Sector Wide Approach to Strengthening Health ( SWASTH )

Bihar Technical Assistance Support Team (BTAST)
Government of Bihar initiative supported by Department for International Development, UK


From our archives: Family Friendly Hospitals Initiative

The Family Friendly Hospitals Initiative (FFHI) was designed to improve quality of care in public health facilities, enhance patient satisfaction and increase service uptake.

1. A Challenge: Achieving Quality of Care in a Low Resource Context:
With overall health statistics among the lowest in India, Bihar’s progress is hampered by a shortage of public health facilities able to deliver the required quality healthcare. Increasing and changing demand for services resulting from public education and social changes compounds the problem. Although recent in-creases in spending on infrastructure and human resources have led to substantial improvements in both quality and quantity of services delivered, there is still scope to increase the benefits gained from these inputs in terms of patient experience and health outcomes.

2. A Solution: Creating Family Friendly Hospitals:
The Family Friendly Hospitals Initiative (FFHI) was designed to improve quality of care in public health facilities, enhance patient satisfaction and increase service uptake. A family friendly facility uses evidence based protocols to ensure safe, effective and timely treatment while making patients and their families feel comfortable and welcome. Appropriate infrastructure, management and support provide an enabling envi-ronment for service providers to deliver quality services. FFHI promotes better use of available resources, without additional spending. Facilities that achieve the required standard receive FFHI certification, an intermediary step towards eligibility for more major investment, which acts as a motivator and ensures that any future investment is properly utilised.

Health staff and management are orientated on the importance of quality of care and undertake a vision-ing exercise to identify problems and develop solutions. Departmental teams work on agreed solution paths to achieve FFHI standards in seven areas. When they feel ready the facility carries out an internal assessment and invites the District Quality Assurance Cell to initiate formal assessment, with detailed feedback on findings. In 2012/13, 62 facilities were nominated for FFHI in 38 districts. BTAST supports 45 of these (in 14 districts), of which three have completed the final audit.

3. Observed Changes in Patient Satisfaction and Service Uptake:
Initial improvements seen in hospitals include a cleaner environment, more reliable supply of drugs, func-tioning equipment, better diet for inpatients, more staff on duty and positive staff attitudes. Although hu-man resource shortages are not fully under the control of the hospital, more strategic use of existing staff is reported to have made a difference, deputing staff with particular skills to stations where they are need-ed and placing more staff in busy departments. Client satisfaction survey showed patient satisfaction at perceived reduced waiting times for registration and consultations, more convenient layout and better inpatient care. These trends are reflected in increased uptake for both major and minor surgery in some hospitals and stated intention of patients to use the hospital again.

Hospitals often start with “quick wins” by improving the external appearance of the hospital, providing better signage and clear information about services, incentives and free drugs available, which gives a pos-itive impression to patients as they arrive and quickly translates into improved staff morale and greater pride in the institution. Improving and rationalising record keeping helps ensure availability of the re-quired data without unnecessarily wasting staff time. Particular improvements are seen in labour rooms and newborn care units, which are a priority focus in the Government drive to reduce maternal and new-born death rates and increase institutional delivery.​