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Wednesday, August 7, 2013

Quality Training in Healthcare



Paul Borawski, the CEO of American Society for Quality (ASQ) writes an interesting blog that is worth following.  His most recent missive is on the state of Quality Training, as viewed by ASQ members and survey participants  [see:  http://asq.org/blog/2013/08/global-state-of-quality-professional-training/?goback=.gde_3618260_member_263460329 ].  In many respects I am both disappointed and relieved in his observations.  

In-organization results of the ASQ survey data indicate that organizations with central Quality Teams tend to provide Quality education more than other organizations, but usually only to people within the organization with direct interactions with the Quality Team.  The rest get nothing.  Quality training seems to increase with the size of the organization.  By-and-large service sector organizations trail in the amount of Quality Training.  Those are not what I would call great results from Quality oriented people responding to a survey send out by the American Society for Quality.  That is the disappointing part.

The relieved part is that against that yardstick, Healthcare doesn’t look as bad as I thought.

That is not to say that healthcare training in Quality is any great shakes.  It is not.  If fact it stinks.  First off the number of healthcare institutions with a functional Quality Team is rarer than rare.  

Quality is not an active component of the curriculum in medical school, nursing school, or institutes for technology training.  But during the last 5-7 years, increasingly Quality is becoming a part of the conversation for some during their post-graduate training.  A large portion of it is informal, but at least it it is present. 
I can give you some examples in which I get to participate.  

The British Columbia Society for Laboratory Science (BCSLS) puts on regular continuing education webinars on a variety of topics of interest for working medical laboratory technologists.  Over the last 2 years I have put on 3 two-hour teleconferences and have updated a training DVD.  

The BC Patient Safety and Quality Council puts on an annual conference, primarily attended by nurses.  Even if much of the projects that are presented as research are pretty weak, at least nurses are getting engaged in Quality projects.

For Medical Laboratory residents (specialists-in-training) we put on a regular 8-10 hour seminar series to talk about Quality issues relevant to medical laboratory practices.  While this may seem like a minimal effort in a training program that can take 4-5 years, it is a big start.  When I was a resident, and for many years after me, the very folks that were training to become the leaders in medical laboratory practice, worked in a total Quality vacuum.  

Over the last while there have been an increasing number of healthcare related conferences dedicated to medical laboratory Quality.  Probably the best in the United States is the Quality Confab, put on each year by Robert Michel of the Dark Report.  

In Canada, I have put on a number of highly informative conferences.  In October 16-18, 2013,  I am hosting the University of British Columbia Quality Conference for Medical Laboratories in Vancouver BC.  The meeting is being held in conjunction with Standards Council of Canada putting on their annual national celebration for World Standards Day, and with the BCSLS (see above) who are promoting the conference as an ideal conference for medical laboratory technologists.  We have an array of brilliant speakers on a variety of issues critical to medical laboratorians including Error, Competency, Stress, Measurement Uncertainty, plus, plus, plus.  [see:  http://polqm.ca/conference_2013/conference_2013/conference_home.html ].

And we have our virtual classroom on-line Certificate Course in Laboratory Quality Management.  

So is that enough training for Quality for medical laboratory professionals? Absolutely not !  But in comparison to how little was being done back before 1999 (Do you remember Too Err is Human ?) it is a pretty good start.  

Healthcare’s record on Quality is not sterling.  Too many people are severely sickened or worse as a consequence of health care error; infection, faulty medications, surgical misadventure, etc.  Trying to control this through the litigation process (i.e. malpractice suits) has been an abysmal failure, with the only measure of success being the personal wealth of malpractice lawyers.  The answer lies in implementing Quality and Error awareness into the education process from the get-go for administrators, docs, nurses, technologists, and indeed every person who works within a healthcare facility.  

Do it right, or don’t do it.

PS: Our conference is not only for Canadians; to date we have registrants from Canada, US, Saudi Arabia, and Australia.

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