Dear Quality Proffessionals

Any one have a guide line or presentation , on how to establish a quality management system in clinic and hospitals.

Probably the same way you would a pizza factory. Identify what your product is and how you will manage the quality of it to achieve customer satisfaction.

The process of establishing a QMS in a hospital is no different than anywhere else, all that changes is the product, the customer and the specific processes involved in product realization and customer satisfaction.

A good place to start looking for resources is the web page of the ASQ Healthcare Division (http://www.healthcare.org/). Their "Additional Resouces" page has links to a large number of other quality-oriented healthcare organizations.

Dear Randy

Your answer is really good , I know what is the starting point in developing any management system , but can you please tell me what are the benefit of implementation and ISO9001:2000 system to a hospital , and please don't tell me the genaric benefits , which is customer focus .....etc , i mean real benefits that you can tell to top management.

Gohary said:
can you please tell me what are the benefit of implementation and ISO9001:2000 system to a hospital , and please don't tell me the genaric benefits , which is customer focus .....etc , i mean real benefits that you can tell to top management.

Hello Gohary

I hope this helps....

There is no automatic benefit from ISO 9000, and especially not from simply implementing ISO 9001 on its own - OTHER than opening up business if an organisation's customers are impresssed by an ISO 9001 certificate.

ISO 9004 tells us "the adoption of a quality management system should be a strategic decision by the top management of an organization". So you can't TELL your hospital's top management what the benefits will be from their own QMS. You can only help them figure out what the benefits are going to be - essentially by implementing the PDCA cycle as defined in 9001/0.2. Their objectives will define the benefits.

If you can find success stories from other hospitals, that might help indicate what benefits are possible. But none of them will come automatically from simply implementing 9001.

Finally, I wish you, your family and your colleagues well in the events that are about to unfold in your region.

As you can imagine with the state of hospital / healtcare facility finances today, they are strongly motivated by trying to get/stay profitable.

To that end, a healthcare facility lives and dies by its accreditation. Accredited facilities are eligible for re-imbursement through the government. As the old Apollo 13 movie went; "no bucks...no buck rogers."

Whats all this got to do with a QA program? The main accreditation organization is JCAHO (Joint Comission on Accreditation of Healthcare Organizations). They generate the standards for facilities of this nature. These standards run the full gambit of business areas and put focus on risk assessment and CAPA systems. In essence they are like an ISO organization.

Inside the hospital, the JCAHO effort is usually headed up by a QA person or group. QA systems & management in a hospital environment are not as you would recognize; they are either under the auspices of a nurse, a bio-med, or a risk managment group (again, screw up accreditation, big risk to your financing).

JCAHO has standards and about every 4 years, they come out and see if the facilities "programs" measure up to the standards. If they don't you can have up to 2 years to improve as long as you show progress.

To the best of my knowledge, there is not good reason for a US hospital to chase ISO certification; especially when they are always complaining about costs and manpower issues. About the only way I can think of that there might be an interest is if the hospital is affiliated with a corporation that has other core businesses that require certification and that the corporation would like to see all their business units complying to the same standard.

Hope this helps a bit.
Regads,
Dave Gronostajski

From http://www.bizjournals.com/houston/stories/2008/03/24/daily9.html


DNV Healthcare Inc. (http://www.bizjournals.com/houston/related_content.html?topic=DNV%20Healthcare%20Inc), a Houston-based, third-party hospital assessment company, has received notification from the U.S. Centers for Medicare & Medicaid Services that its application to rule hospitals in compliance with the Medicare Conditions of Participation has been accepted for formal review.
If approved, DNV could become the first new provider of hospital accreditation in more than 40 years.
According to the notification from CMS, the formal review period began March 12, 2008, and a 30-day public comment period will begin in late April.
"This is a turning point, not just for us, but for the many hospitals seeking a new approach," said Yehuda Dror, president of DNV Healthcare.
"Healthcare spending is over $2 trillion a year, yet preventable medical errors are still on the rise. Hospitals don't need more pressure to improve, they need the tools that will help them change the system from within. If we can innovate the accreditation process, we give hospitals the key to systemic change."
DNV has developed the National Integrated Accreditation for Healthcare Organizations program which blends ISO 9001 quality management with Medicare's Conditions of Participation for Hospitals.
The result, the company said, is a more streamlined accreditation process that captures "best practices" and turns them into standard practices across the organization, leading to sustainable, continual improvement.
DNV Healthcare Inc. is a division of DNV, an independent foundation with 300 offices in 100 countries.
Last August, DNV Healthcare acquired TUV Healthcare Specialists, a Cincinnati-based hospital accreditation firm. The company said at the time that the acquisition would help support its efforts to gain recognition from the CMS. Check also http://www.newaccreditation.com (http://www.newaccreditation.com/) for more information on this alternative hospital accreditation process.

Although I am in Canada, this needs to be seriously considered even in a publicly run system.

I was required to use the healthcare system last week. Yes, it just cost me time and taxes off of my paycheque (don't go there!). My experience could be one of the worst experiences ever. Due to a lack of resources (ISO clause 6.2) and a lack of a system to handle the issue I needed to have taken care of (clause 7.1? or 4.1?) resulted in 13.5 hours in an emergency waiting room for a 10 minute procedure (clause 8.1)!! (could there even be a finding under Management Commitment?).

I could understand this if there was some analysis and decisions to be made; however, this was already diagnosed and test results from the same day were given to us before we went to the hospital!!

Let me tell you, I would have been willing to drive to Buffalo to take care of it if I knew what the price would have been. It was that frustrating and disappointing.

Maybe that could be my next job - fixing the healthcare system. Nope...too many politicians involved!:notme:

John

As a long time member of the Institute for Healthcare Improvement (http://www.ihi.org/ihi), I applaud any effort to error proof a healthcare operation, but I hasten to point out the continuing and serious flaw in many systems is the "side tracking" of patients with the least serious or urgent afflictions during the triage stage when one first enters an "emergency" care facility.

Almost every healthcare system in the world is rife with stories (anecdotes and verified case studies) of patients left to molder while dozens and dozens of patients deemed "more urgent" are run efficiently through the system.

The main problem, of course, is the patient and/or the non-medical professional (mom, dad, coworker, etc.) who brings the patient to the emergency care center has no yardstick to measure the relative urgency of the condition for which the patient seeks treatment and the various healthcare systems neglect or refuse to advise the patient of his relative place in the queue after the triage process. If that simple step were added to the triage process (perhaps with an alternate "non-urgent" location to transfer such patient or a referral to return at a less "hectic" time), much of the delay and frustration patients experience could be reduced or at least ameliorated.

All the triage-initiated delays are compounded by the fact many of the skilled specialists who might easily treat the non-urgent condition in "ten minutes" are not on the premises and the non urgent nature of the condition means they won't be called in except to treat an "emergency," but that the patient will have to wait until such specialist arrives for a regular shift (also not communicated to the patient or patient's representative.)

Yes, sadly, many healthcare operations are lacking in simple courtesy for their patients. The arrogance and hubris of many healthcare administrators and professionals is astounding when dissected in the cold clear light of day.

Although I am in Canada, this needs to be seriously considered even in a publicly run system.

I was required to use the healthcare system last week. Yes, it just cost me time and taxes off of my paycheque (don't go there!). My experience could be one of the worst experiences ever. Due to a lack of resources (ISO clause 6.2) and a lack of a system to handle the issue I needed to have taken care of (clause 7.1? or 4.1?) resulted in 13.5 hours in an emergency waiting room for a 10 minute procedure (clause 8.1)!! (could there even be a finding under Management Commitment?).

I could understand this if there was some analysis and decisions to be made; however, this was already diagnosed and test results from the same day were given to us before we went to the hospital!!

Let me tell you, I would have been willing to drive to Buffalo to take care of it if I knew what the price would have been. It was that frustrating and disappointing.

Maybe that could be my next job - fixing the healthcare system. Nope...too many politicians involved!:notme:

John

Wes,

I appreciate your points; however, with this scenario it was the lack of a system to handle the issue that caused this problem. It is basically a system that has said "We don't want to deal with this, so let emergency handle it".

Basically, in Ontario (this may change depending on the province), hope you don't need the medical system with a pregnancy less than 13 weeks. We learned the hard way that there is nothing there for you to go to except the emergency. The OB/GYN cannot see you as you aren't officially their patient (here they won't get paid until that time), there is effectively no early pregnancy clinic (open 6 hours a week!), and your GP don't have the training to help you.

I forgot to mention - we were told after 5.5 hrs on the 1st day that we could come back the next morning as they were refer us to the early pregnancy clinic. THEY NEVER DID! So we could not go to the clinic as they were already booked for the day. Back to emerg for another 8 hrs before anything was done.

There is a large gap in the health system that will not be filled until (OPINION COMING UP) more women are involved in the upper levels of the health system and politics.

John

Wes,

I appreciate your points; however, with this scenario it was the lack of a system to handle the issue that caused this problem. It is basically a system that has said "We don't want to deal with this, so let emergency handle it".

Basically, in Ontario (this may change depending on the province), hope you don't need the medical system with a pregnancy less than 13 weeks. We learned the hard way that there is nothing there for you to go to except the emergency. The OB/GYN cannot see you as you aren't officially their patient (here they won't get paid until that time), there is effectively no early pregnancy clinic (open 6 hours a week!), and your GP don't have the training to help you.

I forgot to mention - we were told after 5.5 hrs on the 1st day that we could come back the next morning as they were refer us to the early pregnancy clinic. THEY NEVER DID! So we could not go to the clinic as they were already booked for the day. Back to emerg for another 8 hrs before anything was done.

There is a large gap in the health system that will not be filled until (OPINION COMING UP) more women are involved in the upper levels of the health system and politics.

JohnI am able to and willingly will participate in debates and discussions on these and other points about health care systems anywhere in the world, but you have really pinpointed two of the stumbling blocks:

compensation for skilled heath care professionals
effective glass ceilings for femalesWe note a greater percentage of females entering medical schools, but they are not rising in the higher paid ranks or positions of authority of health care professionals, yet.

Structured quality in medical care is finally beginning to get enough public focus to even find its way on the political radar screen. But there are many constraints to progress. Some are personal, and others are systemic.

When my employer closed and lost my internal auditing job in 2001, I looked for QA work in hospitals and discovered they always ask for a registered nurse for the position. So, I was not able to find my way into medical quality, even though I felt pretty sure I could contribute. So I went into education instead, and found myself facing the same problem: they want an expert in getting it wrong to be in charge of getting it right. But I digress.

I decided that part of the problem was lack of understanding of what quality management means. When they ask for a QA Supervisor, they could really have an inspector in mind. No matter what brilliant ideas that inspector may have, they wither from lack of fertile soil to take root. This happens in manufacturing too, so I can't rightfully pick on the medical field for this myopia. Many improvements are not even dreamt of, never mind introduced, because of the effort they would require, the responsibilities and authorities don't match, the people causing problems are not harmed by them, or influential people just do not understand the payback.

I regret to say that the law of inertia is enabling this problem in a crippling way. Until it becomes a crisis, the "If it ain't broke, don't fix it" mindset will endure and people will be harmed until a tipping point is reached.

:2cents:

Dear Quality Proffessionals

Any one have a guide line or presentation , on how to establish a quality management system in clinic and hospitals.
I have heard about the Cleveland system in hospital management. Can any of you tell more about this and provide links if any .......

Gohary,

Get IWA 1 from www.iso.org That will give you a lot of background regarding ISO 9001 in healthcare - not just why but how.

The attached ppt can posibly help, though it is India specific. You are free to modify it to suit Dubai specific references and use it.

Best of luck.

I have heard about the Cleveland system in hospital management. Can any of you tell more about this and provide links if any .......

Somasekhar, If you could tell me some more details of what exactly you are looking for and why, maybe all could help in some way. You can send me a message with the details if you want.