1. WORKSHOP ON ACCREDITATION OF BODIES CERTIFYING MEDICAL DEVICES INT MARKET 56458 TOPIC 9 CH 8 ISO 13485 MEASUREMENT, ANALYSIS AND IMPROVEMENT INTERNAL AUDITS Philippe Bauwin Medical devices expert Belgium

2. 8 Measurement, analysis and improvement 8.1 General The organization shall plan and implement the monitoring, measurement, analysis and improvement processes needed a) to demonstrate conformity of the product, b) to ensure conformity of the quality management system, and c) to maintain the effectiveness of the quality management system. This shall include determination of applicable methods, including statistical techniques, and the extent of their use. NOTE National or regional regulations might require documented procedures for implementation and control of the application of statistical techniques.

3. Monitoring the work environment as well as production equipment ensures appropriate production conditions. The QMS conformity is verified by internal audits. The efficiency of the system is evaluated during management reviews. Quality indicators are selected for the various processes and help to evaluate their efficiency. They can be changed or adapted as needed.

4. 8.2 Monitoring and measurement 8.2.1 Feedback As one of the measurements of the performance of the quality management system, the organization shall monitor information relating to whether the organization has met customer requirements.

5. The organization shall establish a documented procedure for a feedback system [see 7.2.3 c)] to provide early warning of quality problems and for input into the corrective and preventive action processes If national or regional regulations require the organization to gain experience from the post-production phase, the review of this experience shall form part of the feedback system The methods for obtaining and using this information shall be determined.

6. It is not always easy to obtain customer feed-back except in case of complaint because customers rarely respond to enquiries. The most efficient seems to be through sales representatives reports but they must be motivated to make them. Customer satisfaction can be evaluated by : -collecting and analysing data related to the quality of delivered goods such as shipping incidents, service rate, complaint rate -examining and analysing customers requirements during contract reviews -customer enquiries This is usually described in the procedures of the customer process. These informations will be evaluted during management reviews

7. 8.2.2 Internal audit The organization shall conduct internal audits at planned intervals to determine whether the quality management system a) conforms to the planned arrangements, to the requirements of this International Standard and to the quality management system requirements established by the organization, and b) is effectively implemented and maintained. It is important to verify that the planning is implemented, completed and the schedule followed

8. An audit programme shall be planned, taking into consideration the status and importance of the processes and areas to be audited, as well as the results of previous audits. The audit criteria, scope, frequency and methods shall be defined. Selection of auditors and conduct of audits shall ensure objectivity and impartiality of the audit process. Auditors shall not audit their own work.

9. The internal audits take in account results of previous internal audits but also external audits made by Competent authorities or the Notified Body, customer requirements and complaints, previous process problems and improvements identified during previous management reviews Auditors must be independent of the audited proces. In small organisations it may be advantageous to use external auditors for example consultants Auditors shall be qualified. An audit shall not be limited to documentary review. Actual processes need to be followed in order to verify that the procedures are implemented.

10. The responsibilities and requirements for planning and conducting audits, and for reporting results and maintaining records shall be defined in a documented procedure. The management responsible for the area being audited shall ensure that actions are taken without undue delay to eliminate detected nonconformities and their causes. Follow-up activities shall include the verification of the actions taken and the reporting of verification results The follow-up is important and shall be verified NOTE See ISO 19011 for guidance related to quality auditing. This standard gives requirements for auditor qualifications

11. 8.2.3 Monitoring and measurement of processes The organization shall apply suitable methods for monitoring and, where applicable, measurement of the quality management system processes. These methods shall demonstrate the ability of the processes to achieve planned results. When planned results are not achieved, correction and corrective action shall be taken, as appropriate, to ensure conformity of the product.

12. 8.2.4.1 General requirements The organization shall monitor and measure the characteristics of the product to verify that product requirements have been met. This shall be carried out at appropriate stages of the product realization process in accordance with the planned arrangements and documented procedures. In-process quality control as well as final quality control is important Evidence of conformity with the acceptance criteria shall be maintained. Records shall indicate the person(s) authorizing release of product This includes in process releases not only final releases

13. 8.2.4.2 Particular requirement for active Implantable medical devices and implantable medical devices The organization shall record the identity of personnel performing any inspection or testing. This is common practice also for other medical devices in the industry

14. 8.3 Control of nonconforming product The organization shall ensure that product which does not conform to product requirements is identified and controlled to prevent its unintended use or delivery. The controls and related responsibilities and authorities for dealing with nonconforming product shall be defined in a documented procedure. The organization shall deal with nonconforming product by one or more of the following ways :

15. a) by taking action to eliminate the detected nonconformity; b) by authorizing its use, release or acceptance under concession; c) by taking action to preclude its original intended use or application. The organization shall ensure that nonconforming product is accepted by concession only if regulatory requirements are met. Records of the identity of the person(s) authorizing the concession shall be maintained

16. Records of the nature of nonconformities and any subsequent actions taken, including concessions obtained, shall be maintained When nonconforming product is corrected it shall be subject to re-verification to demonstrate conformity to the requirements. When nonconforming product is detected after delivery or use has started, the organization shall take action appropriate to the effects, or potential effects, of the nonconformity. Records of the nature of nonconformities and any subsequent actions taken, including concessions obtained, shall be maintained When nonconforming product is corrected it shall be subject to re-verification to demonstrate conformity to the requirements. When nonconforming product is detected after delivery or use has started, the organization shall take action appropriate to the effects, or potential effects, of the nonconformity.

17. If product needs to be reworked (one or more times), the organization shall document the rework process in a work instruction that has undergone the same authorization and approval procedure as the original work instruction. Prior to authorization and approval of the work instruction, a determination of any adverse effect of the rework upon product shall be made and documented Records of the nature of nonconformities and any subsequent actions taken, including concessions obtained, shall be maintained When nonconforming product is corrected it shall be subject to re-verification to demonstrate conformity to the requirements. When nonconforming product is detected after delivery or use has started, the organization shall take action appropriate to the effects, or potential effects, of the nonconformity.

18. 8.4 Analysis of data The organization shall establish documented procedures to determine, collect and analyse appropriate data to demonstrate the suitability and effectiveness of the quality management system and to evaluate if improvement of the effectiveness of the quality management system can be made. Records of the nature of nonconformities and any subsequent actions taken, including concessions obtained, shall be maintained When nonconforming product is corrected it shall be subject to re-verification to demonstrate conformity to the requirements. When nonconforming product is detected after delivery or use has started, the organization shall take action appropriate to the effects, or potential effects, of the nonconformity.

19. This shall include data generated as a result of monitoring and measurement and from other relevant sources. The analysis of data shall provide information relating to a) feedback, b) conformity to product requirements, c) characteristics and trends of processes and products including opportunities for preventive action, and d) suppliers. Records of the results of the analysis of data shall be maintained

20. 8.5 Improvement 8.5.1 General The organization shall identify and implement any changes necessary to ensure and maintain the continued suitability and effectiveness of the quality management system through the use of the quality policy, quality objectives, audit results, analysis of data, corrective and preventive actions and management review. The organization shall establish documented procedures for the issue and implementation of advisory notices. These procedures shall be capable of being implemented at any time.

21. Records of all customer complaint investigations shall be maintained. If investigation determines that the activities outside the organization contributed to the customer complaint, relevant information shall be exchanged between the organizations involved. If any customer complaint is not followed by corrective and/or preventive action, the reason shall be authorized and recorded. If national or regional regulations require notification of adverse events that meet specified reporting criteria, the organization shall establish documented procedures to such notification to regulatory authorities. For example some countries require incidents notification not only by manufacturers but also by professional users and distributors.

22. 8.5.2 Corrective action The organization shall take action to eliminate the cause of nonconformities in order to prevent recurrence. Corrective actions shall be appropriate to the effects of the nonconformities encountered.

23. A documented procedure shall be established to define requirements for a) reviewing nonconformities (including customer complaints), b) determining the causes of nonconformities, c) evaluating the need for action to ensure that nonconformities do not recur, d) determining and implementing action needed, including, if appropriate, updating documentation e) recording of the results of any investigation and of action taken, and f) reviewing the corrective action taken and its effectiveness.

24. 8.5.3 Preventive action The organization shall determine action to eliminate the causes of potential nonconformities in order to prevent their occurrence. Preventive actions shall be appropriate to the effects of the potential problems. A documented procedure shall be established to define requirements for a) determining potential nonconformities and their causes, b) evaluating the need for action to prevent occurrence of nonconformities, c) determining and implementing action needed, d) recording of the results of any investigations and of action taken, and e) reviewing preventive action taken and its effectiveness.