1. QESTRAIN –project Personnel training model for integrated quality-environment-safety managements system in hospitals and public health services 1st Internal Report Lohja Hospital Area and Lohja Health Centre Sykli Environmental School of Finland

2. QESTRAIN -project The main targets of Lohja Health Centre Basis: –Holistic approach (quality-safety-environment) –Practical tools –Work towards learning organization Main targets : –Commitment of management –Holistic view of quality –International and local cooperation

3. The main targets of Lohja Health Centre… Management commitment: –Economy, process, staff & client perspective –Strategies of the Health Centre and the Hospital Area –Practical working instruments –Management education Holistic view of quality –Safety, quality, environment = Quality Policy –Unite existing quality projects: common procedures, common target and criteria –Continued quality control –Practical quality methods International & local cooperation –Sharing & making use of knowledge –Examples Safety plan “How to encounter an aggressive client / patient” Long term patients excretion function Implementation of guidelines for treatment / caring –Common work, common world

4. QESTRAIN -project The main targets of Lohja Hospital Area To have a good continuation to the successfully started quality work to continue with quality To combine quality, environmental and safety activities (QES) together (= holistic approach) by having QUALITY of operations as the viewpoint To highlight the quality view in the managemetn of operations The continuous development and training of QES Cooperation with Lohja Health Centre with the QES issues and activities

5. Task 1.1 – Evaluation of needs and existing problems Objective: to identify the areas as related to the development of quality-environmental-safety issues at Lohja Hospital Area and Lohja Health Centre for the basis of the development of the training model –strenghts, best practices –develomental areas and issues –problematic areas and issues

6. Task 1.1 - Evaluation 02 – 05 / 2003 Survey of work done and existing material 02 –05 / 2003 –including interviews and discussions Management review & meeting 27.03. 2003 / 03.04.2003 –project info, basic concepts and managements views Personnel informations 4.4.2003 / 06.05.2003 –project info & basic concepts Questionnaires 23.04. – 09.05.2003 –specified personnel groups, working groups and departments Work shops (2 – 3 hours) spring and autumn 2003 –specified personnel groups, working groups and departments Management system audit at Health Centre –physiotheraphy and clinical laboratory, 13. & 14.05.2003 resp.

7. Survey of work done and existing material 02 – 05 / 2003 Organization and operational surroundings Environmental review and programme Quality work –EQFM approach /hospital area –ITE –method / health centre Occupational safety and security Including interviews and discussions with key persons  reports 06/2003

8. Management review and meeting general information of the project –the objectives of the project –the objectives and targets of pilot organizations –schedule and resources review of total quality (QES) and management systems & processes management interview managements view of the most important areas

9. Personnel information general information of the project –the objectives of the project –the objectives and targets of pilot organizations personnel´s role, schedule and resources review of total quality (QES) and management systems & processes managements view of the most important areas

10. Questionnaire 23.04. – 09.05.2003 Target groups at the hospital area : –multiprofessional quality group –nursing quality group –environmental group and ”agents” of the departments –occupational health and safety organization –security group –management group Target groups at the health centre: –Health & family counselling / as group answer –Hospital wards / in connection with the work shops, group answers –Technical service (partly) / in connection with the work shop –Doctors Questionnaire possibly used in connection with the work shops at autumn?  reports 06/2003

11. Work shops 2 – 3 hours per group Facilitator (subcontractor) used At health centre: –hospital wards – excretion function problem 07.05. ja 20.05.2003 continuation at autumn – process model –technical service (part) 22.05.2003 - questionnaire –dental care at autumn 2003 – process model –health and family counselling at autumn 2003 – process model At hospital area: –Dates only agreed for autumn

12. Management system audits Based on standards ISO 9001, ISO 14001 and OHSAS 18001 Lohja Health Centre –Physiotheraphy –Clinical laboratory –several years experience on ITE –method (based on main elements of ISO 9001) –one day audits

13. Task 3 – Testing of the training model 02 –08 / 2004 Objective: to test the personnel training models developed together for the implementation of quality – environmental – safety issues –On the basis of the needs of pilot organizations –  raportti 09 / 2004

14. Task 1.1. – Results of the evaluation Management reviews and meetings –Management´s objectives & key areas for the project and for the training –Linkage with other programmes and projects Balanced Scorecard / both organizations Human Resource Strategy / City of Lohja, Health Centre Organizational groups / Lohja Hospital Area EFQM Approach / Lohja Hospital Area ITE –method / Lohja Health Centre, departments Environmental Programme / both organizations Security/safety programme / both organizations –Management´s commitment –Resources for the project –Training for the modelling and charting of processes!!

15. Task 1.1. – Results of the evaluation… Personnel information –One hour sessions for all personnel –Project leaflets –No discussion generated –Use of Intranet instead? –For smaller groups instead?

16. Task 1.1. – Results of the evaluation… Survey of the work done & existing material –Information for the review of the present state / 1 st task for the development of integrated) managements system –Detailed information of the training needs, needs for improvement, good & best practices –Further discussion with the management vs management review + departments / groups  training needs categorized based on the importance of each item

17. Task 1.1. – Results of the evaluation… Questionnaire –Questions based on: Management system elements / standards Legal requirements / environmental, occupational safety, hazardous chemicals legislation –Tailored for both organizations Specific programmes, plans, procedures, organizations / utilization of the results of the survey –Answers Individually  use of statistics vs answering percentages/personnel groups As groups by discussing  no possibility for the use of statistics BUT as a tool for discussion –Results / need for further information, training etc. Further discussion with the management vs management review + departments / groups  training needs categorized based on the importance of each item

18. Task 1.1. – Results of the evaluation… Work shops: –2 –3 hours per work shop –Facilitator & trainer as external agents –Delayed start, continued during autumn –Process approach! –Example: excretion function at Lohja Health Centre, hospital wards Real, long term problem intertwining quality, environmental and safety aspects Multiprofessional discussion needed  work shop participants from different personnel groups Problem defining & problem solving Process approach: patient´s day - as a concrete model Continues on September  process model / chart

19. Task 1.1. – Results of the evaluation… Management system audits –As system audits difficult At departmental level vs system elements No top management commitment to system elements & procedures –As a tool for training & discussion  ok As a tool for further development  ok –Results clear nonconformancies to requirements –Audit as a tool e.g. for Orientation programme for new employees

20. Orientation material The following material was used as orientation for total quality (QES), management systems and processes –at the management meetings –at personnel informations Linkage with Balanced Scorecard Linkage with EFQM

21. Plan Review of present state Goals Do Action programme Objectives and targets Activities Check Achievement of objectives Level of operations Act New objectives Developmental issues DEMING CIRCLE AND CONTINUOUS IMPROVEMENT

22. Task of pilot organization Values of parent organization Customer needs Legislation Expectations of society and interest groups Needs of personnel Vision Strategy Goals OPERATIONS Core processes Support processes Results - customer feedback - financial result - outputs - personnel safisfaction - etc. Resources - know how - technology - economy - cooperational tahot Control - responsibilities, SOP´s, instructions, training - measures - conrol of onconformancies - development of processes Assessment Development of operations Objectives

23. NEEDS OF CUSTOMERS AND INTEREST GROUPS SATISFACTION OF CUSTOMERS AND INTEREST GROUPS CORE PROCESSES Services to the customers core process support process management process Nees of teams and personnel Economical, quality, environmental and safety objectives SUPPORT PROCESSES Financial Man´ HR Management IT Managment Interest group coop´n Housekeeping Communication Satisfaction of teams and personnel Achievement of economica, quality, environmental and safety objectives Economical, quality, environmental and safety goals&objectives Achievement of economical, quality, environmental and safety objectives PROCESS MODEL OF OPERATIONS

24. Management System Standards: ISO 9001 (quality) ISO 14001 (environment) OHSAS 18001 (occupational health & safety) Management and development of qualoity, environmental and safety issues: - review of the present state - identification & determination of important QES -aspects - developmental objectives and activities - responsibilities, procdures, instructions and control of operations - training and communication - assessment of operations, follow up and continuous improvement

25. MODEL OF INTEGRATED MANAGEMENT SYSTEM SAFETY QUALITY Managed: responsibilities continuous follow up nonconformancies corrective & preventive actions Managed: responsibilities continuous follow up nonconformancies corrective & preventive actions Improved: goals & objectives actions responsibilities & resources schedule follow up Improved: goals & objectives actions responsibilities & resources schedule follow up instructons training communication continuous improvement Follow up and development internal audit management review suggestions for improvement Follow up and development internal audit management review suggestions for improvement TOIMINTAYMPÄRISTÖ operations present state remarkable environmental aspect risk categories important success factors processes products Policy ENVIRONMENT PRODUCTIVITY

26. BALANCED SCORECARD (BSC) (Tasapainotettu tuloskortti) The implementation of strategy Measurements of operations and results Critical success factors 1. customer view 2. economical view 3. personnel view 4. effectivity / process view Objectives and measures for the different levels / units / processes of the organization

27. BSC and Management Systems together BSC and integrated Management System approaches can be applied simultaneously Problems: double work Different elements can be taken for specified purposes: - setting up of goals and objectives & implementation of strategy -> BSC - development and management of operations -> management system - assessment and development -> BSC

28. Resources INPUTS OUTPUTS Control BASIC PROCESS MODEL Personnel: knowledge, skills, attitudes Surroundings, machines, equipments, materials, etc Economical resources Instructions, responsibilities Training Control of nonconformancies, improvement of process measures, follow up

29. patient taken in Inspection and diagnosis Inspection and diagnosis treatment activities treatment activities Follow up and assessment Actions in different phases of the process Critical factors (quality, environment, safety) Flow of information between the different phases of the process Issues to be documented Records to be created Utilization of process descriptions in the planning of integrated management system (example)

30. WHAT IS NEEDED: Identification of QES aspects and critical success factors together Review of processes as a whole Ideas and development Agreements of common procedures and principles Documentation of procedures and instructions Communication and training Assessment and follow up Integration of QRS issues to the planning and management of other operations