Quality management in practice - not a paper tiger

Kanton hospitals are notoriously large organizations. In addition, they are the focus of various interest groups.

This is no coincidence: central hospitals such as the Kantonsspital St.Gallen (KSSG) are a significant economic factor for an entire region. Today, the KSSG is a conglomerate of different buildings, a city within a city, as it were, an organisation with over 5,000 employees. This makes it one of the largest hospitals in Switzerland. Under the management, the organization is divided into ten departments. One of these is the Department of Operations & Infrastructure. This includes all catering, housekeeping & grounds, logistics, medical technology, technology (building services) and the Central Sterile Supply department (CSSD).

A nice piece of work

An organization as large as the Cantonal Hospital St.Gallen must regularly consider which processes - in addition to the core competencies in the medical field - it wants to keep in-house and which may have to be purchased externally. This is because cost and competitive pressures are increasing. The Operations & Infrastructure Department is particularly concerned with this issue. Thomas Sojak, head of the department, is keen to find answers to this question that are as precise and well-founded as possible. And he also knew of an instrument that could be used to create the basis for this. "We decided on certification in accordance with ISO 9001," Jochen Miklo explains. He was entrusted with this project in 2012 and led the department to certification in November 2013. It was a real "flying by the seat of his pants", but one that paid off, Miklo recalls today.

Approaching measured variables and key figures

But cost pressure was not the only important motivation for the certification. "We wanted to standardize the processes according to industry standards. This makes us more comparable with many of our external partners, most of whom already work with these standards. In fact, there was still little discussion of key figures and metrics," Jochen Miklo recalls of the time before the project began. "The cost pressure was not yet so present." Furthermore, the project was also about the continuous improvement of the entire department and the optimisation of interfaces, whether between individual areas or with other departments of the KSSG. "We also wanted to focus more on customer needs," says Miklo.

build knowledge

The conditions for successful implementation were therefore quite different. Looking back, Jochen Miklo sees an important success factor in the strong support from the department's top management. With CSSD and Medical Technology, the Operations & Infrastructure Department already comprised two certified areas (according to ISO 13485). This meant that experience was already available there, but not in the other areas. "The process and quality knowledge was only slightly developed. So the first thing we needed was a strong build-up of knowledge," says Jochen Miklo. A first measure was also the appointment of divisional quality officers. Overall, a basis had to be found for the entire department in terms of management and support processes.

Two years time

The fact that a lot of development and training work had to be done proved to be an advantage. A second was the time factor: the department gave itself two years to implement the project. For Jochen Miklo, this was very important. "It was the only way to integrate the employees and bring quality management to life." The effort was considerable: 16 interdepartmental quality management circles were held with all quality officers. In addition, more than 50 divisional workshops were held and there were 53 internal audits. The process map, including all tools, was also completely redesigned. Today, this is available to everyone on the intranet and provides intuitive access to all important documents.

Many follow-up projects

What has ISO 9001 certification brought? Jochen Miklo can list a few things. "The documentation of processes alone has eliminated many duplications and redundant process steps. This makes us more competitive in direct comparison with purely economically operating service providers." And the intensive screening of the organization has also provided proof of need for many follow-up projects, he says. "Many of these are already being addressed," says Miklo. Also part of the ISO9001 project was the introduction of consistent error management and mandatory supplier evaluations in the purchasing department. "But the other areas have also already started on this," continues Jochen Miklo. The extent to which the introduction of quality management has already had a financial impact cannot yet be quantified. "However, this will become important in the future, as cost pressure is increasing," says Miklo.

Part of the corporate culture

So far, so good. You often hear that ISO 9001 has been introduced and certified in companies, but that it is hardly ever implemented properly - unless a new audit is imminent. What about the KSSG's Operations & Infrastructure Department? Was the whole project sustainable enough? Jochen Miklo can answer this question in the affirmative. "The external auditors praised above all the fact that the subject of quality management is really lived out in our department. We have achieved a high level of employee satisfaction, as evidenced by the most recent employee survey." Employees also actively make suggestions for improvement. The procurement of a uniform CIP tool is also being examined.

Relying on our own know-how

The unreserved support of all levels thus made the ISO9001 project successful. The fact that no external consultants were brought in should certainly not be underestimated. Internal audits were carried out "crosswise", e.g. the quality representative of the catering division audited the logistics division. The QM officer from the neighbouring Finance Department also provided advice. Overall, this ensured that the know-how remained within the department itself and that full use could be made of its own resources.

And where do we go from here? "We have launched many interdivisional and cross-departmental projects for further optimization," explains Jochen Miklo. Risk management has been set as a major goal for the year, and environmental management and occupational health and safety are also to be driven forward. However, a specific date for their certification has not yet been set. Work is also underway to define customer needs and to further develop the department's strategy.p