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Wednesday, June 26, 2019

Quality Management Education – Message and Structure by Design

It has been a while since I have been in a blog writing mood.  Too many things happening.  Over the next short while I expect we will be much more active.  My most recent experience has been in teaching Quality Management to laboratorians of all professions as part of our university's Continuing Professional Development program

Our Virtual Classroom On-Line Education (VCOLE) course has been growing rapidly, to now almost double our enrolment of 2015.  This was in interesting lesson for me because I have always been resistant to allowing the course to get larger than 25 participants because I thought that too many people would create chaos in the classroom discussions.  I was convinced to be more open, and this year we had over 40 people, with physicians, technologists, quality managers, and administrators from multiple countries, and I was amazed at how well it worked.  Yes, there were some comments on overcrowded discussion sites, but we learned how to fix that, and it indeed worked excellently.  The participants really seemed to enjoy the course, and I know that their course colleagues will continue to be an important contact source for the participants as they develop their own contact networks.  It took a little bravery on my side, some risk/benefit analysis, and we came out with a success.  

In a similar vein, we were approached by an international health organization to see if we were interested in taking our course to South East Asia to deliver the course for an additional 26 Quality Managers and Laboratory Managers.  The challenge was that most of the group spoke little English and their internet access was usually unstable.  So with a little head scratching and some Deming-like Planning, we figured out to deliver the course not on-line, but on-site with the assist of some translators.  Rather than run the course for a continuous 21 weeks, as the current on-line course runs, we had to adapt the schedule to allow people to come together from across the country in a single place without disrupting their work.  (Also if I had decided to go to leave Canada for 21 weeks, I suspect my wife would have not been pleased).  So we settled on 1 week every six months, with continuity plans built in.  That meant maintaining the content of the on-line course, but adapting it to 3 very intensive weeks that included content, presentations, discussion, assignments, quizzes and a final exam.  

As with every plan it needed some tweaking along the way (call that Plan-Do-Study-Act) but it was amazing how well it came together.  The group stayed intact, their performance evolved to a very productive point, and their reviews at the end were in the range of 88% high level success.  

All it took was a little innovation, creativity, planning and impetus, but I suspect that you would all say that if every plan was put together with the same tools, the outcome would be fairly predictable.  

This has been a very busy time for all our mentors and staff, and for me.  And it took a lot of background administration to bring it all together but this is what I learned:

  • Health organizations around the world are increasingly aware to the Costs associated with Poor Quality.
  • The appetite for Quality Management training in the laboratory area continues to grow.
    • People want the knowledge
    • Their institutions want the knowledge
    • The public demands the knowledge.
  • More and more institutions are prepared to support their staff participating in courses that are designed to deliver. 
  • Quality Management courses can and should be delivered in a variety of appropriate organizations and institutions, including universities.
  • The impact of the Quality education impacts the people that take the course, their staff, their customers, their family members, their organizations and institutions and public health.

  • The sharing of knowledge is profoundly positive and enriching on all sides. 

So now we have one course in Laboratory Quality Management that is ready to go in two formats, both on-line and on-site.  We know there is an audience and with two proven approaches, we are ready to continue on. 
Burn-out is NOT an option.

For more information visit: www.POLQM.ca

Monday, February 4, 2019

GB/T32230: Quality Culture and the Medical Laboratory.

So I was browsing in this month’s Quality Progress (January 2019) and found an interesting article written by Ningning Jing about Quality Culture, a topic about which I have a lot of interest.  What caught my eye was that in 2015 a new guideline was created and subsequently published by China Standard Press entitled Chinese National Standard, GB/T32230-2015—Guidelines for Quality Culture Development in Enterprises.  I was unable to find an ISO equivalent, so I am unsure where or how the Standardization Administration of China (SAC) developed guideline.  As it turns out it is available in English, but it was fairly expensive

The guideline makes for some interesting reading.  It reminded me of how much medical laboratories have changed over the last 15 years, dating in my mind back to the original publication of ISO15189:2003 (Medical laboratories – the particular requirements for quality and competence).   

Laboratory life has changed a lot since those early days.  Despite the awareness of some of the efforts of W Edwards Deming and perhaps of Armand Feigenbaum and Total Quality Management in the 1980s, for the most part, quality in the medical laboratory was largely mechanical and technical.  The concepts of quality were mostly about accuracy and documentation, and very little about timeliness, or appropriateness, or clinical relevancy.  The quality dynamic was the laboratory, the physician customer and the specimen.

Quality principles as expressed in ISO15189:2003 made a material change because it introduced concepts of Quality Managers and patients and the needs and requirements of the staff.   In today’s medical laboratory, quality has expanded to address satisfaction, and interested parties and stakeholders and service excellence.  Modern laboratory quality is an essential component of every aspect of the total experience.

Today many almost every laboratory conference and education program and continuous improvement program for medical laboratorians will focus on some aspect of the essentialness of a Culture for Quality.

What many may not realize is that Quality Culture is not a new concept.  Joe Batten has been writing on the topic going back to 1992.   Back then Batten presented a definition of Culture that I still rely upon today [Culture: The pervasive philosophy, central values, beliefs, attitudes and practices of an organization, and the micro-elements that make things happen.] 

While I still have my old copy of Building a Total Quality Culture, I see it is no longer available even on Amazon, but I see there is a new edition (2014) available.
This new guideline defines quality culture as the “total of quality concepts and values, habits and behavior patterns, basic principles and systems as well as their material performance recognized by the enterprise and its staffs”.  With interest, ISO 9000:2015 provides a similar definition: “a culture that results in the behaviour, attitudes, activities and processes that deliver value through fulfilling the needs and expectations of customers and other relevant interested parties”  When either of these variation definitions is combined with the one used by Batten, back in 1992 you capture a clear picture of Quality Culture. 

The new guideline makes several points: (a)  the culture must be driven and directed from the top; (b) that without leadership, a quality culture is unlikely to happen.  And (c) that leadership by itself is insufficient and if the staff are not engaged then the process with fail.  (I am reminded of Feigenbaum who said that Management is responsible for 80 percent of Quality, with the organization sharing the responsibility of the 20 percent).  (d) the document reminds that Quality Culture is NOT a cookie-cutter operation.  Each organization is unique and their culture must have the freedom to reflect that.  And importantly (e ) building a Quality Culture is NOT a one-and-done activity; culture is a philosophy/attitude that must mature and change with experience.   

Importantly the new guideline urges that to ensure that the organization has implemented a truly effective program, it has to find a way to measure its impact, which begs the question, can one really measure an attitude?  Well the important answer is “yes, you can!” 

In our course on Laboratory Quality Management we talk about Quality Culture, and provide some ideas on how culture measurement can be done and more  to the point, illustrate how it is possible to assist culture realignment when the organization’s changing needs require. 

I have not yet taken the opportunity to read the guideline thoroughly, but so far I am pretty impressed.  I suspect that when the crafters of GB/T32230-2015 were thinking about “enterprises”,  medical laboratories were no where on their list.  But they have done us a valuable service. 
Do I think that the new version of ISO 15189: 202(?) will incorporate some elements of quality culture?  I would be pleasantly surprised if it did. 

But regardless, it is well worth the read.