The Front Desk: NABH Quality Management for Rural Hospitals

INTRODUCTION

With the high costs and paperwork that is involved many rural hospitals even in the West do not seek accreditations of health care organizations [1]. Also the rural hospitals have been shielded from many of the external pressures to improve quality till now. In USA Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) found that while over 95% of the urban hospitals were accredited to them only about 60% of the rural hospitals have such accreditation [2].

In addition to the costs involved the reasons for such low accreditation rates are as follows [3]:

1. The smaller size and lower census in rural hospitals means that they do not experience a sufficient volume of events (e.g., unexpected deaths) necessary for using many quality improvement indicators and measures. Insufficient volume complicates reliable measurement of safety in many areas of the hospital.
2. Most rural hospitals provide only a small subset of services that are available at larger urban hospitals.
3. Many of the smaller rural hospitals might not have the resources to implement all the patient safety practices.
4. The cultural communication norms are different at smaller hospitals where each individual have several roles to play.

The following series of articles attempt to adapt the NABH [National Accreditation Board for Hospitals and Healthcare Providers] fourth edition standards to rural hospitals. Several examples and suggestions are given.
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