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

Charalampos Mamoulakis, Iordanis Skamagas, Maria Petrodaskalaki, Charalampos Mavridis, Georgios Georgiadis, Charalampos Belantis, Ioannis-Erineos Zissis, Georgios Avgenakis, Eleftheria Giannitsi, Dimitra Pantartzi, Stavros Synodinos


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.


Health Care Sector;Quality Assurance, Health Care; Quality Indicators, Health Care; Quality Management Systems; Quality of Health Care

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