Friday, October 28, 2011

Consensus and Quality.

Somebody (?) once said that the path to success is to find the work you want to do and to do it with passion surrounded by others that feel the same way.  That’s how it seems to work out for me in medical laboratory quality.   

In my career I have migrated from providing care on the individual level, to caring at the institutional level, and then for the province and nation.  In Quality I find I have impact at the international level.  It is something like being a doctor without borders, but different. 

Perhaps the most eye opening aspect is the people that I have met and interacted with; people from government, public sector, private sector, engineering, and nursing, standards development and assessment bodies proficiency testing providers and academia.  Some are self-employed as specialists or consultants, other are generalists.  Some are full-time employees, while others are part-time employees, and these days, many are what we called retired from gainful employment, but still busily engaged in doing good things.   All of them have similar levels of interest and passion and share the common belief that they (and we) are individually and collectively  working to make healthcare better. 

What is important here is that with all this interest and passion and diversity of background comes a lot of differing opinion about what exactly makes for better healthcare.  Purse-string holders see it as doing better but for less.  Others agree, as long as their own special interests are funded to the level that they want.  And others still see it not a matter of money but more about what is “just and right”.  There is the “right” way (also called “my” way) and then there is everything else.  And what is really annoying about all this is that all these opinions in there own way are valid and all of them can lead to the best path to better care. 

Fortunately the crafters of Quality understood that true Quality has to accommodate to all reasonable paths.  In the end, there is almost always a route to common purpose and common goal.  It is called consensus. 

Consensus is not 51% support, or even “super-majority – 66%”, or indeed even 90%.  Consensus is the recognition that while everyone may not love the decision, at least there is no one who is so absolutely and totally opposed, that they feel beyond absolutely compromised.  The point of the challenge is to find that place where everyone can live and support and agree.  You may not be happy, but at least you are not going to have to resort to self-immolation.

As Mick Jagger said,  “You can't always get what you want, but if you try sometime you find, you get what you need”. 

This is not only the best route to Quality, it is the only route, and there is only one way to get there.    It takes lots of discussion, lots of input and a lot of free-flowing opinion.  And it takes knowing the difference between wanting and needing, and being prepared to argue for what they believe is right.

So for those that participate with me in the pursuit of Quality, let me give full warning.   I will say that by nature I tend to be a pretty assertive (some say feisty while others say aggressive) participant in Quality discussions.  It is part of the passion.   I know what I know and believe what I believe and I will argue my point to the limit.  When I concede it is because I have found the way to “get what I need”.  It is not my responsibility to watch out what you want, but it is my responsibility , to all my extent possible, to respect what you need.

It isn’t personal, it is just business.


PS:  For those interested, the POLQM Certificate Course in Laboratory Quality Management is filling in more quickly this year than in any previous year.  If you are interested, check out the information at  

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