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Healthcare Customer Satisfaction: More Talk AND More Action

Healthcare Customer Satisfaction: More Talk AND More Action Customer satisfaction (Voice of the customer) is a recurrent th...

Friday, October 7, 2016

Conference Report: The laboratory and customer satisfaction

Program Office for Laboratory Quality Management (POLQM)
hosted a successful conference/workshop on
Customer Satisfaction and the Medical Laboratory.

Business and industry are very much aware of the importance of listening to and responding their customers’ needs and requirements.  It is not only good business practice and consistent alignment with international standardization (ISO9001:2015 Quality Management requirements, it makes powerful business sense.  You can call this customer-focus or customer-centric. but business understands that nothing will kill off a business faster than having a large herd of unhappy people who prefer to go elsewhere for their goods and services needs.  

Healthcare in general, and Medical laboratories in particular are now slowly getting aligned with the same mindset.  In some countries, the final argument is too compelling to ignore.  The unhappy customer is apt to “sue you into the stone age”.  

 That may not apply so much in Canada, but at least in Canada we can drag the industry forward through mandatory accreditation.  (I really don't like using accreditation as a club, but sometimes you have to make folks understand that this is something they have to do.)  

For medical laboratories in Canada, the accreditation requirement (ISO15189:2012 medical laboratories – requirements for quality and competence), has become pretty much a national requirement and an effective approach to introduce process change on customer needs.
On October 5, 2016 we (the UBC Program Office for Laboratory Quality Management or POLQM) hosted a one-day conference/workshop on listening to laboratory customers in the medical laboratory. Topics covered included defining who are our customers, capturing their opinions (including complaints, concerns, comments and compliments) and monitoring satisfaction as a Quality Indicator,  Speakers included experts from the American Society for Quality, private sector laboratories, public sector health authorities, accreditation bodies, and quality educators, and the new BC Agency for Pathology and Laboratory Medicine.  The participants were all from Canada from Victoria to Toronto and as far north as the Yukon Territories, and from a wide variety of programs and facilities.  

From my (clearly biased and vested) opinion the day went very well.  Most attenders were Quality Managers or Quality Leads or folks in senior positions.  While it was clear that folks came were there to support their per-existing mindset.  As best as I could tell there were no skeptics in the crowd, but perhaps if they were there they were too intimidated to speak up (That can sometimes happen).  

There were some great ideas raised; some stood out.  

  • There are lots of ways to address focusing on the customer.   Maybe some are better than others, but don’t over plan.  Pick one and get going.
  •   Laboratories have a way of thinking they know what their customers want, but all too often don’t get around asking their opinion.  Get the customers involved.
  •    Laboratorians think their work is all about accuracy and precision.  Those are important but so is customer experience.  Many complaints result from  rudeness and indifference.

I talked about on-line surveys, and that if you are going to do them, make sure you do them right; short, simple, if possible on a continuous basis.  Don’t intrude on your customer’s time, effort, and patience, and generosity.  

No conference/workshop goes off perfectly.  One of our speakers decided to back out 4 days before the event (Whata Jerk!!).  One person was annoyed because the lunch did not accommodate vegetarians well (she was probably right; lots of sandwiches, but only about 10 percent were vegetarian.  Our mistake).  But on the whole, people found the day worthwhile and well spent.  There were a few who said the meeting was too short, but none that said it was too long.  I interpret that as a positive!

In our own on-line survey (about 35% of participants responding) they rated their program satisfaction high (mean 85% and median 90%).  

For those with interest in the topic, there is a follow-up webinar on October 27th, and presentations are available at www.POLQM.ca
Safe the Date: 
next Fall Conference on
Laboratory Quality Management
Vancouver BC Canada
 October 1-3, 2017!

Monday, September 12, 2016

When is a standard NOT a standard?

There are a bunch of words that get thrown around a lot in the Quality community; words like “continual” or “continuing” or “improvement”  or “risk”.  But I would argue that the most significant word in the Quality arena is the word “Standard”.
In the Quality arena “Standards” is a powerful word.  It describes a document that indicates either “the right and thoughtful thing to do” or “the only and absolute thing to do”.   

A standard has a higher value than “guidance” which is something you can take or leave.  The general public understands this; David Letterman used to say “Traffic signals in New York are just rough guidelines” or there was the pirate in the movie Pirates of the Caribbean who said “the code of the brethren is more what you'd call guidelines than actual rules”.  Think of standards as similar to, but more righteous than regulations or laws and certainly more dignified than “rules”, which can be arbitrary, and more real than guidelines, which all too often are not much more than a punchline.

The word “standard” must be viewed as special and be safeguarded from abuse.
Standards deserve that special prominence because there are specifics about how standards must be properly designed and properly constructed.   Simply put, a standard is a respected document of requirement, not because of its content but more so because how those words were selected for proper use.  

The ultimate source of standards is the International Organization for Standardization (ISO) which points to a process of both objectivity and consensus.  ISO as the premier standards development body has established the importance of standards development objectivity.  ISO does not decide what standards it is going to write.  Instead member bodies have to make a solid proposal which is circulated through member committees to get approved.  

ISO committees that are given approval to develop the standard are made of individuals from a variety of jurisdictions, each with their own vested opinions.  To get through this process a document has to achieve agreement from at least two thirds of committee members with less than 25 percent of votes cast to the negative.  That is called committee consensus.  

But that alone does not assure the path to publication.  After committee consensus, the document has to be circulated broadly throughout the world to interested parties to get a broad sense of opinion.  All issues and differences raised through this process have to be addressed.  Only after the process has been repeated several times, to ensure as broad an agreement as possible,  a document can be published and referred to as a “standard”.  

And importantly, in order to ensure that any error that slip by are addressed and to ensure that the standard remains relevant to the times, it must be revisited every 5 years.

If a document does not succeed in going through this arduous process, often the result of differing opinions, it can still be published, but the term “standard” cannot be used.  The meaning of the term “standard” is, as it must be, protected from abuse or trivialization. 

There are solid reasons for this arduous process.  First off, when a small group of people decides to get together and write something, there is always a great risk for bias and for exclusion.  Not asking for broad opinion almost guarantees that none will be found.  The product generated, whatever its intent and purpose, is tainted because of the lack of broad consideration.  

Tainted standards are not the product solely of small organizations who strive a little too hard.  They all too often finds itself in the products of large “august” national bodies, who should know better.  They result because of the innate arrogance of august bodies.  “We must be right because we are so damn important”.

This last while, I have been dealing with one such organization with a disturbing track record.  An organization that makes up rules without working through objectivity or wide consensus, but who stills calls its products "standards".  An organization who wraps itself in a cocoon of self-import of its own making, either oblivious or indifferent to the flaws in their own “standards”.   I can’t go into specific detail here for obvious reason, but the battle ground is now set.

So let me just end (for now) with the following thought, if an organization is not prepared to put its work through a process of objectivity and the scrutiny of consensus through transparency, then it is just a bunch of guys and women hanging out making up its own rules.  Hardly august, and hardly dignified; more about pretense and self-serving rules than actually writing standards.

Just another herd of Pirates. 

Tuesday, August 23, 2016

Noble`s Seven Rules for Successful Conferencing

Noble’s 7 Rules for Successful Conferencing

Over my career I have organized a lot of conference/workshops – all told somewhere around 50plus.  All have been small (500 people or less) and most are one-day events, and most (but not all) have been financially successful in the sense that they have not lost money.   I put these on because I have a sense of mission about creating opportunities for people to meet and share ideas, knowing that when they leave they have a tad more passion that when they came. 

My most recent venture is our upcoming conference/workshop on Listening to the “Voice of the Customer” in the Medical Laboratory [ http://conference2016.polqm.ca ]

It seems that I have reached that point in my career that I am starting to feel comfortable with trying to systematize what I do, to share ideas and maybe some experiential knowledge.  And so just as with my previous “Rules on How to Not Die…”  I provide the following:

1: Quality IS Conferencing.
Quality is all about continuing education, error reduction and continual improvement, and customer satisfaction and managing risk.  Conferences are all about continuing education, error reduction and continual improvement and customer satisfaction and managing risk.  

2: Conferencing IS Quality
There is nothing more “Deming” than putting on conferences.  The only chance for success is to be laser focused on Plan-Do-Study-Act.  PDSA can’t guarantee success, but its absence will absolutely guarantee failure.

3:  Plan your Upside
The things that promote the opportunities for success are:
Topic:            Be current and relevant.  A small committee will help focus on your top 3 ideas.  A big committee will distract and delay.  Pick your topic and work with it.
There are 4 good months and 12 bad months.  If possible aim for April, May, October, or November, but understand those are the same months when the level of conference competition is greatest.  December-January and June-August are poison. 
Sponsors are a tremendous asset because they help build up a bankroll.  But sponsorship does NOT work as the more the merrier.  Keep the group small and close.  
Pick your audience. 
For smaller conferences, you are probably looking at a select audience.  In my situation, I focus on the group of laboratorians with an interest in matters Quality.  Physicians, Scientists, Technologists, Administrators, Ministry workers and students.  We understand that the audience is going to be fairly “close to home”, with perhaps 2-3 percent being from away.   Knowing this helps us sort out how we can promote the meeting
[ As long as I am talking about meeting promotion, please visit http://conference2016.polqm.ca ]

4: Plan for Success
Meeting attenders at large conferences are pretty much settle to be passive observers and party attenders.  There is little opportunity to really get engaged.  Small meeting attenders on the other hand are looking for another experience.  They still want the name speakers, but expect the opportunity to get engaged in conversation.  Some want to talk about their own experiences, either in person or by poster.  We create opportunities for all that.
Our accreditors require that at least 25% of the conference/workshop is spent in discussion-interaction.  Because we are small and continuing education focused we ensure they get all that (and more).

5: Don’t shoot for the moon.
Small conferences benefit from the comradery and collegiality.  They can be designed for all sorts of pluses, but a big revenue stream is NOT one of them.  But if you cover your costs plus 100 percent, that will give you enough to feel pretty good, and maybe enough to bankroll the next one.  Don’t make up for smallish target attendance by setting registration high.  That will only serve to annoy and discourage.  

6: Control your Downside.
The single most significant way to ruin conferences for now and for the forever future is to lose money.  Money failure is (near) always excess expenditures, like excess speaker travel costs, or overly generous honoraria, or two killers of all killers, excess expenditure on promotion and especially food. 
There are tons of free promotion site these days, LinkedIn, Facebook, and Twitter, just to name a few. 
To the extent possible, avoid holding your conference in a hotel; without trying very hard hotel catering food and service costs can run up to $150-200 per person per day (without alcohol).

7:  Study-Study-Study.
If you are thinking about doing more than one conference, get really sharp and active in your satisfaction surveys.  Find out what worked and especially what did not.  Design them to optimize for truth telling.   As a general rule, in my experience and that of others, most people do not like to fill in surveys.  At first pass you might get a 5-10 percent response, which is interesting, but not relevant.  Push for 15-20% if you really want to know what your audience thought.  Instead of one long survey, consider randomly sending out 2 or 3 short ones. 
(If you really have absolutely no interest in going through this again, don’t bother).