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Wednesday, April 11, 2018

Quality Story Telling - take 1: An additional cost for quality??



There are many paths that lead to Medical Laboratory Quality Improvement; education conference and study, implementation of innovative programs, and working at the level of personal responsibility and in particular building a strong positive organizational culture that supports and promotes quality thinking.   In our course we put a lot of emphasis of highlighting all these approaches, and we do it through the process of storytelling, which is the way that adult learners share their experiences in a way that others pick on new insights.  
 Storytelling can benefit both the story teller and the story listener.  It is a great way to communicate and learn all at the same time.

So let me tell you a story.

The other day I was in a discussion with a person with a lot of responsibility for laboratory activities in our province.  We were talking about our province’s on-line reporting system for medical laboratory error, in part because of the two recent manuscripts that I and colleagues have recently had published on the subject.
(Medical laboratory associatederrors: the 33-month experience of an on-line volunteer Canadian province wideerror reporting system. Restelli V, Taylor A, Cochrane D, Noble MA. Diagnosis (Berl). 2017 Jun 27;4(2):79-86 and Laboratory error reporting rates can change significantly with year-over-yearexamination.  Noble MA, Restelli V, Taylor A, Cochrane D.  Diagnosis (Berl). 2018 Mar 28;5(1):15-19.
[Both available on PubMed].

 This provincial reporting system (the BC Patient Safety Learning System or PSLS)  is now about 10 years old, and suffers many of the problems of most 10 year old software; that being said, the system has far more positives than negatives and provides us with a lot of information and insights on the state of laboratory quality efforts in British Columbia.

It is a volunteer program where the reporter identifies a problem and goes to the on-line site and completes a reporting.  Sometimes, the same event can be reported by more than one person, each from their own perspective.  Sometimes an event that people wanted to report does not get reported because it was inconvenient at the moment to stop and report, and then people forgot or got otherwise distracted. 
Error reporting is not particularly balanced; there are some profession groups and some geographic parts of the province that are likely to report events and other seem to have little interest, and that was the topic of our discussion.

So I was having this conversation and this person came up with two comments the first was that the system is not helpful or user friendly because a laboratorian would have to take 5 minutes to complete an on-line report, and that laboratory physicians are far too busy to stop and take the required 5 minutes just to report an error.  
In this person’s mind consuming 5 minutes of their valuable time was some sort of terrible imposition that way overrides the systemic benefits of reporting errors.   As personal conviction, reports should not be entered until PSLS spends the money to revamp the software so the events can be entered in less time, caving these poor overworked souls 2-3 minutes a day.  Regardless of costs, their time constraints demand it. 

But then they went further; the reason that people don’t report is because there is no financial incentive to participate and report.  

Rather than pursue the conversation I decided to change the topic.  If what I thought was being said was indeed being said, our discussion would have turned into an ugly confrontation that would have benefited no one.  Surely nobody with a modicum of quality awareness thinks that the best way to enhance error reporting is to pay people to report.  What could possibly go wrong with that idea!!

In actual fact, the data in the two manuscripts points to the fact that this person was wrong.  Over the years, the rate of error reporting has gone up substantially.  It seems that increasingly people are using they system, despite what slight software inconveniences exist.    The system probably could be enhanced, tweaked, to make it a little more user friendly, but major overhauls would cost a ton and likely introduce all sorts of interface problems with not much benefit towards reporting.  

If we need to do something it is to work with the groups who choose to not report and find solutions to the barriers.   I suspect it is probably something as simple as being unaware, or “fear of the learning curve”.  I suspect it is more about habit than conviction.  And I suspect it has NOTHING to do with people begrudging the couple of minutes to report.  (By the way, if a laboratorian is having to report more than 2-3 errors a week, costing them more than 15 minutes there is something going on that needs a lot more attention.

The evidence to date is that reporting errors has a lot to do with quality awareness, and personal conviction and growth that comes with quality activity.
 Reporting progress does not need BIG thinkers, it needs engaged thinkers who see value in spending a few minutes to initiate a report and implement a corrective action.  

But if it requires extra MONEY to support a pay-for-reports program, then we are really in trouble.
M