Design of an integrated management system (IMS) in a government-run medical evaluation organisation

1. The TQM Journal
Design of an integrated management system (IMS) in a government-run medical
evaluation organisation
Rafael Manzanera Josefina Jardí Xavier Gomila Joan Ramón Pastor Dolores Ibáñez Glòria Gálvez
Constança Albertí Albert Navarro Joaquín Uris Alicia Pomares Lluïsa López Cristina Zuazu Primitiva Sabaté
Immaculada Aguado Lidia Domingo Carolina Infante Josep Gomis Aurora Jover Jordi Iglesias Antoni
Mestres
Article information:
To cite this document:
Rafael Manzanera Josefina Jardí Xavier Gomila Joan Ramón Pastor Dolores Ibáñez Glòria Gálvez
Constança Albertí Albert Navarro Joaquín Uris Alicia Pomares Lluïsa López Cristina Zuazu Primitiva
Sabaté Immaculada Aguado Lidia Domingo Carolina Infante Josep Gomis Aurora Jover Jordi Iglesias
Antoni Mestres , (2014),"Design of an integrated management system (IMS) in a government-run medical
evaluation organisation", The TQM Journal, Vol. 26 Iss 6 pp. 550 - 565
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http://dx.doi.org/10.1108/TQM-01-2012-0007
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Design of an integrated management
system (IMS) in a government-run
medical evaluation organisation
Rafael Manzanera
MC Mutual and Catalan Institute of Medical Evaluations (ICAMS), Barcelona, Spain
Josefina Jardı´ and Xavier Gomila
Catalan Institute of Medical Evaluations (ICAMS), Barcelona, Spain
Joan Ramon Pastor
Public Health Agency and Catalan Institute of Medical Evaluations (ICAMS),
Barcelona, Spain
Dolores Iban˜ez, Glo`ria Galvez and Constanc¸a Albertı´
Catalan Institute of Medical Evaluations (ICAMS), Barcelona, Spain
Albert Navarro
Health Department, Barcelona, Spain
Joaquı´n Uris
Catalan Institute of Medical Evaluations (ICAMS), Barcelona, Spain
Alicia Pomares
Humannova and Catalan Institute of Medical Evaluations (ICAMS), Barcelona, Spain
Lluı¨sa Lopez
Department of Health, Catalan Regional Government and Catalan Institute of
Medical Evaluations (ICAMS), Barcelona, Spain
Cristina Zuazu, Primitiva Sabate´, Immaculada Aguado,
Lidia Domingo, Carolina Infante and Josep Gomis
Catalan Institute of Medical Evaluations (ICAMS), Barcelona, Spain
Aurora Jover
Health Department and Catalan Institute of Medical Evaluations (ICAMS),
Barcelona, Spain, and
Jordi Iglesias and Antoni Mestres
Catalan Institute of Medical Evaluations (ICAMS), Barcelona, Spain
Abstract
Purpose – The authors present the application of the Lopez-Fresno approach in designing an integrated
management system (IMS) for an aviation company to the development of an IMS in a government-run
organization responsible for the medical evaluation of work disabilities. The purpose of this paper is to
share the design process, with the intention of showing that this approach is applicable to other sectors
and proposing generalization and applicability strategies to other smaller government entities.
TQM
26,6
Received 27 January 2012
Revised 11 February 2013
Accepted 17 May 2013
The TQM Journal
Vol. 26 No. 6, 2014
pp. 550-565
r Emerald Group Publishing Limited
1754-2731
DOI 10.1108/TQM-01-2012-0007
The authors wish to thank the management team and the consultants working on the
organization’s quality model for their participation in this study as well as the employees of the
ICAMS, Board members, stakeholder representatives, and specially Palmira Lopez-Fresno,
Maria Dolores Nu´n˜ez, Eugeni Sedano, Virginio Gallardo, Josep Maria Costas, Jaume Ribera, Rosa
Sun˜ol and Joan Carles Cordon, for their help, encouragement and cooperation.
The authors acknowledge the support and input from their unforgettable colleague Xavier
Gomila, who sadly passed away a few months previously.
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3. Design/methodology/approach – The study involves two phases. Phase I applies the Lopez-Fresno
approach to design a basic IMS-I and ends with a European Foundation for Quality Management
(EFQM) evaluation, whose suggestions were taken into consideration for the final design of IMS-II
during phase II. The data were obtained from the organization’s own functioning. There was a
significant degree of personal involvement by the authors, external consultants and members of the
management committee in areas ranging from the approach itself to the various components analyzed.
Findings – The approach led to a better use of human and material resources and produced various
advances in both internal and external communication and significant progress in employee
motivation in their dealings with users and stakeholders.
Originality/value – The study offers guidelines and recommendations for designing an IMS
adapted to small, compact, administrative organizations that operate with stakeholders with highly
disparate outlooks and interests, with different quality levels, in a context related to competitiveness
and economic development.
Keywords Public sector, Quality management, European Foundation for Quality Management,
Management systems
Paper type Case study
1. Introduction
Organizations are strongly influenced by pressure from their clients and stakeholders,
and even more so in a context of a deep economic recession. One of the greatest
challenges is to get organizational and management systems to work together to
avoid inefficacies and inefficiencies. This need is particularly acute in complex,
highly regulated sectors where professional groups have a high level of
independence, empowerment and powerful corporate protection, as is the case of the
healthcare sector.
Integration is viewed as the only means to work adequately while obtaining
benefits from the large number of mandatory requirements. The need for the
development of an integrated management system (IMS) dates back to the mid-1990s
and since then, it has been extensively discussed in the literature, together with
the themes of quality, working climate, health and safety. However, the continuing
development of requirements also requires constant expansion of these viewpoints.
In 2010, an article was published (Lopez-Fresno, 2010) on IMSs applied to an
aviation company. This paper takes a systematic approach to a practical application
of the integrated management model which has obtained excellent results. This case is
applied to an airline, with a significant number of guidelines and recommendations,
and may be useful for sectors considered to have a high degree of complexity.
The Catalan Institute of Medical Evaluations (ICAMS) is a health organization
responsible for evaluating the fitness for work from a medical viewpoint of patients
having a clinically defined disease. The patients evaluated at the ICAMS work in
specific sectors and companies, with values and attitudes that are strongly focussed on
the individual. There is a high degree of complexity, in which clinical medicine,
attitudes, social reality, the firm and employment coexist. The ICAMS works within an
extensive body of health and economic regulations covering the Social Security,
employment and mutual insurance companies, the productive economy, trade unions
and employers.
Given these distinctive features, the ICAMS Steering Committee decided to
integrate the management system in two consecutive phases. The first phase, in which
the model’s basic elements were put in place as IMS-I, lasted from January to October
2010. It concluded with the first external evaluation of the European Foundation for
Quality Management (EFQM) model in November 2010. IMS-I includes organizational
Design of an
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system (IMS)
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4. aspects, human resources, users and main stakeholders (the National Social Security
Institute, Occupational Injury and Disease Insurance Companies and others). The
second phase, from November 2010 to June 2012, consists of two stages, and concluded
in December 2012 with a second EFQM evaluation.
These stages, focussed on the design and implementation of the IMS-II, were
structured as follows.
First stage: January-October 2011; on the clinical product (improvement in clinical
guides, peer agreement studies), users (rights and duties), processes (processes
mapping) and the Strategic Plan 2011-2014.
Second stage: November 2011-June 2012, on management and objectives (fulfillment
management, objectives evaluation, strategies impact) (Figure 1).
2. Existing research
2.1 IMS: concept, principles and techniques
The debate on the integration of management systems and how this should be done is
ongoing. For Hoyle (1996), it encompasses all disciplines and management processes,
reaching all corners of the firm. For Karapetrovic and Willborn (1998), these
two concepts are systems that function as an integrated whole, thereby losing their
independence. Karapetrovic (2002) acknowledges that each organization has its own
concept of integration.
A number of authors provide detailed definitions of the concept of integration.
Thus, Griffith (1999) expresses it as modules that act synergistically, providing mutual
support that enables them to respond to each of the organization’s needs, while Bhutto
(Griffith and Bhutto, 2009) propose an approximation to the business process model.
2004
Business Plan
2005 – Workers’
Opinion Survey
– 1 stage
2006 - EFQM
Self -Evaluation
2007 - EFQM
Improvement Plans
2008 - Social
Responsibility Report
2009 - Start process
development
2009 - Product
Quality Evaluation
2009 - Opinion
Polls
Integrated
Management
System
IMS-I
Evaluation
EFQM
2010
Integrated
Management
System
IMS-II
Evaluation
EFQM
2012
Evaluation of clinical
product quality and
monitoring
Evaluation
of leadership,
communication plan
Knowledge and
People
Management Plan
Strategic Plan
Goals, Scorecard
and MBO
Environmental
and process
management ISO
Evaluation of user
policies and analysis
of expectations
Evaluation of staff
policies and
Workers’ Opinion
Survey-2 stage
Stage I Stage II
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Figure 1.
Stages in the IMS
design process
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5. Hall (1998) believes that non-integrated functions disappear when they are most
needed, that is, when they must be used to address problems.
Jonker and Klaver (1998) suggest that the lack of methodology for integration
processes is one of the main reasons for their difficulty and advocate the use of
frameworks such as the EFQM.
Jonker, together with Karapetrovic (2004), define two phases – analysis and
conceptual model – for integration ( Jonker and Karapetrovic, 2004).
Thus, many factors come into play to make organizations different, so that it
is not possible to define “the universal methodology” ( Jonker and Karapetrovic,
2004). However, it is possible to define a series of guidelines and principles that may be
helpful in the integration process. In our case, we use a broad integration concept
which involves the implementation of a quality management system with the
progressive integration of environmental and work-related components or further
components when needed (Castillo and Sanasaloni, 2004).
2.2 Barriers for integration
As in all management processes, there are many obstacles that must be taken into
account. Among the best known are outlined by (Shillito, 1995; Zutsi and Sohal, 2005;
Heras et al., 2007):
. no understanding of the concept of integration, limiting it to documentation and
record-keeping;
. no strategy, model or methodology;
. no engagement by management, particularly senior management;
. unsuitable organization culture;
. lack of resources and expert personnel;
. poor communication;
. wariness of people involved in previous processes, particularly among their
owners;
. different visions regarding the systems that must be integrated;
. different visions of the integration of systems; and
. frequent changes in regulations and guidelines.
2.3 Benefits from integration
The literature identifies a number of benefits that can be attributed to integration
(Hale, 1997; Lopez-Fresno, 2003; Griffith and Bhutto, 2009):
. better management decisions due to considering a larger number of aspects and
having a more integrated vision;
. simplification of documents and audits;
. reduced costs due to a more efficient use of resources;
. increased employee motivation due to better staff leadership and less conflicts;
. effective improvements in internal communication, eliminating communication
barriers;
. improvements in the provision of services and products to clients;
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6. . improvements in supplier confidence and corporate image; and
. improved responsiveness by employees to changes.
3. Model and methodology
The Lopez-Fresno approach is based on the most solidly grounded quality models,
empirical studies and the literature review. Figure 2 summarizes the main conceptual
aspects used.
The criteria set forth in the Lopez-Fresno paper highlight the following aspects:
(1) Global approach to complexity
Organizations act as complex, dynamically adapting systems (Battram, 2001).
The analysis must focus on their structure and components (cells) and
how they interact within the system as a whole. In this conceptual scheme, the
intangible elements – information, communication and culture – are extremely
important. Thus, the IMS must be designed as a global model from a
systemic perspective that addresses the whole organization, integrates rules
and requirements, and includes the improvement cycle as a response to
stakeholders.
(2) Processes
Processes must be the primary elements of analysis rather than functions or
departments.
(3) Cultural maturity
Whether it will be feasible to apply the standards will depend, to a great extent,
on the organization’s baseline situation as regards maturity and integration.
(4) Flexibility
The model must be open to current and, especially, future requirements, and
offer opportunities for new horizontal and top-down integrations.
(5) Sustainability
Being systems that are in a process of continual adaptation, organizations need
methodologies to constantly supervise their quality and the areas that need
improving. Accordingly, they need powerful internal continual assessment
methods.
Integrated Management System
European Foundation for Quality Management EFQM
Quality
ISO 9001
IMS
Environment
ISO 14001
Safety/Health
OHSAS 18001
Corporate Social Responsibility CSR
P
R
O
C
E
S
E
S
S
C
H
A
N
G
E
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Figure 2.
Conceptual aspects used
for the IMS approach
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7. Although it is true that Lopez-Fresno acknowledges that the methodology for
implementing an IMS must be specific for each organization if it is to achieve a robust,
internally consistent integration, it is also possible to identify certain guidelines that
facilitate universal implementation, for example, implementation by units (cells),
apoptosis criteria, management team commitment and cooperative leadership.
4. Field study. The ICAMS case study
4.1 Background and context to the case
As a public organization controlled by the Catalan Department of Health, ICAMS is
subject to the rules governing the operation of public organizations and submitted to
financial and functional control by the Catalan Regional Government’s Audit Agency.
Furthermore, the Steering Committee decided to perform a set of studies (showed as
initial activities in Figure 1) and reviewed the quality-related standards:
. Organizational consulting process and Information System Plan (2003).
. Business Plan (2004-2007).
. Workers’ Opinion Survey 1 stage (2005).
. EFQM Self-Evaluation (2006).
. Development of Improvement Plans based on the findings of the EFQM
Self-Evaluation (2007).
. Corporate Social Responsibility Report: environmental, economic and social
aspects (2008).
. Development of processes (2009): Processes mapping and procedures definition.
. Evaluation methodologies and quality of the clinical product (2009): clinical
guides and peer-agreement study.
. Survey of user and stakeholder satisfaction (2009): Qualitative and quantitative
studies about stakeholders’ satisfaction.
. Stakeholder opinion poll (2010): Qualitative and quantitative studies about
stakeholders’ opinion.
The studies are performed to the extent and in the sequence that ICAMS considers
necessary to implement its approach, as is shown in Figure 3. It starts with the
organizational consulting process, information system plan and business plan as tools
for organizational consolidation. The workers’ opinion survey focusses on the internal
client. The EFQM self-evaluation and the improvement plans generated from this
broaden the vision to users, processes and quality of the clinical product.
The ICAMS’ entrepreneurial approach has led to the creation of an Information
System Plan (2003), which analyses, defines and programs the different parts of the
organization with a view to implementing a broad information system that could become
a genuine “lever for change.” The Business Plan (2004-2007) broadens the analysis of our
organizational state to other aspects more closely linked with the functioning rules of the
Social Security in Spain and the provision of work disability benefits.
The focus on the professionals and employees working in the institution was
considered essential from the outset. Accordingly, a first Workers’ Opinion Survey
was performed in 2005, which pinpointed the deficiencies and capacities indicated by
the internal clients. Basically, more and better organization, more organized quality and
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8. ICAMS
Organization
Internal
Client
I.N.S.S.
Mutual
Insurance
Companies
Users
Society
Employers
Trade unions
Occupational
Health
Environment
Integrated
Management
System
Baseline
IMS-I IMS-II
more effort in communication and leadership were suggested. More policies focussed on
innovation and on motivation were requested, whilst at the same time taking into
account the significant and well-known limitations posed by the public services sector.
Improving the quality of the service provided was considered a priority task and,
with this aim self-evaluation applying the EFQM model was done in 2006. As a result,
six lines of improvement were defined, with the participation of a quarter of the
organization’s employees. These lines addressed communication strategies, user
service, process methodology, improvement of the clinical product, focus on the
internal customer and quality improvement from a general viewpoint. These processes
were developed during 2007 and 2008.
The “Activities Report 2008” presents a vision of the organization as socially
responsible through including financial equilibrium and environmental protection.
During 2008 and 2009, the user service strategy was formalized and intensive,
systematic work was undertaken on process methodology (processes and procedures
map), quality strategy and evaluation of the clinical product (reports, guidelines and
agreement analysis). These activities were performed simultaneously, providing
results in 2008, 2009 and 2010.
In 2008, the User Service Unit was created. This decision was based on two reasons:
to provide an effective response to the highly negative view held of the organization by
some patients and to achieve user satisfaction as an essential action program. Within
this process, in addition to creating a complaints’ window, the user would become the
organization’s leitmotiv, defining rights and responsibilities that are integrated in the
organization’s clinical and technical processes.
Thus, over a period of ten years, powerful and systematic participation processes
and organizational quality improvements have been developed, related with systems,
users, internal and external clients, and a greater social balance has been achieved with
users and professionals, within a more efficient economic framework and with a
greater degree of environmental protection.
4.2 Need for an IMS
From its creation, the organization demonstrated a powerful focus on improving
quality, shown, among other actions, by the implementation of an organization and
systems’ consulting process (2002).
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Figure 3.
Agents involved in
the IMS design
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9. This led to the various studies, reports and self-evaluations which are individually
supported and articulated in the organization’s annual reports. However, the Steering
Committee and the 150 members of the working groups for improvement identified
several aspects that required an integrated quality management approach:
. excessive fragmentation of the goals achieved;
. relative lack of connection between these goals;
. excessive workload of the organization’s active members;
. lack of internal communication;
. insufficient communication with agents and stakeholders;
. lack of development of individual and department strategic goals; and
. lack of alignment with the above-stated individual and department strategic goals.
Consequently, in 2010 a decision was made to undertake an integration exercise in an
IMS with the primary goal of reducing the detected problems of dispersal, lack of
synergy and lack of communication among agents, together with an excessively
diverse leadership, while at the same time improving the objectives and their
articulation as management tools.
The decision to create a first IMS called “ICAMS Quality Model” included
developing policies, creating guidelines and establishing unified requirements
targeting all levels, professions and areas of the organization, both in its internal
operations and in its interactions with external stakeholders. The overriding goal
here was to overcome limitations, remedy defects and move forward as a socially
responsible entity.
4.3 Designing an IMS-I adapted to the ICAMS case
In designing the IMS-I, the five steps described thereafter have been followed.
Step 1. Analysis of the baseline situation. In general lines, the ICAMS’ activities are
defined within the framework of the regulations governing the Catalan Civil Service,
which are highly concentrated on economic aspects and human resources
management, and those concerned with the monetary benefits provided by the
Social Security, such as the type and nature of the benefits evaluated in this
organization.
In the same way, its clinical activities are based on regulatory medical criteria and
the profession’s good general practices.
Both the regulations and medical practice are subject to specific audits, which are
applied to a greater or lesser degree. Those concerning budget management come
under the responsibility of the Catalan Regional Government’s Audit Agency, while
those concerning human resources are governed by the Civil Service regulations.
Regarding the Business Plans, the work climate studies, the surveys and other
studies and plans, these have all fostered the development of different types of actions,
disconnected from previous actions and with relatively formalized audits.
Step 2. Definition of the scope of integration. The integration should allow
alignment of the strategy with the requirements of the different stakeholders,
the organization’s status as a public entity, the efficiency and management needs of a
modern organization, the medical nature of the activity, and the economic impact of the
decisions made.
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10. Step 3. Detection of the organization’s requirements. As a result of the preparation of
the report based on the EFQM model, the implementation of the management by
processes methodology, the optimization of the clinical work and the evaluation of
its quality, it was possible to systematize the organization’s basic requirements.
One of the goals of this three-pronged analysis was to detect the organization’s
essential requirements as a prior step to creating the framework for the IMS,
identifying:
. Universal rules, which the entire organization must follow: Budgetary Law,
Public Contracts’ Law, Civil Servant Regulation.
. Specific rules for a particular area, department or process: Medical Ethical Code,
Law for the Patient’s Autonomy, Law for Personal Data Protection.
. Rules without a target standard that the organization needs to apply to optimize
management or ascertain the expectations or needs of stakeholders: regulations
for applying Social Security Benefits.
Step 4. Relationship between rules and defined processes. Public health service
organizations have tended to pay more attention to their functions or services than to
their processes. Implementation of the IMS in the ICAMS was perceived as an
opportunity to improve the processes’ focus and to increase efficiency and
competitiveness. It was also seen as an opportunity to increase the engagement of
professionals and employees, provided that the implementation was gradual and took
into account their needs, culture and criteria.
First of all, the organization identified the “macro” processes that did not entail
particularly dramatic changes as they were already acknowledged to some extent
though very independently. Thus, clinical evaluation, legal management, user service,
teaching and offsite training and studies, research and publications processes were
defined. These “macro” processes showed a correlation between the people owning the
processes and each process.
Next, the system’s strategic processes were defined: documentation, improvement
actions and internal audits, and then the services’ strategic processes: service planning,
information, people and complaints. Likewise, the support processes were defined:
people support, general services, budgets, contracts and purchases, ICT and records.
Subsequently, the most significant processes and sub-processes were classified in
six strategic processes, five key processes, with 38 dependent sub-processes, and four
support processes, with eight dependent sub-processes.
This systematic description enabled the definition of a matrix that correlated
processes, sub-processes and requirements.
Step 5. Model design: framework and modules. In designing the IMS-I, certain
criteria were highlighted:
. global approach to the organization as a whole and to the interrelation of its
parts;
. focus on processes;
. paper-free, easy-to-update documentation;
. outreach to coexisting cultures (medical, clerical, primary care, Social Security
and mutual insurance companies, users);
. management responsibilities and skills;
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11. . flexibility in adaptation to changes;
. sustainability and updating of the IMS;
. integrative element for improving quality; and
. the EFQM evaluation as a measuring instrument and for detecting areas
requiring improvement.
The IMS has been called the “ICAMS’ Quality Model,” with quality as a basic,
management-linked strategy. Taking these criteria into account, it was structured as
follows:
. General framework.
The general framework, defined in the ICAMS’ Quality Model, encompasses the
body of policies and guidelines as essential elements that describe key
management aspects and offer a broad view of the organization. Its primary goal
is to offer staff an overview of the main interrelations between different
management aspects, systems and subsystems within the organization.
. Modules.
The ICAMS’ Quality Model Manual is structured in three modules to facilitate
understanding, follow-up and review: Operational, Strategic and Support
(Figure 4).
. Monitoring and evaluation tools.
The ICAMS’ Quality Model has been built on the PDCA quality improvement cycle and
is structured as follows:
. Introduction
. Organization and Policies
. Planning
. Resource management
. Process and activity management
. Evaluation of the activity
. Ongoing development
STRATEGIC MODULE
OPERATING MODULE
Products
Medical Evaluation
Training and Teaching
Investigation
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Occupational Health
and Safety Environment Figure 4.
SUPPORT MODULE
The ICAMS’ Quality
Modules within the
IMS-I framework
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12. . Relations with the Catalan authorities
. Relations with other authorities and international organizations
. Appendices
4.4 Need to evaluate the IMS-I with EFQM prior to its application
The methodology for implementing the ICAMS’ Quality Model should be based on:
. commitment at the highest level of the organization;
. implementation in each organizational unit;
. definition of signs of apoptosis (or signs of inadequate implementation);
. senior management commitment and cooperative leadership;
. high level of communication;
. provision of training at all levels of the organization;
. implementation with self-generated resources; and
. cross-organization improvement teams.
Being aware of the project’s complexity, compounded by shortcomings in the
preparation of phase l of the implementation of the IMS, it was decided to change the
focus in the implementation of IMS-I, and the preparation of the organization’s
report was modified to align it with the EFQM model and its corresponding external
evaluation.
This realigning of the general strategy was driven by three basic factors:
(1) Need to reflect on the quality projects currently in progress.
(2) EFQM evaluation as an analysis and measuring tool.
(3) Interest in external recognition (getting the EFQM mark 400 þ).
Thus, the development and implementation strategy of the IMS (now called IMS-II)
would be expanded, improving its technical quality and performing a new
self-evaluation (and external evaluation) in accordance with the EFQM model, at the
end of 2012.
4.5 Findings from the EFQM evaluation of the IMS-I
Execution of the classic EFQM review procedure generated highly positive opinions
and improvement proposals: Leadership (process and evaluation), Strategic Plan,
Satisfaction and People Management Plan, Process Consolidation (ISO-14001,
environmental, already implemented and ISO-27001, occupational health in working
process), Objectives and Balanced Scorecard, Review and Improvement of User Service
Policies, Communication and External Image Plan, Training Plan, Knowledge
Management, Expectations and Needs of the Organization’s People, Environmental
Management and Acknowledgements and Awards.
A series of actions were programmed on the basis of the recommendations received:
. Evaluation of the quality of the clinical product and ongoing monitoring.
. Evaluation of the Leadership and the Communication Plan.
. Strategic Plan 2011-2014.
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13. . Knowledge and People Management Plan.
. Environmental and process management International Standards Organization
(ISO).
. Evaluation of user service policies and analysis of expectations.
. Workers’ Opinion Survey-2 stage and evaluation of the policies with the people
involved.
. Objectives, Scorecard and Participative Management by Objectives.
The people responsible for these lines and their working groups, with their respective
timelines, were defined. Those responsible for administrative quality (administration
manager) and clinical quality (clinical care manager) were also defined and
preparation of the IMS-II began.
4.6 Redesigning the IMS-I after EFQM: IMS-II
The construction of the IMS-II takes advantage as much as possible of the effort made
in designing the IMS-I and incorporates the reports and evaluations carried out during
the EFQM process, as already mentioned and shown in Figure 5.
The process concluded with the presentation of the IMS-II for the second external
EFQM evaluation (September 2012-December 2012).
4.7 Benefits from designing and evaluating the IMS-I prior to its application as IMS-II
The results – the tangible and intangible benefits – achieved during construction of the
IMS-I, which concluded with obtainment of the EFQM mark 400þ, can be
summarized as follows:
. Increased efficiency in the use of resources: more and better medical evaluation
activity and improvement in peer-agreement.
The ICAMS’ IMS-II
Documentation
Strategic Procedures
of the Management System
Strategic Procedures
of the Service
Environment
ISO 14001
Occupational Hazards
OHSAS 18001
Identification Evaluation Planning Action
Integrated Management Manual
Key Procedures
Medical Evaluation Management
Training and Teaching
Investigation
of the Disability
QUALITY ISO 9001
Support Procedures
EFQM 400 + REPORT
CSR/GRI REPORT
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Figure 5.
Redesigning the IMS-I
after EFQM: IMS-II
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14. . Implementation of the organization’s strategic vision: renewed Strategic Plan
2011-2014.
. Implementation of management by processes: processes mapping, procedures
and quality management system.
. Improved staff motivation: improved workers’ opinion when comparing first and
second Workers’ Opinion Surveys.
. Consolidation of the focus on the user: Letter of Rights and Duties.
. Focus of the culture on social responsibility: report on Corporate Social
Responsibility and adhesion to the Global Reporting Initiative.
. Improved corporate image, acknowledgement of the sector and its professionals:
several prizes and certifications acknowledged the quality improvement process.
The results that were hoped to be achieved with the implementation of the IMS-II,
which was revised in the light of the results of the EFQM evaluation at the end of 2012,
were the following:
. implementation of a Strategic Plan;
. global vision of the organization, with precisely defined objectives and personal
duties assigned to each employee, evaluated on an ongoing basis;
. improvements in internal communication;
. consolidation of the improvements in staff motivation;
. continuity of the efficiency improvements in the use of resources;
. strengthening of the focus on the user and guarantees of compliance; and
. corporate image as a benchmark in organization in its field, in Spain and abroad.
This revision has been recently done achieving an excellent mark of 500þ.
5. Conclusions and managerial implications
This article presents the experience of the creation, in two phases, of an IMS, in a
public health organization specializing in medical evaluation.
In the authors’ opinion, this paper is particularly useful because it discusses a case
study of a situation that is relatively common in Spain, namely, there are a number of
medium-sized government-run enterprises that have a high degree of complexity and
are governed by different bodies or regulations, with mandatory or recommended
control systems, but experience certain difficulties such as a certain lack of integration,
excessive employee workload, communication problems between the different players,
and with certain areas of strategic interest that are less valued than others.
Given this situation, the authors have endeavored to convey certain
recommendations for organizations having similar features that may be interested in
designing an IMS considering the clear evidence of synergy in the use of standardized
management systems in our country (Casadesu´s et al., 2011) and the importance of the
level of integration (Bernardo et al., 2012). On the basis of the experience described,
the following are considered indispensable:
. combine the systemic vision of the organization with an analysis of its
components;
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15. . maximum and visible commitment from the senior management;
. have the necessary resources to integrate the different systems;
. overcome the resistance to change through training techniques, group work and
peer review;
. guarantee vertical and horizontal communication within the organization:
communication plan based on social network, including evaluation and policies
for recognition;
. facilitate integration of the organization’s people: newcomers’ integration
plan, practical training and fulfillment management of individual
objectives;
. systematically applying the PDCA quality improvement cycle as a basis for
improvement and for moving the model’s reach forward;
. be alert to the main risks (apoptosis criteria);
. incorporate flexibility as an essential element of the model; and
. integrate the audit as an instrument for continual improvement of the
organization and driver of the model.
Our case study has several limitations related to the organizational size, the general
lack of flexibility in the Public Administration, the recent implementation of our
initiatives, the broad and ambitious project requiring serious and permanent
evaluation and the current rigid Social Security rules which may, however, change
abruptly in the context of the present economic crisis in Spain. Further studies are
needed to monitor whether or not the changes that could take place in the near future
in the Social Security rules, the Public Administration, the Steering Committees and so
on, have an effect in our organization and require further actions.
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About the authors
Dr Rafael Manzanera is former Director of the ICAMS, and is currently based at the MC Mutual,
Barcelona.
Dr Josefina Jardı´ is former General Manager at the ICAMS and a Member of the ICAMS
Management Committee.
Dr Xavier Gomila (1963-2014) was Medical Director at the ICAMS and a Member of the
ICAMS Management Committee.
Joan Ramon Pastor is a former Administration Manager at the ICAMS and is currently based
at the Public Health Agency (ASPCAT), Generalitat de Catalunya.
Dr Dolores Iban˜ez is a Medical-Legal and Knowledge Management Manager at the ICAMS
and a Member of the ICAMS Management Committee.
Glo`ria Galvez is a User Service and Qualitative Methodologies Manager at the ICAMS
and a Member of the ICAMS Management Committee.
Dr Constanc¸a Albertı´ is a Research and Quantitative Methodologies Manager at the
ICAMS. Dr Constanc¸a Albertı´ is the corresponding author and can be contacted at:
constanca.alberti@gencat.cat
Albert Navarro was employed at the ICAMS from 2002 to 2010 and is currently based at the
Health Department, Generalitat de Catalunya.
Joaquı´n Uris is a Quality Expert and Advisor to the ICAMS in EFQM methodology.
Alicia Pomares is an Organizations Expert and Advisor to the ICAMS on the MBO project.
She is currently based at the Humannova.
Dr Lluı¨sa Lopez is a Manager of the Care Quality and Accreditation Service, Department
of Health, Catalan Regional Government, and Team Member of participative projects at
the ICAMS.
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17. Dr Cristina Zuazu is a Member of the ICAMS Management Committee.
Dr Primitiva Sabate´ is a Member of the ICAMS Management Committee.
Dr Immaculada Aguado is a Member of the ICAMS Management Committee.
Dr Lidia Domingo is a Member of the ICAMS Management Committee.
Dr Carolina Infante is a Member of the ICAMS Management Committee.
Dr Josep Gomis is a Member of the ICAMS Management Committee.
Dr Aurora Jover is a former Member of the ICAMS Management Committee and is currently
based at the Health Department.
Jordi Iglesias is a Member of the ICAMS Management Committee.
Antoni Mestres is a Member of the ICAMS Management Committee.
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