A discussion site for folks interested in improving the quality of medical laboratories. Most will be the thoughts and vents of a long time player in the medical laboratory quality from many perspectives, complex and basic laboratories, developed and developing countries, research and new knowledge.
This post is a deviation from my usual.It is written in response to Julia McIntosh who
put forward a June question for ASQ Influential Voices.Enjoy.
One of the advantages of participating in ASQ is
that it crosses all the industry and professional borders.In ASQ we have the opportunity to think about
and apply our common interest of Quality in the broadest variety of subjects
and situations.I think we call that being
engaged in the world around us.
My personal interest in Education is much more at
the adult end of the scale and in particular continuing education in the arena
of healthcare.To be honest, my kids are
well beyond school age, and when they were involved in school, my wife was much
more engaged than me.It would be far to
say that I am not an expert or an authority in the area of Quality and primary
and secondary Education.But that does
not mean that I am without opinion.
Being from Canada, I am pleased with our record of
OECD performance, but also recognize that we too have a ways-to-go to improve
our schools.In comparison to the United
States, I note that on the aggregate Canadian schools and students do better,
but as an observer of successes of the American side of my family (my mother
was from Kentucky) I think that it is probably still true that our education
performance falls within a fairly narrow band, above the OECD average, while the US
performance is much broader with more higher peaks and and unfortunately more lower valleys.
of students and schools does appear to have a powerful influence on
2.Regardless of their own
socio-economic background, students attending schools with a socio-economically
advantaged intake tend to perform better than those attending schools with more
3.Across OECD countries,
first-generation students – those who were born outside the country of
assessment and who also have foreign-born parents – score, on average, 52 score
points below students without an immigrant background
4.Successful school systems
– those that perform above average and show below-average socio-economic
inequalities – provide all students, regardless of their socio-economic
backgrounds, with similar opportunities to learn.
5.Schools with better disciplinary climates, more positive behaviour
among teachers and better teacher-student relations tend to achieve higher
scores in reading.
And in my mind, most importantly…
6.In all countries, students who enjoy reading the most perform
significantly better than students who enjoy reading the least.
My first comment here is that from the OECD
perspective, there is a lot of room for finger pointing at those who design and
administer education, those who work within it and students and their
families.Put in the terms of ISO and Crosby, Education does not appear to be "meeting requirements" for many, or perhaps, hardly anyone.
And maybe within that group
there are some apathetic students and teachers and administrators who think
that “good enough” is indeed good enough, but on first glance the issues seem to be a lot
bigger and maybe a little less petty.
The message to me is that large and powerful
structural issues abound with socioeconomic statues, single parents, ESL, teacher
engagement, and the student desire to read.
And that is what concerns me.The
aforementioned are “big ticket items” that require and demand a lot of thought
on how to address and focus on better schools, better teachers, more societal
wealth stable families and more engaged students who love to read.
These are not issues that Qualitologists are
going to solve.
These are big issues that must be addressed in the arena of
engaged and honest brokers; debate devoid of party politics, and unions, and media
bias.These are not the sort of issues that go
away tomorrow, or next month.OECD
measures time in decades and multiple decades, and that makes sense to me.This is about LONG TERM commitment and
resources and vision. This requires acknowledgement that “Baby Steps” are part
of an important path forward, but certainly not the goal.
So upon reflection, maybe Michelle Rhee is
part of the solution.Maybe the first
step has to be the understanding that “success” will ONLY be found when we
understand acknowledge demand and accept that “Good Enough” will never be good
There is a revolution afloat
in international standards development.Without knowing all the details yet, the International Organization for Standardization (ISO) is creating new requirements
that include new format rules and perhaps more importantly new justification
rules.I suspect the organization is
feeling some concerns about some sector and subject specific documents that
each introduce some subtle variation from the parent document.Whether or not my assumption is correct, from
my perspective, this is a dangerous road for the organization to travel.It could well end up with some unintended
So far I am aware of two
examples where the process has resulted in a rejection of approval to update an
existing standard. One example is the standard for what the medical laboratory
community calls Point of Care Testing.This is the performance of a laboratory test, sometimes by a laboratory
trained person, often not, outside of the traditional laboratory
environment.This is possible, primarily
as a result of innovation and inspiration by researchers and reagent
producers.These kits in many respects
have been created to be almost idiot proof, the key and operative word being
ALMOST.The results of POCT tests are still vulnerable
if the sample is collected improperly or insufficiently, or if the kit is out
of date or stored or used improperly.Folks need to know and understand this because clinicians, and
especially patients, expect to get accurate and reliable information regardless of who did the
test and where it is performed.And the
standard that was developed was used as a foundation document to help people
learn and introduce the necessary precautions.
Without going too far into the
details, when the technical committee set out to update the document, ISO,
applying the new rules first halted the process and then caused it to cease, as
is their right,
But if the document is not
updated, the existing document now obsolete and incomplete may continue to be
used.That serves nobody’s purpose, and
that includes ISO.
First off, to be clear, just
because a company puts the word “standard” in their name, does not mean that
their documents are recognized and used as standards.Authoritative and informative documents can equally
be written by national or provincial or regional organizations.In many jurisdictions, an accreditation body
has the right and authority to consider a number of documents and decide which
one makes the most sense in their domain.In jurisdictions where there is
no accreditation body, local groups can convene and make their own local
decisions.More importantly, in
situations of litigation, the courts can deem any public document as a standard
of practice, including information written as a “Letter to the Editor” in what
the court considers a journal of record.
The bottom line is that organizations
including bodies like ISO have competition, and more importantly can be subject
to the good will of their document writers, all of whom are volunteers, many of
whom are putting their own time and money on the table.The reality is that while ISO personnel are
managers of their document structure and format and style, they are totally
dependent on those volunteers for the true essence of the documents, the
When organizations change
the rules, countries can choose to no longer send delegates, and volunteers can
choose to no longer expend their effort and expertise and slowly and quietly the
documents starts to diminish and their appeal starts to decline.
The truth is that many folks
are already feeling a certain degree of ISO fatigue.Meetings are expensive to attend and cost a
bomb to put on.ISO puts nothing in to
process other than their name and expects that participants to put up with
their whims and vagaries.This is not a
formula that leads engenders a lot of lasting support.
Once upon a time there was a
young prince born in 1971.A gangly
child, army brat who hung out on university campuses, until his early twenties
when he suddenly became known worldwide.He was swift of foot, indeed so fast that he rapidly developed the
reputation of being the microsecond man… flash.Nobody faster.He was the darling
in all the land and everyone wanted to know him.
As the years and decades
passed the prince went from young shiny and handsome to something larger.With an appetite ravenous he bulged and
bulged; what started as a flash and media darling slowly (or rapidly depending
on your time frame) started to bog down and seemed to choke on his own gargantuan
mass, until one day people looked around and realized the young svelte flash
had transformed into one ginormous frog.
This parable is of course my
story of the transformation of email from the miracle of modern magic to the
bane of human existence.A few years ago,
Martin Bryant wrote that by 2001, there were around 31 billion emails were sent
daily, and by a decade later that number grew to staggering 294 billion.Some days I have the terrible feeling that
everyone on planet has decided to include me as a CC and I receive all 294,
ever day, seven days a week.
To Qualitologists this has
become a major problem.For all intents
and purposes, communication has ceased to function.Every step of get on top of this mountain of
electrons fails.Keeping separate email
addresses for work and pleasure fails in a matter of days.Using an index system buries critical
messages.Trying to sort out what needs
to be addressed now becomes near impossible and makes things infinitely worse
because the pressure to push out a response cause all sorts of errors, not
limited to tragic spelling or unchecked grammar or misconstrued text.Spam pollutes and phishing savages.There is no relief.
I am starting to think that
Quality professionals need to get a grip on all the misdirected emails, the
lost messages, and the generated confusion.Start with the premise that even if the sender believes that the message
of value, the risk of a non-value outcome or a jeopardous outcome is too
Over the last 2 working days
I have received 201 emails.Twenty-six
were relevant and material, and 24 more were valid but unnecessary copies sent
to me, just because.Sixty-two were spam
or phishing files sent directly to my spam file, unfortunately along with 1
file that I was actually supposed to receive.Twenty-three were social media related to LinkedIn or Twitter.The remainder were emails that were not spam
but were clearly in the promotion or updates category of which I really was not
too interested, except for 2 that should have been in my primary index.And annoyingly there was one of my usual
misdirected homonymous misdirects, an email sent to me but really intended for
Taken at its best this
represented a defect rate of 4 per 201 (Sigma value 3.6).On the other hand if we take into
consideration the unwanted and dangerous stuff the error rate is more like 100
(Sigma 1.6).The point is that neither
value is one of which a Quality program would be proud.And this was only two random days,
My point is that I know that
my email experience is all too typical, but is fraught with error and confusion
to a level that no one interested in Quality should tolerate.Email has become time consuming, error prone,
loaded with opportunity for miscommunication or lost communication.What started with so much promise has become
a choke point, a quality failure and a true pain in the butt.
Business and society will
tolerate this for only so long, and then technology will thankfully move
on.As far as I am concerned, enough has
clearly and definitely become enough.