Sure, General Motors and Chrysler do it, but why would a small company go through the expense and hassle of installing the international quality standard known as ISO 9000? To find out, Enterprise Online's Dennis Berman spoke to nurse-clinician Jack Davis, who is in charge of ISO standards for a two-doctor, eight-employee orthopedic surgery practice based at the Hospital for Special Surgery in New York City.

Q: Your firm is tiny compared to most companies that use ISO 9000?. Why did your office decide to adopt the standards?
A: It started about two and one-half years ago. One of the surgeons in this office, Mark Figgie, had been familiar with ISO through his family's manufacturing background. He thought there would be a place for it in the health-care industry, which has been trying to pull more information from practitioners to demonstrate how they provide quality care.

But since there is no entity overseeing everything, except for the state licensing boards, there are only bits and pieces monitored. As the trend of managed care increases, those companies want to look further at who's providing what to whom. So we saw ISO as a mechanism to help us get organized and set down the framework for continuous quality management.

Q: How did you specifically start putting ISO 9000 in place at your office?
A: We started in September, 1995, and it took us about a year, with a couple of visits from consultants, to get down on paper everything we're doing.

We were pretty organized to begin with, but the prcess of looking at what we were doing opened our eyes and helped us make improvements. For example, a new patient would call to make an appointment. We'd ask some basic questions, and they would book an appointment. When they would come in, we'd then find out they may not be a candidate for our surgeons' specialty. So we adjusted our screening process to identify what questions should be asked, and if the patients weren't in our scope of practice, we'd send them elsewhere.

It saved us a lot of time and eliminated a lot of the waste of coming in for an initial consult.

Q: Can you describe the actual auditing process?
A: For certification, we had to send some of our written material ahead of time. They came in for a one-day audit, which was booked as a preliminary audit, and which turned into a certification audit because we were ready. It was a two-auditor visit. They stayed for about 10 hours. We just got re-certified as well.

Q: What other results have you seen from your year of using ISO 9000 standards?
A: We looked at ways to better track our patients when they come into our system. New patients would come and we'd take all their information right at their initial visit, which would take 15 to 20 minutes to get an adequate history. But we found they were leaving things off and have to call us back. So we decided to send new patients a history form a couple days in advance, so they could complete it when they felt comfortable and had the time, which helps get a more comprehensive history. We still review it in the office, but it takes about five minutes, which save us time and them time, too.

Q: Employees often approach new management ideas by simply rolling their eyes. How did your colleagues feel about ISO?
A: It's such a small place. There are only four pepople in the office at one time. So we understood quickly that this is what we have to do, and this is the best way to do it. But since we are such a small operation, it did take some time to get used to. I put a lot of hours into it, and it took a while to get used to some of the new forms we fill out.

Q: Does anyone choose to visit your practice because it's ISO 9000 certified?
A: We have a few patients who have had engineering backgrounds and have used the system. We have a plaque and that gets them asking questions -- and helps them realize that we have a pretty tight ship here.

And the health insurance people anticipate in the next year or so that they're going to be looking for reasons to refer their patients to an orthopedic surgeon. If they ask us, we can show that we now have a system that patients are satisfied with.

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Updated Dec. 12, 1997 by bwwebmaster
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