Tuesday, October 5, 2010

Cheap and Easy Things That You Can Do to Improve Your Laboratory's Quality (Part 1)

One of the myths that people perpetuate is that implementing quality improvement is a problem because it is complex, time-consuming and expensive.  Those of us that do this on a regular basis know and understand that this falls into the classification of self-fulfilling prophesy.  Many laboratories decide that quality has to be complex, time-consuming, and expensive and, thus it is.
But there is a graph, not as well known as it should be, by Joseph Juran that pointed out the small changes in prevention and assessment costs result in big changes in failure costs.  In a sense it is another version of the 80-20 rule, a 20 percent change in prevention costs results in an 80 percent reduction in failure costs.

So with that in mind, I propose the following as simple things that can be done by everyone in every laboratory which can help laboratory improve quality.

Set a Goal for Personal Competency Assessment
Your laboratory doesn’t have a competency assessment program?  That’s OK (well actually it’s not) but it shouldn’t stop you from setting your own goals.  Commit to reading at least on SOP in some detail every week, two-week, month (whatever).  See if anything has changed since you read it last.  Write some notes, think up some scenarios, see if you could work through them following the SOP. (Sounds like what you suggest to kids in grade 5 or 6 when they are starting to learn about how to learn).
Cost to you:                           An hour a week, or an hour every two weeks.
Cost to the laboratory:           Nothing.
Benefits to the laboratory:      Huge.  You are better informed.
What’s the downside?:           Maybe you find the SOPs are in a mess.  But even that is a benefit.  (This will come back in part 2 with “Perform personal internal audits”.)

Rethink and re-present some of your procedures.
This will seem counter-intuitive, but the problem with many (maybe most?) laboratory SOPs is that they are too complicated.  Most contain too many steps, too many rules, too many words, and too many pages.  And, in my opinion, a complicated flow chart is a worse choice than no flowchart at all.   If you are running a high security, high tension laboratory, some of that might seem appropriate, but one thing is for certain, complex procedures rarely get followed accurately. 
Many procedures in many laboratories, or are constructed by a person or a group that doesn’t  actually perform the procedure.  So some hands-on input can be very helpful, and in an laboratory with a open-door attitude should be very welcome.
Once you have worked with a procedure, you are likely to get a better feel for what it says and what it means. 
First off, don’t do the three “Don’ts”.   (1) Don’t just complain to your colleagues, and (2) Don’t just deviate off  from what is expected, and (3) Don’t just talk to a supervisor.  Put your thoughts in writing, and make sure that you include your thoughts on how you can make the procedure clearer and better.  Maybe it can be made clearer with some simplifying pictures along with some simpler text.  Maybe there is an opportunity to supplement with video clips, combined voice and text, (digital cameras are now really cheap, and editing software is downloadable and free).
Cost to you:                            An hour of your time.
Cost to the laboratory:            At the most $300 for a camera
Benefit to the laboratory:        Huge, because it creates engagement, and potentially will result in improved operating procedures.
What’s the downside?:           Supervisor ignores your ideas.  At least you know.

Start a Quality Discussion Group.
The Culture for Quality needs to start somewhere.  Most often with a discussion group.  Get a group of people together that want to talk about quality stuff they have experienced, or thought about.  Use it as a brainstorm.  “Is there any stuff in there that might work in your laboratory. 
It takes a lot of ideas, many of them turn out as not very good ideas before you find the right one.  Sooner or later the pearls will start of flow
Can’t think of a starting point?  Get the group to check out Making Medical Laboratory Quality Relevant and then have a discussion or conversation.
Cost to you:                            A lunch time once a month
Cost to the laboratory:            Nothing, or maybe someone springs for some cookies.
Benefit to the laboratory:        Starts or builds upon a culture of quality.
What’s the downside?:           Nobody else is interested.  At least you know.

To be continued …

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