Certification and Quality
Modern Healthcare Online (article available to subscribers only, March 12, 2007 Issue)
I think it's been true in the manufacturing world that quality certifications, such as ISO-9001, aren't necessarily predictors of world-class quality. I've seen it be far too easy for bad factories to get ISO certification. Companies play the game, they put together their binders, they coach their employees how to pass the certification, and their sole ISO focus is getting that certificate (as opposed to using the methodology to actually drive improvement).
The same dynamic is often true in healthcare, not surprisingly, maybe. Hospital labs have regular certification cycles with the same common dysfunctions as ISO.
Modern Healthcare magazine writes about the “Joint Commission” accreditation for hospitals and how some recent quality problems have occurred in accredited hospitals, including Walter Reed and West Texas Hospital (a specialty hospital where employees had to, on 15 occasions, call 911 to get patients moved to other hospitals for emergency care).
Dennis O'Leary, President of the Joint Commission says:
O'Leary defended the value of his organization's accreditation, but acknowledged that the process has its limits. “Accreditation is not a warranty that any organization is perfect,” he said.
True. The burden isn't on any certification or accreditation organization. Quality is an ongoing process that is management's/administration's burden. As a customer/patient, don't take quality/safety for granted just because all of the right certification tickets have been punched.
We can't expect outside inspectors to catch every systemic process problem, as the article explains:
At Walter Reed, the problems may be linked to the accreditation process' focus on clinical areas. Dean Samet, director of regulatory compliance services at consultancy Smith Seckman Reid and a former Joint Commission associate director, said it wouldn't be uncommon for a building like the one affiliated with Walter Reed to not be included on the survey list. Whether any of the Army hospital's staff mentioned the building's condition during the overall accreditation survey is unclearâ€”but also unlikely. “To be quite honest, the staff normally wouldn't be airing their problem areas” to surveyors, Samet said.
Typically, Joint Commission surveyors focus first on the main clinical areas, such as inpatient and ambulatory-care settings, Samet said. “Time permitting, they may try to do a random sampling of some of the other areas,” he added. “But that's only time permitting.”
Ticking off the checklist, Samet said that surveyors need to focus on emergency management, sentinel event alerts, compliance with the National Patient Safety Goals and, at the base level, the ever-changing Joint Commission standards. “That typically keeps surveyors pretty busy,” he said.
Of course employees aren't going to bring up problem areas. When the management focus is on “pass the inspection,” speaking up in the name of solving a problem would probably only bring punishment down on yourself. Employees should be bringing those issues up to management first, ideally. And, ideally, management should be helping address those issues independent of any inspections/certifications.
Paul Keckley, executive director of the Deloitte Center for Health Solutions, Washington, noted that it's generally accepted that Walter Reed's problems are on its ambulatory side while the Joint Commission is more geared toward assessing acute care, but that the Joint Commission is probably getting “a spotlight it deserves” and thatâ€”at timesâ€”it “has been its own worst enemy.”
What these scandals illustrate is that “you can do all the right things to get accredited, yet there can be systemic problems in your organization,” Keckley said. “I think (the Joint Commission) made a couple changes that are significant in the past 18 months. That said, I still don't think the Joint Commission is as significant a force in quality and safety as it should be.”
What are your experiences with certification and quality, in manufacturing or other industries? Do people just try to “pass the test” or use it for real improvement?