Rx for Health Care

Good management skills may be more reassuring to nervous patients than a dozen plaques nailed to the wall.

by Paul Scicchitano

A peculiar thought occurred to me as I contemplated the delicate mix of cherry blossoms, oversized goldfish and tranquil temples coexisting seamlessly alongside 20th century Japan: What if I get sick?

Actually, this wasn't my first thought. But it did cross my mind as I wrestled with flu-like symptoms on a recent business trip to the ancient city of Kyoto. Judging from my mixed success getting around by train (avoid purchasing a Japan Rail Pass unless you speak fluent Japanese or carry bags of extra cash), I wasn't exactly sure how I would fare with a full-blown medical problem.

For example, how do I communicate this important patient feedback to my attending physician: "Doctor, please don't stick any more of those long needles in my back. It's quite painful," or "Is that your way of asking me to cough?"

Back in the United States, I could call good old Dr. Mroczek, feeling fairly confident he doesn't even own a set of long needles. Japan, on the other hand, is half a world away. It's even a different day of the week there. And there most certainly are no Mroczeks listed in the yellow pages.

That's when I realized the true potential for ISO 9000 registration in the health care industry. At a minimum, third-party registration would tell knowledgeable patients that physicians' practices, hospitals and clinics are managed competently -- and hopefully with a consistent level of care.

Enter Manhattan doctors Mark Figgie and Richard Laskin, who are believed to be the first physicians to hold ISO 9000 registration in the United States. Both were registered to ISO 9001 late last year. The physicians, whose certificates were issued by Kemper Registrar Services Inc., share office space at The Hospital for Special Surgery, but they also maintain separate offices.

In the case of critical services such as medical treatment, good management skills may be more reassuring to nervous patients than a dozen plaques nailed to the wall.

Jack Davis, a nurse clinician who pulls double duty as the shared ISO 9000 management representative for the orthopedic surgeons, says patients have been spending less time in the waiting room since ISO 9000 implementation.

"Before we started using this, for example, we were seeing new patients and getting everything to them at the point when they came to see us," explains Davis. "Now we're sort of screening the whole process. When [patients] book [an appointment], we mail them our questionnaires. They're satisfied they're not waiting in the waiting area, getting rushed to fill out forms. They can fill out the forms on their own time and get a more complete physical."

    It may not be a cure for cancer. But, according to Davis, the advance work cuts down on a certain percentage of patients who really don't require the specialized services that the surgeons have to offer. "The difference that we see now is that we're eliminating some not totally necessary visits, and it's much more time-effective," he explains.

Figgie and Laskin are not the only health care workers who recognize the potential for ISO 9000 in health care. The American Legion Hospital in Crowley, Louisiana, was the first hospital to hold registration. Hospital officials say they considered ISO 9000 as an alternative to more traditional industry accreditation. On a smaller scale, the Cleveland Center for Joint Reconstruction was the first medical facility to hold registration in the United States.

One of the main differences between auditing a physician's practice and a hospital is that physicians must track patients over a longer period. Most hospital care stops once the patient is discharged.

ISO 9000 might one day help distinguish doctors from one another because no major accreditation programs cover their practices. It also could prove valuable if third-party payers, such as health maintenance organizations, begin to set performance measurements for doctors.

If managed care companies put pressure on physicians, they will implement ISO 9000 systems, observes Davis. "You don't need to be certified to have outcome measurements, but I think if there's a standardized format, it will be easier for people to keep track of."

Who knows? Even doctor Mroczek might want to consider registration at his practice. You never know when the occasional Japanese visitor is going to develop flu-like symptoms in our neck of the woods.

About the author

Paul Scicchitano is managing editor of Quality Systems Update and The Environmental Management Report, monthly newsletters devoted to ISO 9000, QS-9000 and ISO 14000 by The McGraw-Hill Companies, 11150 Main St., Suite 403, Fairfax, VA 22030. Telephone (703) 591-9008, fax (703) 591-0971 or e-mail pscicchitano@qualitydigest.com.