ISO 9001:2015 – A framework for NHS success
Paul Simpson investigates how the ISO 9001:2015 model can be applied to the NHS’s process problems and makes suggestions for implementation.
Who would dare apply the Marmite test to the NHS? Surely unless we are ideologically opposed we would all support a successful health service free at the point of delivery? Or perhaps we love the idea but hate our experience of the service.
This doesn’t mean that we haven’t become better at the end of our interaction with the NHS but sometimes we are angered, frustrated and inconvenienced in the process of receiving our treatment. In a worst case scenario a visit to your local A & E can actually be fatal. The Berwick report produced to improve the safety of patients following multiple tragedies at Mid Staffordshire is well known and applies the principles of quality management espoused by Dr Deming to the challenges faced by the NHS.
Now this piece is not going to close with recommendations for wholesale restructuring or changes to the way of funding our NHS but it will follow a model I know well and apply it to process problems with suggestions for how this could be implemented.
That model is, wait for it, ISO 9001:2015. Before you click away to another open tab on your browser or reach for the green pen to write a ‘disgusted of Tunbridge Wells’ letter please hear me out.
This latest edition of the world’s most popular quality management system standard (topic of another Marmite debate, I’m sure) is dramatically different and can now provide a framework for the health sector to make the improvements it needs to be able to deliver a wider range of services to an increasing and aging population. This is our reality and appears at a time when there isn’t too much cash around – as the Kings Fund reports.
The recommendation isn’t for a huge investment that will probably end up costing us a fortune – as for the ill-fated NHS IT records system featured in this Guardian piece. The approach is one of involving people in making their work work, tapping into the expertise of those delivering front line and back office services.
So, back to ISO 9001. How does this help? With an increased focus on leadership and commitment it encourages Directors of NHS Trusts to:
- Accept their accountability for the service delivered by their Trust
- Show leadership on managing complex processes
- Support efforts of staff at all level in delivering those services to patients.
This will involve getting their heads out of PFI financing reports and visiting wards where the good work is done.
There is a new focus on risks and opportunities in 9001. Despite their cash-strapped status each Trust needs to look at what they are expected to deliver – identify patterns of demand and staffing levels needed to meet national targets through all these busy periods and to cope with foreseeable and yet unpredictable peak demands through bad weather and outbreaks of illness.
All of these are primarily for leaders at the higher levels of the NHS but the main service they can provide for the service and for UK PLC is to release the potential in their staff and allow them to improve their own processes. Allow clinicians, nurses and support staff to get stuck into processes and make improvements that have the patient at the centre of attention and make efficient use of scarce resources.
The potential is jaw dropping. For a Service that uses your and my money we should care about how it is spent. In the Kings Fund report mentioned earlier the talk is of £22 Billion efficiencies required over the next 5 years.
Some key messages from the Kings Fund report are:
Sources of poor performance
- Variations in care across the country
- Overuse – unnecessary care
- Underuse – effective care is not delivered when required
- Misuse – care is delivered poorly
All of these terms are familiar to the quality professional and form part of the organisational context that the latest edition of ISO 9001 requires organisations to understand and consider as they develop their quality management system.
Changing organisational context
Report authors make the point that the operating landscape for Trusts is changing as our population ages and new treatments become available. These challenges have to be tackled by Trust Directors and the only way they can deliver high quality care in this new context is by planning to meet these needs, embedding quality and eliminating waste.
- Improvement benchmarks – by far and away the most positive reading in the report is the section on examples of process improvements. There are numerous examples of how people have worked together to make their work work, provided better services and generated efficiencies to reinvest elsewhere.
- Reductions in time individual patients spend in hospital have enabled more patients to be treated in the same time and avoided the need for 10,000 extra hospital beds.
- Increases in day surgery rates have generated £2 billion of savings and enabled treatment of 1.3 million more patients.
My favourite example, though, is for Walsall Clinical Commissioning Group they looked long and hard at the process for managing repeat prescriptions and came up with an innovative process with collaboration between GPs and pharmacists that has led to reduced over-ordering of medicines, aligned patients’ prescription renewals so that they can be dealt with more efficiently among other things and has led to over £800k savings.
Why is this my favourite? Having just gone through the first round of my new GP repeat prescription service I have seen a one-day turnaround ‘improved’ to 2 weeks. Ah well, you can’t win them all.
Effective quality management remains the answer – no matter what question is asked.
About Paul Simpson
Paul Simpson is Global Policy, Risk and Certification Manager at SAI Global where he is responsible for the management system and for maintaining approvals to deliver conformity assessment services for his global client network.
He has worked in quality and management systems all his working life in a range of organisations including Network Rail, Pirelli, Perkins Engines, the British Standards Institution and the Chartered Quality Institute. With a first degree in engineering, Paul has extended his postgraduate qualifications into fields of marketing and business as well as professional areas of auditing, health and safety and quality. Paul contributes to Standards Development and the quality profession through participation in UK and International committees as a UK Technical Expert on quality management and auditing, writing articles for industry magazines and volunteer roles. He is a co-author of ‘Implementing ISO 9001:2015 – Thrill your customers and transform your cost base with the new gold standard for business management.”