Quality in healthcare
Standardizing clinical practice and management functions across two hospital sites while meeting tough national care standards is not an easy task. Sheila Oliver, senior auditor at SGS UK Ltd, and Kris Riley, risk management director of Affinity Healthcare, explain how ISO 9001 was used as a framework to help achieve just this
Two become one
Previously registered to ISO 9000 as two separate organizations, Cheadle Royal Hospital and Middleton St George Hospital in the UK, came together as Affinity Healthcare in 2001. A decision was taken early on to develop one corporate QMS to bring services together.
There were several challenges to overcome in meeting this: the two systems were complex and different, assessed by different certification bodies, one to ISO 9001:1994, the other to ISO 9002:1994, and staff at each site were protective of their own systems. Despite this, Affinity Healthcare organization achieved ISO 9001:2000 certification in December 2002, following successful assessment by SGS UK Ltd under the Healthmark scheme. (Healthmark is a branded ISO 9001:2000 scheme for the health and social care sector developed and owned by SGS.) Two years on, the system continues to develop.
The Affinity transition
Affinity Healthcare's mission is to provide high quality, value for money and innovative and responsive mental health services. In recent times a greater emphasis has been placed on quality by bodies such as the Healthcare Commission and the Commission for Social Care Inspection. The implementation of ISO 9001:2000 helped the organization to both manage and monitor the various requirements and to improve services.
The overarching framework of the standard is used as a management tool and has resulted in a number of positive changes. When Affinity Healthcare acquired the Middleton St George Hospital it was necessary to develop consistent ways of working. The ISO 9000 quality management standard framework was used to achieve this in the key areas of complaints, policies and procedures, internal auditing and document control. It reinforced the need for consistency and improvement across the two sites and facilitated shared learning.
The documentation overhaul
One of the most well-received changes resulting from the implementation of the corporate QMS was the overhaul of the documentation system.
The standard requires the 'control' of documents. To achieve this, the organization implemented an electronic system for the management of all policies, procedures and associated documentation. There is now a corporate format and the aim is to have company-wide policies and procedures though some sites and service-specific procedures are permitted where required. This has had a positive effect on clinical practice. Both hospitals reviewed the key clinical policies and procedures. Good practice was shared and debate was lively, and the result was not only improved documentation but also improved practice.
Policies, procedures and associated documentation are accessible electronically. Staff who receive them electronically are alerted by email that a policy has been reissued or revised. Staff may print policies and procedures for training purposes etc but know that once a document goes beyond the 24 hour print date (on the footer of the document) it is no longer a controlled document.
Changes to any of these documents or requests for new documents are managed through the quality department. This ensures that all changes have been agreed by the relevant staff and that related documents are also amended. It also ensures that the changes flow through the whole of the company.
All documents have an easily accessible history. This has been very useful during Healthcare Commission inspections, enabling the organization to efficiently demonstrate how recommendations have been actioned and how findings from the National Institute for Clinical Excellence guidelines and enquiries have been implemented.
The focus of ISO 9001 is continual improvement. The organization continues to seek further ways to improve the document control system to ensure that it is both effective and user friendly. The next step is to introduce a system that will enable staff to electronically 'approve' and comment on draft documents.
Customer focus
The emphasis on patient satisfaction focused attention on the various ways the organization obtains and measures satisfaction. All patients are surveyed on discharge and on-the-spot surveys are also undertaken. The complaints system is also used as part of this process. Attention is given to corrective action and to preventing recurrence. Information about complaints and patient satisfaction is regularly reviewed and trends are analyzed. Action plans drawn up based on patient comments are subject to regular monitoring and reviewing.
Internal auditing
Another key benefit is the revised internal audit system which now has a team on each site supported by a quality officer. Initially focusing on auditing the requirements of the standard, the function is now widely used as a management tool to audit units/departments and particular policies and procedures.
As well as providing valuable management information, internal auditing has enabled units to benefit from the good practice of others and to work collaboratively to resolve shared problems. Not least, it facilitates staff from different backgrounds visiting other units and meeting staff they would not generally come into contact with. This promotes a better understanding of the functions of each department and how they interface with each other.
A framework for change
There are clear drivers within the health sector for the implementation of robust QMSs, and there can be no doubt that the latest revision of ISO 9000 is a useful framework for care providers to ensure customer focus, continual improvement and evidence of compliance with national care standards and statutory requirements.
ISO 9000 continues to stand the test of time. Now with defined national service frameworks and standards to meet, it is proving for many organizations to be the quality management tool of choice.
About SGS
SGS is an inspection, verification, testing and certification company.
With 37,000 employees, SGS operates a network of about 1,000 offices
and laboratories around the world. Healthmark is a branded ISO 9001:2000
scheme for the health and social care sector developed and owned by
SGS.
For further information visit www.uk.sgs.com/healthmark
About Affinity Healthcare
Affinity Healthcare is an independent company providing a range of
specialist mental health services at two hospitals: admissions service,
psychiatric complex/intensive care, female complex care service, low
secure rehabilitation, intensive rehabilitation in an 'open therapeutic
environment', detoxification services, dual diagnosis service, designated
eating disorders service, mental health service for healthcare professionals
and young peoples' service (opening November 2004).
About the authors
Sheila Oliver is a senior auditor
and UK health and social care sector coordinator for SGS UK Ltd. She
is a qualified nurse and midwife with an MSc in healthcare quality
management. She worked in the NHS in clinical, quality and project
management posts, joining SGS in 1998. Contact Sheila on e: sheila.oliver@sgs.com
Kris Riley is the risk management
director for Affinity Healthcare. Her background is in mental health
nursing and she has an MSc in nursing studies. She has worked in the
independent mental health care sector in a variety of roles including
clinical and quality management posts, taking up her current position
in 2002.
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