Hospitalwide ISO-9002 Status Stimulates Gains In Laboratory

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AFTER 181-bed St. Charles Medical Center became one of a handful of hospitals in the United States to earn its certification as an ISO-9000 facility three years ago, interaction between nursing and the laboratory has improved in unexpected ways.

Located in the central Oregon community of Bend, 181-bed St. Charles is one of less than 10 hospitals nationally which operate with ISO-9000 certification. Its pioneering experiment with ISO-9000 systems has generated some surprising outcomes.

Breaking Down Silos

“Using ISO and other management methods, our administration has definitely broken down the silos traditionally found in most hospitals,” stated William Railsback, Laboratory Services Leader/Manager for the two-hospital Cascade Health Services system. “We are proud of the high degree of interaction and collaboration found within our institution.

“Take nursing, for example,” continued Railsback. “Our laboratory has developed a close collaboration with the nursing department. Each department’s planning teams include members from the other department and use a common method for implementing revisions.”

According to Railsback, the ISO system established an objective framework for developing and managing work processes. “It’s allowed us to expand point-of-care testing (POCT) in our hospital while maintaining strict control over quality and cost,” he noted. “The work systems are based on objective criteria that removes many of the subjective or emotional factors that typically accompany POCT.”

One interesting effect of these systems is to isolate “cowboys” in the organization. “Because every department in the hospital understands these objective criteria, if a supervisor unilaterally implements an arbitrary work policy, the work flow processes of our hospital quickly surface that anomaly and make that individual accountable,” noted Railsback. “This has greatly reduced discord and replaced it with common purpose across our departments.”

Railsback says the ISO-9000 documentation has not been a burden. “Laboratories already have their procedures documented,” he said. “So we were ahead on that count. Once certification was complete, it’s been very manageable. Our next initiative is to move to electronic signatures as part of our hospital’s effort to implement the electronic medical record and a master population index.”

Next Level Of Quality

St. Charles is moving forward with its quality initiatives. “Currently we use the Malcolm Baldridge National Quality Award Criteria as our guide to the next level of performance,” commented Railsback. “The emphasis is on leadership, with management playing a smaller part in our daily activities.


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