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Carlos Emanuel T. Pires Bicheiro – Universidade de São Paulo (USP)/Brasil

Carlos Eduardo Sanches da Silva


This article analyzes the adaptation of the requirement of the ISO 9000 standards in the
process of implementation of the quality system ni attendance Dental companies, that are
characterized by the professionals accreditation. It tries to discuss the several ways that can
be adopted in the implementation process and its reflexes in the quality of the rendered
service .


The Quality System implementation according to ISO 9000 standards in Health related
companies, mainly those in the Dental area, is relatively new.
Several points have been motivating some organizations both in the manufacturing and in the
service area to work towards this implementation.
According to D’ANGELO (1997), the cause of such concern comes from marketing reasons,
which are customer demand or the opportunity to use the certificate as a means of advertising
to the general public and make a difference in the market. Yet, there are circumstances where
the certification is used to strengthen the quality system.
There are, still, cases in which the certification is not needed since the market does not
require it, as in the dental service providers, for instance. The reason, then, is the chance to
obtain profit (internal and external) resulting from the implementation of the quality system.
Therefore, it is important to understand and implement the quality system, through activities
that aggregate value to the company and, consequently, improve its performance.
A quality system may induce a better company evolution through the activity standardization.
It may also provide gradual evolution of the whole company through continued improvement.
In this case, the quality system, according to the ISO 9000, must be seen as the first step
towards other processes of the company development.
That is why this article discusses the best way to implement the quality system according to
the ISO 9000 in dental service providers whose main characteristic is their professional

ISO 9000

The standards are not specific to any particular product and may be used not only by the
manufacturing but also by the service industry. The standards define what to do and not how
to execute a company’s quality assurance guarantee. However, they define appropriate
quality patterns, document their processes and prove consistent adherence to those patterns
and documentation.

Services: The Sector Dental

Proceedings of the Tenth Annual Conference of the Production and Operations Management Society, POM-99,
March 20-23, 1999 Charleston, S. C.
The service sector needs new concepts and adequate methodologies instead of using existing
techniques from the manufacturing industry. According to GIANESI and CORRÊA (1994),
the features of the service activities are that they are intangible, the client or company goods
need to be present in the process and that service is provided and used simultaneously.
Within the service sector, the dental care service companies whose process is “Professional
Services” are pointed out by:
− the accreditation of its professionals, who work on their own and in their own offices;
− their high level of interaction with their clients;
− the high degree of client participation in the process.


CORRÊA (1994) came up with the
expression Moments of Truth to
symbolize the exact moment of
contact between the service provider
and the client. During the service
provision, the client goes through a
series of Moments of Truth, which
occur in a specific sequence named
Service Cycle.
The service company Service Cycle is
shown in the figure.


Since the main reason to implement the Quality System in the dental care industry is to
improve and make profit, the Service Cycle, the ISO 9001 or ISO 9002 requirements, and
the guidelines of the ISO 9004-2 standards must be taken into consideration throughout the
implementation. Four key factors, then, arise to the success of the implementation of the
Quality System:
- Identification of customer needs and expectations;
- Establishment of management responsibilities;
- Identification of required personnel and material resources;
- Establishment of a well-structured quality system.
The basic steps for developing a quality system involve the following:
1- Customer Needs
- define and identify customer needs and requirements;
- develop a system to identify customers’ expectations;
2- Management Responsibility
- identify and document quality policies, goals and objectives;
- assign quality responsibilities and authority;
- allocate appropriate personnel, material and financial resources;
- identify suppliers and subcontractors;
3- Quality System Structure
- Establish appropriate procedures and processes;
- Develop a documentation system: (Quality manual, quality plan, quality
procedures, quality records);
- Establish a documentation review/change control process;
- Establish internal quality audit procedures;
Proceedings of the Tenth Annual Conference of the Production and Operations Management Society, POM-99,
March 20-23, 1999 Charleston, S. C.
- Interface with customers;
4- Service Process
- identify all the processes involved in the service. Here, either accredited
professionals must be dealt with as service providers, and qualification
criteria must be established according to item 4.06 of the ISO 9001
standard. Or they must be considered part of the process and patterns to
control the process according to item 4.09 of the ISO 9001 must be
adopted. This, however, goes in conflict with the fact that they are
autonomous and different offices have different routines, and
consequently it makes standardization more difficult.
- define process goals and priorities;
- define process requirements and boundaries;
- flow chart the processes;
- establish processes procedures;
5- Continuous Improvement
- collect data to analyze the processes and projects;
- review reports and performance levels;
- analyze the nature and extent of errors, trends and quality costs;
- institute appropriate corrective/preventive measures;
6- Evaluation
- establish audit/evaluation procedures;
- identify the system strengths and weaknesses;


Then connecting the implementation of the quality system framework for service
organizations will bring benefits well in excess of the recognition of certification. They will
establish the basis for Continuous Improvement in the area of process management and better
yet create a key stepping stone, and a defined building block towards TQM.
As indicated above, there are two elements that require special attention: obtaining customer
input and improving performance of the persons directly in contact with and responsible for
delivering the service to the customer; a continuous evaluation of the customer’s needs,
requirements and perception of service quality which is fundamentally important for
profitability and competitive survivability.
Besides those benefits, the implementation of the Quality System is useful to prevent against
possible law suits, since all processes are documented and the results are recorded.


- D’ÂNGELO, F. ; NETO, J. A; “Motivações e Contradições na Implementação e

Certificação de Um Sistema da Qualidade”. XVII Encontro Nacional de Engenharia de
Produção/III Congresso Internacional de Engenharia Industrial, Gramado – RS, Brasil,
- GIANESI, I. G. N.;CORRÊA, H. L. “Administração Estratégica de Serviços”. Editora
Atlas, São Paulo, 1994;
- PURI, S. C. “Service TQM Model Via ISO 9004-2”. ASQC Quality Congress
Transactions, Boston, 1993;

Proceedings of the Tenth Annual Conference of the Production and Operations Management Society, POM-99,
March 20-23, 1999 Charleston, S. C.