ISO 9000: How they do it on the bayou
One hospital’s search for a JCAHO alternative
Small hospitals like American Legion Hospital (ALH) in Crowley, LA, may be likely candidates for ISO 9000 certification. Leonard Spears, CEO of ALH, turned away from 33 years’ accreditation by the Joint Commission’s services four years ago. The 178-bed facility is one of the first hospitals in the United States to opt for ISO 9000 certification.
Spears saw the incumbent Joint Commission accreditation as "overly prescriptive and bureaucratic." Following an investigation of alternative mechanisms, ALH elected to pioneer implementation of the international standards as provided by Kemper Registrar Services in Flemington, NJ. After four months of intensive preparation, the hospital was ready for audit.
Spears says the decision was made because "there’s widespread dissatisfaction with JCAHO. . . . ALH determined it was in its best interest to seek an alternative both to assure quality care and to demonstrate that quality to the public."
The administration and staff of ALH were satisfied with the outcome. The facility enlisted the help of consultants for the transition, but the staff was more involved than ever in every aspect of the process and they liked it that way.
"Preparation for the ISO evaluation stimulated cooperation between departments and among employees," comments Spears. "It made our operation more efficient.
"One of the most arduous tasks was to adapt our document and data-control system to become compatible with theirs," says Spears. ALH maintains detailed records on every aspect of operations and patient care, but its record keeping had to be streamlined and merged into one system of data flow and documentation.
Every aspect of the facility’s diagnostic and treatment services was touched upon under ISO. The system was applied to acute and subacute medical, surgical, obstetrical, psychiatric, emergency, and home care. In addition, laboratory, radiology, respiratory therapy, and physical therapy now fall within the scope of the re-engineered quality management system.
Employees took a course on ISO at the University of Southwestern Louisiana so they could measure ALH’s quality standards against theirs. Some adjustments had to be made to the hospital’s operations to ensure compliance.
The ISO certification didn’t completely substitute for Joint Commission accreditation, because ISO does not yet have Medicare deemed status. "Our state agency came in and did the HCFA [Health Care Financing Administration] survey and the state’s minimum standards survey," notes Angie Wadlington, director of quality assurance at ALH.
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