Case Study: Ludgate House

Introduction

Clackmannanshire Council Services for Older People consists of two ISO accredited services. The first is Ludgate House Resource Centre which provides 11 short break and 50 day care places for older people who live within the Clackmannanshire area. Meanwhile, Menstrie House provides Care Home accommodation to 40 older people. The central aim of both services is to provide person-centered care based upon an assessment of need.

Services for older people in Clackmannanshire were originally registered with the accreditation body SGS Yarsley in 1997 with ISO 9000:1994, and has successfully maintained this and the subsequent ISO 9000:2000 standard

Why Use ISO 9002:1994?

A number of reasons are pertinent here. In the early nineties it was acknowledged that in the future the residential support homes run by Central Regional Council would be competing with homes in the Voluntary and Private sectors because of the Government’s CCT legislation. While still under Central Regional Council, prior to the 1996 re-organisation of Local Government Managers of the homes very much felt the need to highlight their management practices vis-à-vis their private sector competitors. Registration to ISO 9002:1994 appeared to provide a good means to meet the challenge ahead of them. The proposition of performance indicators in the form of Best Value added impetus to improve accountability and transparency.

Secondly the challenge of future twice yearly inspection of all care provision in Scotland by the Care Commission was also looming. Thus again it was felt that an ISO 9000-designed management system that could stand regular second and third party inspection was the way ahead.

Finally the production of a Procedures Manual was thought to be a particularly useful source for all staff to access in order to know what to do and why.

ISO 9002:1994 Developments

Initial interpretation of the ISO 9002:1994 standard led to the formation of a staff team to ‘write procedures based upon an understanding of what could be defined as best practice’ within the Home. Staff were made aware of the principles of the Management System and were encouraged to become involved in the development of the Procedures Manual. All areas of work were subject to review and some practices were changed to reflect ‘Best Practice’. For example the contracted pharmacist was considered to be operating differently to the way recommended by the supply monitored dosage system company used by the services. Through meeting with the contracted pharmacist it was agreed to instigate quality improvements which would in turn meet the ISO standard while improving the accountability of the Service. Clearly the introduction of the quality system required the contracted pharmacist to comply with the NOMAD guidelines for the supply of medication. Many other small but significant changes in procedures were made which often formalized best practice system already in place.

A timescale for the completion of all procedures and related documents was set. This was followed by a systems review conducted by the original Audit Team to satisfy everyone that they were workable.

The full blown ISO Quality Management System was launched, staff were trained in Internal Auditing and Corrective and Improvement Action Procedures were in place and in 1997 the System was given a rigorous assessment by SGS Yarsley, the accreditation company, and both Ludgate House and Mentsrie House were accredited as achieving the standards required by ISO 9002:1994.

The staff were delighted and proud to have achieved this accreditation. They saw it as a confirmation that they were indeed providing a quality service. Then the hard work began. Maintaining the system and continuously improving it was, at first, a cumbersome task and a great amount of work was done to streamline systems to make them more accessible and user friendly.

ISO 9001:2000

The introduction of the revised framework in 2000 was welcomed and four staff attended a transition course in the first instance. As most staff within the care field of work are hands on workers their readiness to access written procedures and work instructions had proved to be very necessary as access to electronic information was not practical. However, it was identified that within the ISO 9001:2000 standard there was scope to produce simplified process-based documentation which could be displayed diagrammatically. The production of the process-driven approach to ISO 9001:2000 was viewed as an improved way of working. Both procedures and documentation were considerably reduced through the review process that ensued once the new framework was bedded in. Microsoft Visio software was introduced to facilitate the recording of the newly defined processes. Registration affirmed against the ISO 9001:2000 standard was achieved in 2003.

Within the new process-driven approach as well as the reduction in procedures internal audits became much more firmly focused upon identifying areas for improvement coupled with a focus upon ‘Preventative Actions’. The role of the Management Team within Ludgate House has been brought into more central position as defined within the ISO 9001 framework. This was coupled with a better statement of quality-related objectives, a stronger focus upon the views of service users and more regular reviews of the management system. SGS took into account the views of other stakeholders of the House’s work during their regular external audits. And finally recommendations from the Care Commission’s inspections were integrated into the ISO 9001:2000 management system audits.

Janice Young, the Team Leader responsible for the QMS within Ludgate House, notes that ‘…there is a feeling now that things operate in a more organic whole. Why go through two separate inspections when you can use ISO9001:2000 to manage both?’

Service users are regularly surveyed for their views on the operation and provision of the service. This includes stakeholders such as doctors and users families. As a result services frequently change to meet users needs. Recent feedback from service users of the Day Care Services offered within Ludgate House have commented that they did not enjoy some of the larger groups operated within the centre Consequently this has resulted in a complete change in the daily organization of the staff group. Smaller groups have been arranged which are more person-centred and allow users more time in a less daunting environment to chat with friends or participate in activities. Serving lunches in these smaller groups has also been more positively received with staff being more able to assist those who require help to eat, while observing the eating patterns of others. Such feedback is incorporated into the Annual Review of the Service, facilitating the setting of objectives and targets for the coming year. In following this cycle of improvement as per the ISO standard (PDCA cycle), while encompassing any recommendations made by the Care Commission during their formal inspection process has led to a culture of self-scrutiny which seeks to continuously develop.

Further information can be obtained from the Janice Young at Ludgate House. (Tel. 01259 222060)