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Almost Eighteen Months In...

  A colleague of mine experienced   a recent death in his near-extended family.   The person was young and despondent, and unfortunately...

Friday, April 23, 2021

Almost Eighteen Months In...

 

A colleague of mine experienced  a recent death in his near-extended family.  The person was young and despondent, and unfortunately successfully suicidal.  Regardless of all the factors involved, it is always a tragedy when a young person takes their own life.

We are now nearly 18 months into this life-altering, society-altering event that is impacting people and their societies world wide.  Tragedy is a good word to describe what is happening.  Whether this was an accident of nature, or an accident of science may never get resolved.  But there are some things that are apparent, the first of which is how much harm has been done.  And by harm I do not mean viral.

The rise in suicide rate and overdose deaths has been disturbingly high and both linked to the pandemic (1,2) neither a consequence of being infected by the virus, but rather, as being a victim of the societal consequences that have been created in the attempt to reduce the risk being infected.  In the words of the current day vernacular, the rise in suicides and overdoses seems to be a result of our perpetual challenge to “keep safe” and “flatten the curve” by creating a society of “shut-ins”, closing schools, closing businesses, creating financial damage, closing recreation, closing exercise, and closing social gatherings of spiritual purpose.

There has been much work over the last near eighteen months, much with the goal of making life better, with the best of intent, trying to sustain some sense of normalcy, all while trying very hard to make this virus go away.  There has been hard work of creativity, invention and innovation and monumental personal effort, and some with regulatory force. But despite all that the virus has gone through “waves” coming and going, waxing and waning, regardless of our actions.   

In a science based, learning society, we have to be able to stand back and look at what we have accomplished (or not) and then either go forward or recalibrate.  So far it seems there has been a lot of non-success and very little recalibrating.  There have been meetings (many, many meetings), public health people "public-healthing",  politicians being political, journalists "journalizing", to little avail.  The restrictions and proscriptions escalate.  Science types are creating more and better tests, and more treatments, and more preventions, but to date with little evidence that the virus is going away.

 There has been lots of money spent, many pronouncements and predictions made, all with questionable or little impact.   

It would be difficult to call this any sort of success. 

I would like to think that with all that active human brain power we would have been able to effectively outsmart or out-strategize the virus, especially since the virus has NO brain, NO brain power, NO thinking and NO strategizing.  The virus just is.

But with regret the opposite is true. I don't want to say we are still at Virus 1 - Human Brain Power No score, but it is hard to see in what way we are winning.

Thanks to the epidemiologists in our province our experience over the last 18 months.  We can look our society in three groups of people. 

 

People 30 years or younger
“education group”

People over 30 years but under 70 years  “adult worker group”

People 70 years or older.
“senior and elder group”

In our province

1.7 million

2.8 million

0.67 million

People test positive

43,000

62,000

9,300

Got sick

363

2,200

2,300

Died

2

212

1300 

Percent COVID illness in the province

0.02%
20 per 100,000

0.008%
80 per 100,000

0.343%
343 per 100,000

Percent COVID deaths in their age group

0.0001%
~1 per
1,000,000

0.007%
~100 per 1,000,000

0.194%
~2,000 per
1,000,000

 

These proportions have remained faithful and consistent through the whole of this experience.  And they are essentially the same in every jurisdiction in every country in the world.  The young are largely, near completely unaffected, the adults are marginally affected, and the brunt of illness is carried by our seniors and elders.   Our elder care in nursing homes has been a travesty. 

To put this into perspective, we have, over the last 100 years done much better with far worse; Smallpox, Yellow Fever, Malaria, Tuberculosis, Syphilis, Typhoid, Ebola, Lassa, Zika, Meningitis and Influenza.  Dealing with this virus should not be this hard.    

Maybe it is time to acknowledge that perhaps our approach is part of the problem.  We have over-thought, and over strategized, and at least in my opinion what has been done has made things worse rather than better.   If young people are killing themselves through drugs and other means at a disturbingly high rate, almost at the same rate as the virus (if not higher), then it is time to pull back.

We are smarter than what we are doing now.   If we keep creating harm while trying to find a solution, then what we are doing is not working out.  

Regardless of profession, can we all agree that Hippocrates, near 2500 years ago stated a universal truth: First, Do No Harm.

1.       1.  McIntyre RS, Lee Y. Projected increases in suicide in Canada as a consequence of COVID-19. Psychiatry Res. 2020;290:113104. doi:10.1016/j.psychres.2020.113104

2.     2.  https://calgaryherald.com/news/postpandemic/canadas-hidden-crisis-how-covid-19-overshadowed-the-worst-year-on-record-for-overdose-deaths.  Dated March 29,2021.  Visited April 23, 2021

Friday, March 12, 2021

Organizational Quality and Competence - Part 4

 


Measuring Competence

In this series I have focused on personnel competence starting from the  definition of competence put forward by Gonczi and Hager which includes demonstrating  knowledge and skills to perform a job, and  having the soft skills ability of judgement, (problem solving), ethics and talent to perform the job in context. When knowledge, skills, and context are found together people can  take their work responsibilities to the next level, justifying our confidence they are competent and can and will do the job that needs to be done. 

I have this internal personal pressure that wants to modulate competence with adjectives such as “highly competent” or “totally competent”, and it makes me wonder if competence has a scale of its own, ranging from “barely competent” or “marginally competent”, perhaps followed by “competent” progressing upward to “completely” competent.  But that is a musing for another time.

Since you can define competence, then it must in turn, be possible  to measure it.  There are many documents describing traditional competence assessment. 

But as Gonczi and Hager point out, traditional competency based standards all too often create a check box list of things to tick off (tick ΓΌ), but often the check boxes are all based around have certain skills or knowledge, and do not get into the essential contextual parameters of judgement.   As a personal perspective, ISO/IEC 17025:2017 (General requirements for the competence of testing and calibration laboratories) is an example of this. 

 

In the current version of ISO 15189:2012 (Medical laboratories – requirements for quality and competence), is a superior competence standard because actually goes to the effort to describe competence assessment.  That document provides both a definition and informative action plan which frames and  incorporates the concepts raised by Gonczi and Hanger. 

The standard states:

“ Competence of laboratory staff can be assessed by using any combination or all of the following approaches under the same conditions as the general working environment:

a) direct observation of routine work processes and procedures, including all applicable safety practices;

b) direct observation of equipment maintenance and function checks;

c) monitoring the recording and reporting of examination results;

d) review of work records;

e) assessment of problem solving skills;

f) examination of specially provided samples, such as previously examined samples, interlaboratory comparison materials, or split samples.”

 

Measuring soft skills like judgement and problem solving can be difficult to assess directly because they are highly situational can only be done in context.  Creating simulations and scenarios is too artificial and there are few opportunities to directly witness and address showing judgement.  Laboratory directors actually have scarce opportunities to point to employee competence.  And that is a shame. 

 

So, I have come up with some suggestions that might help the characterization of people as displaying their competence and completeness as highly qualified workers. 

Consider asking the following:

1.    When co-workers are unsure about what do to in a situation, is there a “go-to” person that they tend to consult (judgement) ?

2.    Are there workers who generally handle their own work smoothly and then  looks around to see if there are people who might benefit from some support and help (ethics)?

3.    Are there people who can look at accreditation standards and read into them alternative interpretations that don’t compromise the quality of work, but save time by reducing steps that upon reflection add little to the benefit of the work (problem solving)?

4.    In crisis situations like we are currently experiencing through the pandemic, are there people who adjust and re-organize with the workflow demands without compromising sample quality (problem solving)?

5.    Is there a person who speaks up at laboratory meetings and brings up fresh ideas based on experiences that did not work out as well as the laboratory would have liked (judgement, innovation)?

6.    Who are the creators, the innovators, the people who make work interesting?

These are the same questions that you would go through to discover who are your positive leaders, innovators, and initiators that you look to when you need to get the job done.

 

As I think through my personal experience of team building and leadership,  I realize that competence is a talent that may be in part innate, but more importantly is a character pattern that people can learn and grow into through experience and situation and time. 

Not everyone is reaches the level of competence, not because of inability, but because of time and circumstance.    But if you have a team where everyone is strongly capable, you can thank your lucky stars.