Looking beyond accreditation for enterprisewide quality standards
Looking beyond accreditation for enterprisewide quality standards
If Baldrige and ISO 9000 could bail out businesses, why not health care?
Health care is looking at itself in new ways these days. Savvy industry leaders have noticed the eye-popping rejuvenation of the American service and manufacturing communities and figure there are lessons to be learned from the quality programs that fueled it. Given the dawning awareness that health care really isn't that different from other industries, "It's a key time for us to do this," observes Carleton Rider, continuous improvement officer at the Mayo Foundation in Rochester, MN.
Two of the quality programs behind the enviable progress in American business are the Baldrige Criteria for Performance Excellence, co-administered by the National Institute of Standards and Technology (NIST) in Gaithersburg, MD, and the American Society for Quality in Milwaukee; and ISO 9000, administered by the American National Standards Institute in New York City.
It's not that accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has lost its punch. JCAHO gained needed ground with its 1993 standards revisions. But there's a consensus among many quality improvement leaders that we need to apply more - or perhaps different - quality standards if we hope to improve patient care outcomes and make rudimentary health care affordable.
This month, QI/TQM explores the applications of the health industry's commonly used "Big 3" quality programs: JCAHO accreditation, Baldrige criteria for health care, and ISO 9000. QI leaders discuss the value of each. They also share opinions about the resource investment required for each program.
Big 3 at a glance
Let's take a brief look at the organizational function of each program:
1. JCAHO accreditation certifies that an organization meets the commission's prescribed performance standards. As Paul Schyve, MD, JCAHO senior vice president, explains it, "Accreditation standards tell us the right things to do, what we know about doing them well, and how one can continuously improve to attain better outcomes."
He calls it "the seal of excellence for every health care organization. Accreditation is for the whole society; it spreads excellent health care throughout the country."
2. Baldrige criteria for health care guide organizations through a systematic self-assessment. The criteria challenge an organization to identify key measures for excellence in its internal operation and its actions as a corporate citizen. The assessment then requires users to "identify how you cascade [the measures of excellence] through the whole organization from the individual units up to the leadership objectives for the organization," explains Harry Hertz, PhD, director of the Baldrige National Quality Program at NIST. One requirement is the summarization of results from key accreditation evaluations.
Though NIST piloted the Baldrige health care criteria in 1995, federal funding for Baldrige Quality Awards for Performance Excellence in health care is not a done deal. It is included in the 1999 budget, however. "We're hopeful," Hertz says. "The President is behind it, and both houses of Congress support it. But the actions of Congress, I cannot predict." Nonetheless, Baldrige quality programs at state and regional levels enjoy eager participation by health care organizations that benchmark their quality improvements with local competitors and other businesses.
3. ISO 9000 is a system for improving business practices and maximizing business resources, says health care consultant David Simmons, ScD, PE, CCE, who directs the health care division of Alamo Learning Systems in San Ramon, CA. Simmons explains that ISO 9000 standards consist of 20 clauses that stimulate continuous quality improvement, correction and prevention, internal auditing, and overall management review.
In the following example, Simmons illustrates how ISO 9000 might work in health care: A hospital employee cuts a finger on the jagged edge of a piece of medical equipment. The cut is treated, and an incident report is filed and turned in to internal auditing. If the jagged edge is removed from the equipment, that is corrective action. The incident reports go to management. If management orders a survey of all such equipment to identify and remove similar hazards, that's preventive action.
The term ISO comes from the Greek word isos meaning "equal" or "standard." ISO standards are market-driven, developed by international consensus among experts from the sectors that will use them. To implement ISO 9000, a facility first must identify the goals and measures for performance and improvement, program costs, and customer satisfaction.1 Many organizations employ consultants for assistance in that process.
Once goals and measures are in place, consultants provide lists of registrars for clients who wish to pursue formal certification. In the United States, ISO 9000 registrars are accredited and monitored by the Registration Accreditation Board (RAB) in Milwaukee. Even without formal certification, many organizations use ISO 9000 as an internal QI tool.
(For a list of the components of each, see Elements of Big 3 quality programs, at right.)
Reference
1. Simmons DA. Examining ISO 9000 for health care. Quality Digest 1998; 18:26-30.
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