Sunday, December 19, 2010

Preparing our next generation of leaders

I am preparing a number of new presentations for our Resident and Graduate Student Quality Seminar Series and took the opportunity to re-read Deming’s Out of the Crisis, written in 1982 to expand on the 14 Principles.  In chapter 2 Principles for Transformation of Western Management he writes “Support of top management is not sufficient.  It is not enough that top management commit themselves for life to quality and productivity.  They must know what is is that they have committed to – that is, what they must do.  The obligations can not be delegated.  Support is not enough; action is required.

This is a core message that I am going to convey.  

Medical laboratories provide a broad variety of services including creation and provision of a menu of diagnostic tests, creation of a method for ordering tests (I hate that term: more on this later) and then providing a process for collection and transport.  The samples get accessioned and tested and results get generated and reported.   

Along the way some quality processes take place, including quality control and proficiency testing and sometimes accreditation.  Some projects, like the application of “Lean”, or a Lean variant of time and motion get initiated and sometimes actually competed. But we all know that problems still continue.  Over the last very few years we have seen pathologists misinterpreting and misreporting findings, faulty HIV testing, faulty tissue diagnostic tests, and pathologists with a pathological ineptness in writing reports.  We also have well documented sample contaminations in chemistry and microbiology.
In some laboratories we are starting to do more.  Quality management is starting to manifest some continual improvement processes (which is good) and even some error investigation (which is better).

So far I have told you nothing that you don’t know and that you have not heard before. 

But here’s what our residents need to know and understand.  That when push comes to shove all the above mentioned errors have a single primary root cause and it has little to do with technologist training or standard operating procedures, or competency assessment.  Our primary root cause of laboratory error is the consistent and persisted absence of personal active engagement by our medical laboratory directors in Management Review and change.  
 Quality is not about hiring a Quality Head, however named, and then delegating authority.  Management Review is not about being handed a bunch of manuals and annually signing them off, or about asking the Quality Guy how we are doing.

Our next generation of medical laboratory directors need to know that quality management is as much a part of their job as is reading pathology slides or signing our reports or dealing with human resources and budgets.  And it is not about number of slides read per hour worked or number of INRs ordered per week.  And it barely is about some artificial and artefactual measure of turnaround.   

They need to know there is a quality expectation, a quality vision.  Keeping laboratory staff focused on what matters is a critical function of the laboratory director . They need to know that satisfaction is not about making complaints go away, but is about comprehensive communication with hospital staff and patients.   

They need to know that quality is a science of planning, execution, measurement and response.  And they need to it is their job to make these things happen.

So it should be an interesting seminar series.

PS: I have a plan to see if we can monitor our impact on three scales: immediate, intermediate and at five years.  

PPS:   We have made some important changes to the Quality Weekend Workshop.  Dr. Denise Dudzinski is a bioethicist who recently published an article in NEJM on Disclosure Dilemma – Large-Scale Adverse Events.  I am looking forward to her presentation.

PPPS: I would really appreciate it if you can go back to the previous entry and fill in the survey.

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