Sunday, October 16, 2011

No "I" in TEAM but there is in "ISO"

I am looking forward to our annual plenary meeting ISO Technical Committee 212.  This one is at the MGM Grand in sunny and warm Las Vegas.  A lot of discussion, and maybe some time for a show.  ISO meetings are an interesting experience.  They remind me of that there is no “I” in TEAM” but there is a big one in “ISO” and a small one in “Quality”.

ISO (aka the International Organization for Standardization) is a collective of individuals each representing their country, their region, their organization and themselves.  There is a large wack of egos (including mine) in the room each there addressing a series of personal agendas.  On the highest level, there is the Prime Directive to ensure that any standard that gets created meets the needs of  each individual country and region.  The whole point of ISO is to set rules that will create and foster the foundations for common trade, business alliances and product compatibility.  If a document is created with undue unfairness or bias then a country’s business and trade can be compromised. 
I often remember the conversation that I had with a long-time colleague who told me that his specific instruction from his country was to attend these particular meetings and ensure that no document would ever see the light of day unless it was fully compatible with his country’s specific health system needs.

Individuals are very much aware that they attend these meetings at the pleasure of their employers.  Time to attend and participate in meetings in nice hotels in nice places comes with certain expectations.  For manufacturers they want to see their products on the winning side.  For accreditation bodies, they need to see opportunities for documents that can be used to help laboratories in their specific region.  For consultants they need to see opportunities for doing their consulting thing and making money.  And for academics it is about the books and manuscripts and coursework edge.  And for “bloggers” it is a gold mine for shared opinion and experience. 

None of this is bad stuff.  We might as well put our money on the table and acknowledge our collective vested interests.  What happens is course is that all these interests intermingle as the standards development process moves forward.  A little bit of altruism and a large dose of collective, sometimes incompatible self-interest trying to find that place where everyone can live with the outcome. 

As complicated as it sounds, what is remarkable that when the smoke clears it usually works fairly well, baring the unintended consequences that can arise, but more on that another time.

I will tell you that there is one collective loser in the process.  Resources limited regions (RLRs) always get ignored or always get the short end of the stick.  Folks from RLRs rarely have the resources to attend meetings and participate in the discussion.  The interests of the RLRs get subsumed by the interests of the attenders.  So the documents usually are a collective of wealthy region assumptions and wealthy region practices.  Many of the requirements are so far outside of the reality of the RLRs that their opportunity to adopt these documents in a meaningful way is all uphill and near impossible.  Good for the 1 percent, but  rarely a successful strategy for the remaining 99.  This could be fixed if RLRs were represented and were in a position to stand up for their reality and circumstance.  But this will unfortunately take a long time and a massive amount of work to overcome. 

An organization like the Gates Foundation could make dramatic steps forward in RLR health by a judicious use of representation money and resources with a lot of strings attached.  Bill, if by chance you are out there reading this, give me a call J.

But there is another “i” that is important to consider.  Documents like ISO 15189 and 9001 and 9004 and even (shutter) 17025 can enhance operational quality for the medical laboratory.  There is an "i" in Quality and It is in every person’s best interest for quality processes to succeed. 

For the employee Quality programs enhances personal TEEM (time, effort, energy and money).  Structure reduces time to the detection of error and reduces the effort and energy for getting back on track.  Reduced error saves the budget, and reduces the risk of budget overruns thereby protecting positions.  In the private sector, Quality increases profit. 

For the patients, quality reduces error and distrust and frustration, and reduces the need for looking for compensation (as in reducing the risk of malpractice suits).  For the clinicians it speeds up the process to high value diagnostic information. 

None of this is bad, indeed self interest is a motivator to make ones life better, and if it helps others at the same time, that is OK.  Gordon Gecko (a character in the 1980`s movie Wall Street said “Greed is Good”.  Well, by the same spirit,  self interest in Quality is also all for the good”.

More on the ISO meeting coming up.    

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