Joint Commission ISO announcement inspires hospital interest
TJC and SGS Group to offer certification program
In the first weeks after The Joint Commission and SGS Group announced they would be offering joint accreditation and ISO certification to interested hospitals, SGS reported a fourfold increase in calls from hospitals curious about what ISO could do for them.
The program will allow hospitals to opt for certification in ISO 9001 (management systems), ISO 14001 (environmental management), ISO 27001 (information security), OSHAS 18001 (occupational health and safety) and food safety testing and certification. Joint Commission accreditation will occur on a triennial basis as before, but ISO auditors will come in at least annually. There will be an additional cost for the joint certification, with the fee dependent on how many standards in which a hospital seeks to be certified.
A few hospitals have been making use of ISO certification for years, says Tony Perkins, senior vice president, Systems and Services Certification, at SGS. However, most users come from other industries, particularly manufacturing. "People use ISO certification as a framework to develop a best in class business and management system," Perkins says. "They want to see how their processes, people, departments, and procedures all interact with their customers." From a hospital perspective, those customers may be external — patients, yes, but also the practitioners, administration, and other staff.
As with manufacturers who use ISO certification, the goal is in part to reduce errors and develop a level of consistency. In healthcare, ISO can help an organization determine where there is the most risk for error or the potential for error so that a hospital can eliminate that potential, says Perkins. "Two decades ago, American cars weren't reliable," he says. "They were riddled with errors and not a single U.S. nameplate was in any of the top 10 lists for Consumer Reports." The root cause was similar to what Perkins sees in many hospitals: a lack of connectivity between processes. "In the auto industry, they found a lot of problems in their supply chain. By addressing it, they reduced defects by 90%."
When an organization sees where the opportunity for error is, it can correct the problem and work on consistency — something researchers say will help improve outcomes in healthcare. "You find ways to not make the mistake, and not make it every single time," Perkins adds.
An example is the universal protocol procedures required before every single surgery. The Joint Commission standard requires that before any procedure, the providers verify that it is the right patient, the right procedure, the right body part, that the body part is marked before starting, and that there is a time-out before the first cut is made. The ISO 9001 certification in quality management systems would require auditors to ensure there are processes in place to make sure that universal protocol is followed every single time, what paperwork or forms there are to make sure it's done, and the success rate for getting it done.
While there isn't a decade of healthcare use of ISO standards, there are some organizations that have been early adopters and are willing to talk about it. Detroit (MI) Medical Center, which uses the ISO environmental management standards, has saved money by finding areas to improve in power, electric, supply, and hazardous waste use and disposal.
The facility also reports that it is in a state of continuous readiness for Joint Commission surveys because it has the annual audits from SGS. Perkins says that people so appreciate the audit process that most clients have them come in twice a year, not once. "It is a collegial event that involves a lot of coaching," Perkins says. "We review results, verify closure of any areas of non-compliance, and then re-audit. But it's not looking for areas of non-compliance, but looking for system weaknesses and areas for improvement. We let our customers tell us where they see a struggle and we give them suggestions about how to address it."
Not a response to others
Some have suggested that the rationale behind The Joint Commission linking with SGS is upstart accreditation company DNV, an Oslo-based firm that offers ISO 9001 certification alongside hospital accreditation. But Mark Crafton, executive director of state and external relations at the Joint Commission denies it.
"We developed this option because we were hearing from our customers that they were interested in ISO certification," he says. Board members who work in other industries — automotive comes to Crafton's mind immediately — had seen it work and wanted to know whether it might be of use in healthcare, too.
Rather than offer it themselves, however, The Joint Commission felt that getting an expert organization like SGS would be the most appropriate way forward. "We wanted to pursue it through a very credible industry registrar and do it in a very coordinated fashion." Further, Joint Commission surveyors have "a different kind of skill" from an ISO auditor, Crafton notes. "This isn't our area of expertise. Better to partner with a world leader than trying to acquire these skills ourselves." This is particularly true given that there are several standards that hospitals can attempt to master, not just one.
In addition, DNV doesn't give its clients a choice about ISO 9001 certification: All clients seeking accreditation with that company must also work toward meeting the ISO 9001 standards, says Crafton.
"We believe it is complementary to our accreditation," Crafton says. "It allows facilities to put additional focus on processes that are key in their organizations." For example, The Joint Commission requires that there is medication reconciliation for patients. He says bringing ISO standards to bear will help a hospital identify, study and map out the entire process and see how it works. "They can shine a spotlight, help you improve, and then document that improvement," Crafton notes.
If accreditation is the thing that defines key processes, then certification makes sure you aren't just going through a book but continuing to assess how those processes work.
Those who opt to pursue accreditation along with ISO certification can choose to do the two processes at the same time or in sequence. Currently, Joint Commission and SGS operations teams are planning the entire process out to ensure it is streamlined for those who want both teams on site at the same time. "It would be detrimental to show up at the same time and then compete with each other to see the same records or policies," Crafton says.
All of the healthcare organizations that have moved forward with ISO certification have done so with a great level of skepticism, Perkins says — just as did the automotive and aerospace industries before them. "Now, not a single car or plane has a part that isn't certified. Healthcare is just the latest segment to adopt a methodology that more than a million firms around the world have adopted."
For more information on this topic, contact:
Tony Perkins, Senior Vice President, Systems and Services Certification, SGS, Rutherford, NJ. Telephone: (201) 508-3014.
Mark Crafton, Executive Director, Joint Commission, Oakbrook Terrace, IL. Email: [email protected].
In the first weeks after The Joint Commission and SGS Group announced they would be offering joint accreditation and ISO certification to interested hospitals, SGS reported a fourfold increase in calls from hospitals curious about what ISO could do for them.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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