The document discusses the implementation of a quality management system (QMS) at AVA Clinic in Finland. It describes: 1) The need for a QMS to comply with regulations and improve patient care, staff performance, and continuous improvement. 2) How AVA Clinic implemented a QMS based on ISO 9001 standards, including defining processes, documentation, tools like an online quality management system, and key performance indicators. 3) Where AVA Clinic is now with an established QMS, including enthusiastic and trained staff, use of tools for documentation control and reporting indicators, and a focus on continuous improvement.

1. Implementation of QMS
in a private Healthcare
organization in Finland
Candido Tomás, MD, PhD
AVA Clinic, Finland
Quality management system in healthcare organizations
Riga 23.9.2011

2. Candido Tomás
Medical Doctor
PhD in Finland
Fertility Doctor
Clinical Director in AVA Clinic in Lisbon
Director of Quality Management System
Scientific Coordinator
executive MBA studies
No conflict of interests with
IMS or its corporation

3. Agenda
• AVA Clinic
• The need for QMS
• Implementation of QMS
• The Tools
• Where are we now

4. AVA Clinic

5. AVA Clinic, Tampere
1993 1997 2003 2006 2010
Staff: 4
Staff: 15 Staff: 15 Staff: 20 Staff: 22
2000"
1996 All%Treatments%
1800" AVA
1801%
1600"Petersburg
S. 1694% 1692%
1609% 1610% 1563%
1400"
1555% 1522%
1485%
1386% 1997 1396% 2007
1307% 1270% 1345%
1200"
AVA Turku AVA Baku
1000"
800"
2000 2005
600"
AVA Lisboa AVA Riga
400"
2004
200" Hospital Scandinavia
0" S. Petersburg
1997" 1998" 1999" 2000" 2001" 2002" 2003" 2004" 2005" 2006" 2007" 2008" 2009" 2010"

8. Making healthy Babies

9. The need for QMS
quality management system

13. Why quality in the Clinic?
• The characteristics of Clinics have changed
• Importance of strategic management
• Compliance with European Directives and Law
• The best to our patients (care and results)
• The best to the Clinic and the Staff
• Need to improve continuously

14. Need for a QMS
• European Union Tissue Directives 2004
• Finnish Fertility Law 2006
• Management of documentation
• Follow-up of results and indicators
• Feedback from customers
• Tracking and follow-up of problems
• Continuous improvement

15. How to handle this?
• Understand all activities
• Interactions
• Focus on the patient
• Remove obstacles,
improve efficiency
• Continuous improvement

16. mission and vision
strategy
Quality Policy organization
quality management
trained staff
continuous education
Staff & Other resources installations
material and equipment
electronic tools
clinical
Processes laboratory
third parties (sperm banks, etc)

17. ISO 9001
suitability to healthcare institutions
• standards for generic • process approach: clinical
management system input - expected outcome
• most world-wide used • interaction of various
international standard departments
• represents a high level of • treatment can only be
quality management successful when there is
harmonic interaction
• leeds to certification between all the sectors
• centered on the customer • Continuous improvement

18. All are involved but…
Keys to success
•Get a quality manager
to coordinate the team
•Get a Consultant that
explains what quality means
in your clinic
•Get the right TOOLS for
helping you DOING THINGS

19. Problems at the beginning
• No knowledge of Quality Management
• Resistance of the staff and Managers
• Few information in our specific area
• Where to start?
• What it means QMS for your clinic
• Have coordinators and consultants; share the information
• Understand what you are doing - The process approach
• Get the right Tools to help you in the journey

20. Entry point
Process Non
GP responsible
Con -
form
ity
Y N Any person at point-of-
Nurse responsible Choice?
contact responsible
Code XYC
Admin responsible
= Use this Clinical Term
QOF 6 pts (90%)
Nurse or HCA Under New GMS, this
responsible is worth 6 pts at 90%
target
This is a hyperlink:
(click here)
SOP-Stand
ard Opera
tive Proced
End point
ure

22. Quality P
A D
C
P
A D
P C
A D
C
P
A D
C
Time
PDCA cycles

23. Implementation
of QMS

24. Organogram

25. Process Map
in AVA Clinic
PATIENTS
ADMISSION
OF PATIENTS
CLINICAL PROCESS TREATED &
SATISFIED
LABORATORIAL PROCESS
STRATEGIC RESOURCES
MANAGEMENT MANAGEMENT
SUPPORT MANAGEMENT

26. Documentation Control
Type of Documents in the Quality Management System of AVA Clinic
QUALITY Quality Policy and strategy.
MANUAL Compliance with ISO 9001:2000
Who? What? When?
PROCESS FILES
SOPs, Procedures and activities. How?
INSTRUCTIONS,FORMS
INFORMATIONS; RULES Informations to stakeholders
07
20
ás.
om
RECORDS
oT
Shows that the system works
id
nd
Ca
©
Reference Documents; Models

27. Records
• Write the Processes
• Write the instructions related to what you
are doing
• Define the Indicators of good performance
• Register the records, events
• Register Reports
• Input the Indicators, follow measurements

28. Design the processes
Recruitment by: Candidate to
• Advertisement Egg Donor
• Word-of-mouth
• Lectures and lectures
• Notice boards
Basic information
CRITERIA
NUR
Still acceptable
STOP NO
and interested? SEND
• Confirmation of reservations
• Questionnaire of medical
YES
history
Evaluation of
the Donor
Psychological Doctor
consultation consultation
Write in Babe Write in Babe
PSY DOC
Decision of Decision of
Psychologist Doctor
Same
opinion? NO
YES Meeting
PSY-DOC-NUR
CONCLUSION
Write in Diary Decision
PSY/DOC
DECISION
Inform the Candidate
NUR
Accepted as Work-Up for
STOP NO YES
Egg donor? Egg donation
NUR
DOC
EGG DONOR Check-list
YES NO STOP
IS ACCEPTED OK
!

29. Design the processes

30. A difficult one:
understanding non-conformities

31. The Tools

32. Patient database
• Paperless Clinic
• Registration of all treatments
• medicines
• events
• equipment
• people
• outcome
• results
• follow-up of complications

33. Quality Management
System tools
• Centralized online system
• Access control leveled by users and by
responsibilities
• Document approval and version control
• Processes, instructions and reports always
accessible
• Follow-up of Indicators
• A real tool and guide to
QMS behavior in the Clinic

34. IMS
Level of use in AVA Clinic
• Processes
• Documentation Control
• Production of forms
• Registry of Events (registers)
• Write Reports
• Indicators and its follow-up

35. Documentation control

37. Indicators

38. Sweets and Sours of IMS
• Essential tool for QMS
• Easy of access from any place with • Only few of the staff knows the fine
Internet features and to take profit of all
possibilities
• Easiness to use and consultation for
the average users • Web tools more limited than desktop
• Clear and stable applications
• Excellent support and training • Graphic capabilities (have improved…)
possibilities
• Forms are limited in comparison to
• Document control Excellence desktop applications
• Excellent for storing and showing • Integration and use of indicators is
indicators work-demanding and requires training
• Many new features to explored
• Fast evolution

39. “Louie, I think this is the beginning of a beautiful friendship”

40. Where are we now?

41. c Quality
thusiasti s
Motivat
ed and
En trained
m anager Staff
Right Tools
Continuous
Recognition Satisfation
Improvement

42. Walking
Learning
Leading
Thank you
ctomas@avaclinic.com