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Tuesday, September 4, 2018

Standards Do Not Create Quality.

So I am putting on new course and it gave me the opportunity to shake and shape my thoughts around Quality; to clear the cobwebs.  What I re-discovered was that standards don't create Quality and nor does accreditation or certification.  It is the reverse that is true.  Quality is derived from Principles, some decades and centuries and millennia old that are the real foundation.  

So what are these core Quality Principles and could I put them together in a sufficiently coherent  structure that I could convey them to students?

Here is what I came up with.

Before you can implement a Quality Program,
first you must understand The Quality Principles

While in this course we are focused on issues related to laboratory quality management, it is important to understand that Quality is universal, and independent of sectors and industries.  Quality is driven by underlying principles that put value on error free products and performance and put value on customer and staff needs. 

Quality Principles in one form or another have existed for decades and centuries.  Early evidence of principles the creation of Egyptian Pyramids (3500 BC)  and creation of Greek ships (2500 BC) creation of Roman Coliseum (1000 BC)

Quality Principles are seen in works of Eli Whitney (Interchangeable parts; 1800), Frederick Winslow Taylor (Time and Motion Studies;1890), Henry Ford (Variation control; 1910),  Walter Shewhart (Quality Control; 1920), W. Edwards Deming (Organizational Management;1940), Piggly Wiggly (Just in Time Inventory Management; 1950) , Taiichi Ohno (Waste Reduction;1970), Phillip Crosby (Error and Quality; 1980)

Quality is the underlying theme of key standards and of accreditation, but it is important to remember that standards and certification and accreditation are the products of Quality Principles, and not their source 

Most groups who understood and adopted Quality as a strategy have gone on to succeed; man who decided to take a different path have failed.  

These Quality Principles include:
a.     Know your Structure
b.     Efficient (time and money)
c.     Organized (work to a plan)
d.     Be Faithful to the Purpose
e.     Prevent and Reduce Error
f.       Prevent and Reduce Waste
g.     Take Risk into Account
h.     Open to Learning and Growing
i.       Create Change and Measure Change
j.       Focus on all your staff
k.     Focus of all your Customers

Know your structure. 
Every organization has a structure.  Someone is the “boss”.  Someone answers directly to the boss, and others report to them.  In a healthy organization, everyone knows to whom  they report and who reports to them.  The chain is essential for clarity and  for avoiding cross purpose.

Efficient (time and money)
Respecting time and money means that work gets done on time and within the limits of resources.  Being efficient allows you to be more productive and more effective.

Organized (work to a plan)
Effective work stems from a plan and stays true to the plan through the hills and valleys If change is required, that too should work to and from the plan

Be Faithful to the Purpose
Creation stems from a vision and a purpose.  Deviating from the vision and purpose risks meandering and loss.  Quality activity is fit-for-purpose.

Prevent and Reduce Error
We cannot stop all error, but we can learn from it in a way to prevent it from recurring.  Other errors may occur, but repeated error is opportunity lost.

Prevent and Reduce Waste
We cannot stop all waste, but we can learn from it in a way to prevent it from recurring.  Waste is can be an abuse of resources and cause damage to our plan.

Take Risk into Account
Pushing limits leads can lead to growth and change and progress.  Extending beyond  limits risks collapse and failure.  

Open to Learning and Growing
If an organization is providing opportunities for all to learn and grow, then the organization risks stagnation.

Create Change and Measure Change
Change is good, but only if it is measured.  If you don’t know how you got to here, then you can’t know what you will be leaving.

Focus on all your staff
Your staff are your business.  Without them you will fail.  Know and understand and respect your staff.

Focus of all your Customers
Without customers, your business will fail.  Know and understand and respect your customers.


  1. Thank you for this discussion.
    It is interesting to note that in The Lancet's (Vol.392 | Number 10150 | Sep 08, 2018)editorial, Putting quality and people at the centre of health systems, they note, "People need to be central to all measures of quality.

    …... people have become invisible in measurements of quality across health systems worldwide. The focus is on “inputs”, even though these are not what matter to patients."

    1. Thanks Anna
      I absolutely and totally agree (ergo - focus on your staff; focus on your customer.) We have allowed healthcare to deteriorate on both sides of the equation. We have laboratories where staff are considered as "robot equivalents" with lots of expectations and little respect. Worse, we allow the generation of reports in our "laboratory language", but not in a manner that are understandable to patients or physicians. And all too often the response is "we know the reports are terrible, but that's the best our printers can do".

      Recently I have been asked by our Standards Council of Canada to chair our Canadian committee to an ISO Technical Committee ISO TC312 on Service Excellence. The premise of the committee is to introduce the Kano Model for Excellence in Service into international standards. In my opinion the hotel and retail and financial systems will benefit from this greatly, but if healthcare representatives get involved from a number of countries, we can work to create a document for service excellence that applies to healthcare.


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