Friday, August 29, 2014

I Don’t Have a Clue Why Anyone Would Do ISO!


Over the last five years ISO 9001 has been whispered across the Healthcare Industry, as the latest
flavor in quality management and improvement.  Many healthcare professionals are asking the same question, “Why ISO?”  CEO’s, Nurse Executives, Quality Managers, Accreditation Directors and the like have had one common theme that recurs,  “With all these programs, regulations, standards, audits and quality tools, why are we still seeing the same problems again and again over the course of time?”  Audit after audit, tool after tool, program upon program end with the same results in the same fundamental problems or fires that the management team continues to try and put out.”  


The second question Healthcare Professionals ask is, “How is ISO going to change what the others haven’t accomplished?”  The answer is management has to stop putting out the fires of the past and install a sustainable system to identify and control fires before the smoke can be seen on the horizon. 
When an organization does not have a strong quality business management system supporting the activities and processes of their organization, top management has relegated themselves to putting out fires from the past.  One CEO stated, “The best thing about ISO is we have to get creative in current mistakes, because the issues/fires of the past are gone.”  Organizational committees, management oversight committees, executive councils and board of directors have found themselves comfortable in their role as fire fighters. What if we could install an early warning system when and where the fires were igniting?  What if we began to put the fire hose into the hands of our process owners to extinguish the fire before it requires involvement and resources from top management?
Initial implementation of ISO 9001 installs an early warning and control mechanism to ensure issues
within the organization no longer get out of control. They begin to place these early fire warning devices across their organization based on the risk and impact to the patient, to highly susceptible processes, potential financial loss or gain centers, and even areas where the organization may be in jeopardy of legal, statutory or regulatory findings.  One of the most exciting evolutions in this system is top management is no longer the only ones identifying fires.  The entire organization is tasked with sounding the alarm and the front line process owner is able to extinguish the flare up before top management ever arrives on the scene.  
In ISO language we call this top management responsibility for establishment of the quality management system, effective goals and objectives, corrective action and management review.  ISO drives an organization even further in the development of processes that can actually detect and extinguish fires (issues) before they even flare up.   
As an organization’s quality management system begins to mature, the natural growth is reflected in the organizations ability to install applications of control for all the past fires across the entire organization.  
Top management reports not only identify the issues and problems within the department, but also the
solution and application of control applied. This reporting would provide confidence that the issue will not reappear.  Instead of a fire brigade of a dozen (management team) now we have a virtual army of fire fighters.  In ISO language top management has established the goals and objectives of the organization.  Process or department managers now measure and monitor their process to do their part to see the organizational objectives are achieved.  This information is used on the department or process level to implement corrective action, analyze for future potential issues, and plan to eliminate fires of tomorrow. With the loss of top management’s firefighting duties, more time is available to lead the organization into the future. 
Finally a fully mature quality management system has reached the point where systems are set in place to identify current potential failures and the risks associated with them.  Top management now relies on their staff to firefight and they now look to the future for the success of the organization, not the maintenance of the organization.  The ISO standard in its fullest implementation is a system of risk (fire) identification, risk control, risk mitigation, risk prevention and risk preparation. 
Why do ISO?  Healthcare needs a sustainable system of risk management because healthcare inherently has great risk.  

Who killed the Management ISO Representative?



“Professor Plum in the Break Room with the ISO 9001:2015 standard!”
It is our strong recommendation that organizations do not make changes to their quality management systems until the formal standard is released in 2015.
One of my first responses to the new standard was, “Where did it go?” “What happened?” “It isn’t in there!”  “They killed the Management Representative!”  In the ISO 9001:2015 standard, at this time, there is no direct call out for the position of Management Representative.  However, if you look closely you can see that under section 5.3 Organizational roles, responsibilities, and authorities, you can see some of the same language used to describe the activities previously given to the management rep.
My second response was, “I’m not sure that I like this” after all who will ultimately be responsible for tying together all the loose ends of our quality management system?  Who will be my pipeline of communication to my organization on ISO matters?  Who will carry the candlestick providing illumination and insight to all the ISO questions in the organization?  Who will ride shotgun when the auditors show up?  Who will cut through all the ISO jargon that comes with our audit report?  Then as if a mighty wrench opened the valve of understanding it dawned on me, Management!  Management is the one who will fill the gap.  We killed the Rep. but have solved the mystery of how to get management truly involved in the quality management system.  We make everyone in a management position or role responsible for the success of the organization.
The ISO 9001:2015standard has once again maintained section 5 as the Management Section of the standard.  Many of the requirements are merely a reiteration of what was required in the 2008 version or were intended and implied, if not directly stated, as a requirement.  For this article I want to bring your attention directly to three profound changes, not only in the ISO standard, but, also how we will need to shift our perspective of the management role in the organization.
5.1.1 (d) Top Management Shall….. ensure the Integration of the quality management system Into the organizations Business Processes.
Can an organization say that they are compliant with the ISO 9001:2015 if:
·         Management washes their hands of the ISO program by sending it to this department or that department for implementation and maintenance, only giving it their attention when the auditors show up?
·         They never include such processes like finance, accounting, capital investment, investor relations, etc… into the quality management system.
·         Management has tasked one individual (the Management Rep.) to be the ISO super hero and develop, define, implement, maintain and continually improve the quality management system.
The new standard seems to make it very clear that the implementation of an effective QMS is always inclusive of the business processes that make up a very important part of the system.  This is very evident and relevant if you consider that the first section of the ISO standard is primarily focused on identifying and dealing with Risk to the organization both internal and external.  Is not one of the biggest potential risks how we run our business and our finances?  The effective ISO system is inclusive of all we do as an organization.  It is what we do, who we are, and there is no process in our organization that does not have an impact.
5.1.1 (i)  Top Management Shall ….. engage, direct, and support persons to contribute to the effectiveness of the quality management system.
Top management is now tasked with recruiting their personnel to become a participant in the development of the organization not just a spectator.  Top management is tasked with not only the direction of the organization, but also to be the directors of their people achieving organizational effectiveness.  Top management is tasked with ensuring that each person not only has a part, but is effectively playing that part for the success of the whole.  In short management has become the Generals of a great army of Management Representatives.
5.1.1 (k)  Top Management Shall..... support other relevant management roles to demonstrate their leadership as it applies to their areas of responsibility.
This has to be my favorite part because, even though we killed off the management representative, now we have top management actively involved in the mentoring of other relevant management roles so that they in turn can now demonstrate their leadership throughout the organization.  If each member of a good top management team were able to teach, train, mentor, and release two good department managers a piece, where would the organization be in a very short time?  Good leadership needs to replicate itself in those in authority below them.  We can literally create a QMS that has no need of an ISO expert, an ISO champion, an ISO department or even a management rep.  We now have an organization filled with business leaders on all levels effectively dealing with the risks that face an organization and leading their staff, their department, their process, and their organization to continual improvement and success.
So prepare the Eulogies and write the Obituaries.  It’s a great new day in ISO.
See You in 2015
Professor Plum