Cambodia Trust Rehabilitation Services Implements ISO
By Mick Stimpson, CPO (UK) In this addition to the article, "ISO 9001 for Nonprofits: Is It
Worth the Expense?" Michael "Mick" Stimpson includes more details
as to how this feat was accomplished in Cambodia.
Like many small nongovernmental organizations (NGOs), the
Cambodia Trust began by trying to fulfill a desperate need in a
war-ravaged country with just a couple of expatriates and a few
local staff. Practices and procedures tended to be committed to
memory and became almost rumor. written down. Policies and
procedures frequently changed with the arrival of new management.
In the meantime the organization grew to provide services in three
clinics, operate an International Society for Prosthetics and
Orthotics (ISPO) Level II prosthetic and orthotic school and employ
almost 100 staff members.
Initially, the Bendigo Regional Institute of Taffe (BRIT) was
contracted from Australia to assist with quality management and
audit training of senior staff and to give advice on
implementation. Two volunteers from Ireland's Agency for Personal
Service Overseas (APSO) were recruited to document procedures and
practices, a task so big that it took one year and required the
assistance of all CT senior staff. An implementation team or
steering committee was set up to meet on a regular basis to discuss
progress.
The first and probably the biggest hurdle for the implementation
process was to get the staff to take ownership of the project.
Developing trust and allowing staff to speak openly were
facilitated with the formation of small meeting groups. Khmer staff
were encouraged to chair and take minutes for their own meetings.
Monthly appraisal meetings began to be held to promote two-way
communication between staff and supervisors. Internal audits
provided another firm lever for the recruitment of Cambodian hearts
and minds as Khmer staff were trained to be quality managers and
auditors.
A necessary part of the implementation process is staff
training. All staff members have a job description written in their
mother tongue and can explain how their job contributes to the
quality of service to the patient.
The Khmer staff were highly enthusiastic and keen to prove that
they could achieve international standards and be judged by them,
which is why I feel implementation of ISO9001:2000 wins against
adopting a homemade quality system.
Senior staff undertook the final phase of procedure writing. A
volunteer from New Zealand replaced the APSO volunteers and took on
the position of human resources advisor, partnering with the
quality manager, Tang Kea. This highly successful partnership was a
keystone in the foundation of the QMS. Realization of Kea's
organizational and managerial abilities allowed all the ingredients
of the quality management system to be effectively
consolidated.
In late August 2001, ISO auditors from BM Trada, a certifying
organization, swooped in from Thailand, armed with clipboards and
wearing no-nonsense expressions, for a pre-audit check. Despite the
best preparations, some serious nonconformities were highlighted.
After a further three months of work, the implementation team felt
that more work was still required to meet the standard. The final
audit was rescheduled from mid-December 2001 to March 2002. This
realistic decision gave the organization more time to develop
quality objectives and work with preventative and corrective
responses to nonconformities.
The focus on continuous improvement provided some positive
results early on in the implementation process. For example,
spoilage of polypropylene when draping dropped to almost nil in
provincial clinics. Even in the Phnom Penh clinic, where third-year
students from the Cambodian School of P and O conduct their
internship, the technical supervision of students when
manufacturing their devices improved, and the number of aborted
drapes decreased to only one per month per student. These
statistics are collected by the workshop staff themselves and a
month to month running total displayed on a white board. This
visible example of continuous improvement provides staff with
motivation that their quality system is showing results.
Building Confidence, Saving Money
Achieving ISO accreditation has resulted in more efficiency and
cost effectiveness, along with building donor confidence and
increasing the pride and job satisfaction of the Khmer staff. Now
the challenge remains: to maintain this achievement and this
quality system. 
Table Of Contents - February 2003
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