Featured Post

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...

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). 

Thursday, July 21, 2016

Noble’s 11 Rules: How to NOT DIE working in your laboratory (PART 2)

Noble’s 11 Rules: How to NOT DIE working in your laboratory (PART 2)

In my previous entry I offered you Noble’s first 5 safety rules.  The following is the next six.  

6.         Safety is more important than lunch.
        Previous study has pointed out the single most significant causative factor for laboratory accidents and injuries is rushing, especially just before lunch and breaks.  I can believe that.   Apparently rushing is not gender or age biased; anyone can find themselves rushing, and usually getting away with it.  But when the bad thing happens, there you are;  what a risk and what a cost. 
        In my institution, rushing to a cafeteria lunch would not be digestively defensible.  

7.         Think lean.  Work clean.
        There is a lot of Lean thinking that does not translate well from industry and the factory floor to the laboratory, but 5S most certainly does.  Working without a lot of extra stuff around  (sort) and having an expectation of finding you equipment in the right place AND returning them back there after you use them (straighten) and regularly tidying up and getting rid of all the clutter (shine) will make your work less stressful and will likely reduce all sorts of accidents from needle sticks, and twisted ankles and chemical burns.

8.         Pick your information sources.
        In the olden days (pre-internet) the sources of safety information were limited to textbooks, journals, standards, and regulations.  They were pretty good in the day, even if they were a bit biased and dated.  Today we are awash with information from a wide variety of sources (yes, including blogs!).  Much of the information is rapid access-rapid disposal, and some of it is untested, opinionated nonsense that may sound great but don't work out and can even conflict with existing established requirements.  Be selective before implementing a lot of this stuff (including this stuff!) until you determine that if is appropriate for your laboratory.  Confused messages increase confusion, and confusion leads to error.

9.         Surround and Protect yourself with safety.
        This is something like Rule 5 (If you are not prepared, you may pay severely) but is different.     
        If you don’t have immediate access to personal protective equipment or it is not convenient, then you probably won’t use it.  Deciding for the sake of time and convenience to pull boxes out of a -80oC freezer without freezer gloves, puts you at risk for freezer burns.  Choosing to work with tissue damaging and volatile reagents without chemical resistant gloves and respirator mask because they weren’t immediately accessible can lead to all sorts of immediate and long term problems.    Not bothering with a calibration and maintenance program for your equipment can result in aerosols and all sorts of other problems.  I could keep going, but I think you get the idea.
        And there is another thing that fits in here.  (This gets personal).  Every laboratory usually has people who rush, who work distracted, and who don’t bother with detail.  (If you look around and don’t see one in your laboratory, maybe its you!)  There may also be some people who have a couple drinks or a toke at lunch time.   These are people we call accident-prone hazards.  There are some who think that practical jokes in the laboratory break the tension (We call these people jerks.) 
        If you have one of these disaster-waiting-to-happen folks in your laboratory, it would be better if you could figure out how to keep these folks at distance.  When their bad thing happens, it is really a plan to NOT get caught up in their disasters.  

10.     There must be no doubt about when to get OUT.
        Sooner or later someone will drop a tube of blood, or a bottle of reagent, or a beaker of E. coli or something much worse.  For most small spills you can tidy this up with your spill kit (do you know where it is and how to use it?)  But if the spill is substantial and generates aerosols or contains bad bugs or toxins, or volatiles or potential explosives, you are not being a hero trying to fix it.  Get everyone out and call the HAZMAT guys. 
        Just as you probably have fire drills, consider some spill drills.

11.     OPP:  Organization-Personal-Partnership
        Safety is a team sport.  Your organization has an obligation to provide you with a safe environment and the tools to keep it clean and safe.  You have an obligation to work within the rules, to work responsibly and not create hazards for the sake of expediency.  Working together increases your odds of having a long and interesting and safe and healthy career as a laboratorian.  Not doing your part increases your risk. 
        And you always have options if your organization is made aware of safety hazards and chooses to do nothing about them.

If these 11 Rules make sense to you and your laboratory, then enjoy and let me know. 
If they are, in your opinion, the meaningless meanderings of a lost soul, then that’s OK too.  We can always agree to disagree.


Sunday, July 17, 2016

Noble’s 11 Rules: How to NOT DIE while working in your laboratory (PART 1)

Over the years I have worked in many laboratories.  One of my first jobs in the early 1960’s was in a quality control laboratory in a paint factory.  Since then I have been in university laboratories and medical laboratories around the world.  All laboratories one thing in common; they can be dangerous places.  They have toxic chemicals, dangerous microbes, breakable glassware, and equipment that can spew high voltage or spray dangerous bugs.  Laboratory workers put themselves at risk on a regular basis and odds are that at some point a bad thing can happen.

Lots of sources, private, government and otherwise make a lot of rules, but in my experience most of them are so technical and so boring, and sometimes so arbitrary that is understandable why some times some folks don’t read them and adhere to them as faithfully as they could or should.
So from my vantage point of understanding quality management and risk management and the laboratory working environment, and being an admirer of giants like Deming and Crosby,  I have come up with the following. 

I think they are more encompassing and easier to understand and accept and adopt.

1.    If you are not competent, you are incompetent.
This first rule is specifically for the academic laboratory, because they are the single group with the highest failure rate and represent the most dangerous laboratory environments.    Most studies going back 50-60 years point to research laboratories as where the bad things usually happen.

If you have not been trained thoroughly before being asked to take on research laboratory tasks, and have not been assessed by a knowledgeable and competent person as knowing what you are doing, you are a hazard to yourself, your colleagues, your worksite and the rest of the world.  You cost money, and you cost study validity.  You are a hazard.  What you are being asked to do would not happen in an industrial or medical laboratory.

By and large it is usually not your fault.  Most of the time your principle investigator is similarly incompetent because they never learned or understood about safety either.  It is all too often the blind leading the blind.  The old adage of “See one, Do one Teach one” is, was, and always will be nonsense.

If you are not sure what you are doing, and do not feel you are properly prepared, do not allow yourself to be pressured into barging forward,

2.    If you don’t look, you won’t see.
Every laboratory for the last 50 years has understood that some form of internal audit of equipment, reagents, housekeeping, competence is essential on a regular basis.  Maybe it is once a month of maybe one a quarter.  But it is a sad reality that audits frequently are not done, or if they are, it is a five-minute exercise. 

OK; most times nothing new happens, but when they do, if you don’t detect the problems before the cause the bad thing, you will probably detect them AFTER the bad thing has happened.  So its worth the extra 10 minutes one a month to make a screening audit, and if you pick up a problem, fix it. 

3.    OFI and learn.
In Quality management we understand that the single most important way to stop repeated error it to report when you have a problem, write it down, and then fix it.  We call that OPPORTUNITIES FOR IMPROVEMENT.  If laboratory staff are afraid that some one is going to go nuts or punish or belittle for reporting an error, it is not surprising that they never get reported.    We call that OPPORTUNITY LOST. 

4.    Be a mensch
Being a mensch is an Yiddish term for being an adult responsible person.  It distinguishes from being a fool.  A mensch does what is the right thing while the fool does not.  In the laboratory setting a mensch does the sensible and obvious things that prevents harm to themselves and others.  It is being the sort of person that you would like to work with.  A shortd list of what a mensch does in the laboratory includes:

  • Washes their hands
  • Is not embarrassed to wear appropriate personal protective equipemt.
  • Leaves their lab coat in a safe place
  • Doesn’t bring food or drink into the work zone
  • Avoids short cuts
  • Offers a helping hand
  • Supports and encourages reporting OFI.

5.    If you are not prepared, you can pay severely.
If there was a fire, would you know how to get out of your laboratory safely and where to meet, so that you can be accounted for?  If there was a small spill that needed to be cleaned up, would you know where the spill kit is?  If you got a splash in the face, would you know where the eye wash station is?  If there was a bad event, would you know who to call?  If you can’t answer these questions in the affirmative, you and your laboratory are not prepared.

This is the top five.