CEO SUMMARY: For about a year, hospitals and health systems have had a new choice for meeting the Medicare Conditions of Participation. This new choice is Det Norske Veritas (DNV). Because DNV offers a dual process for achieving Medicare accreditation and ISO 9001 certification, it brings client hospitals a different bundle of benefits. As hospitals adopt ISO 9001, it will require the clinical laboratory to align management and operations to the standards of this quality management system (QMS).
IT WAS MAJOR NEWS LAST YEAR when the Centers for Medicare and Medicaid Services (CMS) granted deemed status to Det Norske Veritas (DNV) to accredit hospitals in the United States. This was the first new hospital accrediting body that CMS had approved in 40 years.
But there is more to the story behind DNV’s interest in accrediting hospitals in the United States. DNV wants to be on the leading edge of helping hospitals implement a quality management system (QMS). That is why its Medicare accreditation service gives hospitals the option of achieving certification after becoming compliant with ISO 9001. (See TDR, June 8, 2009.)
As more hospitals opt to pursue a dual objective of Medicare accreditation and ISO 9001 certification, this will change the management culture for laboratories serving these institutions. For this reason, it is helpful for laboratory administrators and pathologists to understand why DNV is gaining credibility as a resource to help hos- pitals meet their Medicare accreditation requirements.
According to DNV’s Executive Vice President Patrick Horine, more hospital administrators are waking up to fact that, to be fully competitive in the changing healthcare marketplace, one critical success factor is to implement a QMS like ISO 9001. Horine was speaking at THE DARK REPORT’S 2009 Lab Quality Confab in Atlanta last September.
Revolution Around ISO 9001
“Adoption of ISO 9001 is a revolution needed right now by hospitals and other providers across the entire healthcare system,” declared Horine. “We pursued deeming authority with CMS so that we could contribute to this revolution.
“DNV has years of experience in working with hospitals,” he noted. “From hospital to hospital, there was a lack of sustainability in improving clinical care and service execution. Too often, as a hospital instituted improvements and made changes to suit certain situations, it was often unable to sustain those improvements.
“We decided to take up that challenge and help hospitals achieve sustainability,” said Horine. “In this regard, quality management systems, such as ISO 9001, have an established track record in many industries and in many countries. This includes hospitals and other types of healthcare organizations in developed countries.”
DNV has an ambitious goal. It wants to tie together the benefits of Medicare accred- itation with the efficiency generated from ISO 9001 certification. “ISO 9001 is a qual- ity management standard that places particular emphasis on leadership and accountability,” explained Horine.
Offer Added Value
“The goal is to offer hospitals added value as they devote considerable resources to meet the CMS Conditions of Participation,” he stated. “In working with hospitals in the United States, we’ve learned that the introduction of quality management concepts— ISO 9001 methods in particular—creates a useful way of holding hospitals accountable to a range of prescriptive measures, including CMS Conditions of Participation.
“The direct benefit is that participating hospitals get a lot more from CMS accreditation than a piece of paper that says, ‘Hey, I can bill Medicare’,” added Horine. “This is how we help a hospital client turn Medicare accreditation into a strategic business asset.”
It is also why forward-looking hospital CEOs are interested in DNV’s offer of helping hospitals meet the CMS Conditions of Participation while also gaining ISO 9001 certification. “Obviously, accreditation is the ticket to participating in Medicare and Medicaid, but is it really a strategic business asset for hospitals?” Horine asked.
Real Difference For Patients
“DNV offers something better, something that makes a real difference for patients and the community served by a hospital,” he said. “We know that hospitals look at budg- ets, and many don’t want to incur additional expenses to become ISO certified in addition to their existing expense of Medicare accreditation. However, additional expense to implement ISO 9001 is not the case. Hospitals are able to implement ISO 9001 without adding any new staff. They will have the same staff doing different things.
“We knew that, if a hospital had the option of achieving ISO in parallel with its CMS accreditation, this would be a budget neutral goal,” added Horine. “It took five years to earn our deeming authority from CMS. Now we can offer both services to hospitals as a unified package.”
DNV does recognize that many hospital administrators are unfamiliar with this approach for a quality management system and how ISO certification can benefit their organization. “It is natural not to accept what you don’t understand,” he said. “Thus, we devote the time necessary to help them fully understand this dual process.
“Becoming ISO compliant requires time,” observed Horine. “It is something that evolves within the hospital as management at all levels gains maturity as they work to implement and sustain the QMS.
“DNV provides every hospital with an opportunity to keep its Medicare and Medicaid accreditation while simultaneously setting up ISO methodologies,” he noted. “A hospital has three years to become ISO compliant and we tell administrators to consider this to be a double-barrelled strategy. They can use their CMS accreditation process as a way to also implement ISO 9001 within their hospital.”
“There are two more secrets that make this work,” said Horine. “First, most hospital administrators come to see that CMS accreditation and ISO certification is a natural marriage. Second, as they gain this insight, they quickly recognize that many aspects of what their hospital needs to become ISO certified are already in place.
“These existing aspects may not be organized and operated as required by ISO 9001,” he added. “ISO 9001 is the infrastructure of the organization’s quality management system and describes ‘what’ has to be done to meet the requirements. The ‘how’ is left to the organization but this must be demonstrated to ensure the effectiveness of what is in place.
“DNV was founded in 1864 and its primary purpose is to safeguard life, property, and environment,” commented Horine. “We bring lots of experience to this unfold- ing QMS revolution in healthcare. We hope to contribute to the changes unfolding in the culture of accreditation in hospitals and across healthcare.”
Another Favorable Issue
Another issue may play to DNV’s favor. Often hospitals feel that the overall process of meeting the CMS Conditions of Participation is adversarial. “DNV wants to be seen as a partner in these activities,” observed Horine. “We want to be collaborative with hospitals to ultimately sustain a future of safety in patient care. And we want to do this with our accreditation process.
“DNV’s goal is to help our client hospitals help their patients even as these hospitals are accountable for meeting requirements in place to ensure they remain compliant and effective,” he noted. “Our role is to be a partner with the client hospitals to help them advance patient care and maximize their potential.
“To that end, we’ve done a few things to take the ‘sting’ out of the Medicare accreditation process,” he said. “We don’t have levels of accreditation status such as preliminary denial or conditional accreditation. A hospital is either accredited or it is not.
Not Focused On “Gotcha”
“If an accredited hospital does not follow through on corrective action plans, it moves into jeopardy status. It can lose its accreditation,” explained Horine. “But DNV is not focused on the ‘gotcha.’ Our focus is to make sure each hospital addresses the things found during our survey process.”
The practical benefits of DNV’s approach are quickly understood by client hospitals. “Before, when a surveyor had already found a number of problems, the institution had no reason to help the surveyors find additional problems—since it could mean the hospital might lose its accreditation,” observed Horine.
“By contrast, DNV wants hospital staff to be comfortable discussing concerns with their processes in order to demonstrate compliance,” he continued. “Unless it involves an issue of an imminent threat to patient health or safety, an institution will have to correct the problems in order to be accredited, whether we find 5, 10, or 50 problems. We emphasize that we are here to help each institution be as transparent as possible and to use that transparency to continuously improve the services it delivers to patients. This is something hospitals are welcoming with open arms.”
DNV’s strategy of offering hospitals a way to earn Medicare accreditation along with a parallel effort to achieve ISO 9001 certification has attracted the attention of a growing number of hospitals. For lab directors and pathologists, this is another sign of how and why quality management systems (QMS) will become more common in the American healthcare system.
DNV Maintains 300 Offices In 100 Countries Worldwide
PRIOR TO GAINING STATUS from the Centers for Medicare and Medicaid Services (CMS) as a deeming authority, Det Norske Veritas (DNV) was relatively unknown in the American healthcare system, although it has operated in the United States since 1898.
Founded in 1864, it is not the typical for-profit corporation. Wikipedia.com writes that:
Stiftelsen Det Norske Veritas, or DNV, is a classification society organized as a foundation, with the objective of “safeguarding life, property, and the environment.” The organization’s history goes back to 1864, when the foundation was established in Norway to inspect and evaluate the technical condition of Norwegian merchant vessels. DNV describes itself as a provider of services for managing risk.
DNV operates 300 offices in more than 100 countries. In 2008, DNV reported revenue of approximately US$1.7 billion.