ISO system called good match for health care
Most access departments heading to compliance
When consultant Kathleen Stillwell, RN, MPA, HSA, speaks to health care audiences on ISO 9000, the standards created by the International Organization for Standardization, she starts by laying out the various Joint Commission on Accreditation of Healthcare Organization manuals for hospitals, home health care, long-term care, etc., and asking who in the audience uses which ones.
At least some of her listeners - whose organizations encompass all these disciplines and more - raise their hands for between 12 and 15 manuals, says Stillwell, president of Stillwell & Associates, a consulting firm specializing in quality man age ment and risk management based in Seal Beach, CA. "Then I hold up the little book, not even a quarter-inch thick, of ISO 9000 elements (American National Standard: ANSI/ISO/ASQ9001-1994, published by the American Quality Society in Milwaukee), and ask, 'How would you like to get to the same place using this?'
"ISO does not eliminate or replace policy and procedure requirements, but it does allow the opportunity to create more efficient policies and procedures through the use of focused work instructions and check lists," explains Stillwell. (For more details on the instructions and checklist, see story, p. 114.)
Don't be afraid of new standard
Access managers shouldn't be afraid of the demands of ISO compliance - in all likelihood they're 50% to 75% of the way there, Stillwell says. "[Access personnel] are already so frontline, customer-focused," she adds. "ISO just supports getting people better qualified and building on their strengths, not their weaknesses. It's a quality system that doesn't ask, 'Who did it wrong?' but asks, 'How are we doing, how can we do it better?'"
As to the question of whether ISO ultimately will replace the Joint Commission's accreditation, Stillwell says her answer is, "Who knows?"
"I don't think it's likely," she adds. "I think we should partner with the Joint Commission, that it should become a [ISO] registrar or perhaps offer second-party auditing."
ISO certainly represents an opportunity to present your organization's underwriters with another quality milestone, Stillwell points out. Insurers ask of health care organizations, "What is the accreditation status, what problems do they have?" she adds. "Someone says, 'We really don't want to insure that organization because they have five Medicare violations or because OSHA [Occupational Safety and Health Administration] has been there 10 times.' From a loss prevention standpoint, a quality management system [such as ISO] is a major loss prevention tool for an organization to protect its assets."
In addition, Stillwell suggests, some of the ISO-registered manufacturers who are the largest purchasers of health care may begin requiring benefit providers to be ISO-registered or perhaps to be in the process of registration, with a deadline of the year 2000. "There is a large employer out of Detroit, with roughly 180 occupational health centers, that is looking at a contract for a hospital system to run their clinics," she adds. "They will require that all of those clinics be ISO-registered."
In late August, she points out, a large California-based managed care company published - in the newspaper and over the Internet - a quality index comparing medical groups in Southern California according to various quality indicators. "It listed 25 indicators that said, 'Here's how this group is doing in the area of mammography, and here's where this one is with immunizations,'" Stillwell notes.
It was likely no accident, she says, that a major employer in the area was having open enrollment for its health care plan in the next two weeks. The idea was that seeing this, the employer would want to switch to [that managed care company] to get to its higher-rated providers, she explains.
The validity of such indexes aside, there's no doubt, she says, that in today's environment, the issue is "not just managing your quality, but marketing your quality."
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