It?s a government hospital!

All perceptions of a public hospital ? filth, poor infrastructure, indifferent doctors and staff?crumble even before you walk into Chacha Nehru Bal Chikitsalaya (CNBC) in Delhi. A phone call for an appointment is answered promptly, leaving you pleasantly surprised. The second impression is better still. As you enter the premises, a detailed layout map of the hospital serves as a ready guide of the 1.6-hectare property. The lobby is squeaky clean and the queue to get the OPD cards made is in perfect order. A housekeeper, stationed in a corner, mops the floor on the slightest provocation of dirt. The short walk to Medical Superintendent Dr KK Kalra?s office reveals Chacha Nehru?s statue, a huge aquarium and a museum for children in the central area.

Dr Kalra is used to the praise heaped on him for the good work. ?It?s more difficult to maintain standards than to set them,? he says in a matter-of-fact tone. And rightly so, because the largest paediatric hospital under the Delhi government, the 216-bed CNBC, also happens to be the first public hospital in India to get a coveted accreditation from the National Accreditation Board for Hospitals and Healthcare Providers (NABH). It took the hospital close to a year and a half to get everything in order before applying for the accreditation, which materialised in February 2009. After all, the accreditation requires a set of standards (close to 1,000) to be stringently maintained at the hospital?certainly no mean task.

Since its introduction in 2006, only 43 institutions have been granted the accreditation, and only two in the list happen to be public hospitals. The second one is the General Hospital, Gandhinagar, which got the accreditation in September last year. ?Around 400 applications are in various stages of processing,? says Dr Bhupendra Kumar Rana, Deputy Director, NABH, Quality Council of India.

For quality control at CNBC, a team of staff nurses conducts a thorough inspection of the entire facility every day and daily training sessions are held, including for the Class-IV workers. Each effort translates into keeping the gross mortality rate at CNBC below 7.5%. The mortality rate at the paediatrics department of All India Institute of Medical Sciences, one of the most premier health institutions in the country, too, hovers around the same level.

Dr Kalra took up the CNBC challenge after 20 years? experience at the Lok Nayak Jai Prakash Hospital. Set up at a cost of Rs 50 crore, CNBC got functional in 2003. ?My motive was to make this hospital different from other government hospitals and create a different image,? he says. The journey wasn?t exactly easy. When he voiced the idea of outsourcing services in the hospital, it wasn?t accepted readily. But he persevered and his requests were agreed to on an experimental basis. Today, all the support services in the hospital are outsourced?including housekeeping, security, kitchen, laundry, nursing orderlies. ?Even horticulture?we were not satisfied with the PWD and decided to outsource horticulture as well. In fact, now some of the old hospitals are also adopting the outsourcing route,? shares Dr Kalra, glancing towards the 42? plasma screen stationed to his left. As many as 33 cameras mounted across the hospital help him monitor things from his office. At home, he does it through the internet.

There are other innovations, too, that one notices. A public feedback form is attached to every case sheet, facilitating attendants to share their views on the security, sanitation and doctors? behaviour, among other things. Surprisingly, a whopping 90% were found to be satisfied with the hospital.

Next on Dr Kalra?s agenda is a separate cancer ward, getting the effluent treatment plant operational and acquiring additional 1,250 sq m land from the Delhi Development Authority for a waiting lounge for attendants? something he has been trying for the past one -and-a-half years. ?Soon, the stores, purchases and a few departments will be fully computerised,? he enthusiastically adds. Obviously, the Rs 28-crore budget for the year is made well use of.

Also, most of the staff looks quite young. Agrees Dr Kalra, ?Yes, it?s done on purpose. Our team of around 125 doctors and 230 staff nurses is young, which makes it more flexible and receptive to training. In fact, 75% of our staff, including the nursing and the lab staff, is contractual, including the doctors. We are adequately staffed and are expecting more employees to join in a month?s time.?

On any average day, there are over 700 patients coming in, not just from Delhi but neighbouring states as well. During the peak season, the figure even touches 1,000. The OPD count for 2009 was two lakh patients! For each new OPD card made, the hospital pays Rs 1.55 to the vendor, something settled for after a tedious tender and sub-tender process. All services in the hospital, like any other Delhi government hospital, is completely free, except the ultrasound, for which OPD patients need to pay Rs 50. Moreover, it is not just the poor, but also middle class and affluent people walking in for treatment ? a clear reflection of the quality of services available. In 2009 alone, the hospital did over 1.3 lakh haematology tests in its lab with another 50,000 odd biochemistry and microbiology tests.

The hospital has a separate neonatal intensive care unit (NICU), apart from the paediatric ICU, and private wards, where rooms are available at Rs 300 per day. The general wards of the hospital are also air-conditioned.

This correspondent met Puja Marwah, a resident of Chanda Nagar, who shifted her newborn from a private hospital to CNBC because ?she didn?t get good response from the private hospital?. Moreover, the treatment was working out to be too expensive for the family. Here, she is happy with the treatment and is even breastfeeding her child, something she was strictly forbidden at the private hospital.

CNBC?s success has prompted the Delhi government to open more such paediatric hospitals. ?CNBC has undoubtedly emerged as a role model. There is no denying that we have to cut the red tape and attain maximum efficiency. We are working to derive set standards to quantify quality and time deliverables, such as the amount of time it must take to attend to a patient after he walks in,? says Delhi?s Health Minister, Dr Kiran Walia.

?There is no reason why the public health delivery mechanism cannot succeed if structural and motivational issues are taken care of. AIIMS in terms of quality of service is very competitive; the first coronary heart surgery was performed at a railway hospital; army hospitals are known for their quality. And, recently, during the swine flu outbreak, we saw people going to public hospitals with scepticism, but walking out satisfied,? says Dr KS Reddy, President, Public Health Foundation of India.

Indeed, it?s time for perceptions to change.