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Monday, August 2, 2010

Culture of Quality - whatamess

Today I was going through a story feed "Clip and Copy Advisory" and came across a Canadian Broadcasting Corporation (CBC) story on the problems and challenges facing Newfoundland and Labrador's Eastern Health Authority (see http://www.cbc.ca/canada/newfoundland-labrador/story/2010/07/29/nl-lab-review-729.html )

Everyone in Canada knows of the unfortunate events that lead to the judicial inquiry by Justice Margret Cameron related to misdiagnosis of breast cancer.  Now there is a problem with measuring and monitoring cyclosporine levels.
I have used the first story many times as an example of out of control Costs of Poor Quality when you add in the MILLIONS associated with the inquiry.  And what is so sad is that they may have to go through this whole cycle again.

I will only focus on a few points, this time, but reserve the right to come back again (and maybe again and again).
From a Costs of Poor Quality perspective, if one looks only at the traditional In-put costs (Prevention and Appraisal) and Out-put costs (Internal and External Failure Costs), you will miss the costs associated with patient and community convenience and expenditure, and way undervalue the costs associated with laboratory error.  [This theme will come back.]

From a Culture of Quality perspective, it must be both painful and embarrassing to read in the public record about dysfunctional relationships among various members of the medical staff, and inappropriate relationships and responsibilities between managers and medical staff, and low morale, suspicion and distrust within the group, not days, or weeks, or months, but years after most of this came to light. 
The messages of Shewhart and Deming and Juran and Crosby were established decades before these problems manifested in such an public and ugly way.  The Eastern Health tragedy has is origins in a medical administration system that ignored all the principles for years as the problems festered and eventually exploded.  

You might be able to cut the physician administration some slack because the knowledge of quality management was not available in medical training at any level (and by-and-large is still not!).  But all those folks with law degrees and business degrees and MBAs have no excuse.  If pointing fingers is something that is going to be done, start there.

So the bigger issue now is whether the folks with lead responsibility will have the personal jam to get the quality management implementation ball rolling now.

m

PS:  This is not a Newfoundland and Labrador story.  Eastern Health is just the one that got caught THIS TIME.  Our history in Canada and the US  is loaded with these stories, and there are many sitting and waiting to come to light.

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