Getting geographically dispersed hospitals in a health system to take care of patients in the desired, uniform fashion is a major task. Sentara Healthcare has addressed the issue by adopting a model based on the ISO 9001 international quality-management principles across the system, and then applying for third-party certification.

The 12-hospital system, based in Virginia and North Carolina, is one of the first — if not the first — to take this system-focused approach using the non-health care-originated ISO 9001 standards.

“We are seeing a lot of our health care delivery systems actively engaged in quality and safety improvement efforts that have been very effective, but the new wrinkle here is: How does one assess their effectiveness and engagement across the system?” says Nancy Foster, the American Hospital Association’s vice president for quality and patient safety policy. “For an accrediting body to take a look at the system impact is a new and interesting development.”

Sentara completed its switch to the ISO 9001-based approach for Medicare accreditation in 2013, hiring DNV GL to conduct it. But its new systemwide certification of quality-management processes is an entirely separate program tailored to Sentara’s needs.

“ISO is a skeleton, but we put the meat on the bones,” explains Deloris Cooper, Sentara’s director of accreditation and regulatory standards.

Basics covered by ISO include standardizing processes for patient satisfaction and complaints, clinical protocols and internal audits.

Variations developed by Sentara include: standardizing processes for prevention of hospital-acquired Clostridium difficile bacterial infections, utilizing the supply chain department for change management, and developing a queuing team to decide in what order and when new initiatives will be rolled out to prevent staff from being overwhelmed.

“The standardization for the safety of our patients was key to this,” says Iris Lundy, manager of quality management. “It shows we’re sustaining what we put in place.”

It’s the first certification of its kind that DNV GL has awarded, and two years ago, the deeming body certified Sentara Leigh Hospital and Sentara Virginia Beach General Hospital as its first two designated centers of excellence for managing infection risk.

Foster says there is always tension created by systemwide directives between the corporate headquarters that order them and the individual units that must implement them, but systemwide initiatives have built-in economies of scale along with the capacity to build tools and strategies to drive the effort forward.

Examples of good systemwide efforts that can be locally customized cited by Foster included antibiotic stewardship programs and efforts to reduce central line-associated bloodstream infections.

She specifically praised Ascension Health’s drive to reduce its rate of early-elective deliveries as an example of a systemwide initiative that was locally prioritized.

“It was applicable only to where they delivered babies and, more importantly, where they delivered a lot of babies,” Foster says.

Organizations like Sentara and Ascension, however, have been on the systematic “journey for quality and safety” for a long time and have been proactive in finding new ways to care for the communities they serve, Foster says.