One challenge in that endeavor was that the hospital seemed more focused on meeting the robust standards of its accrediting organization and passing a tri-annual inspection, rather than continuously focusing on the broader goal.
So Holland Hospital switched and in 2009 became one of the early adopters of a quality-control system long embraced in the manufacturing sector and that is the basis for maintaining accreditation.
DNV Healthcare, a unit of the Norwegian-based risk management giant that began accrediting hospitals three years ago, uses ISO 9001, a system that Holland Hospital Director of Quality Rob Schwartz said puts the emphasis on areas that are more “meaningful” to drive quality and continuous improvement.
Since switching to DNV in October 2009, Holland Hospital has found the program more conducive to embedding a culture of quality among its employees and medical staff of 1,900 people. Rather than setting specific standards for hospitals to meet, which can generate a checkbox mentality, DNV Healthcare provides more of a framework for constant process improvement and accountability by staffers who regularly audit each other’s performance, Schwartz said.
“You are given free rein to have a robust quality program that focuses on what you care about, on what you think is important,” Schwartz said. “It has raised the bar and helped us in terms of the personal accountability we have in ourselves to really do what’s important.”
Holland is among eight hospitals in Michigan — including North Ottawa Community Health System in Grand Haven, Ludington’s Memorial Medical Center of West Michigan and Sturgis Hospital — and 210 nationwide to switch to DNV Healthcare since 2009, when the company first earned federal approval as a health care accrediting organization.
Federal law requires all hospitals to earn accreditation to receive Medicare and Medicaid reimbursements. The Houston, Texas-based DNV Healthcare was the first new accrediting body in 30 years approved by the U.S. Centers for Medicaid and Medicare Services to accredit hospitals.
Until then, U.S. hospitals used The Joint Commission, which is based outside of Chicago and in November launched its own accrediting option based on ISO certification.
DNV Healthcare, with its use of ISO 9001, was “just a natural fit for us to at least explore and see what the pros and cons would be,” said Tami Strong, North Ottawa Community Hospital’s director of quality management and a registered nurse.
“They’re very innovative and they want you to be innovative,” said Strong, who worked in manufacturing before she became an RN and was familiar with the benefits of ISO. “I can really, truly listen to my customers now and incorporate what they’re saying into my processes.”
The Grand Haven hospitals switched from The Joint Commission to DNV Healthcare a year ago. The Joint Commission is “more prescriptive — ‘this is how we want you to do it,’” Strong said, while DNV takes more of a partnership approach to foster continuous improvements.
Both Strong and Schwartz say it’s too early to cite any specific data on where DNV has driven specific improvements in clinical outcomes or operations, though their hospitals are more continuously reviewing and updating processes and procedures for both large and small tasks.
Among the small items that Schwartz cites that can potentially have a large effect on care are processes at Holland Hospital to assure medical equipment is calibrated regularly and recorded accordingly, as well as to assure that all memos posted to inform staff of changes in clinical processes are updated. Quite often a memo with outdated information is left posted, potentially causing confusion in patient care, he said.
“You would be amazed how much important information is actually tacked up on a bulletin board, and it has to be reliable for patient care,” he said.
ISO 9001 also helps to assure an effective process for inspecting and validating the quality of vendors and suppliers that provide everything from medical equipment and supplies to the food served to inpatients and in the hospital cafeteria. The process enables Holland Hospital to check vendors “for how they do business and what they bring you and how is their customer service when there is a problem,” Schwartz said.
In Grand Haven, North Ottawa hopes the switch to DNV can drive external benefits as well. The hospital is forming a philanthropic arm that will seek financial support from the business community in northwest Ottawa County.
When hospital executives visit their corporate counterparts and are asked about how they are working to improve quality and North Ottawa’s operations, they can now speak in common terms, chief communication officer Jennifer Van Skiver said.
“We needed to be able to speak a language they could understand and to look and behave in a way that they’re used to because that’s what they are,” Van Skiver said.
As with manufacturers who adopted ISO 9001, both Schwartz and Strong say the DNV system also generates greater buy-in among staff and eventually becomes intuitive in their thinking.
“This has really driven down the ownership of quality to everybody here,” Strong said.
The move to DNV also alleviated the anxiety that often accompanied the tri-annual Joint Commission inspection for re-accreditation, replaced by a less stressful visit that goes with DNV’s annual ISO re-certification.
“There’s not really that ‘gearing up’ anymore,” said Schwartz, of Holland Hospital. “It’s all about continuous readiness.”