Quality Objectives of ISO-9001 incorporated into Healthcare Services

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In the previous article, the importance of incorporating “risk based thinking” into the healthcare sector has been discussed

This article further outlines the importance of risk based thinking by emphasizing the importance of Quality Objectives (Clause 6.2 of ISO-9001:2015)

Risk based thinking is the platform for setting Quality Objectives, this is the doorway to opportunities for improvement and continual quality improvement
Quality Objectives are to ISO-9001, as are the Key Performance Indicators to NABH (refer Annexure)
Monitoring Key Performance Indicators (KPI) in NABH is mandatory and all the NABH accredited healthcare centres have to mandatorily conform to this requirement. The methodology to be used for capturing and monitoring the KPI data have been outlined in the Annexure itself. But ISO-9001 has not defined any parameters for Quality Objectives, your hospital is free to define and set its own Quality Objectives as per the requirements of your patient care processes

Importance of setting Quality Objectives in patient safety goals
In addition to the mandatory KPIs, your hospital should also set Quality Objectives to further strengthen the quality improvement initiatives
It is essential to set Quality Objectives for all the critical patient care activities, this will enable your hospital to monitor the critical activities more accurately (examples - time taken to register patients, time taken to issue STAT report, time taken to issue medicine from Pharmacy Store during non-working hours)
While defining the Quality Objectives, you will realize that many of these critical activities are already a part of your patient safety goals and risk management plan, or are included in the mandatory KPIs

REMEMBER that Statutory and Regulatory requirements cannot be set as Quality Objectives because these are requirements which have to be complied with mandatorily (examples - Timely renewal of PNDT License, Timely submission of infectious diseases data to the Municipal Corporation)

Objectives are quality tools for monitoring, measuring, reviewing, and maintaining the success and sustainability of patient safety goals
The most important aspect of Quality Objectives is that once achieved, the goals should be sustained and maintained successfully

ISO-9001 demands that a documented information for Quality Objectives should be maintained (Clause 6.2.1). Incorporate this requirement into your healthcare processes
Here, maintaining a documented information means preparing and maintaining a documented process or methodology
Your documented information can be a Work Instruction, outlining the steps to be followed in identifying and setting an objective; further actions that should be taken to ensure achievement of the objective
The Work Instruction should be made available to everyone for reference

This is how you can prepare the Work Instruction for identifying and setting Quality Objectives
General Guidelines
All the departments shall have Quality Objectives for all critical activities and opportunities for improvement
There shall not be any limitations to the number of Quality Objectives a department can set (it can be just one or it can even be 10 or more)
For every Quality Objective the department shall chart out roles and responsibilities of the staff

Now coming to the actual step-wise guidelines
Step 1 - the department shall identify the critical activities / opportunities for improvement and set the objectives (examples - bed sore; phlebitis; needle stick injury; breakdown time and up time of critical medical equipment)
Step 2 - once the objectives have been set, the department shall analyse the risks associated with the objectives (this risk assessment shall be done also from the business risk point of view). A separate risk management programme shall be initiated for all the identified potential risks
Step 3 - the department shall lay down the course of action to achieve the objectives
Step 4 - all the objectives should shall be bound by a time frame (examples - 1 week, 1 month, 3 months, 1 year)
Step 5 - all the objectives shall be quantifiable (measurable in terms of numbers, percentages, units)
Step 6 - the Quality Objectives shall be practically achievable, measurable, and monitorable. Once achieved, they shall be sustainable
Step 7 - the department shall implement a review process for each Quality Objective, to determine the progress made. The review may be done at intervals of 1 week, 3 weeks, 2 months, quarterly, half-yearly, etc., depending on the criticality and importance of each Quality Objective. The more critical ones shall be reviewed more frequently
Step 8 - even after achieving a Quality Objective, it shall be monitored and reviewed periodically, to ensure that the achievement is being sustained. If the nature of the Quality Objective is such that after achieving the target it does not require to be monitored further, then the same shall be mentioned in the Quality Objective format

The following standardized format shall be used by all the departments for capturing, monitoring, reviewing, and measuring each Quality Objective. In this format, the right column is required to be filled in with details

Factor identified for setting as an objective
Process / Function to which the factor belongs
Location / Department
Current statistics
Objective to be achieved
Date of setting the objective
Time frame for achieving the objective
Frequency of review
Quantifiable in terms of (tick whichever is applicable)	Numbers  /  Percentages  /  Units
Person(s) entrusted with the objective
Responsibilities and authorities of the person(s) described briefly
Proposed course of action to achieve the objective
Reviewed on date
Whether target has been achieved (tick whichever is applicable)	Yes     /     No
What are the statistics on review
Reasons for not achieving the objective
Revised objective
Revised course of action to achieve the objective
Next review date
Whether target has been achieved (tick whichever is applicable)	Yes     /     No
What are the statistics on review
Reasons for not achieving the objective
(Note :- in this way, the format will continue till the target is achieved)
If the objective has been achieved, filling up this column is mandatory Does the objective require continuous monitoring even after achievement (tick whichever is applicable)	Yes     /     No If yes, then please use the subsequent format

If the nature of the objective is such that it needs to be reviewed and monitored even after the target has been achieved, then the department shall use the following format

Name the achieved objective
Achieved target
Achieved on date
Monitoring will continue (tick whichever is applicable)	Daily / Weekly / Monthly / Quarterly
Review frequency (tick whichever is applicable)	Quarterly / Half-yearly / Yearly
Whether the achieved target is being sustained (tick whichever is applicable)	Yes  /  No
Further details required to be documented, if any

I have made the above Work Instruction a bit lengthy because I wanted to capture all the details of setting a Quality Objective. Once you understand the requirements, you should be able to prepare your own Work Instruction as your own judgement

All the Quality Objectives that you set should be:-
Practically achievable - do not set a target which cannot be achieved
Measurable - should be quantifiable, that is why objective should always be set in numeric / percentages (examples - 25 minutes, 60 days, 0 deviation, 15%)
Monitorable - measuring and monitoring are actually done together. While measuring the achievement you are also monitoring the progress or regress
Bound by a time frame - you should be able to achieve an objective within the defined time frame (examples - 1 month, 3 months, 1 year)
Once achieved, should be sustainable - the nature of an objective may be such that you will be required to continue monitoring and reviewing it even after it has been achieved, to ensure its continued sustainability

Periodic of review of all Quality Objectives is mandatory to ensure that they are moving along the desired target path
It is mandatory to retain evidences (records) of all activities related to Quality Objectives and, of course, the Key Performance Indicators

This guideline should enable your hospital to define and set Quality Objectives, to enhance patient safety and customer satisfaction

Applicability of ISO-9001 in Healthcare Services - “risk based thinking”

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In the previous article, the incorporation of “design and development of products and services” into the healthcare sector has been discussed (Clause 8.3 of ISO-9001:2015)

This article outlines the importance of incorporating “risk based thinking” of ISO-9001 into healthcare services (this is the core concept of ISO-9001:2015. Refer 0.3.3 and A.4)

ISO-9001 focuses on Performance Indicators - this can be considered similar to the Quality Indicators of NABH

The quality management principles of ISO-9001 are very much applicable to the quality management practices of the healthcare sector

Given below is a short diagrammatic representation of the perfect alignment of “risk based thinking” of ISO-9001 with the “risk based approach” of healthcare services

In ISO-9001 “risk based thinking” is the core concept of all quality related activities, viz., identifying the risks that may hamper performance and at the same time identifying the opportunities that may enhance performance

Risk assessment and risk management automatically become an integral part of all patient care and support service activities; a lot of Preventive Actions (controls) are required to be implemented at every level to prevent any potential mishap and ensure patient safety in error-free service delivery

In ISO-9001:2015 there is no separate provision for Preventive Action, because preventive action is an integral part of “risk based thinking”, which provides for a strong Quality Management System (refer A.4). There is provision only for Corrective Action as a tool for further improvement, in other words, continual quality improvement (refer Clauses 9.2.2, 9.3.2, 10.1, 10.2)

Important aspects of “Risk Based Thinking”:-

One - Patient safety risk

Two - Business risk

Three - Reputation risk

The first two risks are tangible and the third risk in intangible, and all three are interlinked - any problem in one will have a negative impact on the other two

Retain records of all crucial findings, recommended actions, actions taken, gap between desired results and actual results. This will be helpful in finding opportunities for improvement

In all your risk analysis exercises, take into account the statutory and regulatory requirements

Patient Safety risk

Patient safety is the core of all healthcare services all over the world. Therefore, take into consideration the risks associated with services during the delivery process and also post delivery

Identify the possible risk factors in your patient safety goals. Remember to identify the possible risk factors also in your infection control activities

Some examples - zero medication error, zero wrong patient wrong surgery, zero patient fall, zero ventilator associated pneumonia, zero urinary tract infection, zero surgery related infection at site of suture

Business risk

When you are considering the needs and expectations of the interested parties, do a thorough analysis of the potential and present risks involved. These interested parties are directly and indirectly involved in your hospital’s processes, and are directly and indirectly affected by those processes. This risk analysis provides scope for recognizing opportunities for further improvement (continual quality improvement), which is required for sustaining the business

Risk analysis of outsourced services should also be included in your business risk assessment, viz., Housekeeping, Security, Catering, Pharmacy, Blood Bank, Ambulance, Laundry, Biomedical Engineering

Reputation risk

Harm to the reputation of a business organisation is a very well-known aspect

The healthcare organisation should also do a reputation risk assessment, because the healthcare sector often comes into the news for all the wrong reasons; more so because the sector deals directly with human lives

Because reputation risk is intangible, therefore a thorough analysis of the potential risks should be carried out

One - Determine what could be the potential risks or accusations

Two - Rate them as per the probability and severity (chances of occurrence and the impact)

Three - Determine the control measures (Preventive Action)

Four - Device contingency plan to tackle a situation in case it actually does occur

Five - Set a periodic review process for the controls and contingency plans. Based on the review results, make changes if required

Six - If reputation risk actually does take place, then it should be dealt with quickly and most effectively

Guideline given here should enable a healthcare center to carry out the risk analysis of its services in an effective manner, to enhance patient safety and customer satisfaction

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Applicability of ISO-9001 in Healthcare Services - “design and development of products and services”

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When it comes to healthcare, a lot of articles are published on the role of NABH; whereas ISO-9001 (QMS) which forms the core of a good Quality Management System, is hardly written about, even though quite a good number of Hospitals and Clinics are ISO-9001 certified

This article outlines the importance of incorporating design and development of products and services in the healthcare sector (Clause 8.3 of ISO-9001:2015)

The earlier version of ISO-9001 (Clause 7.3 of ISO-9001:2008) mentioned design and development only in terms of products
Whereas the new version of ISO-9001 (Clause 8.3 of ISO-9001:2015) has mentioned design and development in terms of both products and services. Thus, making the design and development Clause more compliant with service industries

Earlier this factor was being excluded by the service sector because the older version of ISO-9001 allowed for exclusions from the Design and Development Clause - refer Clause 1.2 of ISO-9001:2008
But the new version of ISO-9001 does not provide any scope for exclusion of design and development - refer Clause 4.3 and Annex A.5 of ISO-9001:2015 - an organisation can decide a requirement as not applicable (exclusion) ONLY if it does not negatively affect the organisation’s ability to ensure conformity of its products and services and enhancement of customer satisfaction

Since the functions / processes of all the departments and units are interlinked to each other, therefore:-
One - The healthcare organisation needs to justify the “exclusion” very emphatically
Two - Review the customer complaints thoroughly to ensure that they have not arisen from design and development errors
Three - Do a thorough Root Cause Analysis of all errors in processes / services to ensure that they have not arisen from design and development errors

What types of healthcare services can be considered as design and development of services?
Here are some examples:-
One - Treatment modules and methods designed for successful recovery of patients - when Doctors / Surgeons come together to decide upon the line of treatment of a critical or rare case
Two - Designing and developing methods to prevent wrong treatment of patients - implementing strong controls to prevent medication error, transfusion error, wrong site wrong surgery, wrong identification of patient, wrong diet served
Three - Designing and developing new training modules to increase the effectiveness of the training process
Four - Designing newer and better care pathways, in keeping with the requirements of the hospital’s service delivery processes

In design and development, remember these basic requirements
One - Clearly outline the responsibilities and authorities, and the review process
Two - Ensure that legal and other requirements are complied with mandatorily
Three - Maintain and retain documented information as per requirement

NOTE
Maintain documented information means preparing documents like SOPs, Manuals, Work Instructions, etc. and maintaining them properly
Retain documented information means retaining records of the work done (registers, forms, check lists and other methods which have been used to document the work done and actions taken)
Records are the evidences of the work done

This guideline should enable a healthcare center to design and develop newer and better services to enhance patient safety and customer satisfaction

Timebucks - a Site for Earning Extra Money

Timebucks is a good platform for earning little bit of extra money by taking Surveys, playing Games, performing simple Tasks. There are also the Content, Referral and Offerwalls sections
How to register on Timebucks:- to learn the basics of the correct method for registration, go to YouTube and search. There are many informative videos on this, you can select the video which you feel is most appropriate for you
Timebucks pays the highest for taking Surveys, so everyone likes to attempt all the surveys that are available

Here are some important facts you need to be aware of:-
Chargeback
Honesty
Getting blocked
Survey termination
Sweepstakes
Push Clicks

Chargeback:- is what you should be very wary of. Too many chargebacks can lead to your account getting permanent blocked from taking surveys
Chargeback happens a few days after you have successfully completed the survey. While analysing the survey responses, if they feel that your response was inconsistent and there are too many discrepancies, they reject your survey and chargeback the amount that had been credited to you
You can view the chargeback details by clicking on MENU and selecting My Completions

Honesty:- is desired by Timebucks and also by all the Survey Platforms
Be very-very honest, do not give false information about yourself during registration (particularly your name, age and Date of Birth). When Timebucks will ask you to submit your ID proof before disbursing your first payment, at that time the information you have given earlier should tally with your ID details
Answer all the survey questions honestly, or else you may be blocked by the survey platform for dishonesty

Getting blocked from a survey platform:- there are different platforms on Timebucks for taking surveys. Suddenly you may find that you are unable to access surveys on a particular platform. Generally, this may happen because you have been temporarily blocked. The reason for this could be inconsistency in your survey responses. They might feel you have not been honest in your replies and that there is too much of gibberish in your responses

Survey termination:- most often you will not qualify for a survey, which is fine because each survey has its own specific age and demographic requirements
Sometimes your survey response will be terminated midway into a survey, without assigning any reason
There will be times when your survey responses will be terminated after you have completed the survey, and you will not be credited for completion
All these different types of terminations will confuse you and dishearten you, and may make you will feel cheated that even after responding honestly to all the survey questions you have been disqualified. Frankly speaking, this happens also with me, and I do not know the reason behind it. Do not be disheartened, continue to attempt surveys

Sweepstakes:- there are various ways of earning points for weekly sweepstakes - all these details are available in the Timebucks website
But, some of you may not be aware of one way of earning some extra sweepstakes entry points. For this, click on the message icon and in the drop-down menu come to New Tasks Available (this message is sent by Timebucks on a daily basis)
In the New Tasks Available section you will see three tasks with links. Click on all the three links daily to earn 1000 sweepstakes entries
The more sweepstakes entries you earn, the better will be your chance of winning the weekly lottery
Since the New Tasks Available message is sent daily, you will have to click on the links on the day the message is received. If you will click on the links the next day you will not earn any points

Push Clicks:- you can earn also from push clicks But the push click pop-up window will not show in your computer or mobile phone, if the pop-up option is disabled. To enable it, come to timebucks website, right click on the padlock in the web browser and enable “Pop-ups and redirects” (as shown in the image below)

The Best Work from Home Resources for Small Business Owners

All the images used in this blog are AI generated. The images have been used for representation purpose only.

(tools used - Blue Willow, Stable Diffusion)

With the increasing importance of internet and online scopes for good home-based income, many small business owners have transitioned their businesses to operate remotely. This has presented the challenge of finding the right tools and resources to keep their businesses running smoothly. Here are the top work from home resources for small business owners:

Zoom: This video conferencing platform has become an essential tool for remote teams to communicate and collaborate.

Slack: This instant messaging platform allows teams to communicate and share files, reducing email clutter and improving efficiency.

Asana: This project management tool helps small business owners keep track of tasks, deadlines, and team progress, all in one place.

Google Workspace: This suite of productivity tools includes Gmail, Google Drive, and Google Calendar, all of which are essential for remote work.

Todoist: This task management tool helps small business owners prioritize and organize tasks, ensuring that nothing falls through the cracks.

Grammarly: This writing and grammar checker helps small business owners produce high-quality work, even when working from home.

By utilizing these resources, small business owners can increase their productivity, collaboration, and overall success while working from home. Additionally, many of these tools offer free plans, making it easy for small business owners on a tight budget to access essential work from home resources.

 

Here are some common FAQs

What are the advantages of using virtual assistant services?

Virtual assistant services can help small business owners free up their time and focus on the more critical aspects of their business.

Which project management tool is right for small business owners?

Small business owners can choose from tools like Trello, Asana, Monday, Basecamp, and Jira, based on their business needs.

What cybersecurity tools can small business owners utilize?

Small business owners can utilize tools like Norton Security Suite, McAfee Total Protection, Avast Antivirus, Bitdefender, and Kaspersky to protect their sensitive information.

What is the best financial management software for small businesses?

Small business owners can choose from software like QuickBooks, Xero, Wave, FreshBooks, and Zoho Books, based on their business needs.

How can I network with other small business owners online?

Small business owners can network with others online using platforms like LinkedIn, Reddit, Facebook Groups, Twitter, and Slack Communities.

 

How Working from Home Benefits both Employers and Employees

This is AI generated image and is used for representation only (toll used Blue Willow)

WORKING REMOTELY FROM HOME

The rise of remote work during the pandemic has led many employers and employees to re-evaluate the traditional 9-to-5 office setup. While some may have initially been hesitant about the shift, the benefits of working from home have become increasingly apparent for both employers and employees.

For employers, the benefits of remote work include increased flexibility, reduced overhead costs, and the ability to tap into a wider pool of talent. By allowing employees to work from home, employers can save on office rent and utility costs, as well as reduce the amount of sick time taken by employees. Furthermore, remote work provides the opportunity for businesses to recruit and retain top talent from anywhere in the world, regardless of location.

Employees also stand to gain from the shift to remote work. By eliminating the daily commute, employees can save time and money, as well as reduce their carbon footprint. Furthermore, remote work allows employees to work in a comfortable and familiar environment, which can lead to improved focus and productivity. Additionally, remote work provides employees with greater flexibility and control over their work-life balance, allowing them to better manage their time and responsibilities outside of work.

CHALLENGES OF WORKING FROM HOME
Despite the many benefits of working from home, there are also some challenges that employers and employees must address. For employers, one of the biggest challenges is ensuring that remote workers stay connected and engaged with the company culture and team. This can be achieved through regular virtual team-building activities and check-ins, as well as open lines of communication and clear expectations for remote work.

Employees must also overcome the distractions and isolation that can come with working from home. To address these challenges, it is important for employees to establish a routine and set boundaries between work and personal life. Additionally, employees should make an effort to stay connected with colleagues and engage in virtual team activities to maintain a sense of community and connection.

In conclusion, the benefits of working from home are many and varied, ranging from increased flexibility and reduced overhead costs for employers to improved focus and work-life balance for employees. By addressing the challenges and creating a supportive remote work environment, both employers and employees can reap the full benefits of this new way of working.