Applying the ISO 9001 process approach and service blueprint to hospital management systems

Quality Objectives in Standardized Quality Management Systems

BACKGROUND AND OBJECTIVES

The effectiveness of a quality management system consistent with the ISO 9001 standard depends on how quality objectives are established and pursued. The aims of this article are to identify quality objectives in selected certified organizations providing medical services, assess their compliance with the requirements of the ISO 9001 standard, and determine factors influencing such objectives.

METHODS

The first theoretical part of the article is based on a systematic literature review. The empirical part contains an analysis of documentation related to quality management systems and conducted audits. The data were collected during 42 quality management system audits conducted in 16 health care organizations in the years 2015-2020. Uncategorized interviews were conducted with quality management system representatives. The data were verified by interviews with 6 management system auditors having at least 15 years' experience in auditing health care organizations. The assessment of the methodological correctness is based on the ISO 9001:2015 standard criteria.

RESULTS

The most frequently formulated quality objectives include improving customer satisfaction, task-based objectives related to planned works, improvements, and development of new medical services. The quality objectives fulfill the requirements of the ISO 9001 standard. However, they are not ambitious. The most significant factors influencing the processes of goal setting are economic (financial incentives, available resources for modernization), social (community needs), and managerial (the scope of performed analyses, the quality of the audit process, and the calculation of necessary effort).

CONCLUSIONS

Health care organizations need to pursue more ambitious objectives, intensify the use of performed medical analyses, and integrate quality objectives into management remuneration systems.

Enhancing Hospital Efficiency and Patient Care: Real-Time Tracking and Data-Driven Dispatch in Patient Transport

Inefficient patient transport in hospitals often leads to delays, overworked staff, and suboptimal resource utilization, ultimately impacting patient care. Existing dispatch management algorithms are often evaluated in simulation environments, raising concerns about their real-world applicability. This study presents a real-world experiment that bridges the gap between theoretical dispatch algorithms and real-world implementation. It applies process capability analysis at Taichung Veterans General Hospital in Taichung, Taiwan, and utilizes IoT for real-time tracking of staff and medical devices to address challenges associated with manual dispatch processes. Experimental data collected from the hospital underwent statistical evaluation between January 2021 and December 2021. The results of our experiment, which compared the use of traditional dispatch methods with the Beacon dispatch method, found that traditional dispatch had an overtime delay of 41.0%; in comparison, the Beacon dispatch method had an overtime delay of 26.5%. These findings demonstrate the transformative potential of this solution for not only hospital operations but also for improving service quality across the healthcare industry in the context of smart hospitals.

A service blueprint approach to prioritize operational improvements in a new outpatient clinic

As a US-based health care system, Mayo Clinic faced considerable challenges opening a new affiliated outpatient facility in the UK at the beginning of the COVID-19 pandemic, which severely affected patient volumes and staffing. As COVID-19 restrictions were eased, the clinic had to prioritize gradual improvements to reestablish service while using resources responsibly. To assist in understanding the current state and to isolate challenges, we elected to develop a service blueprint. We describe how we did this during the COVID-19 pandemic with the use of both face-to-face and virtual services. In many industries, service blueprints are used to help with the design, delivery, and management of new and established services. Although they share some features with value stream mapping, service blueprints often focus on human tasks and the customer's service experience, while value stream maps emphasize information or product flows and capabilities. Several themes for prioritized improvement efforts were identified for future work. In addition, the service blueprint workshops led to a much better understanding of how each person's work affected the other team members and the patient experience. We learned that service blueprints are an efficient way to identify and anticipate critical operational interdependencies and team dynamics that will affect the patient experience when building new clinical services.

Analysis of the Health Examination Service Process Using Service Blueprint: Focus on the Older Adult Patient in South Korea

As the older adult population grows, the paradigm of aging is shifting from simply living longer to living longer while maintaining health. This shift has led to a transformation in healthcare from passive to proactive approaches, emphasizing disease prevention. Health examination services have seen significant growth as they transition from being solely diagnostic processes to crucial tools for disease prevention. This study focuses on the health examination service industry, particularly in the context of the older adult population, and aims to develop a service blueprint to identify challenges and solutions in utilizing these services. The research employs the service blueprint methodology to map out the health examination service process comprehensively. The distinction is made between customer interactions and internal procedures that are observable and those that are not. Through a comprehensive analysis of the service process, it is possible to identify potential instances of customer unhappiness. These instances primarily occur during the initial interaction between older clients and the service, as well as when they receive their examination findings. There are several factors that contribute to discontent among individuals, namely the insufficient comprehension of the needs of the aged by service providers and the provision of substandard facilities. The study suggests strategies to improve customer satisfaction, such as dedicated personnel for older adult assistance, specialized education for staff, and better facilities tailored for older adult patients. Furthermore, the research highlights the significance of effectively addressing both areas of critical discontent and elements that enhance satisfaction in the process of service design. This research provides a detailed analysis of health examination services for the older adult, highlighting opportunities for improvement through enhanced customer experiences and specialized services.

Factors for improving performance in ISO 9001 certified small- and medium-sized service enterprises

Purpose

The purpose of this paper is to investigate the factors that are important for improving the performance of ISO 9001 certified small- and medium-sized service enterprises (SMSEs).

Design/methodology/approach

Preliminary research questions were set on the basis of a literature review and then submitted to a Delphi panel of experts. The results from the Delphi panel were transformed into hypotheses in the form of a survey. A sample comprising 115 Italian SMSEs answered the survey, which also included specific fields for qualitative notes. The hypothesis tests used 95% confidence intervals, and notes and suggestions from the respondents were also collected.

Findings

The findings relate to the role and responsibilities of the quality manager, as well the entrepreneur and partners, the quality of the enterprise culture, training, awareness concerning process key performance indicators, visual management and modern digitised documentation and communication. Furthermore, criticisms emerged regarding the ISO 9001 standard in terms of cost of quality measurement, day-to-day improvement and problem-solving.

Research limitations/implications

This research is limited to SMSEs. The limitations of this research open avenues for further research. In particular, many suggestions from the respondents seem generalisable to other industries and also to large manufacturing firms.

Practical implications

The findings of this research could be used as a guideline for implementing ISO 9001 in the SMSE sector. Moreover, some of the criticisms could be taken into account for the next revision of the ISO 9001 standard.

Originality/value

This is one of the first papers to discuss important factors for improving the performance of ISO 9001 in the SMSE sector.

Redesigning In-Flight Service with Service Blueprint Based on Text Analysis

Airline services should be passenger-focused to be sustainable. In this study, we redesign an in-flight service process using a service blueprint while incorporating direct customer perceptions of service experiences. To incorporate these, we apply topic modeling to 64,706 passenger-written online reviews of airline services. Passenger experiences of in-flight services are the sum of experiences from service encounters in all the subsequent steps and we assume that their direct perceptions of their experiences are faithfully contained in the online reviews. Topics extracted from the reviews can be regarded as service encounters based strongly on passenger experiences. Then, the service encounters are reorganized within the framework of a service blueprint. The results show that the complexity, a number of service steps, decreases by 38% compared to the benchmark service blueprint. However, the divergence, a latitude of service steps, should increase for a couple of service encounters. Moreover, we quantitatively analyze the divergence using the probability of word frequency statistically distributed across topics. The in-flight service using the proposed design could be sustainable with respect to customer-focused service while considering direct customer experiences in real-time.

Certification ISO 9001 in clinical ethics consultation for improving quality and safety in healthcare

This paper refers to the quality management process of the Laboratory of Clinical Bioethics (LCB) of the University of Padua (Italy), which has obtained the quality certification to ISO 9001:2008, as a Clinical Ethics Support Service. Its activities consist mainly in clinical ethics consultations and training services, addressed to those who are called to decisions with ethical implications in the clinical setting, proposing a structured approach to identify and analyze the ethical issues that may loom in the relationships between health professionals and patients, and participating in their solution. The expected benefits of the application of ISO 9001 were mainly the following: to formalize the procedure adopted for clinical ethics consultation and training, to obtain a controlled management of documents, information and data, to ensure and demonstrate the quality of the provided activities and to make methods and organization publicly available. The main results which have been achieved with the 'quality management project' are summarized as follows: the enunciation of LCB Mission and Quality Policy; the drafting of the procedure by which clinical ethics consultation is provided; the formalization of members' skills and the adoption of relevant process and outcome indicators. Our experience may be useful in promoting accountability for the quality of ethics consultation services. We consider the certification process as a tool for transparent and reliable management of one of the most critical tasks in the current context of healthcare, motivating similar facilities to undertake similar pathways, with the aim to provide quality control on their activities.

Waiting too long: bottlenecks and improvements – a case study of a surgery department

Purpose

The purpose of this paper is to promote a business process approach for developing and improving the efficiency of hospital service quality in order to reduce clinical risks and increase patients satisfaction. The problems healthcare facilities face are how to reduce waste and risk and improve quality. The adoption of a process-focused organization could reduce organizational errors which have a negative influence on performance.

Design/methodology/approach

The research is based on a case study methodology, analyzing a specific real-life case. It is shown a practical example in the surgery department of an Italian hospital, identifying, analyzing and managing critical situations, in terms of improvement. To this end, national and international contributions, public documents, institutional websites, conference papers, books, workshops and hospital websites have been analyzed. Moreover, other data were collected through questionnaires.

Findings

Results show how a comprehensive view of the processes may lead to improvement in operations by identifying different risks and bottlenecks, suggesting the rapid implementation of corrective policies and improvements, in terms of overall efficiency.

Practical implications

By implementing innovative organizational processes to identify and reduce bottleneck a healthcare system could achieve a competitive advantage.

Originality/value

Within the Italian healthcare system, limited attention has been paid to the design of healthcare facilities. Flexible solutions are necessary for lean management. The originality of this work lies in the analysis applied to a complex organization, through which hidden critical situations have been identified, and solutions to improve and provide better healthcare management have been suggested.

Framework for establishing records control in hospitals as an ISO 9001 requirement

Purpose

The purpose of this paper is to present the process followed to control records in a Jordanian private community hospital as an ISO 9001:2008 standard requirement.

Design/methodology/approach

Under the hospital quality council’s supervision, the quality management and development office staff were responsible for designing, planning and implementing the quality management system (QMS) using the ISO 9001:2008 standard. A policy for records control was established. An action plan for establishing the records control was developed and implemented. On completion, a coding system for records was specified to be used by hospital staff. Finally, an internal audit was performed to verify conformity to the ISO 9001:2008 standard requirements.

Findings

Successful certification by a neutral body ascertained that the hospital’s QMS conformed to the ISO 9001:2008 requirements. A framework was developed that describes the records controlling process, which can be used by staff in any healthcare organization wanting to achieve ISO 9001:2008 accreditation.

Originality/value

Given the increased interest among healthcare organizations to achieve the ISO 9001 certification, the proposed framework for establishing records control is developed and is expected to be a valuable management tool to improve and sustain healthcare quality.

ISO 9001 in health service sector: a review and future research proposal

Purpose

– This paper aims to describe the state-of-the-art in ISO 9001 research in healthcare service sector and propose the future research agenda.

Design/methodology/approach

– A comprehensive literature review of the ISO 9001 studies in healthcare service sector was carried out.

Findings

– The effectiveness of ISO 9001 implementation in healthcare service sector is still not clear. Previous researches show common stages for implementing ISO 9001 in a healthcare service organization. However, there is no previous research that reveals the content of the system implemented. In addition, there is no previous research that reveals the interpretation of ISO 9001 based on the practice of ISO 9001 implementation in an organization. Based on the review, eight future research agendas were proposed.

Originality/value

– The paper is believed to be the first to discuss the state-of-the-art of ISO 9001 researches in healthcare service sector.