Asante Adopts System to Improve Outcomes, Reduce Costs

OPINION -- Why did Asante decide to pursue ISO?     We talk about every patient, every time, but this is putting that talk into action. When you hard wire your processes so you do everything the same way every time, you improve the patient experience and safety.    Healthcare is evolving. To be a viable provider in the future, we have to improve clinical outcomes, reduce costs and exceed the expectations of our patients. ISO 9001 helps organizations to develop highly efficient processes that ensure every procedure is done the same way every time. That is crucial to reaching our goal to provide the best care to every patient, every time.   Win Howard, CEO, Asante Three Rivers Medical Center, said, “We are joining other great organizations who believe quality is a standard you build into your culture. This is an achievement for us and a victory for our patients.”   An ISO 9001 certificate proves that the Asante quality management system has met the highest international standards of operation for consistency in superior patient care and safety. The goal is to use proven medical research to develop standardized processes to ensure that each procedure is done the same way every time.   Susan Binette, Asante manager for accreditation and quality management, said the achievement was the result of a tremendous collaborative effort involving multiple individuals and teams within Asante. “ISO 9001 certification provides a firm quality management foundation to continue to meet and exceed the needs of our customer—the patient,” she said.   Was it because of your plan to achieve DNV accreditation or was the decision made before?   It was not our plan, but when we saw how integrated it was with the DNV accreditation process, we definitely understood the value of being ISO compliant. DNV incorporates ISO into the NIAHO Accreditation (National Integrated Accreditation for Healthcare Organizations) Requirements, so it becomes part of what you do. It creates alignment with your business and your quality efforts.  What would you say was the biggest challenge in moving the organization in this direction?   The greatest challenge was translating ISO language into healthcare language. We brought in a consultant that understood ISO and how healthcare people think and operate, and that was a great asset. DNV provides a gap analysis of ISO compliance for the first three years of the survey visit. That helped immensely.   ISO requires strict document control. How did this impact your efforts? Specifically, how many policies and procedures did you have before the effort, and how many now?    Our leadership identified the need for and the difficulty involved with a robust document control system. They allotted for a full-time position at each hospital to build a strategic plan for a detailed journey. Our planning included all areas of controlling documents including policies and procedures, forms, external documents, and everyday working documents such as memos.    We have not necessarily seen a large reduction in the number of our policies and procedures, but we have identified many redundant policies and procedures and combined them into one. In addition, many polices have become more succinct and easier to navigate thanks to the document control process. We now have much more sophisticated control and an understanding of how documents affect the organization.    What benefits have you seen from your efforts? Is it too early to tell? There are many significant benefits from our efforts. ISO is designed to help you monitor input, throughput and output. You then clearly see the gaps in the process. That way, you find opportunities for corrective and, more importantly, preventive actions.  

• We now have standardization of both the form and content of our policies and procedures. 
• Document control has created a system to manage all documents used to conduct Asante patient care and business. This ensures accuracy and efficiency in retrieving and using documents such as policies and forms. For example, document control means a patient form is used properly for every patient every time.
• We have management review consisting of the regular collection of data and analysis of the outcomes to evaluate and improve all Asante processes for patient care. Research shows that about 80 percent of patient care should happen to all patients the same way. For example, though every patient is unique, the standard procedure for Asante to perform gall stone removal should be the same for every patient, every time.
• A very important benefit is we now conduct internal audits to monitor all of our key processes to make sure we are doing things the way we said we would do them for every patient, every time.

How have you integrated ISO with your performance improvement efforts? Has this happened?    It is an ongoing journey, but yes, they are integrated and they function as two sides of one continuous process. Performance improvement focuses on process improvement initiatives, process mapping, and root cause analysis. As a quality management system utilizing ISO, we review the effects of those efforts and validate the improvement by refining our policies and procedures to standardize them. In short, PI mines data and maps processes and quality management validates it.    For example, performance improvement may find a better way to do a procedure, but if only 70 percent of clinical staff is using it; that is not standardization.     Are we all the way there? Not yet. But we are on our way.   What advice would you offer other hospitals interested to follow in your footsteps?    Know before you begin that ISO 9001 will affect every nook and cranny of your organization. It is a huge culture shift, be ready for change. You have to have support and barrier removal from the top, and you have to have in place a viable quality management, process improvement, and document control. Talk in depth with other organizations that have done this. Employ a consultant who understands ISO and healthcare.   Scott Kelly is CEO of Asante Rogue Regional Medical Center in Medford.