A Step in to NABH 5th Edition Implementation

NABH Consultancy



Medpoint Healthcare is a leading healthcare consultancy in India and abroad to help healthcare organization achieve business excellence through the rational development and improvement of the business system. Medpoint  support  its clients to prepare themselves for a NABH accreditation using a unique approach aimed at transforming Healthcare facilities to delivering efficient, safe and predictable care while remaining viable.

We help our clients create value and architect change through our unique spectrum of Healthcare Consulting Services. With our ongoing in- house research and quality improvement efforts, we always strive to be up-to-date and able to provide the client qualitative, cost effective and comprehensive solutions.

Accreditation would be the single most important approach for improving the quality of Healthcare Facility. Accreditation is an incentive to improve patient option of choosing a Healthcare Facility. Accreditation system ensures that Healthcare Facility, whether public or private, national or expatriate, play there expected roles in national health system.

Initiating the Project

  • Discussion with Top Management of HCP via Opening meeting to have a situational appraisal and understand the sponsor’s perspective of the output/ deliverables.
  • Chalk out a tentative plan
  • Formation of Core team & Sensitization
  • Gap Analysis


GAP Analysis

Creation of Internal Committee
Prepare Gap Report
Discuss GAP Analysis report with Management/ Head
Handover Draft Report to Management for internal review, decisions, comments, suggestions, recommendations for closing featured gaps
Discuss Management reviews over GAP Analysis Report & Finalize Action Plan for completing gaps
Freeze Responsibility/ Task Monitoring & Control Plans
Implement monitoring & supervision plan
Closure of Gap Assessment points

Develop Policy & Procedure Manual

Identify all Policies (Clinical, Administrative & Support Services)
Provide prototypes for all policies listed to concerned/ responsible personnel/ teams
Frame rough draft of mandatory Policies/ Protocols/ Guidelines/ Manuals/ Process Map
Get draft counterchecked by relevant head of process. Amend changes if any
Finalize the all documents
Distribute the copies of relevant sections to stakeholders

Awareness and Training

Initiate awareness program & scale up the same
Identify training needs
Develop training time table/ program
Identify potential trainers
Training of trainers
Conduct (General) trainings as per the schedule for staff at all levels
Conduct (Specific- Policy & Procedures related) trainings as per the schedule for staff at all levels

Outcome & Performance Analysis Indicators

Discuss Quality Indicators contents and collection protocols and formats with concerned activity holder
Conduct a pilot QI data collection test.
Freeze & Implement QI data collection formats
Collection of Quality Indicators

Internal Audit

Self-Assessment toolkit
Closures of Gaps observed

Applications, Audits & Assessments

Application to NABH
Pre Assessment
Review of the Pre-Assessment report
Correction of the deficiencies
Final review
Re-training of all staff
Final Assessment

Consultancy Support Content:

·        100 Standard Policies for all 10 NABH Chapters
·        Form and Formats: Ex
-         Registration cum General Consent form
-         Initial Assessment form
-         OPD Form
-         Informed Consent (in Bilingual language) etc
·        Training Presentations as per NABH standards: Ex
-         Induction/ Orientation
-         Infection Control
-         Disaster Management in the HCP
-         BLS (Basic Life Support) etc
·        MOU templates
·        Clinic Scroller template for TV/ LCD
·        Clinic Signage
·        Formats and Checklists for Inventory Management/ Sterilization protocols/ Quality Indicators
·        Legal Compliance Tracker
·        Healthcare Privileging Format
·        Training Need Competency Matrix template
·        Clinical Audit (minimum 2) & MRD Audit template
·        Mock Audit Template and Checklists – Chapter wise
·        NABH Application filing support
·        Audit Closure template and support

Healthcare Facility Planning, Design, Patient Safety, Quality Improvement, Review and Rating Service. facebook instagram linkedin twitter youtube

Post a Comment

Thanks for your Valuable Comment