Driving Improvement using the ISO 13485 Medical Device Management Review Process

Posted: May 18, 2023

Driving Improvement using the ISO 13485 Medical Device Management Review Process

Welcome to our blog on “Driving Improvement using the ISO 13485 Medical Device Management Review Process” In today’s fast-paced and highly regulated medical device industry, organizations strive to continually improve their quality management systems (QMS) to ensure patient safety, product efficacy, and regulatory compliance. ISO 13485:2016, an internationally recognized standard specific to the medical device industry, provides a comprehensive framework for implementing an effective QMS.

Clause 5.4 of ISO 13485:2016 focuses on management reviews—a powerful tool for evaluating the performance of the quality management system and driving continuous improvement.

In this blog, I  will explore the key aspects of management reviews, their requirements as per ISO 13485:2016, and the significance of establishing an efficient and collaborative management review process. Additionally, I will address common questions such as who should attend these meetings and discuss the inputs, outputs, and records associated with management reviews.

Table of Contents

What is ISO 13485:2016?

ISO 13485:2016 is an international standard that specifies the requirements for a QMSin the medical device industry. The standard sets out guidelines for organizations to follow when designing, developing, producing, installing, and servicing medical devices. Compliance with ISO 13485:2016 demonstrates a commitment to quality and safety, ensuring that medical devices meet regulatory requirements and are safe for patient use. For a medical device start-up, achieving ISO 13485:2016 compliance is critical to building a successful business, establishing credibility with customers and regulatory bodies, and ultimately ensuring the safety and efficacy of their products. An effective quality policy is a crucial component of a compliant QMS and plays a key role in demonstrating the start-up’s commitment to quality and safety.

Learn more about ISO 13485:2016 by taking our Introduction to ISO 13485:2016 Training Course.

What is a Management Review?

A management review is a systematic evaluation of the quality management system by top management within an organization. It is a formal process that assesses the suitability, adequacy, and effectiveness of the quality management system in achieving the organization’s objectives and compliance with ISO 13485 requirements.

During a management review, top management examines relevant information, such as customer feedback, audit results, and regulatory compliance, to make informed decisions about the organization’s quality management system. The review aims to identify areas for improvement, set objectives, and allocate necessary resources to enhance the system’s performance.

The management review serves as a platform for management to analyze the overall effectiveness of the quality management system, ensure its continued suitability for the organization’s needs, and promote a culture of continual improvement.

A management review is a systematic evaluation of the quality management system by top management within an organization.

ISO 13485 Mgt Review Meeting

ISO 13485:2016 Management Review Requirements

The following are the specific requirements for the management review process that can be found in Clause 5 Management Responsibility within ISO 13485:2016.

Clause 5 Management Review

“5.6.1 General

The organization shall document procedures for management review. Top management shall review the 

organization’s quality management system at documented planned intervals to ensure its continuing 

suitability, adequacy and effectiveness. The review shall include assessing opportunities for 

improvement and the need for changes to the quality management system, including the quality policy 

and quality objectives.

Records from management reviews shall be maintained (see 4.2.5).

 

5.6.2 Review input

The input to management review shall include, but is not limited to, information arising from:

a) feedback;

b) complaint handling;

c) reporting to regulatory authorities;

d) audits;

e) monitoring and measurement of processes; 

f) monitoring and measurement of product;

g) corrective action;

h) preventive action;

i) follow-up actions from previous management reviews;

j) changes that could affect the quality management system;

k) recommendations for improvement;

l) applicable new or revised regulatory requirements.

5.6.3 Review output

The output from management review shall be recorded (see 4.2.5) and include the input reviewed and

any decisions and actions related to:

a) improvement needed to maintain the suitability, adequacy, and effectiveness of the quality 

management system and its processes; 

b) improvement of product related to customer requirements; 

c) changes needed to respond to applicable new or revised regulatory requirements; 

d) resource needs”

 

ISO 13485:2016 Clause 5.6

The management review process is also referred to in clause 8.5 Improvement. It states the follwoing: 

8 Measurement, analysis and improvement

8.5 Improvement

“8.5.1 General

The organization shall identify and implement any changes necessary to ensure and maintain the continued suitability, adequacy and effectiveness of the quality management system as well as medical device safety and performance through the use of the quality policy, quality objectives, audit results, postmarket surveillance, analysis of data, corrective actions, preventive actions and management review.”

ISO 13485:2016 Clause 8.5.1

Management Review and Continuous Improvement

Continuous improvement is an essential aspect of any QMS, aiming to enhance processes, products, and overall performance over time. The concept of the management process within ISO 13485:2016 is clearly emphasized as a vital element of continuous improvement in a medical device company. This importance is explicitly stated in Clause 8, titled “Measurement, analysis, and improvement,” and specifically in Clause 8.5, titled “Improvement.”

Regular management reviews serve as a platform to assess the performance of the quality management system, review key metrics, and make informed decisions for improvement.

Clause 5.4  is directly related to the concept of continuous improvement within the organization.  Here’s how Clause 5.4 contributes to the concept of continuous improvement:

Evaluation of Performance: The management review process outlined in Clause 5.4 involves assessing the performance of the quality management system. It allows senior management to review relevant metrics, data, and feedback to evaluate the effectiveness of processes, identify areas for improvement, and make informed decisions.

Identification of Improvement Opportunities: During management reviews, various aspects of the quality management system are analyzed, including quality objectives, process performance, customer feedback, and nonconformities. These evaluations help identify potential improvement opportunities and areas where corrective actions can be implemented to enhance efficiency, effectiveness, and compliance.

Data-Driven Decision Making: Management reviews in Clause 5.4 emphasize the importance of data analysis and trend monitoring. By examining data and trends, organizations can gain insights into performance patterns, identify root causes of issues, and make data-driven decisions to drive continuous improvement initiatives.

Setting Objectives and Targets: Through the management review process, organizations establish quality objectives and targets that align with their strategic goals. These objectives provide a framework for continuous improvement efforts and serve as benchmarks for measuring progress and success.

Feedback and Adaptability: Management reviews create a feedback loop within the organization. Feedback from previous reviews, along with customer feedback and other inputs, is used to inform future reviews and improvement initiatives. This iterative approach promotes adaptability, ensuring that the quality management system remains responsive to changing circumstances, emerging risks, and evolving regulatory requirements.

Resource Allocation: Effective management reviews also address resource management, including personnel, infrastructure, and training. By reviewing resource allocation, organizations can identify opportunities to enhance resources that support the quality management system and enable continuous improvement efforts.

By integrating Clause 5.4 into their quality management systems and conducting regular management reviews, organizations can foster a culture of continuous improvement. The systematic evaluation, identification of improvement opportunities, data-driven decision-making, and feedback loops provided by Clause 5.4 all contribute to the organization’s ongoing efforts to enhance quality, compliance, and overall performance.

The concept of the management process within ISO 13485:2016 is clearly emphasized as a vital element of continuous improvement in a medical device company.

Establishing an Effective Management Review Process supports Continuous Improvement

To harness the full potential of the management review process to support continuous improvement in a medical device company, it is crucial to establish an effective and well-defined review process. Here are key steps to consider when setting up your management review process:

Define Review Objectives:
Start by clearly defining the objectives of your management reviews. These objectives should align with your organization’s strategic goals and quality management system requirements. Common objectives include evaluating the performance of the quality management system, identifying areas for improvement, and ensuring compliance with applicable regulations.

Assemble the Right Stakeholders:
Identify the key stakeholders who should be involved in the management review process. This typically includes senior management, quality managers, process owners, and representatives from relevant departments. Involving the right individuals ensures diverse perspectives and expertise during the review, leading to comprehensive evaluations and effective decision-making.

Establish a Review Schedule:
Determine the frequency of your management reviews. This can vary based on the size of your organization, the complexity of your operations, and regulatory requirements. It is recommended to conduct reviews at regular intervals, such as quarterly or biannually, to ensure timely monitoring of performance and progress.

Develop a Structured Agenda:
Create a structured agenda for each management review meeting. The agenda should outline the topics to be discussed, review objectives, and allocated time for each item. Include a review of key performance indicators, customer feedback, nonconformities, corrective actions, and resource management. A well-structured agenda ensures that all relevant aspects are covered and keeps the review process focused and efficient.

Review Relevant Metrics and Data:
Gather and analyze relevant metrics and data before each management review. This can include performance indicators, customer satisfaction surveys, audit results, and other quality-related data. Reviewing this information provides an objective basis for evaluating the effectiveness of processes, identifying trends, and making data-driven decisions for improvement.

Document Review Findings and Actions:
During the management review, document the findings, conclusions, and actions identified. This includes areas that require improvement, potential opportunities, and decisions made during the review. Clear documentation ensures accountability and provides a reference for tracking progress and follow-up actions.

Follow Up on Action Items:
After each management review, ensure that action items and improvement initiatives are assigned to responsible individuals or teams. Set realistic timelines and monitor the progress of these actions. Regularly review and report on the status of these items during subsequent management reviews to ensure accountability and drive continual improvement.

By establishing an effective management review process, organizations can streamline their evaluations, drive improvement initiatives, and maximize the benefits of ISO 13485:2016 Clause 5.4. A well-structured process enhances communication, fosters collaboration, and facilitates the identification of improvement opportunities critical for achieving and maintaining high-quality standards in the medical device industry.

Become an ISO 13485 internal auditor and learn how to audit a Management Review Process by taking our course Internal Auditor ISO 13485:2016 Training Course

Should I attend Management Review Meetings?

If you are wondering whether you should attend these meetings, consider the following points:

Role and Responsibilities:
Assess your role and responsibilities within the organization. If you hold a position of authority, such as a manager, department head, or process owner, your attendance at management review meetings is essential. Your insights and expertise in your specific area can contribute to the overall evaluation and improvement efforts.

Impact on Quality and Performance:
Consider the impact of your work on the quality and performance of the organization. If your responsibilities directly relate to the quality management system, product development, production, or customer service, attending management review meetings allows you to provide valuable input and contribute to the improvement process.

Involvement in Process Improvement:
If you are actively involved in process improvement initiatives or responsible for implementing corrective and preventive actions, attending management review meetings is highly beneficial. Your presence ensures that your inputs are considered, and you can actively participate in decision-making processes.

Knowledge of the Quality Management System:
Evaluate your knowledge and understanding of the organization’s quality management system. Attending management review meetings helps you stay informed about the system’s performance, identify areas for improvement, and align your actions with the organization’s objectives and strategies.

Opportunity for Learning and Collaboration:
Management review meetings provide an excellent opportunity to learn from others, share experiences, and collaborate with different stakeholders across the organization. Attending these meetings fosters a culture of continuous improvement and can broaden your understanding of the overall quality management process.

Organizational Policies and Guidelines:
Familiarize yourself with your organization’s policies and guidelines regarding attendance at management review meetings. Some organizations may have specific requirements or expectations for certain roles or departments to attend these meetings, while others may provide flexibility.

Ultimately, the decision to attend management review meetings should be based on your specific role, responsibilities, and the impact of your work on the quality management system. Actively participating in these meetings not only demonstrates your commitment to quality but also allows you to contribute to the organization’s improvement efforts and stay informed about key decisions.

Remember, management review meetings provide a platform for collaboration, learning, and aligning actions with the organization’s strategic goals. By attending these meetings, you can play an active role in driving improvement and ensuring the effectiveness of the quality management system.

Please note that the above information is provided as general guidance, and you should consider your organization’s specific requirements and context when determining your attendance at management review meetings.

ISO 13485 Mgt Review Input and Output

Clause 5.6 of ISO 13485:2016 focuses on management review inputs and outputs. Management review inputs typically include:

Quality Objectives: Information related to the established quality objectives of the organization should be considered during the management review. This includes reviewing the progress made towards achieving these objectives and evaluating their continued relevance and effectiveness.

Process Performance Data: Relevant data and information on process performance should be gathered for review. This can include key performance indicators (KPIs), metrics, trends, and statistical analysis results that measure the performance of the quality management system and its processes.

Customer Feedback: Input from customers, including complaints, feedback, and satisfaction surveys, should be considered during the management review. This provides insights into customer perceptions, expectations, and areas for improvement.

Internal and External Audit Results: The findings and recommendations from internal and external audits, including any nonconformities or observations, should be reviewed. This helps identify areas for improvement and ensures compliance with regulatory requirements.

Regulatory Compliance: Information regarding compliance with applicable regulatory requirements, standards, and regulations should be assessed. This includes any changes in regulations and their impact on the organization’s quality management system.

Risk Management: The results of risk assessments, including identified risks, risk mitigation strategies, and effectiveness of risk controls, should be considered during the management review. This ensures that risks are adequately managed and mitigated to maintain product safety and compliance.

Resource Management: Input related to resource allocation, such as personnel, infrastructure, training, and other resources, should be reviewed. This helps evaluate whether the resources are sufficient and effectively utilized to support the quality management system.

Remember that these inputs are general guidelines and can be customized based on the organization’s specific context and needs. It is essential to analyze the applicable clauses and requirements within ISO 13485:2016 to identify the specific inputs for the corresponding management review process.

 
 

The outputs typically include:

Conclusions: The management review should result in documented conclusions regarding the overall performance and effectiveness of the quality management system. These conclusions are based on the review of inputs, data analysis, and discussions during the review process.

Decisions: The management review should lead to decisions regarding improvement opportunities, corrective actions, and preventive actions. These decisions may include changes to policies, procedures, processes, resource allocation, and strategic direction to address identified issues and ensure continual improvement.

Action Items: Management reviews generate action items that need to be addressed to drive improvement. These action items may involve specific tasks, responsibilities, timelines, and resources required for implementation. They are typically documented and assigned to responsible individuals or teams.

Updates to Quality Objectives: The management review may lead to updates or revisions to the organization’s quality objectives based on the evaluation of their effectiveness, relevance, and alignment with business goals. Any changes to the quality objectives should be documented.

Documentation of Follow-up Activities: The outputs should include records of follow-up activities related to previously identified improvement initiatives and action items. These records demonstrate the organization’s commitment to monitoring and tracking the progress of these activities.

Communication: The outputs of the management review should be communicated to relevant stakeholders within the organization. This includes sharing the conclusions, decisions, action items, and any updates to quality objectives to ensure transparency, accountability, and alignment throughout the organization.

It’s important to note that the specific outputs may vary depending on the organization’s context, needs, and the results of the management review. It’s crucial to document the outputs of the management review to demonstrate compliance with ISO 13485:2016 and facilitate implementation of improvement initiatives and corrective actions.

 

To be in compliance with ISO 13485:2016, organizations are required to maintain certain management review records. While the standard does not specify the exact format or structure of these records, it provides guidance on the key elements that should be documented. The following types of management review records are typically maintained:

Meeting Minutes: Detailed minutes or records of each management review meeting should be documented. These records should include the date, attendees, agenda items, discussions, decisions made, and action items identified during the meeting.

Review Inputs: Records should be maintained for the inputs considered during the management review. These inputs may include relevant metrics, data, customer feedback, audit results, nonconformities, incidents, regulatory requirements, and other relevant information reviewed during the process.

Review Outputs: The outputs of the management review, including conclusions, decisions, and actions, need to be documented. This includes any improvements or changes identified, action plans, responsibilities assigned, and target dates for completion.

Action Plan Tracking: Organizations should maintain records that track the progress of action items identified during management reviews. This ensures that the identified improvements are effectively implemented, monitored, and closed within the specified timeframes.

Follow-up Reviews: Records should be maintained for subsequent management reviews that follow up on the progress of previously identified actions and improvements. These records serve as evidence of ongoing evaluation, follow-up, and review of the organization’s quality management system.

It’s important to note that the specific record-keeping practices may vary depending on the organization’s size, complexity, and documentation management system. It’s recommended to establish a consistent and well-documented process for maintaining these management review records in accordance with the requirements of ISO 13485:2016. These records serve as evidence of compliance during audits and demonstrate the organization’s commitment to continual improvement and regulatory requirements.

It's recommended to establish a consistent and well-documented process for maintaining these management review records in accordance with the requirements of ISO 13485:2016.

Conclusion

In conclusion, ISO 13485:2016 Clause 5.4 highlights the importance of management reviews in driving improvement within a medical device organization.

Management reviews serve as a systematic evaluation of the quality management system, enabling top management to assess its suitability, adequacy, and effectiveness. By integrating Clause 5.4 into their quality management systems and conducting regular management reviews, organizations can foster a culture of continuous improvement.

The management review process allows for the evaluation of performance, identification of improvement opportunities, data-driven decision-making, setting objectives and targets, and resource allocation. By establishing an effective management review process, organizations can streamline their evaluations, drive improvement initiatives, and maximize the benefits of ISO 13485:2016 Clause 5.4. Attending management review meetings can be beneficial for individuals who hold roles and responsibilities related to quality management, process improvement, and compliance.

The inputs and outputs of management reviews include quality objectives, process performance data, customer feedback, audit results, regulatory compliance information, risk management results, and resource management input. The outputs typically include conclusions, decisions, action items, updates to quality objectives, and updates to the quality management system.

Overall, effective management reviews contribute to the ongoing efforts of organizations to enhance quality, compliance, and overall performance in the medical device industry.

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    Picture of Dr. Fiona Masterson

    Dr. Fiona Masterson

    With over 25 years’ experience in quality management, operations management,
    and higher education, Fiona combines technical expertise with highly engaging
    training. She has worked in fast-paced manufacturing environments including
    medical device companies, and lectures part-time in universities.

    She has Bachelor and Master of Science degrees, and a Doctorate in
    Mechanical Engineering. Fiona has published in peer reviewed journals on
    topics such as medical device and pharmaceutical regulatory affairs, on-the job
    training and innovative training technologies and strategies. .