STANDARD OPERATING PROCEDURES IN HOSPITALS - A REALITY CHECK
Author(s): S. Bedi, S.D. Behera, S.K. Arya, S. Singh
Vol. 18, No. 1 (2006-01 - 2006-12)
Key Words: Quality Systems, Standards, SPOs, Quality Initiative
ABSTRACT
The need for quality system evaluation in hospitals is
well established. However lack of basic standards
including standard operating procedure (SOPs) for
hospitals makes this a difficult job. SOPs have been
found to be of immense use in proper working, training
of personnel and favourable outcomes. Thus SOPs are
an essential pre-requisite for any Quality initiative. With
this aim a study was conducted in two hospitals in the
NCR of Delhi, with regard to status of knowledge and
practice of Standard Operating Procedures was used
to suggest guidelines/measures for writing Standard
Operating Procedures for hospitals. A pre-tested semistructured
questionnaire was administered to randomly
selected sample of physicians and nurses in two
hospitals (n = 175). The study has revealed that there
is general awareness of the concept of SOPs, but
written SOPs are available in very few instances. The
study also shows that commonest method of learning
how to perform procedures in the workplace is by
verbal instructions by seniors, which very often leads to
variations. There is a felt need among healthcare
workers for SOPs in their workplace, which are drafted
by end users by consensus. However, SOPs should be
customised to suit existing practises in different
healthcare institutions.
INTRODUCTION
The need to adopt quality measures and have it validated
by quality evaluation systems is now well established.
Studies show that these have significant potential to
enable provider organizations to improve quality without
increasing costs1. However the absence of healthcare
standards, both structural and process, in our country
makes this a difficult task. A fledgling effort in terms of
structural standards may be present, albeit arbitary
and not evidence based or comparable to international
standards, which in the absence of process quality
would not facilitate the achievement of the desired
favourable outcomes.
Standards
As per Donabedian, standards are professionally
developed expressions of the range of acceptable
variations of a norm or criterion2.
Standard Operating Procedures
A SOP is a written set of instructions that someone
should follow to complete a job safely, with no adverse
effect on personal health or the environment, and in a
way that maximizes operational and production
efficiency3.
Need for writing SOPs(3)
- To serve as a training document for teaching users
about the process for which the SOP was written.
- To provide people with all the safety, health,
environment and operational information necessary
to perform a job properly.
- SOPs act as Clinical Guidelines.
- SOPs and CQI in Healthcare-The key concepts in
CQI4 i.e. reduction in variation and improvement
of processes has need for standards as a basic.
- SOPs specify job steps that help standardize
services and therefore quality.
Barriers to SOPs
Despite the widespread development and awareness
of need of guidelines in the developed countries, there
are certain barriers to their adoption like physicians not
aware of their existence, contents or may not agree
with these5.
Pre-requisites to creating SOPs
Commitment of top management coupled with will and
knowledge to develop SOPs and belief in the usefulness
of SOPs are essential pre-requisite for creating
SOPs6.
Standards should be set for all services and are of two
types-general standards and specific standards7.
General standards set the level of service and objectives
Specific standards deal with specific issues such as
infection control practices in laundry or safety in
radiology or OT cleaning measures and are based on
specific criteria, which are discrete and measurable.
Although who will set these standards and will these be
uniform for all healthcare institutions remains to be
seen. In any case SOPs are the first step towards
quality evaluation-whether for accreditation, certification
or grading.
SOP is therefore an important document in terms of
quality measures and evaluation and it would be deemed
proper to know where we stand in terms of SOP writing
and adoption in our health care institutions. In view of
the foregoing it was decided to conduct a survey of
hospitals to find out the status of SOPs in these hospitals
and use this study to suggest guidelines for writing
SOPs.
AIM
To conduct a study in two hospitals in the NCR of Delhi,
with regard to status of knowledge and practice of
Standard Operating Procedures and to use this study
to suggest guidelines/measures for writing Standard
Operating Procedures for hospitals.
METHODOLOGY
The study was conducted in two hospitals in the NCR of
Delhi. One hospital was a secondary level care hospital
and the other was a tertiary level care hospital. The
sample consisted of physicians and nursing staff from
various specialities of both hospitals. Randomly selected
sample of physicians and nurses (n = 175) of these
hospitals were chosen for the study. Selected subjects
were interviewed with the help of a semi-structured pretested
questionnaire to elicit information about the status
of SOPs in their respective hospitals. Respondents were
assured of confidentiality of identity and consent was
taken from them. The response rate was 88%.
OBSERVATIONS
The observations are tabulated as under.
TABLE 1: OBSERVATIONS
Sr.
No.
Questions
Doctors
Nurses
Secondary
Hosp
Tertiary
Hosp
Secondary
Hosp
Tertiary
Hosp
1.
Awareness of SOP
• Yes
50%
87.5%
46.15%
88.4%
• No
22.7%
12.5%
15.2%
7.6%
• Faint idea
27.7%
0%
38.4%
3.8%
2.
Presence of any manual with instructions regarding how to perform your job in your department?
• Yes
13.6%
12.5%
7.6%
57.6%
• No
86.3%
87.5%
92.3%
42.3%
3.
If yes, were you given a copy of this to read when you joined work in this department?
• Yes
9.0%
0%
7,6%
50%
• No
91%
100%
92.3%
50%
4.
Have you read this manual completely?
• Yes
9%
0%
0%
50%
• No
91%
100%
100%
50%
5.
If you have not read the manual or if none
was given to you, then how did you learn to
perform the tasks of your present job?
(a) Training was given
13.6%
6.25%
7.6%
7.6%
(b) Verbal instructions given by
senior/instructor
27.2%
81.2%
46.10%
57.60%
(c) Learnt on-the-job by own self
54.5%
0%
0%
27%
(d) Verbal Instructions + self learnt
0%
12.5%
15.3%
7.6%
(e) Combination of training verbal
instructions & self learnt
4.5%
0%
30.7%
0%
6.
Is there a manual of how to perform any other
job in your department for jobs other than that
of yours?
• Yes
0%
12.5%
0%
26.9%
• No
100%
87.5%
100%
69.2%
7.
Is there a written down procedure for patient
flow processes in your department?
• Yes
0%
6.25%
7.6%
23.07%
• No
100%
93.7%
92.3%
76.90%
8.
Is there a written down protocol of clinical care
pathway for diseases in your department?
• Yes
13.6%
12.5%
15.3%
23.07%
• No
81.8%
87.5%
84.6%
76.90%
9.
Do you think such a manual is necessary or
appropriate to help you to perform your job
successfully?
• Yes
77.2%
100%
100%
100%
• No
18.1%
0%
0%
0%
Study shows that awareness regarding SOPs is high in
the tertiary hospital among both clinicians and nursing
staff, whereas in Secondary Hospital, 50% of the doctors
and nurses (approx) are aware. A majority of doctors in
both hospitals informed that there are no written
guidelines in their workplace. In cases where these are
available, very few were provided with a copy of
guidelines, and to none in Tertiary care hospital. Those
who got the copy reported that they read these
completely.
Awareness of SOPs
Nurses (87%) in the Secondary Hospital informed that
there are no written guidelines in their workplace. On
the other hand, in the Tertiary Care Hospital, 58% of
the nurses reported that their hospital has written
guidelines for certain procedures in some of the areas.
This was confirmed by checking with chief of nursing in
the hospital.
However only 50% of those who work in the area
where these are available, were actually given a copy
of the same and thus only they had read these and
were aware of the same.
As regards the procedure (where there are no
guidelines), questionnaire was intended to elicit
information as to how the respondents learnt to perform
the procedures. This question had three choicestraining,
verbal instructions from seniors and learnt by
self on-the-job. The respondents responded by marking
either a single choice or by a combination of choices. It is seen that doctors as well as nurses learn the
procedure by a mix of training, verbal instructions from
seniors and on their own. In the secondary hospital,
doctors (55%) learnt on their own, whereas in tertiary
hospital 81% reported to have learnt by verbal
instructions from their seniors and on their own by
observing their peers and seniors (12.5%).
Nurses in the secondary hospital have learnt by verbal
instructions from seniors (46%) and by a combination
of all three (30%). In the Tertiary Hospital, majority of
the nurses have learnt by verbal instructions by seniors
(58%), followed by self learnt (27%). In both hospitals,
there are no formal training programmes either for
doctors or nurses. (The respondents, who had chosen
training as their response in the above question when
asked, clarified that they were referring to training during
the course of their nursing/medical education.)
Regarding the existence and practice of patient flow
processes and clinical care pathways in the hospitals,
doctors in the secondary hospital informed that there
are no written down procedures for patient flow process
in the hospital, but there are some written down protocols
for clinical care in the hospital (13.6%). Scenario in the
Tertiary Hospital is also not very different. Here only
6% of doctors reported that there are written down
procedure for patient flow processes and 12.5%
reported about presence of written down protocols for
clinical care pathways in the hospital.
Very few nurses in the secondary hospital reported that
written down procedures for patient flow processes
(7.6%) and written down protocol for clinical care
pathways (15.3%) were available. In the tertiary Hospital,
the scenario is better and 23% nurses reported that
written down procedures for both patient flow processes
and clinical care pathways are in existence in their
hospital.
Almost all doctors and nurses in both hospitals are in
agreement that such guidelines are necessary.
There were two open ended questions to elicit
information regarding
- Who should make such SOPs
- Manner in which such SOPs should be written to
ensure that these are easily understood and
followed.
The clinicians have suggested that SOPs should
be:
- Clear-cut, concise, simple, in an easy language
and in the form of algorithms
- Different for different categories of personnel in
the language they can read.
- Practical as per limitations
- Can be enforced on ground
- All concerned should be given a personal copy
- Should include safety hazards
- Should be regularly updated.
- Should take into account all possible exigencies.
- Should delineate responsibility of all concerned in
the process.
The nurses have suggested that SOPs should be:
- Clear, simple, flexible, brief and easy to understand.
- More necessary in administration than in clinical
side
- Should be made department wise, disease specific
and as per hospital policy
- Should be demonstrated & regularly updated
- Copies should be given to all concerned
Majority of clinicians felt that SOPs should be drafted
by the department head with input from the users.
Some suggested that committees of experts different
specialities, from a group of hospitals should write
such SOPs for this group of hospitals.
The majority of nurses feel that the senior most nurse/
senior nurses, nursing educators and hospital
administration are the right people for this job.
Significantly, most respondents (both doctors as well
as nurses) have opined that Hospital Administration
should be an integral part of team involved in writing
SOPs.
DISCUSSION
The study shows that healthcare workers in hospitals
are by and large aware of the concept of SOPs. Written
guidelines are available in very few instances and here,
either the staff is not provided a copy or all those who
get a copy do not read these. This clearly shows that
the concept is not practised despite widespread
awareness. Available literature on the subject shows
that lack of awareness that a guideline exists and lack
of familiarity with the details of the guideline are the
topmost barriers to SOPs5. Hospital administrators will have to make a note of this and find ways and
means to eliminate barriers to adoption of SOPs if
these are to be successfully implemented.
Analysis of data shows that the commonest method of
learning how to perform procedures in the workplace is
by verbal instructions by seniors. Such a practice is not
devoid of variation as instruction may vary from
instructor to instructor. This is therefore, not conducive
to delivery of uniform and predictable quality of
healthcare4.
There is a felt need among healthcare workers for
such guidelines in their workplace. Healthcare workers
desire that these guidelines be simple, comprehensive
and applicable. They opined that these should be drafted
by the end users and consensus should be there. Both
clinicians and nurses suggested that commitment of
the leaders should be manifest. The heads of the
departments and hospital administration should not
only be involved in drafting but also in implementation
of these guidelines.
CONCLUSION
The study suggests that there is a felt need to have
SOPs in hospitals. The major bottleneck appears to be
perceived lack of commitment by the top management.
In this study, the respondents were aware of the benefits
of SOPs, how should these be prepared, who should be
involved in making and implementing these. This was in
consonance with the available literature on the subject.
The study suggests that manifest commitment by the
top management is essential for the success of such
an endeavour. If the healthcare workers are involved in
right earnest, the job can be simplified. This will be a
big leap in our quest for introducing quality systems
and facilitate adoption of accreditation/grading systems
in our hospitals.
It is also suggested that SOPs need to be tailormade
for each hospital. However, more studies are
required to workout generic and specific guidelines
for writing SOPs and implementation thereof in
different types of hospitals and other health care
organisations in our country, since these may differ
in scope and limitations.
REFERENCES
- Wagner C. A Measuring System for Evaluation of
Quality Systems, International Journal of Quality in
Healthcare, 1999 ; Vol.-11: No. 2, pp 119-130
- Donabedian A. Exploration in Quality Assessment
and Monitoring, Vol-2, The Criteria and Standards
of Quality, Ann Arbor, Michigan, Health
Administration Press 1982
- Kenneth F. Ten Reasons for Writing Standard
Operating Procedures (SOPs) Department of
Journalism and Communication, Lehigh University,
Bethlehem, Pa, U.S
- Leider HL, Nash DB. Improving the Quality of
Medical Care, Essentials of Medical Management,
Edited by Wesley Curry, and Barbara Linney,
American College of Physician Executives, 2003)
- Cabana M. and others. “Why Don’t Physicians
Follow Clinical Practice Guidelines ? A Framework
for Improvement.” JAMA, Oct. 1999; 282(15):
1458-65, Oct. 20, 1999.
- Heideman EG, The Contemporary Use of
Standards in Healthcare, WHO Division of
Strengthening of Health Service, District Health
Systems, 1993.
- Whittaker S. et al. Status of a Healthcare Quality
Review Programme in South Africa, International
Journal of Quality in Healthcare, 2000, vol 12 No. 3;
247-250.
(1) S. Bedi is Chief Medical Officer ESIC, Noida
(2) S.D. Behera is Commanding Officer, 177 Military Hospital
(3) S.K. Arya is Associate Professor Dept of Hospital Administration, All India Institute of Medical Sciences, New Delhi
(4) S. Singh is Senior Resident, Dept of Hospital Administration, All India Institute of Medical Sciences, New Delhi
Key Words: Quality Systems, Standards, SPOs, Quality Initiative
ABSTRACT
The need for quality system evaluation in hospitals is well established. However lack of basic standards including standard operating procedure (SOPs) for hospitals makes this a difficult job. SOPs have been found to be of immense use in proper working, training of personnel and favourable outcomes. Thus SOPs are an essential pre-requisite for any Quality initiative. With this aim a study was conducted in two hospitals in the NCR of Delhi, with regard to status of knowledge and practice of Standard Operating Procedures was used to suggest guidelines/measures for writing Standard Operating Procedures for hospitals. A pre-tested semistructured questionnaire was administered to randomly selected sample of physicians and nurses in two hospitals (n = 175). The study has revealed that there is general awareness of the concept of SOPs, but written SOPs are available in very few instances. The study also shows that commonest method of learning how to perform procedures in the workplace is by verbal instructions by seniors, which very often leads to variations. There is a felt need among healthcare workers for SOPs in their workplace, which are drafted by end users by consensus. However, SOPs should be customised to suit existing practises in different healthcare institutions.
INTRODUCTION
The need to adopt quality measures and have it validated by quality evaluation systems is now well established. Studies show that these have significant potential to enable provider organizations to improve quality without increasing costs1. However the absence of healthcare standards, both structural and process, in our country makes this a difficult task. A fledgling effort in terms of structural standards may be present, albeit arbitary and not evidence based or comparable to international standards, which in the absence of process quality would not facilitate the achievement of the desired favourable outcomes.
Standards
As per Donabedian, standards are professionally developed expressions of the range of acceptable variations of a norm or criterion2.
Standard Operating Procedures
A SOP is a written set of instructions that someone should follow to complete a job safely, with no adverse effect on personal health or the environment, and in a way that maximizes operational and production efficiency3.
Need for writing SOPs(3)
- To serve as a training document for teaching users about the process for which the SOP was written.
- To provide people with all the safety, health, environment and operational information necessary to perform a job properly.
- SOPs act as Clinical Guidelines.
- SOPs and CQI in Healthcare-The key concepts in CQI4 i.e. reduction in variation and improvement of processes has need for standards as a basic.
- SOPs specify job steps that help standardize services and therefore quality.
Barriers to SOPs
Despite the widespread development and awareness of need of guidelines in the developed countries, there are certain barriers to their adoption like physicians not aware of their existence, contents or may not agree with these5.
Pre-requisites to creating SOPs
Commitment of top management coupled with will and knowledge to develop SOPs and belief in the usefulness of SOPs are essential pre-requisite for creating SOPs6.
Standards should be set for all services and are of two types-general standards and specific standards7. General standards set the level of service and objectives Specific standards deal with specific issues such as infection control practices in laundry or safety in radiology or OT cleaning measures and are based on specific criteria, which are discrete and measurable. Although who will set these standards and will these be uniform for all healthcare institutions remains to be seen. In any case SOPs are the first step towards quality evaluation-whether for accreditation, certification or grading.
SOP is therefore an important document in terms of quality measures and evaluation and it would be deemed proper to know where we stand in terms of SOP writing and adoption in our health care institutions. In view of the foregoing it was decided to conduct a survey of hospitals to find out the status of SOPs in these hospitals and use this study to suggest guidelines for writing SOPs.
AIM
To conduct a study in two hospitals in the NCR of Delhi, with regard to status of knowledge and practice of Standard Operating Procedures and to use this study to suggest guidelines/measures for writing Standard Operating Procedures for hospitals.
METHODOLOGY
The study was conducted in two hospitals in the NCR of Delhi. One hospital was a secondary level care hospital and the other was a tertiary level care hospital. The sample consisted of physicians and nursing staff from various specialities of both hospitals. Randomly selected sample of physicians and nurses (n = 175) of these hospitals were chosen for the study. Selected subjects were interviewed with the help of a semi-structured pretested questionnaire to elicit information about the status of SOPs in their respective hospitals. Respondents were assured of confidentiality of identity and consent was taken from them. The response rate was 88%.
OBSERVATIONS
The observations are tabulated as under.
TABLE 1: OBSERVATIONS
| Sr. No. |
Questions | Doctors | Nurses | ||
|---|---|---|---|---|---|
| Secondary Hosp |
Tertiary Hosp |
Secondary Hosp |
Tertiary Hosp |
||
| 1. | Awareness of SOP | ||||
| • Yes | 50% | 87.5% | 46.15% | 88.4% | |
| • No | 22.7% | 12.5% | 15.2% | 7.6% | |
| • Faint idea | 27.7% | 0% | 38.4% | 3.8% | |
| 2. | Presence of any manual with instructions regarding how to perform your job in your department? | ||||
| • Yes | 13.6% | 12.5% | 7.6% | 57.6% | |
| • No | 86.3% | 87.5% | 92.3% | 42.3% | |
| 3. | If yes, were you given a copy of this to read when you joined work in this department? | ||||
| • Yes | 9.0% | 0% | 7,6% | 50% | |
| • No | 91% | 100% | 92.3% | 50% | |
| 4. | Have you read this manual completely? | ||||
| • Yes | 9% | 0% | 0% | 50% | |
| • No | 91% | 100% | 100% | 50% | |
| 5. | If you have not read the manual or if none was given to you, then how did you learn to perform the tasks of your present job? | ||||
| (a) Training was given | 13.6% | 6.25% | 7.6% | 7.6% | |
| (b) Verbal instructions given by senior/instructor |
27.2% | 81.2% | 46.10% | 57.60% | |
| (c) Learnt on-the-job by own self | 54.5% | 0% | 0% | 27% | |
| (d) Verbal Instructions + self learnt | 0% | 12.5% | 15.3% | 7.6% | |
| (e) Combination of training verbal instructions & self learnt |
4.5% | 0% | 30.7% | 0% | |
| 6. | Is there a manual of how to perform any other job in your department for jobs other than that of yours? | ||||
| • Yes | 0% | 12.5% | 0% | 26.9% | |
| • No | 100% | 87.5% | 100% | 69.2% | |
| 7. | Is there a written down procedure for patient flow processes in your department? | ||||
| • Yes | 0% | 6.25% | 7.6% | 23.07% | |
| • No | 100% | 93.7% | 92.3% | 76.90% | |
| 8. | Is there a written down protocol of clinical care pathway for diseases in your department? | ||||
| • Yes | 13.6% | 12.5% | 15.3% | 23.07% | |
| • No | 81.8% | 87.5% | 84.6% | 76.90% | |
| 9. | Do you think such a manual is necessary or appropriate to help you to perform your job successfully? | ||||
| • Yes | 77.2% | 100% | 100% | 100% | |
| • No | 18.1% | 0% | 0% | 0% | |
Study shows that awareness regarding SOPs is high in the tertiary hospital among both clinicians and nursing staff, whereas in Secondary Hospital, 50% of the doctors and nurses (approx) are aware. A majority of doctors in both hospitals informed that there are no written guidelines in their workplace. In cases where these are available, very few were provided with a copy of guidelines, and to none in Tertiary care hospital. Those who got the copy reported that they read these completely.
Awareness of SOPs
Nurses (87%) in the Secondary Hospital informed that there are no written guidelines in their workplace. On the other hand, in the Tertiary Care Hospital, 58% of the nurses reported that their hospital has written guidelines for certain procedures in some of the areas. This was confirmed by checking with chief of nursing in the hospital.
However only 50% of those who work in the area where these are available, were actually given a copy of the same and thus only they had read these and were aware of the same.
As regards the procedure (where there are no guidelines), questionnaire was intended to elicit information as to how the respondents learnt to perform the procedures. This question had three choicestraining, verbal instructions from seniors and learnt by self on-the-job. The respondents responded by marking either a single choice or by a combination of choices. It is seen that doctors as well as nurses learn the procedure by a mix of training, verbal instructions from seniors and on their own. In the secondary hospital, doctors (55%) learnt on their own, whereas in tertiary hospital 81% reported to have learnt by verbal instructions from their seniors and on their own by observing their peers and seniors (12.5%).
Nurses in the secondary hospital have learnt by verbal instructions from seniors (46%) and by a combination of all three (30%). In the Tertiary Hospital, majority of the nurses have learnt by verbal instructions by seniors (58%), followed by self learnt (27%). In both hospitals, there are no formal training programmes either for doctors or nurses. (The respondents, who had chosen training as their response in the above question when asked, clarified that they were referring to training during the course of their nursing/medical education.)
Regarding the existence and practice of patient flow processes and clinical care pathways in the hospitals, doctors in the secondary hospital informed that there are no written down procedures for patient flow process in the hospital, but there are some written down protocols for clinical care in the hospital (13.6%). Scenario in the Tertiary Hospital is also not very different. Here only 6% of doctors reported that there are written down procedure for patient flow processes and 12.5% reported about presence of written down protocols for clinical care pathways in the hospital.
Very few nurses in the secondary hospital reported that written down procedures for patient flow processes (7.6%) and written down protocol for clinical care pathways (15.3%) were available. In the tertiary Hospital, the scenario is better and 23% nurses reported that written down procedures for both patient flow processes and clinical care pathways are in existence in their hospital.
Almost all doctors and nurses in both hospitals are in agreement that such guidelines are necessary. There were two open ended questions to elicit information regarding
- Who should make such SOPs
- Manner in which such SOPs should be written to ensure that these are easily understood and followed.
The clinicians have suggested that SOPs should be:
- Clear-cut, concise, simple, in an easy language and in the form of algorithms
- Different for different categories of personnel in the language they can read.
- Practical as per limitations
- Can be enforced on ground
- All concerned should be given a personal copy
- Should include safety hazards
- Should be regularly updated.
- Should take into account all possible exigencies.
- Should delineate responsibility of all concerned in the process.
The nurses have suggested that SOPs should be:
- Clear, simple, flexible, brief and easy to understand.
- More necessary in administration than in clinical side
- Should be made department wise, disease specific and as per hospital policy
- Should be demonstrated & regularly updated
- Copies should be given to all concerned
Majority of clinicians felt that SOPs should be drafted by the department head with input from the users. Some suggested that committees of experts different specialities, from a group of hospitals should write such SOPs for this group of hospitals.
The majority of nurses feel that the senior most nurse/ senior nurses, nursing educators and hospital administration are the right people for this job. Significantly, most respondents (both doctors as well as nurses) have opined that Hospital Administration should be an integral part of team involved in writing SOPs.
DISCUSSION
The study shows that healthcare workers in hospitals are by and large aware of the concept of SOPs. Written guidelines are available in very few instances and here, either the staff is not provided a copy or all those who get a copy do not read these. This clearly shows that the concept is not practised despite widespread awareness. Available literature on the subject shows that lack of awareness that a guideline exists and lack of familiarity with the details of the guideline are the topmost barriers to SOPs5. Hospital administrators will have to make a note of this and find ways and means to eliminate barriers to adoption of SOPs if these are to be successfully implemented.
Analysis of data shows that the commonest method of learning how to perform procedures in the workplace is by verbal instructions by seniors. Such a practice is not devoid of variation as instruction may vary from instructor to instructor. This is therefore, not conducive to delivery of uniform and predictable quality of healthcare4.
There is a felt need among healthcare workers for such guidelines in their workplace. Healthcare workers desire that these guidelines be simple, comprehensive and applicable. They opined that these should be drafted by the end users and consensus should be there. Both clinicians and nurses suggested that commitment of the leaders should be manifest. The heads of the departments and hospital administration should not only be involved in drafting but also in implementation of these guidelines.
CONCLUSION
The study suggests that there is a felt need to have SOPs in hospitals. The major bottleneck appears to be perceived lack of commitment by the top management. In this study, the respondents were aware of the benefits of SOPs, how should these be prepared, who should be involved in making and implementing these. This was in consonance with the available literature on the subject. The study suggests that manifest commitment by the top management is essential for the success of such an endeavour. If the healthcare workers are involved in right earnest, the job can be simplified. This will be a big leap in our quest for introducing quality systems and facilitate adoption of accreditation/grading systems in our hospitals.
It is also suggested that SOPs need to be tailormade for each hospital. However, more studies are required to workout generic and specific guidelines for writing SOPs and implementation thereof in different types of hospitals and other health care organisations in our country, since these may differ in scope and limitations.
REFERENCES
- Wagner C. A Measuring System for Evaluation of Quality Systems, International Journal of Quality in Healthcare, 1999 ; Vol.-11: No. 2, pp 119-130
- Donabedian A. Exploration in Quality Assessment and Monitoring, Vol-2, The Criteria and Standards of Quality, Ann Arbor, Michigan, Health Administration Press 1982
- Kenneth F. Ten Reasons for Writing Standard Operating Procedures (SOPs) Department of Journalism and Communication, Lehigh University, Bethlehem, Pa, U.S
- Leider HL, Nash DB. Improving the Quality of Medical Care, Essentials of Medical Management, Edited by Wesley Curry, and Barbara Linney, American College of Physician Executives, 2003)
- Cabana M. and others. “Why Don’t Physicians Follow Clinical Practice Guidelines ? A Framework for Improvement.” JAMA, Oct. 1999; 282(15): 1458-65, Oct. 20, 1999.
- Heideman EG, The Contemporary Use of Standards in Healthcare, WHO Division of Strengthening of Health Service, District Health Systems, 1993.
- Whittaker S. et al. Status of a Healthcare Quality Review Programme in South Africa, International Journal of Quality in Healthcare, 2000, vol 12 No. 3; 247-250.
(1) S. Bedi is Chief Medical Officer ESIC, Noida
(2) S.D. Behera is Commanding Officer, 177 Military Hospital
(3) S.K. Arya is Associate Professor Dept of Hospital Administration, All India Institute of Medical Sciences, New Delhi
(4) S. Singh is Senior Resident, Dept of Hospital Administration, All India Institute of Medical Sciences, New Delhi