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ISO 13485 – need training?

Learn how to become ISO 13485 certified while avoiding the stress that tortures other quality system managers.

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What is ISO 13485?

ISO 13485 is an international standard for quality management systems that is specific to the medical device industry. ISO 13485:2016 is the most recent version of the standard, and it has become the blueprint for medical device company quality systems globally. If your company wants to design, manufacture, or distribute medical devices you should consider becoming ISO 13485 certified.

Table of contents for this page

  1. What is ISO 13485?
  2. Do you have to purchase a copy of ISO 13485?
  3. Medical Device Academy’s experience with ISO 13485 training
  4. Fast-forward to 2022
  5. Previous versions of the ISO 13485 webinars
  6. The most recent version of ISO 13485 webinars
  7. Webinar duration & format
  8. Purchase the ISO 13485 training bundle
  9. Exam and training certificate available
  10. Step 1 – Planning for ISO 13485 certification
    1. Task 1 – Purchase applicable standards
    2. Task 2 – Identify which processes are applicable
    3. Task 3 – Assign a process owner to each process
    4. Task 4 – Prioritize and schedule the implementation of each process
    5. Task 5 – Create forms, flowcharts, and procedures for each process
    6. Task 6 – Perform a gap analysis of each procedure
    7. Task 7 – Train applicable personnel for each process
    8. Task 8 – Approve the procedure
    9. Task 9 – Start using the procedure and generating records
  11. Step 2 – Conducting your first internal audit
  12. Step 3 – Initiating corrective actions
  13. Step 4 – Conducting your first management review
  14. Step 5 – Stage 1, Initial ISO 13485 Certification Audit
  15. Step 6 – Stage 2, Initial ISO 13485 Certification Audit
  16. Q&A

Do you have to purchase a copy of ISO 13485?

Yes, you need to maintain a copy of the ISO 13485 standard as a “document of external origin.” This is needed for reference when you are making updates to procedures in your quality system. If you are looking for the best place to purchase a copy of the ISO 13485:2016 standard, we recommend the Estonian Centre for Standardisation and Accreditation. If you purchase a copy, we recommend selecting the option for a multi-user license so the standard can be used by more than one person in your company and printed. The only difference between the EN ISO version and the International ISO version is that the EN ISO version includes harmonization Annex ZA for compliance with the EU MDR and Annex ZB for compliance with the EU IVDR. This version is also referred to as A11:2021. Here’s a copy of the text from the beginning of the Standard:

“This Estonian standard EVS-EN ISO 13485:2016/A11:2021 consists of the English text of the European standard EN ISO 13485:2016/A11:2021. This standard has been endorsed with a notification published in the official bulletin of the Estonian Centre for Standardisation and Accreditation. Date of Availability of the European standard is 08.09.2021. The standard is available from the Estonian Centre for Standardisation and Accreditation.”

Screenshot 2016 03 08 at 4.51.04 PM ISO 13485   need training?

Medical Device Academy’s experience with ISO 13485 training

Rob Packard created his first quality system in the Spring of 2004. In October of 2009, after successfully managing quality systems for three different medical device manufacturers, Rob joined BSI as a Lead Auditor and instructor. In April of 2010, he purchased the 13485cert.com URL and he began to help companies implement quality systems as a consultant (while continuing to audit and train 140 days per year for BSI). In 2011 his medical device blog postings began as a way to help medical device companies. In 2012, Rob began building a library of quality system procedures for a turn-key quality system and selling the procedures from the Medical Device Academy website. Dozens and dozens of consulting clients have successfully achieved ISO 13485 certification with Medical Device Academy’s turnkey quality system procedures, and hundreds of quality systems were audited and/or improved. This ISO 13485 training webinar is also included as part of our turnkey quality system.

Fast-forward to 2022

Medical Device Academy is currently helping multiple device manufacturers implement their first quality system for compliance–including SaMD, electromedical devices, implants, and IVD devices. We have turnkey quality systems for the US FDA, European MDR, and MDSAP, and we are finishing our most recent turnkey system for compliance with the European IVDR. We have four qualified lead auditors as employees and three subcontractors that are ISO 13485 lead auditors. Our current turnkey quality system clients are located in countries all over the world, including Finland, Japan, Australia, France, and Canada.

Previous versions of the ISO 13485 webinars

This 2-part webinar has been previously recorded three different times. Our previous webinar on the 2003 version of ISO 13485 was split into two parts: Stage 1 and Stage 2. That first webinar was recorded in 2015. The webinars were updated in 2016 and again in 2018. We followed the same format, 2-part Stage 1 and Stage 2, for all of the subsequent ISO 13485 training webinars. The Stage 1 webinar focuses on the following processes:

  1. Management Review
  2. CAPA
  3. Internal Auditing
  4. Quality System Documentation

The Stage 2 webinar on the rest of the standard, including but not limited to:

  1. Change Control
  2. Customer Related Processes
  3. Design Controls
  4. Supplier Controls
  5. Servicing
  6. Process Validation
  7. Acceptance Activities
  8. Incoming Inspection
  9. UDI Requirements

The most recent version of ISO 13485 webinars

The webinars explaining the requirements for ISO 13485 were last updated for 2020. Anyone that purchases these webinars will receive free access to updated versions of the ISO 13485 training webinars. If you are making a new purchase of these two training webinars, the webinars are only being sold as a bundle for $258. You get:

  • access to the Stage 1 webinar recorded July 24, 2020
  • access to the Stage 2 webinar recorded July 28, 2020
  • native slide decks for both webinars

This pair of ISO 13485 training webinars explain precisely what you need to do to implement a quality system compliant with ISO 13485. After you create your own plan (a free template is provided with a subscription), then you can show the recording of these two webinars to your management team so they can implement your plan in the next several months. All deliveries of content will be sent via Aweber emails to confirmed subscribers.

Webinar duration & format

Webinars were hosted live via Zoom in 2020. The Stage 1 webinar was 64 minutes, and the duration of the Stage 2 webinar was 82 minutes. When you purchase this webinar bundle, you will receive a link to download both recorded webinars from our Dropbox folder. In addition, you will receive links to download the native slide deck for each webinar from Dropbox. 

Purchase the ISO 13485 training bundle

ISO 13485 2016 150x150 ISO 13485   need training?
ISO 13485:2016 Training Webinars – Stage 1 & Stage 2

The webinars explaining the requirements for ISO 13485 were last updated for 2020. Anyone that purchases these webinars will receive free access to updated versions of the ISO 13485 training webinars. If you are making a new purchase of these two training webinars, the webinars are only being sold as a bundle for $258. You get:
1 – access to the Stage 1 webinar recorded July 24, 2020
2 – access to the Stage 2 webinar recorded July 28, 2020
3 – native slide decks for both webinars

Price: $258.00

Exam and Training Certificate available

Training Effectiveness Exam4 300x223 ISO 13485   need training?
Exam – ISO 13485:2016 update

This is a 20 question quiz with multiple choice and fill in the blank questions. The completed quiz is to be submitted by email to Rob Packard as an MS Word document. Rob will provide a corrected exam with explanations for incorrect answers and a training effectiveness certificate for grades of 70% or higher.

Price: $49.00

ISO 13485 Certified ISO 13485   need training?

There is a big difference between being ISO 13485 certified and being compliant with ISO 13485:2016, the medical devices quality management systems standard. Anyone can claim compliance with the standard. Certification, however, requires that an accredited certification body has followed the requirements of ISO 17021:2015, and they have verified that your quality system is compliant with the standard. To maintain that certification, you must maintain your quality system’s effectiveness and endure both annual surveillance audits and a re-certification audit once every three years.

Step 1 – Planning for ISO 13485 certification

There are six steps in the ISO 13485 certification process, but that does not mean there are only six tasks. The first step in every quality system is planning. Most people refer to the Deming Cycle or Plan-Do-Check-Act (PDCA) Cycle when they describe how to implement a quality system. However, when you are implementing a full quality system, you need to break the “doing” part of the PDCA cycle into many small tasks rather than one big task. You also can’t implement a quality system alone. Quality systems are not the responsibility of the quality manager alone. Implementing a quality system is the responsibility of everyone in top management.

Below you will find seven tasks listed. I did NOT identify these nine tasks as “Steps” in the ISO 13485 certification process, because these tasks are typically repeated for each process in your quality system. Most quality systems are implemented over time, and the scope of the quality system usually grows. Therefore, you are almost certain to have to perform all of the following nine tasks multiple times–even after you receive the initial ISO 13485 certification. As the saying goes, “How do you eat an elephant? One bite at a time.” Therefore, avoid the inevitable heartburn caused by trying to do too much at one time. Implement your quality system one “bite” at a time.

Task 1 – Purchase applicable standards

The first task in implementing an ISO 13485 quality system is to purchase a copy of the ISO 13485:2016 standard, such as the MDSAP Companion Document. You will also need other applicable medical device standards. Some of these standards are general standards that apply to most, if not all, medical devices, such as ISO 14971:2019 for risk management. There are also guidance documents that explain how to use these general standards, such as ISO/TR 24971:2020, and guidance on how to apply ISO 14971:2019. Finally, there are testing standards that identify testing methods and acceptance criteria for things such as biocompatibility and electrical safety. You will need to monitor these standards for new and revised versions. When these standards are updated, you will need to identify the revised standard and develop a plan for addressing the changes.

When you purchase a standard, be sure to buy an electronic version of the standard so you can search the standard for keywords efficiently. You should also consider purchasing a multi-user license for the standard because every manager in your company will need to look up information in the standard. Alternatively, you could buy a paper copy of the standard and locate the standard where everyone in your company can access it. Often I am asked what the difference is between the EN version of the standard and the ISO version of the standard. “EN” is an abbreviation meaning European Standards or “European Norms,” which is based upon the literal translation from the French (i.e., “normes”) and German (i.e. “norm”) languages. “ISO” versions are international standards. In general, the body of the standard is typically identical but harmonized EN standards for medical devices include annexes ZA, ZB, and ZC that identify any deviations from the requirements in three medical device directives (i.e., MDD, AIMD, and IVDD).

Task 2 – Identify which processes are applicable

Clause 1 of ISO 13485 is specific to the scope of a quality system. ISO 9001, the general quality system standard, allows you to “exclude” any clause from your quality system certification. However, ISO 13485 will only allow you to exclude design controls (i.e., clause 7.3). Other clauses within ISO 13485 may be identified as “non-applicable” based upon the nature of your medical device or service. You must also document the reason for non-applicability in your quality manual. Typically, the following clauses are common clauses identified for non-applicability:

  1. Clause 4.1.6 – quality system software
  2. Clause 6.4 – work environment
  3. Clause 7.5.2 – cleanliness of the product
  4. Clause 7.5.3 – installation
  5. Clause 7.5.4 – servicing
  6. Clause 7.5.5 – sterile devices
  7. Clause 7.5.6 – process validation
  8. Clause 7.5.7 – sterilization validation
  9. Clause 7.5.9.2 – implantable devices
  10. Clause 7.5.10 – customer property
  11. Clause 8.3.4 – rework

Task 3 – Assign a process owner to each process 

The third task is to assign a process owner to each of the processes in your quality system. Typically, you create a master list of each of the required processes. Usually, the assignments are made to managers in the company who may delegate some or all of a specific process. You should expect most managers to be responsible for more than one process because there are 28 required procedures in ISO 13485:2016, but most companies have fewer than ten people when they first implement a quality system.

Task 4 – Prioritize and schedule the implementation of each process

The fourth task is to identify which processes need to be created first and to schedule the implementation of procedures from first to last. You can and should build flexibility into the schedule, but some procedures are needed at the beginning. For example, you need document control, record control, and training processes to manage all of your other procedures. You also need to implement the following processes to document your Design History File (DHF): 1) design controls, 2) risk management, 3) software development (if applicable), and 4) usability. Therefore, these represent the seven procedures that most companies will implement as early as possible. Procedures such as complaint handling, medical device reporting, and advisory notice procedures are usually reserved for last. These procedures are last because they are not needed until you have a medical device in use.

Task 5 – Create forms, flowcharts, and procedures for each process

Forms create the structure for records in your quality system, and a well-designed form can reduce the need for lengthy explanations in a procedure or work instruction. Therefore, you should consider developing forms first. The form should include all required information that is specified in the applicable standard or regulations, and the cells for that information should be presented in the order that the requirements are listed in the standard. You might even consider numbering the cells of the form to provide an easy cross-reference to the corresponding section of the procedure. Once you create a form, you might consider creating a flowchart next. Flowcharts provide a visual representation of the process. You might consider including numbers in the flow chart that cross-reference to the form as well.

Once you have created a form and a flowchart, you are now ready to write your quality system procedure. Many sections are typically included in a procedure template. It is recommended that you use a template to ensure that none of the basic elements of a procedure are omitted. You might also consider adding two sections that are uncommon to a procedure: 1) risk analysis of the procedure with the identification of risk controls to prevent risks associated with the procedure, and 2) a section for monitoring and measurement of the process to objectively measure the effectiveness of the process. These metrics are the best sources of preventive actions, and some of the metrics might be potential quality objectives to be identified by top management. 

Task 6 – Perform a gap analysis of each procedure

Most companies rely upon internal audits to catch missing elements in their procedures. However, audits are intended to be a sampling rather than a 100% comprehensive assessment. Therefore, when a draft procedure is being reviewed and approved for the first time, or a major re-write of a procedure is conducted, a thorough gap analysis should be done before the approval of the draft procedure. Matthew Walker created an article explaining how to conduct a gap analysis of procedures. In addition, Matthew has been gradually adding cross-references to ISO 13485:2016 requirements in each procedure. He is color-coding the cross-referenced clauses in blue font as well. This makes it much easier for auditors to verify that a procedure is compliant with the regulations with minimal effort. The success of these two methods has taught us the importance of conducting a gap analysis of all new procedures.

Task 7 – Train applicable personnel for each process 

You are required to document the training requirements for each person or each job in your company. Documentation of training requirements may be in a job description or within a procedure. In addition to defining who should be trained, you also need to identify what type of training should be provided. We recommend recording your training to ensure that new future employees receive the same training. This will ensure consistency. You are also required to maintain records of the training. You must verify that the training was effective, and you need to check whether the person is competent in performing the tasks. This training may require days or weeks to complete. Therefore, you may want to start training people several weeks before your procedure is approved. Alternatively, you can swap the order of tasks and conduct training after the procedure approval. If that approach is taken, then the procedure should indicate the date the procedure becomes effective–typical 30 days after approval to allow time for training.

Task 8 – Approve the procedure 

Approval of a procedure may be accomplished by signing and dating the procedure itself, while another approach is to create a document that lists all the procedures and forms being approved at one time. The second method is the method we use in our turn-key quality system. Companies can review and approve as many procedures at one time as they wish. Since this process needs to be defined to ensure that all of the procedures you implement are approved, the document control process is typically the first procedure that companies will approve in a new quality system. The second procedure generally is for the control of records. Then the next procedures implemented will typically be focused on the documentation of design controls: design controls, risk management, usability testing, and software development. The last procedures to be approved are typically complaint handling, medical device reporting, and recalls. These procedures are left for last because you don’t need them until you are selling your medical device.

Task 9 – Start using the procedure and generating records

The last task required for the implementation of a new quality system is to start using the procedures to generate records. All of the procedures will need records before the process can be verified to be effective. Records can be paper-based, or the records can be electronic. Whichever format you use for the record retention needs to be communicated to everyone in the company through your Control of Records procedure and/or within each procedure. If you include the information in each procedure, the records of each procedure should be listed in the procedure, and the location where those records are stored should be identified. Generally, there is no specific minimum number of records to have for a certification audit, but you should have at least a few records for each process that you implement.

Step 2 – Conducting your first internal audit

The purpose of the internal audit is to verify the effectiveness of the quality system and to identify nonconformities before the certification body auditor finds them. To successfully achieve this secondary objective, it is essential to have a more rigorous internal audit than you expect for the certification audit. Therefore, the internal audit should be of equal duration or longer in duration than the certification audit. The internal audit should not consist of a desktop review of procedures. Reviewing procedures should be part of gap analysis (i.e., task 6 above) that is conducted on draft procedures before they are approved. Internal audits should utilize the process approach to auditing, and the auditor should apply a risk-based approach (i.e., focus on those processes that are most likely to contribute to the nonconforming products, result in a complaint, or cause severe injuries and death).

After your internal audit, you will receive an internal audit report from the auditor. You should also expect findings from the internal auditor, and you should expect opportunities for improvement (OFI) to be identified. Experienced auditors can typically identify the root cause of a nonconformity more quickly than most process owners. Therefore, it is recommended for each process owner and subject matter expert to review nonconformities with the auditor and discuss how the nonconformity should be investigated. The root cause must be correctly identified during the CAPA process, and the effectiveness check must be objective to ensure that problems do not recur.

Step 3 – Initiating corrective actions

Corrective actions should be initiated for each internal audit finding immediately, to make sure the findings are corrected and prevented from repeat occurrence before the Stage 1 audit. It will take a minimum of 30 days to implement the most corrective actions. Depending upon the scheduling of the internal audit, there may not be sufficient time to complete the corrective actions. However, you should at least initiate a CAPA for each finding, perform an investigation of the root cause, and begin to implement corrective actions.

Also, to take corrective actions related to internal audit findings, you should look for internal audits from other sources. The diagram below shows several different sources of potential corrective and preventive actions.

Risk based CAPA Process Diagram ISO 13485   need training?

Monitoring and measuring each process is the best source of preventive actions, while internal audits are typically the best source of corrective actions.  Any quality problems identified during validation are also excellent sources of corrective actions because the validation can be repeated as a method of demonstrating that the corrective actions are effective. However, your ISO 13485 certification auditor will focus on non-conforming products, complaints, and services as the most critical sources of corrective actions. These three sources are prioritized because these three sources have the greatest potential for resulting in a serious injury, death, or recall if corrective actions are not implemented to prevent problems from recurring.

Step 4 – Conducting your first management review 

In addition to completing a full quality system audit before your stage 1 audit, you are also expected to complete at least one management review. To make sure that you have inputs for each of the 12 requirements in the ISO 13485:2016 standard, it is recommended to conduct your management review only after you have completed your full quality system audit and initiated some corrective actions. If possible, you should also conduct supplier audits for any contract manufacturers or contract sterilizers. It is recommended to use a template for that management review that is organized in the order of the required inputs to ensure that none of the necessary inputs are skipped. Quality objectives will need to be established long before the management review so that the top management team has sufficient time to gather data regarding each of the quality objectives. Also, you should consider delegating the responsibility for creating the various slides for each input to different members of top management. This will ensure that everyone invited to the meeting is engaged in the process, and it will spread the workload for meeting preparation across multiple people.

At the end of the meeting, top management will need to create a list of action items to be completed before the next management review meeting. Meeting minutes will need to be documented for the meeting, including the list of action items and each of the four required outputs of the management review process. We recommend using the notes section of a presentation slide deck to document the meeting minutes related to each slide. Then the slide deck can be converted into notes pages and saved as a PDF. The PDF notes pages will be your final meeting minutes for the management review. An example of one of these notes pages is provided in the figure below.

Print PDF of Meeting Minutes Notes Page Example ISO 13485   need training?

One of the more common non-value-added findings by auditors is when an auditor issues a nonconformity because you do not have your next internal audit and your next management review scheduled–even though each may have occurred only a month prior to the Stage 1 audit. Therefore, we recommend that you document your next 12-month cycle for internal audits and schedule your next management review as action items in every management review meeting. The schedule can be adjusted if needed, but this allows top management to emphasize various areas in internal audits that may need improvement. You might even set a quality objective to conduct a minimum of three management reviews per year at the end of your first management review.

Step 5 – Stage 1, Initial ISO 13485 Certification Audit

In 2006, the ISO 17021 Standard was introduced for assessing certification bodies. This is the standard that defines how certification bodies shall go about conducting your initial certification audit, annual surveillance of your quality system, and the re-certification of your quality system. In the past, certification bodies would typically conduct a “desktop” audit of your company before the on-site visit to make sure that you have all the required procedures. However, ISO 17021 requires that certification bodies conduct a Stage 1 audit that assesses the readiness of your company before conducting a Stage 2 audit. Therefore, even if the Stage 1 audit is conducted remotely, the certification body is expected to interview process owners and sample records to verify that the quality system has been implemented. Certification body auditors will also typically verify that your company has conducted a full quality system audit and at least one management review. Finally, the auditor will usually select a process such as corrective action and preventive action (CAPA) to make sure that you are identifying problems with the quality system and taking appropriate measures to address those problems.

Your goal for the Stage 1 audit should not be perfection. Instead, your focus is to make sure that there are no “major” nonconformities. The term “major” used to have a specific definition:

  1. Absence of a documented procedure or process
  2. Release of nonconforming product
  3. Repeat nonconformities (not possible during a Stage 1)

Under the MDSAP, the grading system for nonconformities now uses a numbering system for grading nonconformities: “Nonconformity Grading System for Regulatory Purposes and Information Exchange Study Group 3 Final Document GHTF/SG3/N19:2012.” Any nonconformity is graded on a scale of one to four, and then two potential escalation rules are applied. If any nonconformities are graded as a four or a 5, then the auditor must assess whether a five-day notice to Regulatory Authorities is required. A five-day notice is required in either of the following situations: 1) one or more findings grading of “5”; or 2) three or more findings graded as “4.” If your Stage 1 audit results in a five-day notice, then you are not ready for your Stage 2 audit. For example, a complete absence of two required procedures in clauses 6.4 through 8.5 of ISO 13485:2016 would result in two findings with a grading of “4.” This would not result in a five-day notice, but the absence of a third required procedure would result in a five-day notice.

The duration of your Stage 1 audit will be one or two days, but a 1.5-day audit is quite common for MDSAP Stage 1 audits. The reason for the 1.5-day Stage 1 audit is that it is challenging to assess readiness for Stage 2 in one day, and if the total duration of Stage 1 and Stage 2 is 5.5 days, then the Stage 2 audit could be completed in four days. The four-day audit is more convenient than a three-day audit for a two-person audit team.

After your Stage 1 audit, you will receive an audit report, and you should expect findings. You should initiate corrective actions for each finding immediately, to make sure the findings are corrected and prevented from repeat occurrence before the Stage 2 audit. The duration between the audits is typically about 4-6 weeks. That does not leave much time for you to initiate a CAPA, perform an investigation of the root cause, and implement corrective action. At a minimum, you must submit a corrective action plan for each finding to your MDSAP auditing organization (AO) within 15 calendar days of receiving the finding. For any findings graded as a “4” or higher, you will need to provide evidence of implementing the corrective action plan to the AO within 30 calendar days of receiving the finding. You are also unlikely to have enough time to conduct an effectiveness check prior to the Stage 2 audit.

Step 6 – Stage 2, Initial ISO 13485 Certification Audit

The Stage 2 initial ISO 13485 certification audit will verify that all regulatory requirements have been met for any market you plan to distribute in. The auditor will complete an MDSAP checklist that includes all of the regulatory requirements for each of the countries that recognize MDSAP: 1) the USA, 2) Canada, 3) Brazil, 4) Austria, and 5) Japan. The auditor will also sample records from every process in your quality system to verify that the procedures and processes are fully implemented. This audit will typically be at least four days in duration unless multiple auditors are working in an audit team.

The audit objectives for the Stage 2 ISO 13485 certification audit specifically include evaluating the effectiveness of your quality system in the following areas:

  1. Applicable regulatory requirements
  2. Product and process-related technologies
  3. Technical documentation

All procedures will be reviewed for compliance with ISO 13485:2016 and the applicable regulations. The auditor will also sample records from each process. If the auditor identifies any nonconformities during the audit, it is important to record the findings and begin planning corrective actions immediately. If you have any questions regarding the expectations for the investigation of the root cause, corrections, corrective actions, and effectiveness checks, you should ask the auditor during the audit or the closing meeting. At a minimum, you must submit a corrective action plan for each finding to your MDSAP auditing organization (AO) within 15 calendar days of receiving the finding. For any findings graded as a “4” or higher, you will need to provide evidence of implementing the corrective action plan to the AO within 30 calendar days of receiving the finding. The auditor will not be able to recommend you for ISO 13485 certification until your corrective action plans are accepted.

If you receive a finding with a grading of “5,” or three or more findings graded as “4,” then the MDSAP auditor is required to issue a five-day notification to the regulators. The auditor will also need to return to your facility for a follow-up audit to close as many findings as they can. It is not necessary to eliminate all of the findings in order to be recommended for ISO 13485 certification, but the grading of the findings must be reduced to at least a “3” before recommending the company for certification. The number of findings also determines whether the auditor recommends your company for certification.

In addition to reviewing the findings and conclusions of the audit during the closing meeting, the auditor will also review the plan for the annual surveillance and re-certification with you. Each certification cycle is three years in duration. There will be two surveillance audits of approximately one-third the duration of the combined duration of stage 1 and stage 2 initial certification audits, and the first surveillance audit must be completed within 12 months of the initial certification audit. In the third year, there will be a re-certification audit for two-thirds of the duration of the combined duration of stage 1 and stage 2 initial certification audits. The initial ISO 13485 certificate will be issued with a three-year expiration, and the certificate is typically received about one month after the acceptance of your corrective action plan.

Q&A

There are no stupid questions, and we can save your weeks of wasted time if you just ask for help. We are always looking for new ideas for blogs, webinars, and videos on our YouTube channel. If you have any general questions about obtaining ISO 13485:2016 certification, please email Rob Packard at rob@13485cert.com. If you have a suggestion for new ISO 13485 training materials, you can also use our “Suggestion Box.” You can also schedule an initial free consultation with Rob using his calendly link.

Posted in: ISO 13485:2016, ISO Certification, Quality Management System

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How to create an IVDR checklist

This article provides an IVDR checklist for updating your ISO 13485 quality system to comply with EU Regulation 2017/746.

IVD Checklist 1024x474 How to create an IVDR checklist

Why I created an IVDR checklist?

Hundreds (if not thousands) of IVD manufacturers are currently updating their ISO 13485:2016 certified quality system from compliance with the In Vitro Diagnostic Directive (i.e. Directive 98/79/EC) or IVDD to the new EU In Vitro Diagnostic Regulation (i.e. Regulation 2017/746). Revision of technical files and the associated procedures for creating your technical files is a big part of these updates. However, there is much more that needs to be updated than just the technical documentation. Therefore, IVD manufacturers are asking Medical Device Academy to conduct remote internal audits of their quality system to identify any gaps. Usually, we conduct internal audits using the process approach to auditing, but this is one of the scenarios where the element approach and an audit checklist are invaluable.

If you would like to download our IVDR checklist for FREE, please fill in the form below.

How do you use an audit checklist?

An audit checklist is used by quality system auditors to collect objective evidence during an audit. This objective evidence verifies compliance with regulatory requirements or internal procedural requirements. If the auditor is unable to find supporting evidence of compliance, the auditor may continue to search for data or identify the requirement as a nonconformity. Typically the checklist is in four columns using a tabular form. The left-hand column lists each requirement. The next column is where the auditor documents records sampled, procedures reviewed, and personnel interviewed. In the third column, the auditor indicates what they were looking for in the records, procedures, or during the interview. Some of the information in the second and third columns can often be entered prior to starting the audit by reviewing audit preparation documents (e.g. procedures and previous audit reports). In the fourth column the auditor will enter the objective evidence for conformity collected during the audit.

How to create an IVDR quality plan

Most of the companies that are preparing for an IVDR audit by their notified body already have ISO 13485:2016 certification and they are using the self-declaration pathway for CE Marking under the IVDD. Under the IVDR, a notified body must now review and approve the technical file. The notified body must also confirm that their quality system has been updated to include the IVDR requirements. The Technical File requirements are found in Annex II and III; while most of the quality system requirements are found in the Articles.  The quality system requirements include:

  1. a risk management process in accordance with Annex I – deviations from ISO 14971:2019 will be necessary)
  2. conduct a performance evaluation–including a post-market performance follow-up (PMPF). This requirement is defined in Article 52 and Annex XIII
  3. create and maintain a technical file in accordance with Annex II & III
  4. create and maintain a Declaration of Conformity in accordance with Article 17
  5. CE Mark the product in accordance with Article 18
  6. implement a UDI system in accordance with Article 24, 26, and 28
  7. record retention requirements for the technical file, Declaration of Conformity, and certificates shall be increased from 5 years to 10 years
  8. set-up, implement, and maintain a post-market surveillance system in accordance with Article 78
  9. document a procedure for communication with Competent Authorities, Notified Bodies, Economic Operators, Customers, and/or other Stakeholders
  10. update procedures for reporting of serious incidents and field safety corrective actions in the context of vigilance to require reporting within 15 calendar days
  11. update the product labeling to comply with Annex I, section 20
  12. revise the translation procedure to ensure translations of the instructions for use are available in all required languages of the member states, and make sure these translations are available on the company website
  13. create a procedure for utilization of the Eudamed database for registration, CE Marking applications, UDI data entry, and vigilance reporting

Which IVDR requirements are already met by your quality system?

Some companies also manufacture medical devices that must comply with Regulation (EU) 2017/745. For those companies, many of the above requirements are already incorporated into their quality system. In this case, you should still include all of the IVDR checklist requirements in your plan, but you should indicate that the requirement has already been met and audited previously.

Content related to our IVDR checklist

On Friday, April 1, 2022 @ 11 am EDT (8 am Pacific), Rob Packard will be Joe Hage’s guest speaker on the weekly MDG Premium Live video (please click on the link to register). The topic of the live presentation will be “How to create an IVDR quality plan.” #MedicalDevices #MDGpremium

Posted in: CE Marking, In Vitro Diagnostic (IVD) Devices, ISO 13485:2016, ISO Auditing, ISO Certification, IVDR - Regulation (EU) 2017/746

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Purchasing Controls and Supplier Qualification

This article identifies the requirements for purchasing controls and supplier qualification procedures, as well as best practices for implementation.

Purchasing Controls

Sourcing suppliers in the medical device industry is not as simple as going on the internet and finding your material and purchasing it. As part of a compliant quality management system, purchasing controls must be in place to ensure that quality products and materials are going into your device and that any service providers that your company uses in the production of your product or within your quality management system are qualified.

ISO 13485 Requirements

In light of that, ISO 13485:2016 sections 7.4.1 Purchasing process, 7.4.2 Purchasing information, and section 7.4.3 Verification of purchased product outline the purchasing requirements. The following are requirements for the evaluation and selection of suppliers:

  • The organization must have established criteria for the evaluation and selection of suppliers.
  • The criteria need to evaluate the supplier’s ability to provide a product that meets the requirements.
  • It needs to take into consideration the performance of the supplier.
  • It must consider the criticality and the effect that the purchased product may have on the quality of the medical device.
  • The level of supplier assessment and monitoring should be proportionate to the level of risk associated with the medical device.

Maintaining Purchasing Controls

To start, in the most basic sense, purchasing controls involve procedures that ensure you are only purchasing from suppliers who can meet your specifications and requirements. The best way to keep track of your qualified suppliers is to maintain an Approved Supplier List (ASL). You should only purchase products or services that affect your product or quality management system from companies on the ASL (you would not necessarily need to qualify things like office supplies or legal assistance through purchasing controls).

When used effectively, the Approved Supplier List can be a great tool to manage the key facets of purchasing control and keep track of supplier monitoring. Items that you can capture on the ASL include:

  • Supplier Name
  • Scope of Approved Supplies
  • Contact Information
  • Status of Approval (Approved, Pending, Unapproved, etc.)
  • Qualification Criteria
  • Supplier Certification and expiry dates
  • Monitoring Requirements/Activities
    • Date of Last Review
    • Date of Next Review

The first step in your purchasing procedure should involve checking to see if the supplier is under active approved status on the ASL. The second step will be to ensure that you are purchasing an item/service that is within the scope of approval of that supplier. If you have not approved the supplier, or the intended purchase is beyond the scope of that supplier, your purchaser will need to go through the necessary channels to add the supplier to the ASL or modify their scope on the ASL.

Supplier Qualification Criteria

As required by the FDA, the level of supplier assessment should be proportionate to the level of risk associated with the medical device. The FDA is not prescriptive about the use of specific qualifications or assessments for different types of suppliers, so that is up to your company to determine. This is a somewhat grey area but based on years working with companies and suppliers, as well as participating in FDA and ISO 13485 audits, there are some general expectations of vendor qualifications that we have observed and would recommend.

It is good practice to have a form or template that guides your supplier evaluation process. Using input from engineering and QA to first determine the level of risk and the requirements of that supplier, and then base your qualification plan on that information. If you have a higher risk supplier who may be supplying a critical component to your device, or providing a critical service such as sterilization, then your qualification process will be much more involved.

Here is an example of two different levels of criteria based on the type of supplier (the intent is not for the following items to be rules, and your company is responsible for determining the adequate acceptance criteria for suppliers, but this is a general example of what you may expect).

  • Critical Custom Component Supplier
    • ISO 13485 Certification
    • On-site audit of supplier’s facility
    • References
    • Provides Certificates of Analysis (CoA)
    • A written agreement that the supplier will communicate with the company regarding any changes that could affect their ability to meet requirements and specifications.
    • You validate a production sample, and it meets requirements
  • Non-Critical Consumable Supplier
    • Product available that meets the needs of the company.
    • An associate has previously used by an associate who recommends the supplier.
    • Adequate customer service returns allowed.

Additional Function of Supplier Evaluation Forms

The supplier evaluation form can also be used as the plan to assign responsibility and track completion and results during the initial evaluation. It can also include the plan for ongoing monitoring and control of the supplier. This evaluation form should be maintained as a quality record, and auditors will frequently ask to see supplier evaluations.

Are Supplier Audits Required as Purchasing Controls?

Also valuable, supplier audits may be included as part of an evaluation plan for a new supplier, the change of scope of a supplier, a routine audit as part of ongoing monitoring, or as part of a nonconformity investigation of a high-risk product. While it is not required by ISO 13485, nor does the FDA does specify in the CFR that you must audit suppliers, it is a very good idea to audit your critical suppliers. If an auditor or FDA inspector sees evidence that your current purchasing controls are inadequate, performing supplier audits may be forced as a corrective action.

Beyond that, you can gain so much value, and gather countless clues and important information in an audit that you just cannot get without visiting your critical supplier. You can see where they plan to/are making/cleaning/sterilizing/storing your product. Talk to the people on the line, are they competent and trained? Does the company maintain their facility well? How secure is it? Do they maintain adequate records and traceability? Have there been any nonconformities relating to your product that have been detected? Etc.

Supplier audits should also include evaluation of the procedures, activities, and records of the supplier that could have an impact on the product or service they are providing your company. If it is not the first audit of the company, you should be sure to review the previous audit report findings and ensure the company has addressed any nonconformities, review supplier performance data, information about any changes that may have occurred at the supplier since your last visit, etc.

Record Maintenance and Ongoing Evaluation of Suppliers

No matter the method of supplier qualification, it is best practice to maintain supplier files that contain useful information relative to the supplier that may include:

  • The original supplier qualification form
  • Supplier certificates
  • References
  • Audit reports
  • Subsequent performance evaluations
  • Expanded scope qualifications
  • Supplier communications
  • Current contact information
  • Copies of any non-conforming material reports related to the supplier, etc.

ISO 13485 requires monitoring and re-evaluation of suppliers, and maintaining detailed supplier files will assist in meeting this requirement, and will help in the feedback system to identify and recurring problems or issues with a supplier. On a planned basis, whether that is annually, or every order (dependent on the criticality of the product), your company should conduct a formal supplier evaluation to determine whether the supplier has continued to meet requirements – In general, annual supplier reviews are standard. Additionally, you must specify this frequency in your procedure (auditors will look for what period you specify in your procedure, and then will check your ASL to make sure all of your suppliers have been reviewed within that timeframe).

During the supplier evaluation, if you find there have been issues, you need to determine and weigh the risks associated with staying with that supplier, and document that in the supplier file. If you determine the supplier should no longer be qualified, then you must also indicate on the ASL that the company no longer approves of the supplier.

Making the Purchase

When you have verified your supplier is approved on the ASL, you are authorized to purchase a product. Engineering is usually responsible for identifying the product specifications, requirements for product acceptance, and adequacy of specified purchasing requirements before communication to the supplier. The specifications may be in the form of drawings or written specifications. Additional information communicated to the supplier should also include, as applicable, an agreement between your company and the supplier that the supplier will notify you before the implementation of changes relating to the product that could affect its ability to meet specified purchasing requirements. When the first batch of product is received from a particular supplier, it is a good idea to verify that the product performs as intended before entering into production with new material or components.

Supplier Nonconformity

From time to time, you may encounter issues with a supplier. Sources of nonconformity include incoming inspections, production nonconformities, final inspection, or customer complaints. You must notify your supplier of the nonconformity and record their response and assessment. Depending on the level of criticality of the vendor, it is reasonable to require them to perform a root cause analysis to determine and alleviate the cause of failure. You should also request documentation of an effectiveness check to ensure the supplier has taken corrective actions. You should maintain copies of supplier nonconformity reports in the supplier file, and discuss nonconformities during ongoing supplier evaluations.

If the supplier does not cooperate or fails to address the nonconformity in an acceptable manner, or if there is a pattern of nonconformities with the vendor, then you should disqualify the supplier, and indicate that the supplier is “not approved” on the ASL.

Purchasing Controls Procedures You Might Need

Medical Device Academy developed a Supplier Qualification Procedure, Purchasing Procedure, and associated forms that will meet purchasing controls regulatory requirements for ISO 13485:2016 and 21 CFR 820.50. These procedures will help you ensure that goods and services purchased by your company meet your requirements and specifications. If you have any questions or would like help in developing a custom procedure or work instructions that meet your company’s unique needs, please feel free to email me or schedule a call to discuss.

Posted in: ISO 13485:2016

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Updating Training Procedure for Compliance with ISO 13485:2016

This article explains my process for updating training procedure SYS-004 for compliance with ISO 13845:2016 while the procedure was also simplified.

Training and Competency 1 Updating Training Procedure for Compliance with ISO 13485:2016

In addition to weekly blogging for the Medical Device Academy website, I am also updating each of my procedures for ISO 13485:2016 compliance. This week the training procedure (SYS-004) was updated. You are updating your procedures for compliance with the revised standard, but are you making any other strategic changes at the same time?

Changes to Training in ISO 13485:2016

The primary change to Clause 6.2 in ISO 13485 was the addition of the phrase, “shall document the process(es) for establishing competence, providing training, and ensuring awareness.” This doesn’t represent a change in the intent of the standard. Still, it does signal that certification bodies should be emphasizing the importance of assessing the effectiveness of training and competency–not just verifying the existence of training records.

Updating Training Procedure

The original version of SYS-004 had eight pages and included three different flow charts to explain the process. The procedure also required the use of a training plan for each employee. While I agree that managers should plan training if you make this a formal requirement with a controlled form, it creates an unnecessary burden for managers.

Therefore, when the procedure was updated to the requirements of ISO 13485:2016, the procedure was also simplified for smoother implementation by start-up companies. When you upgrade your procedures, you might look for similar opportunities to simplify and streamline the processes.

The updated procedure now has suggestions for how to consolidate specific roles for smaller companies. The procedure still references a training record for documenting training, but now there is also a reference to a training matrix to help document training requirements for each employee.

The FDA also requires that there are documented training requirements. Therefore, the procedure identifies the need to create a job description that includes training and competency requirements. The procedure does not, however, require that the job descriptions be maintained as controlled documents. If your company has multiple people with the same job function (e.g., customer service), then it might make sense to have a controlled document that is a job description for customer service. A company with four employees does not need controlled documents, and instead, a unique record for each employee makes more sense.

Updating Training Procedure to Explain How to Complete Forms?

Another option is to make your procedure very detailed to explain how to complete each section of a form, such as the training record (FRM-002) or the training matrix (FRM-026). However, I see very few managers struggle with completing training records. Therefore, instead, I plan to record a brief training webinar that explains how to fill in the forms. This will be provided as a free update to anyone that purchases the training competency procedure. This makes it easier to review the procedure for regulatory compliance and puts the details on how to complete forms in the training curriculum where it belongs.

If you have questions about how to update any of your procedures to ISO 13485, please email me at rob@13485cert.com. Maybe I’ll use your question as a topic for a future blog.

Posted in: ISO 13485:2016, ISO Certification

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Control of Records – Updating Your Procedure for ISO 13485:2016

The Article reviews changes recommended for your control of records procedure to ensure compliance with ISO 13485:2016 and applicable regulatory requirements.

VA File Storage Control of Records   Updating Your Procedure for ISO 13485:2016

Nine months have already passed since the release of the 2016 version of ISO 13485. In 2015, you were told to update your quality system procedures early before the new European Regulations were released. There is a three year transition period, and you decided to do it next year. Now it’s 2017. It’s time to update your procedures.

Quality Plan for Revising Procedures to ISO 13485:2016

I plan to update one procedure each week from the 2003 version of ISO 13485 to the 2016 version. Some of the procedures were already updated last year, but just like you, I decided to finish the work next year. For the next six months, we will be busy revising procedures.

Training on the requirements for Control of Records

In addition to a procedure for control of records, you also need to train employees on good documentation practices. Initially, I created a webinar called “GDP 101” that combined control of documents, control of records, and training. Several people recommended that the webinar be revised to focus on the control of records. New webinars will be recorded each week to explain the updates to each procedure and to ensure that there is a training webinar for each procedure.

Three Generic Updates to Control of Records Procedure (SYS-002)

When you update a procedure, you need to do more than change the reference to the version of ISO 13485. For all procedures I recommend that you make three general improvements:

  1. identify a risk-based approach for that procedure,
  2. identify methods for documenting training effectiveness and competency, and
  3. verify that you have updated the procedure to address regulatory requirements.

In the case of control of records, the most important records should have more rigorous controls and more frequent monitoring of record control to ensure it is effective. For example, the following critical records are frequently sampled by FDA inspectors and should be carefully stored, organized, and monitored:

  • CAPAs
  • Complaints
  • Adverse Event Reports
  • Recalls
  • Nonconforming Material Records
  • Design History Files
  • Training Records

FDA inspectors are not permitted to review records of your management reviews, internal audit records, and supplier records. However, all three records will be sampled by certification bodies, and therefore these three records exempt from the requirements of 21 CFR 820.180 should also be a priority for risk-based control of records.

To address the third of the generic procedural updates, you should be aware that the new EU Medical Device Regulations are expected to increase the required record retention period for non-implant devices from 5 years to 10 years. Implants are expected to remain at 15 years.

Three Procedure-Specific Updates to Control of Records Procedure (SYS-002)

In addition to the generic procedural updates, three changes in the Standard are specific to control of records. First, in the section for control of documents (renumbered as Clause 4.2.4), there is now a requirement to prevent the deterioration and loss of documents.

Second, there is now a requirement in Clause 7.3.10 for maintaining design and development files for devices. This may have previously been addressed as a requirement to meet the FDA requirements for maintaining a Design History File (DHF), but not all ISO 13485 certified companies sell a product in the USA.

Third, there is a new requirement related to the protection of confidential health information, such as the information gathered during complaint investigations and clinical studies. Many companies refer to this as HIPAA compliance.

Updated Procedure & Webinar Bundle

If you need to update your control of records procedure and train your employees, you might consider our new procedure and webinar bundle.

Posted in: ISO 13485:2016, ISO Certification

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Implementing Procedures for CAPA, NCMR & Receiving Inspection

The article shares lessons learned from implementing procedures for a new ISO 13485 quality system. This is the second in a series. The first month of procedure implementation was covered in a previous article titled, “How to implement a new ISO 13485 quality system plan in 2016.”

Implementing Procedures Implementing Procedures for CAPA, NCMR & Receiving Inspection

Typically, I recommend implementing a new ISO 13485 quality system over six months. Still, recently I a few clients have requested my assistance with implementing a quality management system within four months. In November, I wrote an article about implementing a new ISO 13485 quality system. That article described implementing procedures for the first month. Specifically, the implementation of the following procedures was covered:

  1. SYS-027, Purchasing
  2. SYS-001, Document Control
  3. SYS-002, Record & Data Control
  4. SYS-004, Training & Competency
  5. SYS-011, Supplier Quality Management
  6. SYS-008, Product Development
  7. SYS-010, Risk Management
  8. SYS-006, Change Control

These eight procedures are typically needed first. This article covers the implementation of the next set of procedures. During this month, I recommend conducting company-wide quality management system training for the ISO 13485 and 21 CFR 820.

Implementing Receiving Inspection Procedures

During the first month, procedures for purchasing components and services are implemented. As these products are shipped and received by your company, you need to create records of incoming inspection. It is not sufficient to merely have a log for receiving inspection. You need records of the results of the inspection. You may outsource the inspection activities, but receiving personnel must review the records of inspection for accuracy and completeness before moving product to your storage warehouse or production areas. Even if the inspection is 100% outsourced, it is still recommended to verify the inspection results independently on a sampling basis periodically. This should be a risk-based sampling that takes into account the importance of the item being inspected and the existence of in-process and final inspection activities that will identify potential nonconformities.

The most challenging part of this process typically is identifying inspection procedures and calibrated devices for inspection. Your company must find a balance between inspections performed by suppliers, incoming inspection, in-process inspection, and final inspection. Each of these process controls requires time and resources, but implementation should be risk-based and take into account the effectiveness of each inspection process–as determined by process validation. Sample sizes for inspection should also be risk-based.

Implementing Procedures for Identification and Traceability

The lot or a serial number of components must be identified throughout product realization–including incoming inspection, storage, production, final inspection, and shipping. In addition to determining what things are, you must also identify the status of each item throughout the product realization process. For example:

  • Is the product to be inspected or already inspected?
  • After the inspection, is product accepted or rejected?
  • Which production processes have been completed?
  • Is the product released for the final shipment?

The procedure for identification and traceability should be implemented immediately after the purchasing process, implemented during 1st month, because traceability requirements should be communicated to suppliers as part of supplier quality agreements and as part of each purchase order.

Initially, when this process is implemented, there is a tendency to complete forms for every step of the process and to distribute copies of the forms to communicate status. Completing forms and copying paperwork requires labor and adds no value. Therefore, learn manufacturing methods and visual indicators such as color-coding are recommended as best practices for identifying products and their status.

Implementing CAPA Procedures

When a product is identified as nonconforming, corrective actions need to be implemented to prevent a recurrence. Procedures need to include the requirement for planning corrective actions, containing a nonconforming product, correcting nonconformities, and implementing actions to prevent any future nonconformities. These procedures also need to address negative trends to prevent nonconformities before the product is out of specification (i.e., preventive actions). Procedures also need to provide guidelines on how to verify the effectiveness of corrective and preventive actions. Initially, the actions implemented will be specific to a purchased product that is received and rejected. However, over time data analysis of process monitoring and internal auditing will identify additional corrective and preventive actions that are needed.

The effectiveness of CAPA processes, in general, requires three key elements:

  1. A well-designed CAPA form
  2. Proper training on root cause analysis
  3. Performing effectiveness checks

In the CAPA training provided during the second month, the best practices for CAPA form design are covered. The training includes several methods for root causes analysis too. Finally, the training emphasizes using quantitative measurements to verify the effectiveness of corrective actions. It is recommended to identify the quantitative acceptance criteria for an effective corrective action before initiating actions to ensure that the actions planned are sufficient to prevent a recurrence.

Monitoring Your Procedure Implementation Process

As indicated in November’s article, I recommend using quantitative metrics to track the progress of procedure implementation. For example:

  1. % of procedures implemented,
  2. duration of document review and approval process, and
  3. % of required training completed.

Implementing Procedures for ISO 13485:2016

If you already have a quality system in place, you are implementing procedures that are modified for ISO 13485:2016 compliance, some of the same lessons learned to apply. If you are interested in learning more about the changes required for compliance with the 2016 version of the standard, we recorded two live webinars on March 24, 2016.

Posted in: ISO 13485:2016

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Management review revisions for ISO 13485:2016

The article explains management review revisions required for ISO 13485:2016 compliance. The article tells a story about a recent re-certification audit nonconformity and how the revised ISO 13485:2016 Standard will help prevent this type of quality issue in the future. The article includes links to information about new and revised regulatory requirements, how to write a procedure, and there is a link for downloading a free management review webinar.

Management Review 20161 Management review revisions for ISO 13485:2016

One of my clients recently had a re-certification audit in December with their Notified Body, and they received a nonconformity in the first couple of hours of the four-day audit. Here’s what happened.

First, they had an opening meeting with the auditor from 8:30 am – 9:05 am. Next, they took the auditor on a tour of the facility to show her some of the areas of the facility that had been renovated since last year’s surveillance audit. The management representative and the auditor returned to the conference room at 9:40 am, and the auditor began with a review of the management review revisions to the procedure. The procedure had not changed since the previous year, so the auditor asked to see the most recent management review. The company conducted a management review on Tuesday, December 8, 2015. The audit reviewed all the required inputs since the previous management review–which was held on Tuesday, December 9, 2014.

When the auditor reviewed the data analysis of complaints, she noticed a spike in complaints related to shipping errors that occurred from February through May. When she asked for an explanation, the management representative explained that the renovations caused some misplacement of inventory that resulted in shipping delays and a few mistakes. The auditor asked when the trend was first observed. The management representative indicated that the pattern was observed in April, and the warehouse manager made corrections in May. The trend was confirmed to have reversed in the data from the third quarter.

The auditor asked if a formal corrective action was implemented. The management representative said that no formal CAPA was initiated because the problem did not appear to be a systemic problem due to the small volume of complaints relative to the large volume of shipments. The auditor asked if shipping complaints were a quality objective. The management representative confidently indicated that they were. The auditor then asked when top management was notified of the negative trend and reviewed the spike in the performance of the quality objective. The management representative said that the objective quality performance is evaluated by top management during the management reviews. Since the corrections appeared to be effective, no further action was warranted.

The auditor responded that she would be issuing a minor nonconformity against the management review process. The reason the auditor provided was that top management and the management representative did not maintain the effectiveness of the quality management system during a major renovation, because they did not monitor quality objectives on a sufficient frequency to react to quality issues in a timely manner. Furthermore, they failed to modify their planned interval for management reviews to take into account significant changes in the facility that could negatively impact quality.

At the closing meeting, top management asked what should have been done to avoid this finding. The auditor was hesitant to provide advice, but she indicated that management could have been more proactive and taken measures to prevent the shipping complaints in the first place. A quality plan for the renovation could have included increased management oversight and a more frequent review of quality objectives related to the areas being renovated. Instead of reviewing quality metrics quarterly, a monthly schedule might have been used during the renovations. Instead of scheduling the management review for December, top management might have planned a management review during or immediately after the renovations to address any quality issues with corrective actions or action items in the management review outputs. Another possible and less proactive approach would have been for the warehouse manager to initiate a formal corrective action as soon as the negative trend was observed. Then top management would have been aware of the quality issue through the CAPA process. Unfortunately, none of these actions were taken.

The auditor indicated that she could have written the finding against a number of different clauses (e.g., CAPA, monitoring, and measurement of processes, quality system planning). She chose to reference the management review process in the finding because the company will need to make management review revisions in 2016 to document the justification for management review intervals. There are also management review revisions required to address new and revised regulatory requirements in the meeting outputs. Therefore, the company’s corrective action plan might also address the requirements of the revised ISO 13485:2016 Standard.

Management review revisions to the frequency of planned intervals

Most companies satisfy the requirement for conducting a management review (i.e., 21 CFR 820.20 and ISO 13485, Clause 5.6) in one of the following ways:

  1. conducting one meeting each year
  2. conducting one meeting each quarter

If your company is conducting only annual reviews, your reviews will be far more useful if you switch to a quarterly schedule. In the case of my client, top management would have discussed the negative trend in shipping complaints in April 2015 instead of December 2015–8 months earlier. Reviewing data from 9-10 months ago is too late to take action.

Management Review Revisions Medical Device Academy Made

You can download the management review procedure from this website that was just updated for compliance with ISO 13485:2016. If you have your procedure, you might want to read my blog about improving your management review procedure. The key to writing a procedure is to link the procedure to a template that will be used as a starting point for each management review. The template should include each of the eight required inputs (i.e., Clause 5.6.2), the 3 required outputs (i.e., Clause 5.6.3), and a slide for covering both the Quality Policy and the overall effectiveness of the Quality Management System. The procedure should be short, and the bullets should match the requirements verbatim.

Training Top Management

The biggest reason why management reviews are ineffective is that there is little engagement by most of the people in the room. Everyone in the room should be familiar with the requirements and contribute to the preparation for a management review and management review revisions. The best management representatives anticipate the needs of top management and give them tools that explain precisely what they need to do to prepare for a management review and their responsibilities during the meeting.

Additional Management Review Resources

If you are looking for more information on this topic, here are some resources:

  1. How to Improve Your Medical Device Management Review Procedure
  2. Management Review Procedure Case Study
  3. Management Review Webinar: Making your meetings more effective
  4. Medical Device Management Review Meetings: 3 Compliance Issues

Posted in: ISO 13485:2016, ISO Certification

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How to reconcile the conflict between ISO 13485 and ISO 9001

This blog explains how to reconcile the conflict between ISO 13485 and ISO 9001, and discusses whether you should maintain dual certification.

how to reconcile diverging standards How to reconcile the conflict between ISO 13485 and ISO 9001

The previous version of ISO 13485 was released in 2003. That standard was written following the same format and structure of the overall quality system standard at the time (i.e., ISO 9001:2000). In 2008, there was an update to the ISO 9001 standard, but the changes were minor, only clarified a few points, and the periodic review of ISO 13485 in 2008 determined there was not a need to update 13485 at that time. Unfortunately, the proposed structure of the ISO 9001 standard was radically different, and this forces companies with dual certification to reconcile the conflict between ISO 13485 and ISO 9001.

On December 1-5, 2014, the working group for the revision of ISO 13485 (i.e., TC 210 WG1), met at AAMI’s Standards week to review the comments and prepare a first Draft International Standard (DIS). We should have some updates on the progress of the DIS later in December, but hopefully, the news will not be a delay of publication until 2016. The following is a summary of the status before last that meeting.

Updated ISO 13485 and ISO 9001 Standards Being Released

In 2015, there will be a new international version of ISO 9001 released. This new version will have dramatic changes to the standard–including the addition of a new section on risk management and adoption of the new High-Level Structure (HLS) changing from 9 sections to 11. The ISO 13485 standard is also anticipated to have a new international version released in 2015, but the ISO 13485 standard will maintain the current HLS with nine sections. Timing of the ISO 9001:2015 release and the ISO 13485:2015 release will likely be around the same time (Correction: the ISO 13485:2016 standard was released in February 2016). Both standards are expected to have a three-year transition period for implementation. The combination of the three-year transition and lessened requirements in the new version of ISO 9001 for a structured quality manual should allow most manufacturers to wait until the ISO 13485 release before they begin drafting a quality plan for compliance with the new standards. Some of my clients have already indicated that they may drop their ISO 9001 certification when it expires, instead of changing their quality system to comply with the ISO 9001:2015 requirements. However, my clients will not have the ability to allow their ISO 13485 certification to lapse. Will Health Canada be updating GD210 and continue to require ISO 13485 certification for medical device licensing? What should companies do?

Update on the reconciliation of ISO 13485:2016 and ISO 9001:2015 on May 29, 2020:

  • GD210 was never updated, and instead, it was replaced the MDSAP
  • ISO 13485:2016 certification, under the MDSAP program, is required for Canadian Medical Device Licensing
  • Many device companies have dropped the ISO 9001 certification.

Recommendations

From the experience of preparing for the ISO 13485:2016 and ISO 9001:2015 releases, I learned that obtaining draft versions of the standards before publication is invaluable. I was able to use the drafts to help prepare quality plans for the transition. Second, companies need to train their management teams and auditors on the differences between the current and the new standards to enable a gap analysis to be completed. Any manager that is responsible for a procedure required by the current version of a standard should receive training specific to the changes to understand how they will meet the requirements for documented information. Most companies will need to improve their risk management competency (which was updated again in December 2019). I recommend that companies begin drafting their quality plans and enter discussions with their certification body for quality system changes as early as possible. I also recommend that medical device companies maintain a quality manual structure that follows the ISO 13485:2016 standard rather than the ISO 9001:2015 standard. Following ISO 13485:2016 will help everyone locate information faster.

There is also specific text in the introduction of ISO 9001:2015 that states it is not the intent of the standard to imply the need to align your quality management system to the clause structure of the standard. Companies that maintain ISO 9001 certification should consider including cross-references between the two standards in their quality manual.

Historical Note

There are also European National (EN) versions of each standard (e.g., EN ISO 13485:2012). The EN versions are harmonized with the EU directives, but the content of the body or normative sections of the standards are identical. Historically, the differences were explained in Annex ZA, and that was the last Annex in the EN version of the standard. In 2009 the harmonization annex for ISO 14971 (i.e., the medical device risk management standard) was split into three parts to match up with the three directives for medical devices (i.e., the MDD, AIMD, and IVDD). The new annexes (i.e., ZA, ZB, and ZC) were moved to the front of the EN version of the standard. The changes to ISO 14971 consisted of a correction and the change to Annex ZA. In 2012, there were new harmonization annexes created for ISO 13485 to follow the same format that was used for the EN ISO 14971 annexes. It is expected that these “zed” annexes will be released with a new EN version of the standard shortly after the international standard is published.

Posted in: ISO 13485:2016, ISO 9001:2008, ISO Certification

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