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.  

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