Therapy for quality management

The Swiss Paraplegic Centre (SPC) is a highly specialised clinic. Over 1,000 employees provide services in Nottwil, Lucerne, such as initial care and initial rehabilitation, but also lifelong follow-up medical care and clinical research for the benefit of people with spinal paralysis. In order to guarantee holistic rehabilitation and the integral service network for para- and tetraplegics, the SPC has introduced a new system for quality management.

The project is linked to an upcoming ISO 9001:2008 certification and the qualification already carried out by SW!SS Reha, an association of leading Swiss rehabilitation clinics. The latter not only helps to improve profitability, but also guarantees a high quality of medical care thanks to the demanding and binding specifications. "If you want to be at the forefront as a medical facility today, you can no longer avoid optimising workflows and processes, just as in the private sector," says Klaus Schmitt, Head of Corporate Development Rehab Quality Management at the SPC.

The SPC has, of course, already dealt with the optimisation of business processes in the past, as the organisation maintains an internal Quality Management (QM) department and has over 50 process managers from all departments. ISO-zer

Business Process Optimization

Until now, only individual areas were certified, but not the clinic, which represents the main core business of the Paraplegic Centre. The flawless mapping of all processes is a prerequisite for passing the tests and recurring audits of the certification bodies.

Old system reaches its limits

Because the existing system, a document management software with a simple folder structure, had reached its limits for quality management, it was decided to evaluate a new solution. A system in which each division of the company has its own process and document repository, within which the endlessly long folder structures cannot be visualized and documents can therefore only be found with great difficulty, cannot fulfill one of the essential requirements for successful quality management: It must be easy to use, so that it is applied in practice at all. In order to meet the requirements for certifications, it must also be able to ensure the required clarity of process flows. Checklists, workflows and process diagrams must be clearly assignable and easy to find.

Platform for collaboration and more

The choice fell on the Microsoft solution Sharepoint, a web-based software that is geared towards collaboration between employees and organisations, such as managing projects or coordinating tasks. However, Sharepoint can also be used to manage content and to version and store documents. In addition, Sharepoint has a special search function that can be used to design and optimize company-wide and individual searches. Finally, the software can be used to design, modify, graphically display and model workflows. For certain functions, such as the continuous improvement process, some adjustments had to be made in Sharepoint, but Schmitt says: "We decided on Sharepoint because it gives us a container in which we can map the QM topic clearly." Another argument in favor of Sharepoint was that the software is compatible with Visio and that it is therefore possible to use the existing process representation prob

Order in the QM topic

lemlessly and visualize them. While IOZ was responsible in the project for setting up the structure in SharePoint and making individual adjustments, the transfer of documents and processes is currently being implemented by the SPC itself. The process owners in the departments can create and edit processes and documents themselves in Sharepoint. These are finally released after a check by the QM department. The approved versions are then published and made visible to the end users. In the meantime, the departments have transferred around half of the more than 500 processes, sub-processes and sub-sub-processes and around 2,500 applicable documents to the new system.

Very easy to use

"We can use Sharepoint to present our processes in a solution that is adequate for us," says Schmitt, "You go to the QM folder via an intranet page and get into the individual clinical treatment paths there via the business processes, for example." In fact, the structure is very simple and clearly laid out: The business process level forms the entry point to the quality management system. At this top level, where no other applicable documents are visible, the user accesses the individual management, core and support processes and their sub-processes and sub-sub-processes. The clinical processes are easily accessed here, as are those of the individual support services such as IT, technical services or patient administration.

Very importantly, the associated documents are now also visible. "In contrast to the past, where each area had its own folder and the documents had to be painstakingly searched for, the searcher can now get to the process via an integrated system and also has direct access to the corresponding applicable documents," says Schmitt, pleased with the user-friendly solution. Instead of using the folder structure to get to the desired process, it is also possible to use the Sharepoint search function with free search terms such as process numbering. IOZ has also enhanced the display of search results to meet the needs of the SPC. This means that not only the applicable documents are visible, but also the process number and the name of the person responsible for the process. For example, if a nurse does not know the process for performing a magnetic resonance imaging in radiology, he enters the term "MRI" in the search window and immediately sees the subprocess and its number as well as the process owner. This is a simple way to find the documentation of a process and solve the employee's problem.

Continuous improvement

As a further application, the Continuous Improvement Process (CIP) is mapped in Sharepoint. In this reporting system, the user goes as usual via the intranet page, but this time directly to the CIP, records his suggestion for improvement, which is automatically sent to the responsible person in quality management. Within the framework of the process-oriented patient pathways, the person responsible for the process can identify problems in the processes by means of random sampling of defined measured variables, plan changes and check implementation.

"Thanks to the new QMS, we have already been able to achieve improvements in individual processes," says Schmitt, citing an example: "The improvement is important because we are planning a separate ward for acute spinal surgery as part of the regulation of flat rates per case. In order for us to be able to work economically here, smooth processes and optimal utilization are the top priority." As with any change management, several factors are responsible for success in improving quality management, says Schmitt. Employees must be motivated to accept the innovations. Motivation, in turn, must be awakened and also promoted with training courses in order to gradually achieve the improvement goals in an iterative PDCA cycle (Plan - Do - Check - Act). However, this requires an easy-to-use tool so that the employees can also apply it in practice. "With the Sharpoint-based quality management system, we have definitely created this basic prerequisite," says Schmitt. "This is evidenced by the improvements achieved within a short time, even in the clinical area, with which we have already come a decisive step closer to the goal of the certification audits, the clearly defined handling of processes."