Sunday, April 24, 2011

The Measure of Quality

I have found myself in a number of common theme conversations recently about the measure of Quality as it applies in the medical laboratory. When I think about the measure of Quality, I see this as different from the definition of Quality. I am very comfortable with the definition offered by the International Organization for Standardization, which is fulfillment of requirements.

Folks who create Quality Mission and Goal statements for meeting and exceeding requirements, don’t get it. Meeting expectations is a very laudable and difficult goal. Trying to exceed is a combination of bravado, or empty rhetoric and misguided ambition.

If the client wants their product or service on Tuesday at 09:00 AM, then having it ready on Monday may exceed, but is also apt to be as inconvenient as having it delayed until Wednesday. Tuesday means Tuesday. In the medical laboratory we do this all the time. Having test results available when the clinician is not available to use them (the patient has already left the physician’s office, or the office s closed, it is the middle of the night) creates a lot of undue pressure, and is costly of time, effort, energy, and money and and often results in increased reporting errors because the results may not be properly screened.

But to get back to the point. Having a Quality program is a measurable process, and relying on customer satisfaction, while important, is not enough. Crosby talked and taught that total costs of poor quality (CPQ) as the measure, and he was right, but having set up a CPQ in the past, I know that it is a challenge that few laboratory quality managers have the where-with-all to implement tomorrow.

So how about measuring numbers of errors this year versus the number from last year. I like that as a simple countable measure. It would certainly fit with using “Do it Right the First Time” as a laudable goal. The only problem is that we can do all the right things, and have increasing success with DIRFT, and still not see an appreciable drop in the number of recorded incidents. And that doesn’t mean we were unsuccessful. Medical laboratory error is common, and to a large extent unavoidable. Bad things happen with annoying regularity and even worse with annoying and unpredictable irregularity. Slips, distractions, delayed transport, wrong names, crossover contamination and inaccurate dilutions both by “bullet-proof” analyzers. So the absence of error may not prove a useful measure.

So if you can’t really stop them, then at least you can do something about them. There is timeliness of response. The true measure of medical laboratory quality is having systems in place to catch problems quickly, fix the information before bad things start to compound. Acknowledge and advise. Learn and commit to avoid the conditions that set up the error the last time, so that it can be, at least to the extent reasonable, be avoided the next time.

Bad things happen, and they happen all the time. Quality laboratories respond quickly, openly and aggressively.

Poor Quality laboratories don’t.

And that is something that we can all measure.


May 1 is the end of the registration early bird period for the POLQM Weekend Workshop.  Those planning on registring should do it NOW to save money.

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