How do you see ISO 7101 fitting into India’s push for universal healthcare and IRDAI’s ‘Insurance for All by 2047’?
ISO 7101 is the first global standard for Healthcare Quality Management Systems. It can provide Indian organisations with a single, system-level, quality framework that can sit above today’s programmatic layers. It complements PM-JAY’s strategic purchasing, ABDM’s digital rails, and significantly enhances NABH, as well as NQAS conformance by focusing on leadership, risk, data, patient centered care and continuous improvement across clinical and non-clinical services.It enables payers and providers to align on the standardised common indicators with consistent reporting mechanisms (e.g., wait times, patient experience, safety, readmission rate, bed occupancy ratio and bed turnover ration) while IRDAI advances “Insurance for All by 2047.” In short: ABDM = data, PM-JAY = coverage, NABH andNQAS = current facility conformance, and ISO 7101 = the fit for purpose management system that ties it together to drive consistent, measurable, management and clinical outcomes. Crucially, ISO 7101 focuses on optimising performance and accelerating impactful patient and organisational outcomes.
Given the sector’s fragmentation, is one global standard practical for both corporate hospitals and rural facilities?
Yes, because ISO 7101 is scaleagnostic and context-driven. It requires a quality management system but enables each facility to calibrate scope complexity based on its realities, resources, and operating constraints using PDSA (Plan, Do, Study, Act) cycles and implementing risk based controls. In India, the most practical path for providers is “core + staged maturity”. Organisations can start with ISO 7101 to build a robust management system that gives providers a strong foundation, map to NABH and NQAS where relevant, and build capability through hub and spoke support clusters so smaller sites aren’t left behind, particularly in T2 and T3 cities.
Were there any surprising challenges or gaps uncovered during the pilot that point to areas where hospitals still need support?
Four key areas stood out:
◆Measurements e.g. “waiting time” – this sounds simple but splits into several microqueues; hospitals needed help standardising definitions and data capture.
◆Cross-functional ownership—quality indicators often existed in silos making clinical, operations and finance co-own them, which required governance enhancements and strategic alignment.
◆Workforce well-being metrics — some sites lacked robust measures, despite staff well-being having an impact on safety and patient experience. This can be enhanced with clearer indicator dictionaries, lightweight data pipelines, and board-level ownership of a few system KPIs.
◆Risk reporting – This was fragmented and some staff were concerned about being singled out or isolated. The principles of a ‘No-Blame Culture’, underpinned in the ISO 7101 standard, helped these organisations to introduce various robust reporting mechanisms that included anonymous and nonpunitive frameworks. Some pilots also saw the value of openly including risk reporting as an important part of their organisational culture.
The pilot showed reduced readmissions and shorter waiting times—how can leaders convert that into financial outcomes?
By tying each improvement to a line item:
◆Lower readmissions ➝ fewer avoidable costs and freed bed days. Estimate value = excess readmissions avoided avg variable cost per case and where applicable, add reimbursement.
◆Shorter LOS ➝more throughput at same fixed cost. Value ˜ (LOS baseline – LOS actual) × discharges × variable cost/day, Indian examples showed meaningful savings when ALOS drops even modestly.
◆Reduced waits ➝higher OPD/OT utilisation. Value ˜ added visits or cases × net contribution per case.
◆Safety/reliability ➝less waste/indemnity. Track incident-related cost per 1,000 patient days pre/post.
For promoters and boards, what’s a realistic ROI timeline for ISO 7101?
With executive sponsorship and basic digital standardisation and optimisation, we typically see operational benefits within 3–6 months (e.g. throughput, waste, incident rates) and financial ROI in ~12–24 months, faster in multi-site chains that scale playbooks. Evidence from accreditation/QMS programs in India shows efficiency and
performance gains.
How does BSI plan to work with Indian hospital chains, associations, or regulators to accelerate adoption?
Our approach is partnershipfirst and evidence-led:
◆Map and align: Publish crosswalks between ISO 7101, NABH and NQAS so hospitals see exactly how efforts add up.
◆Capability building: Run joint academies with partners like CAHO & AHPI on indicators, governance, and data use. BSI India is already convening ISO 7101 workshops and we’ll build on that momentum.
◆Digital fit: Package ISO 7101 metrics with ABDM/ABHA data flows to lower reporting burden and enable benchmarking.
◆Payer alignment: We are exploring how we work with NHA/insurers on how ISO 7101 performance can inform empanelment tiers or qualitylinked incentives, supporting IRDAI’s 2047 mission.
◆Proof at scale: Run multisite “learning collaboratives” with top chains, publishing before and after results so adoption is based on evidence.
How is India’s ISO 7101 experience viewed by other developing markets could it be a template?
India’s ISO 7101 implementation pilots show that a sector-specific management system can materially lift organisational performance in complex, multilayered health systems. India’s context—mixed public/private provision, variable resourcing, and significant regional heterogeneity—mirrors many large emerging markets (e.g. Indonesia, Malaysia, China), making the lessons highly transferable. Crucially, pilots in Tier-2 and Tier-3 cities demonstrate that ISO 7101 is effective beyond flagship hospitals: by standardising core processes, centralising oversight, and instituting consistent, patient-centred delivery, organisations strengthen governance, quality, risk management, and patient safety. The formality and discipline of the standard enable comparable metrics and benchmarking, turning routine data into targeted improvement. When used together, these factors can not only optimise care for patients but also improve financial performance through reduced variation, better resource utilisation, and lower failure costs. The Indian experience therefore offers a robust, evidence-oriented model that is relevant to both developing and developed health systems seeking reliable, scalable improvement.
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