Saturday, May 9, 2015

Customer Service Counts



There is a story going through the national media that makes two points that are critical to healthcare quality.  The first is that Quality falters in any system when there is an endless supply of customers (patients) and there is no benefit for good performance and no consequence for bad performance, which in essence describes most of our public health care system across Canada.  The second is that all healthcare organizations are surrounded by Quality Partners (educators, accreditors, proficiency/competency assessment, oversight bodies, etc.) but the most powerful effector of Quality change is an outraged public.

In essence this story is of a woman who is given an appointment to attend the hospital to have a cortisone injection.  Unfortunately prior to the 5 minutes it took to receive the injection, she sat and waited for an hour and a half, in part because the clinic booked 5 patients and the same time, and more importantly because the clinic staff decided to take an hour for lunch while the patients sat.  [see: http://news.nationalpost.com/news/canada/after-an-hour-and-a-half-wait-woman-sends-ontario-hospital-122-50-bill-for-wasted-time

After a deliberate period of time, the patient decided to bill the hospital for her time, and to make sure that the public was made aware.  As she told the media in an interview “It’s the total lack of courtesy on the part of everybody at the hospital that really angered me.  It’s totally disrespectful.”  I suspect the hospital’s response did not make her disposition any better.  “We welcome constructive feedback that will help us to improve our performance and provide our patients with the care they deserve.”

The problems here are systemic.  

What on earth would motivate a physician and staff to take an hour for lunch with people sitting and waiting? Are they venal and nasty, intent upon creating harm? Not likely.  What is more likely is that they have become inured to patient inconvenience.  If this was a lifesaving crisis, they likely would have acted differently, but was not about harm, it was about petty inconvenience.  Harm is a big deal, in part because doing bad can have consequences.  Causing inconvenience does not.  
Public healthcare has little regard for customer service, other than what it puts into moto’s and brochures.  “We strive for patient-centred care…” or “We endeavor to put the patient first…”  Words, words, words.   

This has become a truth not only in emergency departments and clinics, it is a reality throughout this system, including, with regret the laboratory.  Take a look at ISO 15189, our international standard on Quality and competence.  The document contains almost no statements relevant to customer service.  This was not by accident; the crafters of the document were well aware of the customer service requirements in ISO9001:2008, but chose to not include hardly any.  

And accreditation bodies don’t help by not making customer service a priority for accreditation.  A telephone call to a laboratory’s pre-selected client doesn’t put across a message that competence at customer service is important.  

The day of reckoning is coming.  We live in a very different society today as compared to even 20 years ago.  The public has become much less interested in the authority of institutions.  The public  has found its voice through a myriad of social media vehicles.  The word about bad behaviour gets around very quickly.

Institutions will learn either on their own, on through the hard ways that customer service matters.  Good service may not have lots of rewards, but bad service will most certainly have consequences.  We, in Canada, may not have a litigious society; malpractice suits are not our style.  But public shaming can be very powerful and weasel words like “We welcome constructive feedback…” don’t cut it. 
Next time the hospital should try “We apologize for what was truly inappropriate behaviour.  We will improve our customer service and will put in every effort to reinforce the message that poor service has no place in our organization”

PS:  For those interested in Quality Conferences, be aware that we are hosting our 4th conference in Vancouver BC on October 28-30, 2015.  See:  http://polqm.ca/conference_2015/home.html  

If you decide to register and attend, I would be interested on your thoughts about this blog. 

Friday, April 10, 2015

Attending Quality Conferences



Julia McIntosh of the American Society for Quality has created a really nice summary on why attending meetings promotes networking [see: http://asq.org/blog/2015/04/the-pros-and-cons-of-conferences/ ].  And many thanks for pointing to my blog on one of the challenges of meeting travel [see http://www.medicallaboratoryquality.com/2014/07/quality-standardization-and-mh17.html ]. 

To be clear, let me underscore that I absolutely agree with Julia.  First and foremost, I know there are some inherent risks, but on greater balance, attending meetings is  critically important to Quality and Communication.  As the old adage goes “the most important part of a meeting is that people meet”. 

When people get together, creative juices flow and innovation and collaboration and synergy opportunities abound.  It is tough (but certainly not impossible) to duplicate that over a telephone or by watching and participating through a computer or tablet screen.

But it is also fair to say that meetings can have costs which have to go into the planning mix.  Yes, even attending meetings is a Deming PDSA opportunity. 

You can’t be in two places at the same time, and sometimes urgent things can happen while you are way, and the longer the meeting, the greater the risk.  Also, it is pretty clear that the more flight legs it takes to get to a meeting, the higher the probability of a problem.  Lost luggage, missed connections, jet lag, and common colds, phlebitis, and more recently it seems, measles, can mess up your meeting.  And let’s not even talk about flying in or out of the North-east anytime between mid-December to early-March (?) with predictably unpredictable weather. 

And then there are the financials to take into consideration.  In my world, an average 3 day meeting can consume between 4 and 5 thousand dollars, for travel, hotel, registration and per diem costs.   

So I can agree that attending meetings is important, and you can optimise the up-side benefits and reduce the downside hazards, with the following:
1.    Ensure the meeting is worth the risk.  Are the people that you want to meet or listen to likely to be there?  In my world, ASQ meeting are right up at the top.
2.    And as an extension to the above, if you go to a meeting and talk only to your friends, or even worse, talk to nobody, that is opportunity lost.
3.    Look for meetings in the sweet spot, May-to-October, (maybe avoid August) to reduce risks of weather.
4.    Make it a meeting worth your while by balancing travel time against meeting time.  Do you really want to travel for hours-and-hours just to attend a one-dayer?  And on the other hand, do you really have the time to be away for 4-5 or 6 days?
5.    Look for meetings in locations that you can get to on one or two flights.  More than four flights is probably a guarantee for at least some lost luggage or a missed connection.
6.    And as another extension, look for meetings in places where you might like to visit. 
7.    Look to save some cash.  Book meetings at the Early-bird registration rate.   Usually the meeting hotel is going to give a good discount and sometimes, meals are included as part of the meeting. 

So ASQ World Conference on Quality and Improvement in Nashville, in a few weeks for most folks in North America would meet all those criteria. 

Where also would be an ideal meeting to consider, if you are in the medical laboratory/healthcare/safety business, is to think about visiting Vancouver BC and the UBC Program Office for Laboratory Quality Management Conference in October 28-30, 2015. 

Sunday, March 15, 2015

Encourage the Next Generation of STEM Professionals



ASQ asks the question about the next generation of STEM (Science,Technology, Engineering and Math) professionals.   My personal experience is that STEM is very much alive and well, with lots of opportunity to grow, especially in Canada and the United States.  

On a personal note, mentoring and motivating is what I do all the time.  
More importantly, both my sons went through science programs in their university years.  One moved on to the world of high tech and internet start-ups and the other to medicine (In an on-line survey [ http://scienceblogs.com/terrasig/2009/12/06/do-you-consider-medicine-and-t/ ] that asks the question are medicine and allied health professions STEM disciplines(?), over 80 percent vote to the affirmative).  Both have great careers, and importantly have integrated Quality and Improvement into their professional activities and development.

At my university, Engineering is thriving very well.  It continues to have far more applicants than places and continues to require extremely qualified students.  The faculty apparently offers courses in a broad diversity of sub-disciplines at a variety of levels, and apparently all are filled to capacity.

It is difficult to talk about how well or unwell STEM disciplines are doing.  In another fairly recent study [see: http://www.conferenceboard.ca/hcp/details/education/graduates-science-math-computer-science-engineerin.aspx] it appears that there is opportunity for growth in STEM education in North America (see the figure), although I have to say that if this figure is an example of the state of STEM knowledge we have a very serious problem. 


Measuring by percentage of graduates has to be just about the poorest application of statistical analysis, ignoring more important issues like, population size, numbers of universities, variety of faculty choices, and many more important variables.   Without looking too deeply, one can say with absolute and total confidence that the United States creates many, many, many fold more STEM graduates than does Finland. 

If we have an apparent increase in vacancies in STEM positions, I think there are a variety of factors that need to be taken into account, at least in Canada, and probably the United States.


  • At one time the United States dominated in science and technology positions.  Today the positions have become far more internationally distributed. 
  • Since the economic downturn in 2008, the pace of manufacturing job increase has dropped dramatically.  While certain parts of the sector, especially high tech has grown significantly, many other jobs are either sitting, or have left the continent.    As the economy becomes more stable and a sense of confidence returns, many positions will open.  They may look very different from what they looked like in the past,
  • The costs of university education have continued to climb, and many people are questioning the wisdom of leaving school with debt of $200K or more.  Scholarships can make the entry decision easier, but having the confidence of an opportunity when the smoke clears is probably at least as important.

  • If the classifiers of STEM disciplines classify their positions narrowly, they are excluding many graduates that are indeed science oriented. Fields including biotechnology, genetics, pharma, nano-tech, tele-health, are making revolutionary change who we are and what we do and will continue for many years to come.   







Sunday, March 8, 2015

Quality and the Quality Conference




Quality oriented conferences have become prolific these days, even in the Medical Laboratory arena.  This actually makes a lot of sense because Quality has become a very relevant issue at almost every level.  It is a HOT topic.

There are so many aspects of Quality that touch the Laboratory arena include Costs, Clinical Relevancy, Patient Safety, Culture, Risk.  It has become near impossible to keep up with moving trends and recent advances if you are not connected to the Quality community.  

For those of you that visit this site from time to time, you may recall a post that I wrote about 9 months ago:  see http://www.medicallaboratoryquality.com/2014/07/quality-standardization-and-mh17.html  in which I argued the downsides of conference travel including cost, and risk.  Perhaps you may think that my now planning on hosting a meeting might seem a bit hypocritical.  

I would not agree.  Thinking in terms of Risk, one can look at conferences from both a occurrence/severity perspective and a risk/benefit perspective, and I can argue that if a meeting has high enough value of information and is held in a really nice and low risk environment and at a fair cost then the balance of factors leans strongly to the side of hosting and attending.  

So I will start from the positive high value side, or as Crosby would say it “Quality has to be defined as conformance to requirements”.  Will the meeting meet customer requirements?

In a short 2 and a half days, we will have speakers talking on Health-Quality-and the Law, on Safety as the Quality Imperative, on Modern Tools for the Modern Quality Manager, and on techniques to solidify the Culture of Quality.   It will be difficult to find a meeting that will provide a better array of topics.  Within those subjects we will talk about Teaching Quality to Adult Learners, reducing risk through Conflict Resolution, Establishing real time inventories of laboratory error and safety accidents and injuries,  We will look at calculating true costs of poor Quality (how Crosbyesque is that!) and determining risk in pre-and post examination processes.  

We will have presentations and roundtable discussions, and presenter contact time and the opportunities for posters and sponsor interactions.  All in all, this will be a high content conference.  This is exactly the structure that meets the Andragogy criteria for Adult Learning. 

In terms of the potential for bad outcomes by every measure they are very small.  The conference is being held in one of the most picturesque cities in North America (Vancouver BC) at a time with little risk for inclement weather, and essentially no risk for personal adversity.  Vancouver is an ideal city; big enough to be world class, but not so big that you get swamped and hit with major costs.  It is a major travel destination, with easy access from across Canada, the United States, Western Europe and Asia.   Thanks to the recent Olympics there is a truly beautiful and efficient airport, to be sure.  

 So it would be fair, reasonable and accurate to say with conviction that the potential for downside risk from either the occurrence or severity perspective is low-low-low.  

Some of you will want to know more and for those of you interested the preliminary website is available now at:  http://polqm.ca/conference_2015/home.html .

I look forward to meeting with some of you in Vancouver from October 28-30, 2015.  

More information will be available shortly. 
I will keep you informed.