Saturday, December 11, 2010

The Science of Qualitology

I like the ASQ’s Quality Management Journal because it publishes articles in a science and experimental structure that I understand and expect to see in a journal.  The article that I was looking at was analyzing factors associated with Quality in hospital settings. (seeR.E Carter, S.C. Lonial, and P.S. Raju.  2010.  Impact of Quality Management on Hospital Performance: An Empirical Investigation.  QMJ.  17(4): 8-24).

The study design was based on a survey sent to hospital executives in 175 organizations in mid-US (Kentucky, Ohio, Tennessee, Minnesota, and Mississippi)). The surveys were sent to Hospital CEOs who were in turn supposed to pass them on to senior folks like the VP administration, Quality manager, Support services manager, Director of nursing.  This was very ambitious.

The conclusions they came to were what I would expect; when it comes to quality size and stress matter.  The more uncertainty in the institution, the larger the institution, the less likely they were to have “measurable” evidence of Quality. 
The “measure” of Quality in this study looked at 5 markers for financial performance, 4 markers of market/service development and 4 markers of quality outcomes.  That, in my opinion was a set unlikely to give a clear picture of hospital quality.

And that brings me to my point. 
What are the objective measures that one can monitor as an indicator for success or failure for introduction of Quality activities in medical laboratories?
Not success in accreditation or proficiency testing scores. They are too readily manipulated  (see   M.A. Noble.  2007.  Does External Evaluation of Laboratories Improve Patient Safety?    Clinical Chemistry and Laboratory Medicine.  Clin Chem Lab Med.  45(6):753-756). 
Not numbers of reported incidents or OFI’s.  They are too open to flexible interpretation.  OFI reports, if anything are like unemployment rates.  A downward movement in rates may mean more people are being employed, or it may mean that fewer people are bothering to look.  And a rise may mean more people are unemployed, or it may mean more people are hopeful and are again more actively looking.  In the same way  a rise in the OFI’s rate may mean more problems are being identified and reported meaning poorer Quality, or it may mean more engagement leading to more reporting meaning better Quality.
How about client or staff satisfaction?  Maybe, but again, very manipulatable and too vague.
And in Canada, financial stability or instability are completely inappropriate since 99 percent (or more) of resources come from the government purse.

So we have a dilemma.  For good studies we need measurable and interpretable and  monitorable outcomes on both a micro- and macro-  basis. We do this on a micro- scale all the time (call that Quality Indicators).  But to move from interesting to convincing and compelling, we will need to define our macro- outcomes as well. 

For Quality to create a lasting imprint in medical laboratories, we are going to have to speak the language of laboratory personnel, pathologists and technologists.  We will need the language of science and experimentation. outcome and conclusion. 

Any and all ideas are most certainly welcome.

PS: Absence of strong interpretable measures makes grant funding difficult, maybe impossible.  I have learned this the hard way. 


  1. Over here in the UK the word "Quality" doesn't mean what one would expect.

    Our "Quality Systems" make no mention at all about blood test results. They are *all* about silly administrative documents being right, nothing being on a notice board unless it is "document controlled"... We could give blood group AB+ to an O- and kill then *if* we did it in the right coloured ink....

  2. Manky
    If that were true, it would be what we refer to as "Quality Behaving Badly".
    Maybe a little over the top?

    Clinical Pathologists Associates, the UK laboratory accrediting body ( incorporates ISO15189 as a core document. Yes?


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