ISO9001 is an internationally recognised, universal quality assurance standard most often associated with the manufacturing industries. So how can a system designed to ensure the quality of car parts help us in the substance misuse sector?
ISO 9001 requires an organisation to identify, define, document, implement, measure, and continually improve the effectiveness of its processes. It offers a disciplined and systematic approach that can be applied to any sector, and is being increasingly adopted in health care systems. Here at Kaleidoscope, we have considered introducing a formal ISO9001 quality management system for a number of years.
With the support of regional commissioners and the Welsh Government, we finally took the plunge with our Powys adult services in Mid Wales. Having a certified quality management system is an expectation that is increasingly being specified in tenders. More importantly, we wanted to establish a system that would help us to optimise the quality of the services that we deliver.
Powys is a large rural chunk of Wales, taking up a quarter of the country, but with a sparse population of just over 133,000 people. With a staff team operating from four primary sites and additional satellite venues, introducing a system to assist us monitor, maintain and improve service delivery and demonstrate quality was attractive to both us and our commissioners.
We of course had apprehensions. We recognise the passion and skills of our employees and trust them to work with our clients in a person-centred way in order to achieve positive, client-defined outcomes. However, we also want them to follow treatment manuals, specific interventions protocols and defined service procedures, so that we deliver a service that is tangible and consistent.
We’d already decided that ISO9001 was the most robust, recognised and trusted quality standard, so in May 2015 we engaged the services of a quality management consultancy to guide us through building our system.
The first big questions for us were ‘what does quality look like?’ and ‘how do we know when we are doing things really well?’ Given that every client has unique needs and goals, how do we uniformly measure to see that what we have delivered constituted ‘quality’?
As a precursor to the ISO9001 project, we had mapped out what we delivered within our services, and defined it in operating manuals. Every key part of the treatment journey featured in the manual, and served to clarify procedures and expectations for staff.
This work actually gave us the basis of our quality management system. We took our Powys operating manual and chopped it up into a range of procedures. We concluded that quality could be defined by regularly auditing these procedures to ensure they were being followed correctly against quantitative and qualitative measures. This in turn should result in service users reporting satisfaction with the service and achieving positive outcomes.
After mapping out the main parts of the treatment journey as low-level process maps, we held a ‘procedure speed-dating’ style event in which each member of staff had a procedure, and five minutes to explain it to a colleague before moving to the next. Four hours and 28 procedures later, our long-suffering team had effectively undertaken a consultation to check through the procedures, refine them and start to understand them. Training sessions and team meetings further helped to embed the procedures into the working life of our teams.So what does our ISO9001 quality management system actually look like? To borrow a software engineering term, I would describe it as having a front end and a back end.
At the front end, we have flow chart procedures that outline the core aspects of what we deliver, such as what an initial client meeting should include and how a care planning session should be approached, right through to how a client should be discharged. These are kept electronically in a folder structure that includes all of the approved documents that are used as part of the treatment system; letter templates and written client information.
At the back end, we have documents and procedures that are less important for staff to understand. These define how the system works, including a quality policy, quality manual, controlled records log and other system-based procedures which describe how quality assurance and continual improvement is demonstrated.
Straddling the two is an audit schedule, which defines which parts of the system are audited when. Typically, audits run monthly. There are some core procedures that are audited each month, such as those looking at referral, assessment and care planning. Others are run quarterly, six monthly or annually.
All of the key aspects of what we deliver as a service are defined by the system, and this in turn gives us control, consistency and a way of defining and measuring quality.
This may sound like an incredibly restrictive and formal approach to delivering a service, but in my view we can still embrace innovation and creativity in our work, because the system is ever evolving in response to service user and staff feedback, and the results of our audits.
Last November we had our second stage external compliance audit and successfully achieved ISO9001 compliance. We are still very much at the start of our quality management system adventure but continuous improvement is of course a journey and not a destination. We continue to develop and refine our system, and we still have some particular areas concerning staff training and demonstrating competence that we want to improve. However we feel that we’ve made a great start and I’m really proud of the benchmark that has been set by our Powys team.
We plan to use these early experiences to embed quality management system principles within our other services. I’ll leave the final words to one of our Powys team members, Ben Chaffey, who says: ‘The QMS helps us to work consistently with procedures, assessment and therapeutic tools. It has taken some time to get used to, but we can see the benefit.’
James Varty is head of development and quality improvement at Kaleidoscope Project, www.kaleidoscopeproject.org.uk