Series: Understanding MSDS for Category II-C Hospitals | Post 1 of 61
“Those Standards Are for the Big Hospitals”
Dr. Kashif Mehmood ran a twelve-bed private hospital on the main bazaar road of Sheikhupura. His wife, a gynaecologist, managed the labour room and the caesarean list. He did the general surgery, and two medical officers covered the nights. The OPD was busy, the wards were rarely empty, and the building had grown one room at a time over ten years.
When a friend from medical college asked whether he had started preparing for the MSDS, Dr. Kashif laughed. “Those standards were written for the big teaching hospitals. We have twelve beds.”
That evening his friend sent him a photograph of a cover page: “MSDS Reference Manual for Cat II-C Health Care Establishments, 2017”. It had been written for hospitals of exactly his size.
Why a Small Hospital Has Its Own Manual
The introduction of the manual starts with the law. The Government of the Punjab promulgated the Punjab Healthcare Commission (PHC) Act 2010 to establish the PHC as a regulatory body, with the objective of improving the quality of healthcare services and banning quackery in all its forms. The PHC regulates all healthcare establishments (HCEs) and service providers in the public and private sectors through registration and licensing, and by setting minimum service delivery standards (MSDS) for all categories and levels of health services. Under Section 13 of the Act, all HCEs are required to get registered with the PHC.
The first MSDS, in 2012, were for Category I hospitals with over 50 beds: 30 standards and 162 indicators. In October 2014 the PHC notified the MSDS for Category II, hospitals with less than 50 beds, with 34 standards and 152 indicators. Registration data then showed that most private Category II hospitals had up to 30 beds, and that smaller private HCEs faced real constraints in acquiring and retaining qualified staff and technical expertise.
The PHC therefore divided Category II into sub-categories:
- Category II-A: 31 to 49 beds
- Category II-B: 16 to 30 beds
- Category II-C: 1 to 15 beds
- Rural Health Centres (RHCs): up to 20 beds
The original Category II standards were kept for II-A. For II-C, the standards were adjusted to suit the level of services, in the manual’s words, “without compromising the core standardization and quality assurance requirements”. The Government approved them in October 2017, and the reference manual followed.
What the Manual Contains
The MSDS for Category II-C comprise 30 standards and 118 indicators in 10 functional areas:
- 2.1 Responsibilities of Management (ROM): Standards 1 to 3, Indicators 1 to 11
- 2.2 Facility Management and Safety (FMS): Standards 4 to 6, Indicators 12 to 20
- 2.3 Human Resource Management (HRM): Standards 7 to 9, Indicators 21 to 25
- 2.4 Information Management System (IMS): Standards 10 and 11, Indicators 26 to 31
- 2.5 Continuous Quality Improvement (CQI): Standards 12 to 14, Indicators 32 to 40
- 2.6 Access, Assessment and Continuity of Care (AAC): Standards 15 to 17, Indicators 41 to 57
- 2.7 Care of Patients (COP): Standards 18 to 22, Indicators 58 to 86
- 2.8 Management of Medications (MOM): Standards 23 to 25, Indicators 87 to 104
- 2.9 Patient Rights and Education (PRE): Standards 26 to 28, Indicators 105 to 111
- 2.10 Hospital Infection Control (HIC): Standards 29 and 30, Indicators 112 to 118
Each indicator carries a survey process, the scoring rules and implementation guidelines, often with sample formats. An Assessment Scoring Matrix closes every standard, and the annexures add the health related laws of Punjab and ready formats.
The Scoring Matrix and the Licence
The manual uses colour coding. The 86 RED indicators require full compliance and carry 100% weightage. The 32 YELLOW indicators accept partial compliance of at least 80%. The same scale is used by hospital staff for self-assessment and by PHC surveyors for licensing. The staff assess themselves to ensure 100% implementation, and the PHC assessors then assess and score for the licence.
The manual adds a sentence worth pinning on the wall: it is highly desirable to achieve 100% in all areas, because these standards are already set at the minimum level. All HCEs are required to implement the MSDS to acquire a licence from the PHC.
What Dr. Kashif Did Next
He read the manual over a week. Much of it described work his hospital already did, but the manual asked for proof: a written SOP, a signed register, a nurse who could explain a procedure when asked.
He called his senior staff together and gave each person a functional area. The head nurse took Care of Patients and Infection Control. The dispenser took Management of Medications. The receptionist, who also kept the files, took Information Management. His wife took the obstetric and anaesthesia indicators, and Dr. Kashif kept Management and Facility Safety for himself.
Within a month they had printed the scoring matrices and completed a first honest self-assessment, with a list of gaps, a name and a date against each one.
A Quick Self-Check
- Do you have a copy of the MSDS Reference Manual for Cat II-C HCEs at your hospital?
- Is your hospital registered with the PHC under Section 13 of the PHC Act 2010?
- Can your senior staff name the 10 functional areas?
- Do you know which of the 118 indicators are RED and which are YELLOW?
- Has each functional area been assigned to a responsible person?
- Have you scored your hospital on the Assessment Scoring Matrix?
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