Archiwum dla miesiąca: October 2017

ISO 9001 – quality in process treatment

Effective management of the treatment process affects the outcome of treatment and satisfaction of patient and employees. The success of a medical unit depends, among others, from the effectiveness of the treatment and effectiveness of treatment depends on many factors.

Factors that affect effectiveness include:

  • Technical background and infrastructure (medical equipment, devices, buildings, environment of the medical establishment)
  • Competent and qualified staff
  • Treatment methods and techniques that utilize the world’s best practices
  • Appropriately designed clinical processes.

Even when having the best material resources, without a well-coordinated and collaborative team, managing the treatment process will be difficult or impossible. Each hospital or medical clinic should have a defined map of the processes and participants. Proper communication is the first step in the proper implementation of medical services.

Quality is a certain grade of excellence. Every self-respecting company, both production and service, is making best efforts to satisfy the customer. The satisfied customer is best business card of the company, therefore, it is worth to strive for the positive consideration of the recipient. All employees of the company should be involved in shaping a high level of quality, because the decisions they make – both strategic and tactical – are responsible for meeting customer requirements. When thinking about quality in health care we mean that any fulfillment of requirements that primarily affect the health of the client which in this case is the patient. Selected topic is about medical services i.e. hemodialysis. Service can’t be seen or touched because it is intangible, diverse and unstable, which means that it exists only at the time of consumption and it isn’t possible to acquire the right of ownership of it. The service provider should be solid and reliable, as well as a certainty that is determined by appropriate qualifications and training to provide service and reduce the risk of medical errors and issues. The basis of a prosperous economy is health, therefore, it is important to invest in improvement of health because it provides long-term benefits.

Patients satisfaction

The purpose of the study was to provide information on patients’ satisfaction from the provided service, atmosphere and working conditions. The study was conducted among patients and staff of three dialysis stations. The customer’s assessment reflects the level of satisfying his expectations for the service, therefore the patient “is a judge in assessing the quality of provided medical services.” Due to the extensive nature of medical services, a group of patients treated with hemodialysis was selected. The subjects of the study were three dialysis stations, two of which have implemented and certified quality management system in accordance with the requirements of ISO 9001: 2009 standard and one doesn’t have an implemented QMS with accordance to ISO 9001: 2009. The subject of the study was to evaluate satisfaction with the quality of  provided services on the basis of anonymous surveys among patients during hemodialysis and first-contact staff (doctors, nurses). The study was conducted by the direct surveys.

The theoretical basis of the study contain ISO 9001: 2008 [Dykowska 2002, s.1-18] and  information about quality, in particular the quality of provided medical services. Respondents answered closed-ended questions in an anonymous survey, which is the author’s own elaboration and relates to the assessment of the relationship on the patient-doctor, patient-nurse, patient- dialysis center environment and patient health education, employee and his workplace.

The results of effective management

The study involved a total of 127 patients (65% men and 35% women) with average age 62.3 years for women and 56.9 years for men with predominant secondary education (48.03%) and 31 employees (3% men and 97% women) with an average 39.7 for women and 28-year-old men with predominant higher grade education (41%).

Doctors and nurses are perceived as a group of people whose primary task is to maintain and restore the health of the treated patients.

Dedicated time by doctor and nurse and their willingness to act is important for patients. The emotional side of treatment has a significant impact on the satisfaction of the patient, who will change the doctor until he reaches the specialist, which in addition to making the right diagnosis, will satisfy their emotional needs and be as engaged in the patient treatment as the patient. [Bishop 2000, s.295] The level of assessment of questions from the group regarding the relationship between the patient and the nurse is formed in all three dialysis stations at a similar level (scores above 4). Better and more intense contact on the patient-nurse line increased patient confidence and satisfaction with during treatment in dialysis station. In order to satisfy the final recipient of the provided services, all medical staff must be involved. First of all, those who have direct contact with patients, i.e. doctors and nurses. They should mostly understand patients, get into and listen to them. Communication skills determine this, because this ability enhances the integration and involvement of the patient and the medical staff. It has also been noted that the absence of a TV in the dialysis room has improved the contact between patients and nursing staff. It is important to make communication tools easy to understand. You should use understandable words adapting to the level of the recipient.

Figure 1 Average scores for each question group for all dialysis stations, Source: own elaboration based on survey results

Group: A-patient-doctor relationship, B-patient-nurse relationship, C1-6 social environment of patient in dialysis station, C7-patient health education

Factors affecting patient satisfaction

The technical area is the so-called the package of service, i.e. external and internal appearance of medical institution and its location. The visual appearance influences patient satisfaction of level of quality of provided service. The look of the waiting area, whether it is neat and clean and whether the chairs are comfortable – it also determines the patient’s opinion about the medical unit as well as the appearance of the employees (clean uniforms, nice apparition, IDs). These factors give patients confidence and feeling of professional attitude towards the patient [Opolski,2010, s.32].

The level of assessment of questions from the group describing the social environment of the patient in the dialysis station is more diverse. The station which doesn’t have an implemented QMS that complies with the standards ISO 9001: 2008 had the best results (rating was 4,7), ratings of the remaining two dialysis stations were 4.1. In this case, patients under study were primarily diagnosed with chronic disease that why the agreement on the patient-doctor line because it is a long-term cooperation is even more important. Patients must regularly use dialysis, which makes them dependent on medical devices and staff [ Daugirdas 2003, s.287]. Satisfaction of patients with health education was best assessed in station no. 1 (the rating is 4.4), rating of station no. 2 was 4.1, rating of station no. 3 was 3.5.

ISO 9001 Process management

Quality planning isn’t just about implementing QMS that complies with the requirements of ISO 9001 standard but primarily on identifying customer expectations and creating processes that will implement these expectations in a legal manner and with safe precautions for life and health through continuous improvement of medical staff. This is a dynamic, multi-stage process involving all staff in the medical institution. Only full involvement of the management and first-contact staff will make the implementation of the QMS compliant with the requirements of ISO 9001 effective, easier and more pleasant. Station No. 2 with implemented QMS compliant with ISO 9001 standard outperformed stations No. 1 and 3 in the overall assessment of patients’ satisfaction with the provided services.

Management of medical staff

The most valuable investment of any organization is investment in human resources. Building and selecting the right team of employees is an important element in creating the environment. Employees should have access to training and improving their qualification, managers should develop employee development plans, regularly evaluate employees and motivate them to engage in the personal development. Exactly it is the medical staff that creates the image of the organization which is the hospital and health care facility. Lack of good communication both in the vertical and horizontal structure will override the largest investments of the management. Both tangible and intangible costs incurred for the implementation of the QMS may be reimbursed if the system is successfully implemented and it will receive regular feedback in the form of process measurements and customer satisfaction surveys. The lack of expected results should motivate the management to check for causes and changes that will provide proper quality and increase patient satisfaction. At dialysis station No. 1, 33,30% of employees don’t know whether the dialysis center implemented QMS compliant with ISO 9001 standard and 66,70% of staff are aware that the dialysis station doesn’t have an QMS compliant with ISO 9001 standard. At Station No.2 all employees know that there was implemented QMS compliant with ISO 9001 standard. At Station No. 3 20% of employees are unaware there was implemented QMS compliant with ISO 9001 standard. 80% of them know about the existence of the implemented QMS compliant with ISO 9001 standard in the dialysis station. The overall employee satisfaction rating is highest in dialysis station number No. 1 (rating 4.3), station No. 2 rating was 4.2 and station No. 3 rating was 3.7.

Providing high quality medical services allows organizations to benefit both internally and externally. Primarily:

  • Reduction of the costs of running a business,
  • Full patient orientation – because patient is the most important link in the process of providing medical services.
  • Respect of the rights of the patient
  • Increase in service efficiency
  • Improvement of the safety not only of the patient but also of the employee.

Organization creates confidence in patients and also by defining objectives and quality policy improves performance of the organization. There occurs a better organization of work and an efficient circulation of medical records. The external advantage is the increase in the competitiveness of the medical institution, the strengthening of loyalty and credibility, thereby raising the hospital’s status in the medical services market. The management should establish and maintain a Quality Manual, quality policy and quality objectives. Operational staff should develop procedural instructions. The instructions concern the treatment of the patient, medicines used and the usage of appropriate medical equipment. Direct contractor of the procedural instructions are doctors and nurses who have direct contact with the patient. They have the greatest influence on the perception of the quality of service provided at dialysis stations. On their behavior, procedures and approach to the patient depends the end result and the satisfaction of the patient. The greater the number of satisfied patients, the greater the company’s profit and better opinion of medical institution among patients and competition [Krodkiewska-Skoczylas 2009].

  • High level of satisfaction from provided services by medical institutions is achieved through listening and meeting the expectations of patients during hemodialysis.
  • Frequent conversations are conducive to exchanging the opinions of both the more and less positive patients.
  • High ratings of the relationship between the patient and the doctor and nurse testify ofinterpersonal contact skills [Miadziołko, 2009, s.28,29].


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