The Cost of Complacency: How Periodic “Quality Festivals” Harm Long-Term Hospital Performance

This is the 3rd article in the series "Festival Fiasco".

Pursuit of excellence is not just a matter of reputation but a critical determinant of patient outcomes for healthcare systems and hospitals. While periodic “quality festivals” have emerged as popular mechanisms to achieve accreditation, the practice raises concerns about the associated economic, reputational, and clinical costs.

This analysis delves into the long-term consequences of failing to maintain consistent quality standards. This has serious implications which are more pronounced in small hospitals under 50 beds.

Economic Implications

Periodic quality festivals often lead to a temporary allocation of resources aimed at improving hospital performance metrics. While these events can result in short-term gains, they can also lead to significant economic inefficiencies. Resources diverted to these festivals include not only financial investments but also staff time and attention that could otherwise be directed towards sustainable quality improvements. Hospitals may face diminishing returns on investment as the costs of organizing these festivals do not always translate into long-term benefits. Additionally, the cyclical nature of these efforts can lead to budgetary pressures and poor allocation of resources, detracting from investments in continuous quality improvement programs.

Reputational Costs

The reputational impact of relying on periodic quality festivals for performance improvement is multifaceted. Initially, hospitals may experience a boost in their public image, thanks to improved performance metrics. However, this improvement is often short-lived, and the failure to maintain consistent standards can lead to public skepticism and erosion of trust. Patients and stakeholders are increasingly aware of the difference between genuine quality care and temporary improvements. As the case studies have shown, hospitals that have relied heavily on these periodic boosts have experienced a decline in patient satisfaction scores and stakeholder trust once the temporary measures dissipate.

Clinical Consequences

Perhaps the most significant cost of complacency in hospital quality efforts is clinical. Temporary improvements during quality festivals do not address underlying systemic issues that affect patient care. This inconsistency can lead to a fluctuation in clinical outcomes, where periods of high performance are followed by declines in care quality. Such variability not only undermines the overall effectiveness of hospital care but also poses direct risks to patient safety and outcomes. Long-term clinical excellence requires a sustained commitment to quality improvement, far beyond the periodic festivals.

The reliance on periodic quality festivals to boost hospital performance metrics does not work. The economic inefficiencies, reputational damage, and clinical risks associated with these temporary efforts underscore the importance of consistent and sustainable quality improvement practices.

Hospitals need to move beyond the complacency of short-term achievements and invest in the long-term health of their quality improvement programs. Only through continuous, consistent efforts can hospitals achieve the level of care that patients deserve, stakeholders demand and accreditation assures!

Case Study: Accreditation of Pragati Hospital* [name masked]

Pragati Hospital is a family run 45 bed hospital in a tier II town in north India. The hospital hired an agency to get quality system implemented in order to achieve accreditation from NABH, India’s first healthcare accreditation body.

Short-term success

The consultant provided pre-designed SOPs, documents, forms, and formats; embedded own personnel within hospital ranks who handled the assessors and resultantly, the hospital sailed through the accreditation. Throughout the process the involvement of clinical teams, doctors, nurses, paramedical staff was negligible and even the management’s mandate was to ‘somehow’ obtain accreditation certificate. The hospital was spruced up, nursing and other staff transplanted from other hospitals temporarily and the hospital was successful in demonstrating that a quality system has ‘indeed’ been implemented.

Long-Term Challenges

While the consultant’s staff was embedded, the hospital did achieve improvement in its performance metrics. The hospital received positive media attention (which was partly motivated), and staff morale briefly improved due to the excitement and focus on quality improvement. However, as the effects of the “festival” waned, so did the improvements. Within a few months staff returned to their regular routines. Policies remained on paper, performance indicators were not captured, and no one bothered about patient’s files and medical records.

The temporary measures implemented were not integrated into the hospital's system since everyone was saw it as “only to get accreditation”.

The economic costs of such a “Quality Festival” were substantial, including the expenses related to additional staffing, training, and promotional activities. Despite these investments, the lack of sustained improvement led to a poor return on investment.

Pragati Hospital's experience underscores the pitfalls of relying on “Quality Festivals” as an approach to quality improvement.