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Sandro Esteves
ANDROFERT, BRAZIL
L9: What are the benefits of
QMS for a fertility center
and how to measure them?
IVF Preceptorship Hamburg, 4-5 July 2014
QMS in the Fertility Centre
ISO 9001:2008
Learning objectives
At the completion of this presentation,
participants should be able to:
• Understand how an organization could
benefit from establishing an effective QMS
• Learn how to measure quality as per QMS
perspective
• Learn what we achieved at Androfert after
having implemented ISO 9001:2008
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 2
2014 JULY
ANDROFERT
What of the following does
your fertility center have?
Strong customer focus
customer needs/expectations are determined and converted into service requirements
Top managers have leadership
provide unity of purpose by quality policies, ensuring that measurable objectives are
established, and demonstrate that they are fully committed to developing, sustaining
and improving your center
People are involved at all levels
awareness of the importance of meeting customer requirements and responsibilities to
do this, and people are competent on the basis of appropriate training and experience
Process approach
key processes are supported by rigidly-defined procedures determining what is to be
done when undertaking a task
Systems approach
processes are managed so that the most efficient use is made of available resources,
to ensure that the needs of all stakeholders are met
Continual improvement for factual decision-making
attention is given to the voice of the customer and the voice of the processes
(measurement, monitoring, analysis)
A set of coordinated activities to
direct and control an
organization to continuously
improve the effectiveness and
efficiency of its performance
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 4
2014 JULY
ANDROFERT
Know your customers and define the processes
to meet their expectations
Define goals and objectives, so that procedures
and processes help you achieve them
Offer resources and infrastructure to fulfill
objectives
Systematically correct and prevent non-
conformities
Measure your performance and your customers’
satisfaction periodically
Make changes, adjustments, and improvements
based on measured results and not on
assumptions
Essentials of a successful QMS
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 5
2014 JULY
ANDROFERT
ISO 9001: Conceptual Model
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 6
2014 JULY
ANDROFERT
Customers are not only our
patients…
• Doctors who use our services
• Our employees
• Suppliers
• People in our community
• Regulatory authorities
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 7
2014 JULY
ANDROFERT
Adoption of QMS is a strategic
decision of a fertility center
Influenced by:
Regulatory directives
Concerns about quality of services
Effectiveness & efficiency
Safety
Customer requirements and satisfaction
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 8
2014 JULY
ANDROFERT
Worldwide tendency is IVF guidelines
including QMS become mandatory
Australia Code of practice for assisted
reproductive technology units,
Reproductive Technology Accreditation
Committee (RTAC)
Brazil RDC 33 and 23, National Agency of
Sanitary Surveillance (ANVISA)
European
Union
EU directive 2004/23/EG, 2006/17/EG,
2006/86/EG
South Africa National Health Act 61/2003; Human
Tissue Act
USA CLIA for Andrology laboratories; FDA
for cryobiology
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 9
2014 JULY
ANDROFERT
What regulatory bodies ask for
Document control system
Personnel training
Periodic audits
Procedures for detection, registration,
correction and prevention of errors and
non-conformities
Compliance with biosafety regulations
System to evaluate and control materials
and equipment
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 10
2014 JULY
ANDROFERT
Concerns about quality of services
Dancet et al.
Hum Reprod 2013
0% 50% 100%
Doctors &
embryologists
Nurses
Patients Safety
Effectiveness
Patient-
centeredness
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 11
2014 JULY
ANDROFERT
How stakeholders value the top 3 quality
dimensions of infertility care
QM focuses on customer requirements
and satisfaction
Lack of psychological support
and poor quality of service ~60%
treatment discontinuation
22 studies sampling
21,453 patients from
8 countries
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 12
2014 JULY
ANDROFERT
A QMS will ensure that two
important requirements are met…
1. Customer’s requirements
confidence in the ability of the center to deliver
the desired service consistently meeting their
needs and expectations
2. Fertility center’s requirements
both internally and externally, and at an
optimum cost with the efficient use of the
available resources (materials, human,
technology and information)
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 13
2014 JULY
ANDROFERT
A powerful “wedge”
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 14
2014 JULY
ANDROFERT
Key points (1)
The benefits are…
1. Enables fertility center to provide
consistency in terms of methods,
materials, equipment, etc.
Safety and effectiveness
2. Ensures that services conform with
customers' needs and requirements
Customer-centeredness
3. Allows an increase in efficiency
Profitability
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 15
2014 JULY
ANDROFERT
QMS benefits can only be achieved
if evidence is provided
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 16
2014 JULY
ANDROFERT
How to get information
Internal and External Audits
Registration of quality actions
Non-conformities, preventive
actions, improvement actions,
complaints
Satisfaction surveys/questionnaires
Data collection
Key performance indicators
Main
Tools
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 17
2014 JULY
ANDROFERT
How to measure & analyze
Pareto diagram
Diagram of cause and effect
Control chart
Histogram
Flowchart
Quality
Tools
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 18
2014 JULY
ANDROFERT
PDCA
Balanced score card (BSC)
Six sigma
Quality
Methods
0
5
10
15
20
25
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Frequency
Andrology Lab - Patients' complaints
Pareto Diagram
Prioritize problems to be solved
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 19
2014 JULY
ANDROFERT
Diagram of cause and effect
Prioritize factors that may cause undesired effect
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 20
2014 JULY
ANDROFERT
Control chart
Monitor the stability or instability of a process
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 21
2014 JULY
ANDROFERT
0
2
4
6
8
10
12
Q1
2010
Q2
2010
Q3
2010
Q4
2010
Q1
2011
Q2
2011
Q3
2011
Q4
2011
Q1
2012
Q2
2012
Q3
2012
Q4
2012
Number of non-conformities
Histogram
Distribute data and shows how a given
process varies
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 22
2014 JULY
ANDROFERT
Histogram
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 23
2014 JULY
ANDROFERT
Flow chart
Visualize a process and identify improvement
opportunities
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 24
2014 JULY
ANDROFERT
PDCA
Method to monitor, correct and improve a
process
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 25
2014 JULY
ANDROFERT
Category Metric Target Status
Customer
satisfaction
Repeat customer % IVF drop-out <50% 50%
Service % IVF cycles
w/complaints
<5% 2%
Financial
No. IVF cycles % Annual growth >5% 8%
No. tests Andrology lab % Annual growth +/- 10% 8%
Payment rate
sperm/embryo bank
% clients in debt
<35% 40%
Employee
satisfaction
Turnover 2-yr. period <5% 9%
Absenteeism Days year/employee 4 2
Quality
ISO recertification approval
Non-conformities No. year 5 5
Balanced Score Card
Provide a hierarchized view of the organization’s
performance management system
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 26
2014 JULY
ANDROFERT
Multiple Perspectives of BSC
How do we look to shareholders?
(Financial)
How do customers see us?
(Customer)
What must we excel at?
(Internal)
Can we continue to improve and create
value?
(Innovation and learning)
Kaplan and Norton
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 27
2014 JULY
ANDROFERT
6 Sigma
Provides a general map that helps to reduce
variability
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 28
2014 JULY
ANDROFERT
Key points (2)
Measurement is carried out by…
Getting information
Audits, registration of quality actions, data
collection of (key performance indicators)
Applying quality tools
Pareto diagram, diagram of cause/effect,
histogram, flow chart
Integrating quality tools with quality
methods
PDCA, BSC & 6 Sigma
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 29
2014 JULY
ANDROFERT
1996 – Androfert Foundation
2000 – IVF Program started
2006 – Started QMS implementation
2010 – ISO Certification
2013 – Recertification
ISO 9001:2008
What we achieved…
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 30
2014 JULY
ANDROFERT
Organizational Framework of Androfert
Quality and
Administrative
Manager
Clinical Director
Urology
/Andrology
Microsurgery
Gynecology
Endoscopy
Nursing
Complementary
health services
Psychologist
Nutritionist
Acupuncture
Anesthesia Ultrasound
Quality &
Administrative
Manager
General
services
Biomedicine
engineer
Maintenance
IT dept.
Data entry
Website &
Intranet
Administrative
assistant
Secretaries
Legal dept.
Lab Director
Lab Supervisor
Andrology Lab
technicians
Cryopreservation
Lab technicians
IVF Lab
Scientific
Director
Research Training
Associated
services
Endocrine
Laboratory
Genetics Laundry Sterilization Hospital Pathology Immunology Radiology
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 31
2014 JULY
ANDROFERT
Main reasons we
implemented QMS
Core reasons
Concerns about quality of services
Regulatory directives
Beyond the core
Image and reputation
Customer satisfaction
Market share (customer retention/acquisition)
Profitability
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 32
2014 JULY
ANDROFERT
Core Reasons Achieved
• Quality of services
– Certified and recertified with
“zero” non-conformities
• Compliance with regulatory
authorities
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 33
2014 JULY
ANDROFERT
Quality
of
Laboratories
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 34
2014 JULY
ANDROFERT
Image and Reputation
Elected Top-quality ART
Center
– Germinative cell and
tissue bank; ANVISA-
Brazil
– Training center for
ANVISA inspectors
(QMS)
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 35
2014 JULY
ANDROFERT
0
5
10
15
20
25
Total number of doctors using Androfert
services after QMS
Market share
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 36
2014 JULY
ANDROFERT
0
2
4
6
8
10
12
14
16
18
20
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Percent
growth
per
year
Year
IVF Program
Profitability
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 37
2014 JULY
ANDROFERT
And more…
Set direction & met customers’
expectations
Improved process control & reduced
wastage
Created a proper documentation system
Facilitated training
Involved staff & raised morale
Improved communication & feed-back
with all team members
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 38
2014 JULY
ANDROFERT
Key points (3)
What we achieved was …
ANDROFERT
androfert.com.br
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 39
2014 JULY
ANDROFERT
o A very well-organized workflow
o Excellence in service provided
o Focus on patient needs and
satisfaction
o Continuous improvement
o Increased operational efficiency
and profitability

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What are the benefits of QMS for a Fertility Centre and how to measure them

  • 1. Sandro Esteves ANDROFERT, BRAZIL L9: What are the benefits of QMS for a fertility center and how to measure them? IVF Preceptorship Hamburg, 4-5 July 2014 QMS in the Fertility Centre ISO 9001:2008
  • 2. Learning objectives At the completion of this presentation, participants should be able to: • Understand how an organization could benefit from establishing an effective QMS • Learn how to measure quality as per QMS perspective • Learn what we achieved at Androfert after having implemented ISO 9001:2008 ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 2 2014 JULY ANDROFERT
  • 3. What of the following does your fertility center have? Strong customer focus customer needs/expectations are determined and converted into service requirements Top managers have leadership provide unity of purpose by quality policies, ensuring that measurable objectives are established, and demonstrate that they are fully committed to developing, sustaining and improving your center People are involved at all levels awareness of the importance of meeting customer requirements and responsibilities to do this, and people are competent on the basis of appropriate training and experience Process approach key processes are supported by rigidly-defined procedures determining what is to be done when undertaking a task Systems approach processes are managed so that the most efficient use is made of available resources, to ensure that the needs of all stakeholders are met Continual improvement for factual decision-making attention is given to the voice of the customer and the voice of the processes (measurement, monitoring, analysis)
  • 4. A set of coordinated activities to direct and control an organization to continuously improve the effectiveness and efficiency of its performance ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 4 2014 JULY ANDROFERT
  • 5. Know your customers and define the processes to meet their expectations Define goals and objectives, so that procedures and processes help you achieve them Offer resources and infrastructure to fulfill objectives Systematically correct and prevent non- conformities Measure your performance and your customers’ satisfaction periodically Make changes, adjustments, and improvements based on measured results and not on assumptions Essentials of a successful QMS ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 5 2014 JULY ANDROFERT
  • 6. ISO 9001: Conceptual Model ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 6 2014 JULY ANDROFERT
  • 7. Customers are not only our patients… • Doctors who use our services • Our employees • Suppliers • People in our community • Regulatory authorities ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 7 2014 JULY ANDROFERT
  • 8. Adoption of QMS is a strategic decision of a fertility center Influenced by: Regulatory directives Concerns about quality of services Effectiveness & efficiency Safety Customer requirements and satisfaction ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 8 2014 JULY ANDROFERT
  • 9. Worldwide tendency is IVF guidelines including QMS become mandatory Australia Code of practice for assisted reproductive technology units, Reproductive Technology Accreditation Committee (RTAC) Brazil RDC 33 and 23, National Agency of Sanitary Surveillance (ANVISA) European Union EU directive 2004/23/EG, 2006/17/EG, 2006/86/EG South Africa National Health Act 61/2003; Human Tissue Act USA CLIA for Andrology laboratories; FDA for cryobiology ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 9 2014 JULY ANDROFERT
  • 10. What regulatory bodies ask for Document control system Personnel training Periodic audits Procedures for detection, registration, correction and prevention of errors and non-conformities Compliance with biosafety regulations System to evaluate and control materials and equipment ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 10 2014 JULY ANDROFERT
  • 11. Concerns about quality of services Dancet et al. Hum Reprod 2013 0% 50% 100% Doctors & embryologists Nurses Patients Safety Effectiveness Patient- centeredness ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 11 2014 JULY ANDROFERT How stakeholders value the top 3 quality dimensions of infertility care
  • 12. QM focuses on customer requirements and satisfaction Lack of psychological support and poor quality of service ~60% treatment discontinuation 22 studies sampling 21,453 patients from 8 countries ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 12 2014 JULY ANDROFERT
  • 13. A QMS will ensure that two important requirements are met… 1. Customer’s requirements confidence in the ability of the center to deliver the desired service consistently meeting their needs and expectations 2. Fertility center’s requirements both internally and externally, and at an optimum cost with the efficient use of the available resources (materials, human, technology and information) ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 13 2014 JULY ANDROFERT
  • 14. A powerful “wedge” ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 14 2014 JULY ANDROFERT
  • 15. Key points (1) The benefits are… 1. Enables fertility center to provide consistency in terms of methods, materials, equipment, etc. Safety and effectiveness 2. Ensures that services conform with customers' needs and requirements Customer-centeredness 3. Allows an increase in efficiency Profitability ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 15 2014 JULY ANDROFERT
  • 16. QMS benefits can only be achieved if evidence is provided ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 16 2014 JULY ANDROFERT
  • 17. How to get information Internal and External Audits Registration of quality actions Non-conformities, preventive actions, improvement actions, complaints Satisfaction surveys/questionnaires Data collection Key performance indicators Main Tools ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 17 2014 JULY ANDROFERT
  • 18. How to measure & analyze Pareto diagram Diagram of cause and effect Control chart Histogram Flowchart Quality Tools ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 18 2014 JULY ANDROFERT PDCA Balanced score card (BSC) Six sigma Quality Methods
  • 19. 0 5 10 15 20 25 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Frequency Andrology Lab - Patients' complaints Pareto Diagram Prioritize problems to be solved ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 19 2014 JULY ANDROFERT
  • 20. Diagram of cause and effect Prioritize factors that may cause undesired effect ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 20 2014 JULY ANDROFERT
  • 21. Control chart Monitor the stability or instability of a process ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 21 2014 JULY ANDROFERT
  • 22. 0 2 4 6 8 10 12 Q1 2010 Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Number of non-conformities Histogram Distribute data and shows how a given process varies ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 22 2014 JULY ANDROFERT
  • 23. Histogram ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 23 2014 JULY ANDROFERT
  • 24. Flow chart Visualize a process and identify improvement opportunities ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 24 2014 JULY ANDROFERT
  • 25. PDCA Method to monitor, correct and improve a process ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 25 2014 JULY ANDROFERT
  • 26. Category Metric Target Status Customer satisfaction Repeat customer % IVF drop-out <50% 50% Service % IVF cycles w/complaints <5% 2% Financial No. IVF cycles % Annual growth >5% 8% No. tests Andrology lab % Annual growth +/- 10% 8% Payment rate sperm/embryo bank % clients in debt <35% 40% Employee satisfaction Turnover 2-yr. period <5% 9% Absenteeism Days year/employee 4 2 Quality ISO recertification approval Non-conformities No. year 5 5 Balanced Score Card Provide a hierarchized view of the organization’s performance management system ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 26 2014 JULY ANDROFERT
  • 27. Multiple Perspectives of BSC How do we look to shareholders? (Financial) How do customers see us? (Customer) What must we excel at? (Internal) Can we continue to improve and create value? (Innovation and learning) Kaplan and Norton ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 27 2014 JULY ANDROFERT
  • 28. 6 Sigma Provides a general map that helps to reduce variability ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 28 2014 JULY ANDROFERT
  • 29. Key points (2) Measurement is carried out by… Getting information Audits, registration of quality actions, data collection of (key performance indicators) Applying quality tools Pareto diagram, diagram of cause/effect, histogram, flow chart Integrating quality tools with quality methods PDCA, BSC & 6 Sigma ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 29 2014 JULY ANDROFERT
  • 30. 1996 – Androfert Foundation 2000 – IVF Program started 2006 – Started QMS implementation 2010 – ISO Certification 2013 – Recertification ISO 9001:2008 What we achieved… ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 30 2014 JULY ANDROFERT
  • 31. Organizational Framework of Androfert Quality and Administrative Manager Clinical Director Urology /Andrology Microsurgery Gynecology Endoscopy Nursing Complementary health services Psychologist Nutritionist Acupuncture Anesthesia Ultrasound Quality & Administrative Manager General services Biomedicine engineer Maintenance IT dept. Data entry Website & Intranet Administrative assistant Secretaries Legal dept. Lab Director Lab Supervisor Andrology Lab technicians Cryopreservation Lab technicians IVF Lab Scientific Director Research Training Associated services Endocrine Laboratory Genetics Laundry Sterilization Hospital Pathology Immunology Radiology ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 31 2014 JULY ANDROFERT
  • 32. Main reasons we implemented QMS Core reasons Concerns about quality of services Regulatory directives Beyond the core Image and reputation Customer satisfaction Market share (customer retention/acquisition) Profitability ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 32 2014 JULY ANDROFERT
  • 33. Core Reasons Achieved • Quality of services – Certified and recertified with “zero” non-conformities • Compliance with regulatory authorities ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 33 2014 JULY ANDROFERT
  • 34. Quality of Laboratories ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 34 2014 JULY ANDROFERT
  • 35. Image and Reputation Elected Top-quality ART Center – Germinative cell and tissue bank; ANVISA- Brazil – Training center for ANVISA inspectors (QMS) ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 35 2014 JULY ANDROFERT
  • 36. 0 5 10 15 20 25 Total number of doctors using Androfert services after QMS Market share ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 36 2014 JULY ANDROFERT
  • 37. 0 2 4 6 8 10 12 14 16 18 20 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Percent growth per year Year IVF Program Profitability ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 37 2014 JULY ANDROFERT
  • 38. And more… Set direction & met customers’ expectations Improved process control & reduced wastage Created a proper documentation system Facilitated training Involved staff & raised morale Improved communication & feed-back with all team members ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 38 2014 JULY ANDROFERT
  • 39. Key points (3) What we achieved was … ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 39 2014 JULY ANDROFERT o A very well-organized workflow o Excellence in service provided o Focus on patient needs and satisfaction o Continuous improvement o Increased operational efficiency and profitability

Notas del editor

  1. 1. The requirements and expectations of clients are taken into consideration in making decisions and procedures. 2. The quality policies & quality objectives are clearly defined and understood inside the organization. 3. Processes & responsibilities to realize objectives are executed and managed; 4. Resources and infrastructure to fulfill objectives are offered. 5. Ways to measure processes, in addition to services, are defined and implemented. 6. Apply measurements results for improvement (measurement without action is usually a waste and resources). 7. Preventing non-conformities and eliminating reasons for non-conformities are systematic and managed to be a process. 8. Framework for verification of processes and services is clearly defined and understood in the business. 9. Management involvement within the system and thorough management reviews in the system. (This needs to be working meetings and not simply "dog and pony" shows
  2. A QMS enables an organization to achieve the goals and objectives set out in its policy and strategy. It provides consistency and satisfaction in terms of methods, materials, equipment, etc, and interacts with all activities of the organization, beginning with the identification of customer requirements and ending with their satisfaction, at every transaction interface.
  3. Doctors often assume that the patient has to adapt to treatment and not the opposite
  4. TQM is important to infertility care, as new ARTs are frequently introduced without prior safety and effectiveness studies in vulnerable patients burdened emotionally, socially and also physically TQM is a solution to take into account patients’ perspectives
  5. That both holds the gains achieved through the quality “journey” and prevents good practices from slipping.
  6. Quality indicators are measurable. They are used to quantify and evaluate the organization’s success. They also measure how much progress you’ve made relative to the objectives you wish to achieve. They are critical to make improvements and support decision making.
  7. Quality indicators are measurable. They are used to quantify and evaluate the organization’s success. They also measure how much progress you’ve made relative to the objectives you wish to achieve. They are critical to make improvements and support decision making.
  8. Select the problem to be compared Decide what measurement is appropriate (eg. Frequency, quantitiy, etc) Select the time period for analysis
  9. Describe the problem clearly Brainstorm and record data on those involved Draw diagram with given problem on the right side Indicate the categories of causes Group the brainstorm result by category Elect the most important causes
  10. Define mean values generated by the process Define the maximum variation the process reaches Obtain the maximum values allowed by the specification Prepare chart and record the values obtained in a given period of time
  11. Register the values found in a given process Accumulate the data
  12. Assemble all information about the process to be studied Draw the current flowchart Study the critical points and draw flowchart with the steps that need to be followed Compare and analyze the differences between what is intended and what is being done
  13. Green: stable process and on target Yellow: stable but not on target Red: not stable and not on target
  14. It allows the organisation to benchmark itself against similar organisations. Accreditation provides evidence to external parties that the organisation has reached the standard required to carry out prescribed functions