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Monday, January 12, 2015

When the Public turns against Quality




I regularly refer to Quality Partners, as organizations committed to improving laboratory Quality.  At the same time, the single greatest impact on Quality comes from the public through its agents: the media, the regulators, and the legislators.  The following describes when the public conspires to kill Quality. 

For those outside Canada, Saskatchewan is a province just west of the true geographic centre of Canada.  It is a province big in size, small in population with a growing economy based largely on agriculture and resources.  It is currently run by a centre-right party (the Saskatchewan Party) with a substantial majority with a centre-left party in opposition (49 seats versus 9 seats).  Most would not be surprised knowing that the government is interested in being financially efficient through error and cost reduction. 

To do that it has turned to Quality and Lean, with particular attention on Healthcare (that is a good thing).  To accomplish this they decided to hire an American consultant group (not sure why; there are many Canadian organizations that could have done equally well) to investigate, advise, implement and train a team of Lean leaders throughout the province.  

One aspect of the implementation was right out of 5S (as in Sort - Straighten - Shine (clean) – Standardize – Sustain); they supplied templates and guides on how to Standardize procedures in Healthcare.  So that was what the team of Lean Leaders did.  They went through the healthcare system and wrote “SOPs” to standardize process.  To anyone reading this story on this site, that would all seem to make a lot of sense; Yes? (of course Yes!).

So now we enter into the politics.  The opposition party (remember their very weak position) decides to take a swipe at government because they say the contract with the American consultant was too rich.   Well, politicians are politicians and opposition parties are supposed to say bad things; so I can live with that.  Besides I’m still annoyed by a decision to go American, when there are lots of good Canadian organizations that can implement Lean programs.

But then things get stupid.  

First the opposition party report through the media that they found a standardized procedure for making coffee.  This, the media jump all over.  The coffee instruction became a major scandal.  The fact that it was not in a healthcare facility was irrelevant.  

Then they went on to complain that over the last few months the amount of savings due to Lean was paltry.  Then they complained that the problem with Lean is that uses too much jargon and is disliked by many front line health care workers [see: http://www.cbc.ca/news/canada/saskatchewan/sask-nurses-say-they-re-being-intimidated-over-lean-program-1.2610542 ].  This too becomes fodder for the cross-Canada media.  Then it is reported that the Lean program was implemented not only in acute care but also in nursing homes.  Shock upon shock.  

To be fair, there were some stupid things done, like deciding to import Japanese senseis to help in the Lean training [see: http://www.cbc.ca/news/canada/saskatchewan/wanted-japanese-translators-to-assist-lean-consultants-1.2816341 ], and an apparent decision to replace nursing home residents' facilities with space for health-care bureaucrats [see: http://www.leaderpost.com/news/Mandryk+Wall+must+avoid+another+lean+mess/10704492/story.html ], but by the end of all this, the opposition centre-Left and the hard left media (the Canadian Broadcasting Corporation – the CBC) have done the province of Saskatchewan and the Canadian news watching population a great disservice.

The outcome of all this is that with all the negative media attention, the government decides to back away from the Lean consultants and terminate the contract early.  No mention is made about if they plan to walk away from the Lean activities they have implemented.

Canadian healthcare is financially out of control and needs significant action, not only in Saskatchewan but all across the country.  One of the reasons that Canadian healthcare has so many problems is that it is controlled by healthcare unions that have no interest in addressing cost effectiveness, especially if it means reducing positions or union wages.  (Gee is it any wonder that these unions would resist and dislike a program like Lean.)   

Recently I wrote that Quality will inevitably fail when an organization has an endless supply of customers, with essentially no threat or consequence to counteract indifferent behavior [see: http://www.medicallaboratoryquality.com/2014/12/competition-and-quality-partner-dynamic.html ].  This is the very definition of Canadian healthcare system 

Going after a government plan to implement continuous improvement through a program like Lean, is easy, just blame it on a mean government being hard on those poor front line workers and point out some trivia like a scandalous instruction about coffee.  

But if this Quality initiative gets killed before it gets started, there will be blood on people hands, and everyone including the government, the opposition, the unions, and the media will all have to wear it.

At least that is my opinion.



1 comment:

  1. I realize that Nurses have a totally different mindset than Lab Technologists and other lab staff. They are patient oriented and are not of the mindset of facts and figures. Most Lab Techs are very technical, goal oriented, and organized. MLT'S tend to be thinking of Quality in a different manner than Nurses due to the variance in training, responsibilities and personalities. I think that there is to much of a barrier of knowledge of what each position is responsible for and therefore misunderstanding of how, where and why Quality in processes work. MLT's have more opportunities to be in the Nursing environment but that does not hold true for Nurses or doctors in the Lab environment. A better understanding of each other's responsibilities I believe would enhance the ability to achieve quality.

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