Executive Dashboard
Compliance operations centre · —
84
NABH Readiness Score — 84 / 100
Your hospital is above the 80-point threshold. Three chapters require attention before the next assessor visit: Fire Safety (72%), HR Training (67%), and Infection Control documentation.
Above accreditation threshold
3 chapters need action
Next assessment
Oct 2026
~148 days
🔁
Open CAPAs
7
2 overdue — action required
📅
Documents Expiring
2
Fire NOC 23d · AMC cert 41d
♻️
BMW Chain
96%
Today: chain complete ✓
🚨
Incidents (30d)
11
2 open · awaiting investigation
🏛
Committees
14/15
Transfusion due Jun 20
🎓
Staff Training
81%
5 staff overdue — Support Dept
📊 Chapter Readiness
Infection Control
12 standards · 4 pending
79%
Fire Safety
8 standards · 2 gaps
72%
HR & Training
15 standards · 5 gaps
67%
Patient Safety
18 standards · 1 gap
94%
Medical Records
11 standards · 0 gaps
91%
📋 Recent Activity
🔁
CAPA #106 closed — Fall risk documentation, Ward 3
Closed by Nurse Supervisor W3 · Evidence uploaded · Verified by QM · 2h ago
♻️
BMW log submitted
All 3 wards · 14.2 kg collected · Morning shift · Today 08:30
🚨
Incident #47 reported
Patient fall · Ward 2 · Medium severity · 6h ago
🏛
Infection Control Comm. minutes filed
June meeting · 9 members · Quorum met · Yesterday
⚠️
Fire NOC expiry alert
Expires in 23 days · Renewal initiated · Pending authority
✅ NABH Tracker
5th Edition · 103 standards · Live readiness score
3 gaps require action
Pending
Fire Safety gaps — Admin HOD (Ravi Kumar)HR Training gaps — Shalini R (HR Head)Infection Control — Dr. Meena
84
NABH Readiness — 84/100
Above accreditation threshold. Three chapters are at risk: Fire Safety (72%), HR Training (67%), Infection Control (79%). Assessor visit: October 2026.
🔁 CAPA Module
Corrective & Preventive Actions · 7 open · 2 overdue
2 overdue
Pending
Overdue: Ravi Kumar (Admin HOD)Overdue: Dr. Meena (IC Head)Due Jun 28: Shalini R (HR Head)
Overdue
2
Action required today
Open
5
On track · within deadline
Closed (30d)
14
With evidence · verified
Avg. Closure
11d
Target: 14 days
All Open CAPAs
| ID | Finding | Chapter | Assigned to | Deadline | Status |
|---|---|---|---|---|---|
| #109 | Fire drill records missing for 2 wards | Fire Safety | Ravi Kumar (Admin) | ⚠ Jun 10 — Overdue | Overdue |
| #108 | Hand hygiene compliance log gaps — ICU | Infection Control | Dr Meena (IC Head) | ⚠ Jun 12 — Overdue | Overdue |
| #107 | HR training records: 5 staff overdue for fire safety recertification | HR Training | Shalini R (HR Head) | Jun 28 | In Progress |
| #106 | Fall risk assessment not documented per-shift in Ward 3 | Patient Safety | Nurse Supervisor W3 | Jun 25 | In Progress |
| #105 | Maintenance log for OT equipment — 2 entries missing | Infrastructure | Maintenance HOD | Jul 05 | Assigned |
| #104 | Patient fall incident #47 — root cause investigation | Patient Safety | QM (Suresh Kumar) | Jul 10 | Assigned |
| #103 | Fire NOC renewal — pending KSPCB authority | Fire Safety | Admin (Ravi Kumar) | Jul 01 | Pending External |
🚨 Incident Reporting
Last 30 days · 11 incidents · 2 open
Pending
#47 open — QM (Suresh Kumar)#46 open — Infection Control Team
Open
2
Under investigation
Resolved (30d)
9
With CAPA closure
Reporting Time
82 min
Avg. from incident to log
🏛 Committee Tracker
15 NABH-mandated committees · 14 current · 1 meeting due
Pending
Transfusion Cmte due Jun 20 — Dr. Anand (Blood Bank)Minutes pending — 1 committee
🎓 Staff Training
Coverage: 81% · 5 staff overdue recertification
5 overdue
Pending
3 overdue — Support Staff HOD2 overdue — Admin Dept (Shalini R)
Overdue Staff
5
Fire safety recertification
Sessions (30d)
12
217 staff trained
Total Coverage
81%
Target: 90%
Training Coverage by Department
Nursing
88%
0 overdue
Administration
76%
2 overdue
Lab & Pharmacy
92%
0 overdue
Support Staff
64%
3 overdue
Doctors
85%
0 overdue
♻️ BMW Chain-of-Custody
CPCB BMW Rules 2016 · Today's chain complete · All logs current
Chain complete
Today's Collection
14.2 kg
All 3 wards logged
Chain Completeness
96%
Last 30 days
Vendor Auth Expiry
187d
GreenTech CBWTF · Valid
Manifests (30d)
42
All reconciled
Ward
Collection
Collection
✓ Logged
→
Segregation
& Weight
& Weight
✓ 14.2 kg
→
Internal
Transfer
Transfer
✓ 08:15
→
CBWTF
Manifest
Manifest
✓ #GT-4219
→
CBWTF
Handover
Handover
✓ 09:40
→
Chain
Complete
Complete
Today
🪪 Vendor Passport
Vendor credentialing · 1 licence expiring within 60 days
1 expiring
Pending
Fire NOC renewal — SafeFire Systems · 23 days · CAPA #103 open
💧 Utility Monitor
Electricity · Water · Diesel · May 2026
48,200
kWh · May 2026
↓ 6% vs April · On target
2,840
KL · May 2026
↑ 4% vs April · Review required
320
Litres diesel · May 2026
↓ 12% vs April · Power cuts reduced
ESG Indicators — May 2026
| Indicator | This Month | Per Bed | Trend | Target |
|---|---|---|---|---|
| Energy Intensity | 48,200 kWh | 219 kWh/bed | ↓ 6% | <200 kWh/bed |
| Water Intensity | 2,840 KL | 12.9 KL/bed | ↑ 4% | <12 KL/bed |
| BMW Generated | 382 kg | 1.7 kg/bed | ↓ 2% | <2 kg/bed |
| DG Diesel | 320 L | 1.5 L/bed | ↓ 12% | <1.2 L/bed |
🗄 Evidence Vault
Compliance documents · 2 expiring within 45 days
2 expiring soon
⚠️
2 documents expiring: Fire Safety NOC (23 days) · Biomedical Equipment AMC (41 days). Renewal actions are open in CAPA.
📋 Management Review
NABH-format board report · Due: June 15, 2026
Report due Jun 15
Management Review — May 2026
City Care Hospital · Bengaluru · Quality Manager: Suresh Kumar
Quality Indicators
| Indicator | May | Apr | Trend |
|---|---|---|---|
| NABH Score | 84 | 81 | ↑ +3 |
| CAPA Closure Rate | 82% | 74% | ↑ +8% |
| Incident Rate | 5.0/1000 | 5.3/1000 | ↑ -0.3 |
| HAI Rate | 1.8% | 2.1% | ↑ -0.3% |
| Staff Training | 81% | 78% | ↑ +3% |
| BMW Compliance | 96% | 94% | ↑ +2% |
Board Actions
Fire Safety NOC Renewal
Owner: Admin COO · Due Jul 1 · In progress
HR Training Gap Closure
5 staff overdue · Owner: HR Head · Due Jun 28
Patient Safety Chapter
94% — all documentation current
Compliance Intelligence Feed
India hospital compliance · NABH · BMW · Regulatory · Loading…
⚡ Active Risk Alerts
ℹ️
Live articles are fetched from public Indian news sources via Google News RSS. Curated intelligence items are researched by Acredify. Acredify does not author or endorse third-party content. Click any article to read the full piece on the original publisher's website.
🏛 COO & Medical Director View
Leadership
Operational compliance visibility · Escalations · Department accountability · Financial exposure
2 overdue — action required
Needs your attention
CAPA #109 overdue — Ravi Kumar (Admin HOD)
Fire NOC expires in 23 days — renewal pending
Transfusion Committee meeting due Jun 20
TPA Revenue at Risk
₹18L/mo
If NABH accreditation lapses, major insurer empanelment withdraws within 30 days
BMW Penalty Exposure
₹2.1L
Median fine for documentation gap in SPCB Karnataka inspections (2025–26)
NABH Readiness
84/100
Above threshold. 3 chapters need action before Oct 2026 assessment
Open CAPAs
7
2 overdue · 5 on track · Avg closure 11 days
Department Compliance Accountability
🔥 Fire & Safety
Admin HOD (Ravi K)
72% · CAPA open
🎓 HR & Training
HR Head (Shalini R)
67% · 5 overdue
🦠 Infection Control
Dr. Meena (IC Head)
79% · Log gaps
🚨 Patient Safety
QM (Suresh Kumar)
94% · Good
📁 Medical Records
MRD Head
91% · Good
♻️ BMW / Environment
Facility Manager
96% · Chain complete
✅ Quality Manager View
Daily Operations
NABH chapters · CAPA queue · Evidence gaps · Committee records · BMW chain
2 overdue
Your queue
CAPA #109 overdue
CAPA #108 overdue
Incident #47 investigation pending
Fire Safety NOC — 23 days
NABH Readiness — 84/100
🔥Fire Safety72%
🎓HR Training67%
🦠Infection Control79%
🚨Patient Safety94%
📁Medical Records91%
CAPA Queue — 7 open
#109 — Fire drill records
Ravi Kumar · 4 days overdue
#108 — Hand hygiene log gaps, ICU
Dr. Meena · 2 days overdue
#107 — HR training: 5 staff overdue
Shalini R · Due Jun 28
#106 — Fall risk documentation, W3
Nurse Supervisor · Due Jun 25
+ 3 more open CAPAs
Committee Status — 14/15 current
Quality Management✓ Jun 2
Infection Control✓ Jun 6
Patient Safety✓ Jun 3
TransfusionDue Jun 20
Evidence Gaps — action needed
Fire Safety chapter
Fire drill records — 2 wards · NOC expiry evidence pending
HR Training chapter
5 staff recertification records missing
Infection Control
Hand hygiene logs — ICU shift gaps
💰 CFO / Finance View
Financial Exposure
Compliance financial risk · TPA revenue exposure · Penalty liability · Cost of current approach vs Acredify
₹18L/mo TPA at risk
Financial risk active
TPA empanelment at risk if NABH lapses
BMW penalty exposure — log gaps identified
TPA Revenue at Risk
₹18L/mo
Cashless empanelment revenue lost within 30 days of NABH suspension. 4 major insurers.
BMW Penalty Exposure
₹2.1L
Median SPCB Karnataka fine for BMW documentation gaps. Current logs have 3 shift gaps.
Annual Consultant Spend
₹3.8L
NABH pre-assessment consultant cost per cycle (every 3 years). Same findings recur.
Acredify Annual Cost
₹1.8L
Full platform access. Replaces consultant spend. Eliminates penalty exposure. Free pilot first.
Cost of current approach vs Acredify
Current — Excel / WhatsApp / Manual
NABH consultant (per cycle)₹3.8L
QM overtime during audit prep~₹1.2L
BMW fine risk (per inspection)up to ₹2.1L
TPA loss if NABH lapses (1 month)₹18L
Total exposure per cycle₹25L+
With Acredify
Annual subscription₹1.8L
QM overtime (continuous = zero sprint)~₹0
BMW fine risk (chain complete daily)Near zero
TPA loss (always audit-ready)₹0
Total cost per year₹1.8L
⚠️
CBWTF vendor co-liability note: Under BMW Rules 2016, if your CBWTF vendor's authorisation lapses, your hospital shares financial liability for every collection during that period. Current vendor (GreenTech CBWTF) authorisation valid until Dec 2026 — monitored continuously by Acredify.
🔍 Auditor / Assessor View
Evidence & Documentation
Evidence completeness by chapter · Finding history · Documentation trail · Retrieval readiness
3 chapters with gaps
Evidence status
Fire Safety — drill records missing
HR Training — 5 staff records incomplete
BMW chain-of-custody — complete ✓
Document Retrieval Readiness
NABH Accreditation CertificateInstant
12 months BMW logsInstant
Committee minutes (all 15)Instant
Fire Safety chapter evidenceIncomplete
CAPA closure evidencePartial
Audit Trail — Recent Events
BMW log submitted — all 3 wards
Today 08:30 · Timestamped · Manifest #GT-4219
Infection Control Committee minutes filed
Jun 6 · Digitally timestamped at time of entry
CAPA #106 closed — evidence uploaded
Jun 12 · Nurse Supervisor · Verified by QM
Incident #47 reported — Ward 2
Today 06:45 · Nurse Preethi · Investigation open
📋 Administrator / Operations View
Operational Control
Vendor credentials · Document expiry calendar · BMW chain · Training coverage · Facility compliance
1 vendor expiring · 2 docs expiring
Expiry alerts
Fire Safety NOC — 23 days · SafeFire Systems
Biomedical Equipment AMC — 41 days
Today's BMW Chain
✓ Collected
→
✓ 14.2 kg
→
✓ Transferred
→
✓ Manifest #GT-4219
GreenTech CBWTF · Collected 09:40 · All 3 wards complete · Chain-of-custody timestamp verified
Training Coverage Gaps
Support Staff64% · 3 overdue
Administration76% · 2 overdue
Nursing88% · Good
Lab & Pharmacy92% · Good