Implementation of quality management systems in public health: The experience of the Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School

Introduction-Objective: Assessing the quality of health service provision at a Department level is difficult and needs to be documented. Documentation is achieved by certification. In spite of the increasing trend for more specialized quality standards, ISO 9001:2015 is the most widespread one. The Directorate of the Department of Urology of the University General Hospital of Heraklion, in cooperation with the Hospital Administration proceeded to study/ install the quality management system (QMS) according to ISO 9001:2015 for the provision by the Department of Urology and its Special Units (Non-Invasive Urology-Lithotripsy & Cystoscopy-Urodynamics) of diagnostic, therapeutic and nursing services as well as for the production of scientific work, research activity and provision of educational services. The procedure was implemented in July 2017 through the Special Account for Research of the University of Crete; using funds from a specific program set up for the development of the Department of Urology. To the best of our knowledge, this is the first case of certification of a Urological Department in a Public Hospital in Greece. The purpose of this study is to present the initial experience/results from the implementation of a QMS according to ISO 9001:2015 at our Department. Material and Methods: The procedure was initiated by providing medical-nursing and administrative staff with self-assessment questionnaires and special forms for problem-filling and improvement suggestions. All forms were filled in anonymously. All data gathered were processed by our quality management consultant. The results were presented to the parties involved in an open meeting at the Department and formed the basis for the QMS design. Through a 12-month strenuous workout with meetings about every 15 days, a QMS consisting of 14 procedures, two working instructions, 17 forms, and 13 administrative nursing protocols was set up. The system included 24 forms provided by the Ministry of Health and 29 clinical nursing protocols issued by the local Health Region. The staff was systematically trained in keeping them up and, with suggestions/ corrective actions the QMS was improved. Results: Through patient satisfaction questionnaires, the Department was rated with 9.1/10 (reception/stay), 9.8/10 (medical follow up), 9.3/10 (nursing care) and 9.2/10 (general service). With the implementation of the QMS, quality indicators related to medical-nursing care (drop-fall rates, fever rates, admission severity-related mortality, etc.) are monitored. Through staff meetings the progress of indicators is presented and actions are being taken aiming at improvements. The operation of the Department has been parameterized and co-perception has been conquered. By implementing a QMS, future goals have also been set: a) Higher staff participation rate problems/suggestions for improvement recording, b) Monitoring achievement of research objectives through standardized procedures, c) Higher satisfaction score achievement, d) Certification according to EN 15224, in order to introduce the of clinical risk concept by adopting scientifically registered protocols in daily diagnostic/ therapeutic practice. Conclusions: Certification of the QMS of a Urological Department in a Public Hospital is difficult but feasible. It can be successful despite organizational-technical difficulties/lack of resources. The benefits are many, such as enhancing organizational structure efficiency and improving communication within/outside the hospital.