Thursday, November 4, 2010

Quality Confab and Disconnection

I attended Robert Michel’s Quality Confab in San Antonio this week.  For those who do not know about the Confab, it is slowly become one of the sentinel Quality Meetings for those interested in medical laboratory quality.  (More on the other sentinel meeting shortly).  Lots of good speakers giving lots of good summary presentations.  Enough material for lots of folks to learn.  Enough material for lots of folks to discuss, ergo the title “confab”.  I gave a presentation about the challenges associated with examination phase error.  I will post the presentation on
But that is not what I want to talk about.  For me the most interesting and intriguing 10 minutes of the whole 2-day meeting, and perhaps for the year, was a brief discussion by Michael Astion (University of Washington) on the concept of Disconnection.
Michael is a long time leading Quality Guy, with a variety of insights on laboratory error, and as it turns out a lot of common sense concepts on Management theory and Human Resources.  In previous meetings he has talked vividly about human slips and foibles that contribute to error.  But this time he addressing error from a broader management perspective.  One point that jumped out for me was that one of the reasons that laboratory workers  make errors is because they have become disconnected from the clinical reality, and that being disconnected contributes to more focus on the self and less on work contribution.   
A solution for this is to reconnect and revitalize by bringing patients to the laboratory and the laboratory to the patient.
This sparked about whole slew of images for me. 
In many microbiology laboratories, not only is the technologist disconnected from the patient, they are disconnected from the specimen and even the requisition.  In some laboratories the technologist working on the culture doesn’t even get to see the patient gram stain.  For them the whole patient care experience is looking at some petri dishes.  Not only does this contribute to formulaic microbiology, it is also extremely difficult to sustain a sense of clinical perspective if you are completely eliminated from any vestige of the customer and patient care. 
The same is probably the case for chemistry and haematology technologists as well, although I suspect being involved in blood transfusions or smears with leukemic cells may snap folks back to something closer to the clinical realm.
A number of years ago there was a lot of discussion that there could be a lot of value in taking a technologist off the bench, and have them make ward rounds with clinical staff to assist with laboratory and testing issues.  The concept was essentially developing a laboratory equivalent to the clinical pharmacist.  By putting a laboratory person on the ward would be beneficial for the patients and clinical staff because they would gain insights from the laboratorian, and the laboratorians would benefit from the clinical exposure.  It was a great idea, but never seemed to take off.  I think it was just a too far ahead of its time.

So this notion of disconnection as a interference that could be reversed has been around for a while, and it is still an intriguing today.

On the other hand, laboratory folks are not the only workers stuck in the ME generation.  Someone once said that hospitals changed for the worse when  they stopped primarily being places where unwell people would go for care and attention, and started being places whose primary focus and function was to hire nurses.  There is lots of clinical staff who have all sorts of access to the patient care experience, and who still focus most of their time and effort working and worrying mainly about themselves. 

So count me intrigued by the concept of disconnection.  I have a lot more thinking and hopefully some reading on the topic.
More on the Confab shortly.

PS - With respect to the other sentinel meeting, eserve June 18-19, 2011 for the UBC Program Office Quality Weekend Workshop in Vancouver.

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