driven voluntary standards and the application of international standards to facilitate market access as well as develop their capability to implement food safety system in the industry. „

Quality of care for hospitals in India ational Accreditation Board for NABH has recommended quality The MoU with NABH is an innovative colHealth and Healthcare Providers towards safe injection practices, waste man- laboration for enhancing patient safety and (NABH) and Becton, Dickinson agement and infusion safety, to name a few, healthcare worker safety in India. BD will and Company (BD) signed an MoU on as minimum requirements across hospitals in leverage our global experiences in impleAugust 24, 2011 to support hospitals in the country, following the lead of several menting infection control programmes by attaining quality-of-care standards for infec- facilities undertaking these processes. Most supporting NABH to enhance infection contion control. This collaboration is an effort to of these are high in volume and have band- trol standards in the hospitals in India.” strengthen health system in India and pro- width as well as desire to improve clinical The collaboration will have three phases. mote continuous quality improvement to outcome; whereas the quality of care in ¾ Phase 1: Initial workshops would be carensure quality care for patients when visiting smaller hospitals, especially which are govried out across hospitals in the country to hospitals with effective ensure the Safe-1 proinfection control pracgramme is adopted by tice in place. With a hospitals as stepping wider roll-out of comstone towards achievmunity health insuring quality. ance initiatives, there ¾ Phase 2: is an increased Centres of Excellence demand for bed capac(CoE) and health ecoity. Existing small and nomic models will be medium hospitals, developed for the benestimated to account efit of country’s healthfor more than twocare after disseminathirds of all beds, need tion of Safe-1 proto strengthen the qualgramme. ity system and these ¾ Phase 3: hospitals can achieve This phase will augquality-of-care sysment national capabiltems by standardising ity of standards and adopting necessary READY TO ROLL: QCI Secretary General Dr Girdhar J Gyani (left) with Manoj Gopalakrishna, MD, dissemination by infection control practices BD-India at the MOU signing ceremony. developing addito ensure patient and tional CoE (or healthcare worker’s safety. ernment empanelled is much more varied in suggest spelling it out in both instances). Dr Girdhar J Gyani, Secretary General, terms of infection control practices. NABH Safe-1 certification will be viewed as a QCI, speaking on the occasion said, “Our currently has 500 hospitals in various phases precursor for preparing HCO (healthcare objective is to develop a basic infection con- of accreditation, and 115 hospitals are organisations) or SHCO (small healthcare trol standard for all hospitals delivering already accredited. organisations) for NABH accreditation. healthcare in India. The association with BD On signing MoU, Manoj Gopalakrishna, Through its experienced field force, BD will will enable us to provide on-and-off-site tech- Managing Director, BD-India said, “BD has guide applicant hospitals towards Safe-1 nical support to collaborating institutions for always worked towards achieving our pur- preparation and other relevant training and upgrading their infection control practices.” pose of ‘helping all people live healthy lives’. development workshops. „


AUGUST-SEPTEMBER 2011 I Quality India I 39

Quality India


NABH recognition beckons ECHS-empanelled hospitals ver 1300 hospitals empanelled for the Ex-Servicemen Contributory Health Scheme (ECHS) will have to obtain recognition from the National Accreditation Board for Hospitals (NABH) within 18 months or face de-empanelment. A Memorandum of Understanding (MoU) to this effect was signed between Ex-Servicemen Contributory Health Scheme (ECHS) and Quality Council of India (QCI) recently to ensure good healthcare services to all its beneficiaries. At present, there exist about 1 , 3 7 7 healthcare providers including hospitals, speciality eye centres, dental clinics, physiotherapy centres, rehabilitative centres and diagnostic centres across the country, which are empanelled for the scheme. “As per GOI, the superspeciality and speciality hospitals empanelled with ECHS have to obtain NABH within 18 months of the older or they will be de-empanelled from the list. Further, remaining General Hospital, Eye Hospital, Dental Hospital and Diagnostic centres will be evaluated by NABH on behalf of ECHS for empanellment,” said Zainab Zaidi,


MUTUAL AGREEMENT: QCI Secretary General Dr Girdhar J Gyani signing MOU along with Major General A Srivastava, Managing Director, ECHS and (top) unveiling of the MOU.

40 I Quality India I AUGUST-SEPTEMBER 2011

Assistant Director, NABH, QCI. The MoU was signed by Major General A Srivastava, Managing Director, ECHS, Government Of India, and Secretary General, QCI, Dr Girdhar J Gyani.

“We hope this MoU with NABH will be a first step towards achieving better and wider clientele satisfaction with a commitment and dedication to progress on the path of excellence in the field of medicare,” Maj Gen Srivastava said. „

Quality India

Towards quality dental health services KNOWLEDGE DRIVEN: Dental Technical Committee with Dr. Gyani, CEO-NABH.

ABH after achieving a landmark achievement in hospitals and in other healthcare fields, takes a new initiative for strengthening the accreditation programme for dental services across the country. There has been a huge demand and need in the dental industry for the standardisation.


A Technical Committee was constituted to revise the existing dental standards based on the industry feedback and needs of the dental service providers due to industry dynamics. The Technical Committee consists of industry experts representing both the public and private sectors with leading practioners, academicians and administrators so

as to get the perspective of all stakeholders. Dr. Girdhar Gyani, CEO, NABH, extended a warm welcome to the members of the newly formed Technical Committee for dental service providers in a meeting held in NABH Secretariat, Delhi, on August 19, 2011. Dr. Gyani apprised the committee about the main objectives and the roadmap for the accreditation programme for the dental service providers. The meeting was attended by the Technical Committee members, Dr. Anup Kanase (Convener), Dr. Tushar Chawla, Dr. Ajay Gulati, Dr. Brij Sabarwal, Dr. P B Sood, Dr. Ajay Bajaj and Dr. Bhawna Gulati (Member Secretary). The final draft of the standards prepared by the Technical Committee would be circulated among the industry for their comments and put on NABH website for one month for public review. The new accreditation standards would cater to the dental hospitals and dental clinics for all over the country and would be applicable to both the private and public organisations. „

Quality drive strengthens in wellness industry ith the quality drive strengthening in the wellness industry, a technical committee meeting was held in Mumbai on August 21, 2011. Dr. Girdhar J Gyani, CEO, NABH, addressed the Technical Committee members and shared some of his experiences of the other NABH accreditation programmes. The meeting was held to discuss the development of the first assessors course and the eligibility criteria for training the new industry experts as NABH Assessors. Keeping in view the diversity of services offered by the wellness centres all over the country, the committee deliberated and finalised a assessors course of four-day duration. Dr. R V Karanjekar, Chairman, Accreditation Committee, was a special invitee to share his viewpoints on the legal requirements and his experiences in taking the programme ahead. The technical committee members attending the meeting were Mr. Jesper Hougaard, Dr. J Lewis, Dr. Leena Phadis, Dr. Rekha Chakraborti and Dr. Bhawna Gulati. Discussions were held on


technical aspects of the standards and the best practices in the industry based on the feedback received from initial audits of the wellness centres. Experiences/learning from

other NABH accreditation programmes were shared. It was also decided to create a checklist for the assessors for strengthening the preassessment process. „

AGENDA SETTING: Wellness Technical Committee meeting in progress. AUGUST-SEPTEMBER 2011 I Quality India I 41

Quality India


Quality as a Service THE TESTING AND CERTIFICATION INDUSTRY IN HONG KONG HAS COME A LONG WAY, WRITES LOTTO K H LAI, AND POINTS OUT THAT QCLOUD WAS ADOPTED FOR QUALITY AS A SERVICE (QAAS). hen we talk about Quality, many people only focus on product quality. It narrows the definition of Quality to only manufacturing-related or productrelated. In the Information Technology (IT) industry, the term “Software as a Service” (SaaS) was well-known that could be referred to as “on-demand software”. It is a software delivery model in which software and its associated information are hosted centrally, socalled cloud computing. I believe that Quality is a kind of service. We always need to provide excellence in service so that Quality is also on-demand by customers. Therefore, I propose the concept of “Quality as a Service”. How does the concept of goods quality convert to service quality from an objective measurement to more abstract and elusive service which is intangibility, heterogeneity and inseparability of production and consumption? It definitely requires to educate the public about Quality as a Service (QaaS). Same as IT software in cloud computing, products’ quality assurance is centralised by different quality service providers such as internal quality assurance and control activities, internal and external quality consultancy, external testing laboratories, inspection bodies and certification bodies. It is similar to cloud computing; I call it Quality Cloud Servicing (QCloud). QCloud is a model of QaaS, indicating that Testing, Inspection and Certification service providers as centralised software database provide quality service to different types of industry. The Testing and Certification (T&C) Industry was identified by the Task Force on Economic Challenges (TFEC) as one of six economic areas which are high growth potential industries in Hong Kong, on June 22, 2009. From 2008 to 2009, T&C industry’s economic growth was about 13 per cent. It was obvious in the mature economy of Hong Kong. Thus, Hong Kong Special Administrative Region (HKSAR) government established Hong Kong Council for Testing and Certification (HKCTC) on September 17, 2009. The vision of HKCTC is to develop Hong Kong into a Testing and Certification Hub in the region by reinforcing the branding of “Tested in Hong Kong, Certified in Hong Kong.” The Census and Statistics Department (C&SD) of HKSAR conducted a survey to collect information and views on the profile of the testing and certification service in Hong


42 I Quality India I AUGUST-SEPTEMBER 2011

Kong from December 2009 to January 2010. It demonstrated that private laboratories dominate in testing in comparison to inhouse laboratories in different industries and government organisations. Moreover, it indicated Testing Service had 66 per cent of business receipts in 2008. The testing service was found mainly in the four mature trades including Textiles (28 per cent), Toys (25 per cent), Medical Testing (20 per cent) and Electrical Products (14 per cent). After that, HKCTC submitted the report with all findings to Chief Executive of HKSAR on March 31, 2011. The report finally recommended enhancement of Hong Kong Accreditation System together with the Factors of Production including Manpower, Technology, Capital and Land. The government of HKSAR accepted the report and the suggestions and took the following actions to enhance the development of T&C industry. For Accreditation System, the current mode of accreditation in Hong Kong should firstly be maintained. Then, manpower should be provided for establishing new accreditation service (e.g. ISO 22000 & ISO 27001). For doing this, universities, Vocational Training Council (VTC) and the industry would cooperate to organise seminars, workshops and career talks to enable students to have understanding of the T&C industry and to encourage the development of their career in this aspect so as to ensure adequate manpower supply. Regarding technology, collaboration between institutions within the existing technology infrastructure such as Hong Kong Science and Technology Parks, Hong Kong Productivity Council and five R&D centres in Hong Kong is supported in order to have a wider use of the Innovation Technology Fund provided by Innovation & Technology Commission (ITC) of HKSAR. Furthermore, the Small Entrepreneur Research Assistance Programme (SERAP) should be promoted extensively to build and preserve capital. Last but not least, land is an important factor for developing the industry in Hong Kong. Industrial buildings could be revitalised for the T&C industry. It should also keep in view government’s plan on land supply for the industry such as the Lok Ma Chau Loop development. The report further identified four trades, which are considered to be good opportunities for new economic momentum, namely Chinese Medicine, Construction Material, Food and Jewellery.

Based on the HKCTC report, one of recommendations related to Hong Kong Science and Technology Parks Corporation (HKSTPC) is to magnify the promotion of their facilities available for shared use. Technology Support Centre of HKSTPC is focusing on this recommendation at present. HKSTPC provides R&D testing service for start-up R&D companies to assist their growth. According to the concept of Quality as a Service (QaaS), a preliminary study was performed on the testing service by HKSTPC. SERVQUAL’s five dimensions suggested by Parasuraman et al. (1988) was adopted and the dimensions are as follows: y y y y y

Tangibles: Physical facilities, equipment, and appearance of personnel Reliability: Ability to perform the promised service dependably and accurately Responsiveness: Willingness to help customers and provide prompt service Assurance: Knowledge and courtesy of employees and their ability to inspire trust and confidence Empathy: Caring, individualised attention the firm provides its customers

Questionnaires were sent out to all existing users and finally 141 responses were confirmed valid. The survey pointed out that around 93 per cent replied customers were satisfied with HKSTPC laboratory service. Hence, it found the most important dimension was Responsiveness and HKSTPC best laboratory service level was Assurance. QaaS is an important concern for the Testing and Certification Industry. It not only ensures the Quality Service in T&C industry but also maintains the industry’s “Five High”. They are: i) High credibility of the Industry ii) High profit margin iii) High value added per person engaged iv) High education staff needed v) High Potential Growth Industry I expect that QCloud will further develop in Hong Kong to support international trade, especially in China, successfully. „ (Lotto K H Lai is currently a Fellow and Chairman of Hong Kong Society for Quality, Senior Member of America Society for Quality and Member of Hong Kong Institute of Engineers as well as, IRCA QMS Lead Auditor.)



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