Sunday, November 27, 2011

Innovation and Quality – Part 3

I have been pre-occupied recently with the concepts of innovation and quality.  Perhaps it has something to do with the recent media attention to Steve Jobs and his impact on manufacturing and design.  Or maybe it has to do with some things that are happening around CMPT and our Program Office course in Laboratory Quality Management.  Making progress through change. 

Today I saw an interview of James Dyson, another innovator perhaps not as well known as Mr. Jobs.  James Dyson is a British engineer with a interest in industrial design who has made among other things significant improvements to vacuum cleaners, room heaters, hand dryers.  Less flash than Apple, perhaps, but he has created a slew of brilliant product improvements, and has been knighted and amassed a ton of money in the process.  And he has established the James Dyson Foundation to support education and research at many levels.  

When asked about where he got his motivation for his innovations, he said it came from passionate anger when he found things that did not work properly.  Find something that doesn’t work and set out to fix it.  Innovation, according to this very successful innovator, starts off from the passion to make things better.

I think that is where the interface between innovation and quality resides: the passion to make things better.

As with many innovators, some of his commentary is pretty far out there, but still has resonance and connection.  Innovation is the product of failure.  In the process of creating the Dyson vacuum, he created some 5127 prototypes which meant that he missed his target 5126 times.  In addition he says that schools drive passion and the innovative spirit out of students.  Grades should be reversed with students being rewarded for error.  When there is no tolerance for error there is no opportunity for improvement and success.  

I kind of get what he is talking about.  All the way through the education process, even today we tend to reward the students who give back what we taught.  The "smart" students all to often figure out what we want to hear.  That being said, while I’m all for the notion of learning from trial and error in the sense of opportunities for improvement, it is a bit of a stretch to start there and go to rewarding for error.  
More on this education conundrum later. 

Many of the famous innovators of our time such as Jobs and Gates and Dyson had one thing in common with the famous innovators of yesterday including Edison, Ford, and Harland Sanders (Kentucky Fried Chicken) is that they were all inspired and succeeded but did it on their own initiative.  They saw flaws, or weaknesses, or absences in the present as inspiration to make the future better.  Their inspiration came from within and they carried out their risk-and-reward on their own terms.  I suspect that that sense of personal investment, drive, and vision are all important contributions to their success.   W. Edwards Deming who clearly belongs in this group deviates somewhat because for a substantial part of his career he was a government employee, not a position usually associated with taking initiative and risks, but perhaps he found  positions that gave him a sense of personal empowerment.

There are, I think, some careful lessons here for laboratory quality.  We work in a domain that requires a certain discipline and a can not tolerate being wrong 5126 times.  There are certain rules.  But these must be opportunities to learn and adapt.  

Within the framework described by standards such as ISO15189 or ISO9001 or CLIA there must be room for passion and design.  There are a number of ways that we can create and deliver quality that may on one level seem to be site specific, but have a certain generalisability.  Those may be the more positive aspects of Lean, or Six Sigma, or may be whole new directions.  There has to be the opportunity to stretch even if sometimes (most times?)  things may not pan out.  That is an essential part of risk and reward. 

And we have to be able to acknowledge that the standards framework itself can sometimes be wrong.  Improvement in standards comes from challenging the status quo.  When standards writers cannot or will not acknowledge that components of requirements have failed the tests of experience and time, they are lost opportunities.  Innovations can and must be allowed to flourish everywhere.

PS:  Our course in Laboratory Quality Management is filling up more quickly this year.  If there are some interested in the course for themselves or for people in their laboratories, it would be a good idea to get in touch a soon.

Wednesday, November 23, 2011

History of Quality - part 2

I was recently invited to participate in a meeting focused on the process of renewal and continual improvement for an organization responsible for Quality standards.  I assume that this is standard practice for all organizations committed to Quality, but there is that old adage about what happens when you ASSUME.  I won’t go there, but I will say full credit to the Canadian Standards Association for being prepared to both talk-the-talk and walk-the-walk. 

Anyways, during the introductory part of the meeting, a comment was made about CSA and Canada and its role and prominence in international Quality.  Not that Canada takes the responsibility as Secretariat for the ISO Technical Committee 176 (which it does) and not that Canada is a leader in Environmental Quality (which it is) but rather that ISO 9000, the cornerstone of all modern Quality Management was based upon a Canadian document specifically Can3 – Z299: 1985 Quality Assurance Program. 

That’s interesting, I thought that the source was another document, specifically BS5750.  Not only had I read that elsewhere but it was supported by information from the modern purveyor-of-all-knowledge (Wikipedia).  Wikipedia clearly and definitively states that the seed document to ISO9000 (first published in 1985) was the standard BSI 5750 published in 1979.  

The provenance of that document was the (US) Mil-Q-standard 9858 which was provided first to the pre-NATO structure (ABCA – America, Britain, Canada, Australia) and then to NATO where it became part of the Allied Quality Assurance Publications (AQAP) quality series.  

British Standards Institute (BSI) borrowed it from NATO to create its own quality document (BS 5179) which was later changed to (BS 5750).  [note: According to Joseph Juran: A History of Managing for Quality – 1995, 5750 was essentially a direct copy from NATO].  Britain then offered BS5750 as the  seed document for ISO9000.  Canada doesn’t come up anywhere, with the exception of being a part of ABCA and NATO.

What is missing here is that if you spend the time going to other sources, especially deep inside, you find the following: " When ISO/TC 176 embarked on the development of generic quality management standards for worldwide application it was able to take advantage of a substantial base of national experience notably in the United Kingdom and in Canada.

In the United Kingdom the BS 5750 standards were well on their way to broad acceptance and in Canada a series of national standards known as CSA Z299 were also widely used.”  

As I pursued further, it is clear that Z299 was a document developed from Mil-Q-9858 through NATO AQAP although, in contrast to BS5750 it was substantially changed to accommodate the new audience.  

I suspect what happened was that the ISO technical committee went on a search for seed documents Britain offered BS5750 and Canada offered Z299.1:1985.  Japan apparently also offered a document.  Based on these seeds, ISO 9000:1985 was created as a collective amalgam.  

All this basically makes sense.  The Quality seed document of note  was the US Mil-Q-9858, created by the US Military to improvement the Quality of companies selling products for military use.  By the language and structure, one can say almost definitively it was written either totally by W. Edwards Deming, or persons strongly influenced by Deming.  NATO used the document for similar purposes, but its potential value for civilian commercial guidance was acknowledged around the world.  Many countries, probably not limited to Britain and Canada created national documents.  I suspect (but can’t say with certainty) that Japan got to the same point not through Mil-Q- and NATO, but more likely from Deming directly.

CAN3 Z299.85 was first designed and written in the 1970’s but was published for the first time (?) in 1985, two years before ISO9000 series.  It is still available and still in circulation, and indeed is still being used as a certification standard today.  (Note that the US Military has dropped Mil-Q-9858 and replaced it with ISO9000).  Z299:1985 is not found in the current CSA catalogue.

So while perhaps the introductory comment was a bit of an overstatement, Canada’s role here has been under-recognized, probably by our own actions. 
It is not surprising that Canada’s role in this process has been missed in history.  It is a common Canadian trait to be at the forefront, but to hide in the background and let others take credit.  It is not a healthy trait.  

There are a few lessons here for me:  First off, the historical forefront and record of Quality does go through Canada and in particular through the Canadian Standards Association.  And second, don’t trust Wikipedia as an absolute source.  It is only as good as the author without a fact checker.  

As a final comment, someone at CSA or Standards Council of Canada could and should correct the Wikipedia record.  Credit when and where credit is due. 

Originally posted Nov 23, 2011.  Edited for grammar and spelling Feb 6, 2015

Saturday, November 19, 2011

Medical Leadership and Quality

An interesting day in Quality teaching, It came together in an interesting way.

I had a lunch time seminar to talk Quality to a small group of laboratory medicine residents.  What was interesting was that for the first time that I can recall, half of the group had already taken our 20 week course in Laboratory Quality Management (see and the other half had not.  So rather than the usual presentation where I talk and engage others to participate, I sat back and let the two course certificate holders take the lead.  All I had to do was add some new knowledge from current research and provide some additional perspectives on bringing knowledge together with building a culture for Quality.

The conversation and discussion by the informed group was active and all in context.  It was clear that not only had they taken the course, but they had taken the time to absorb the information and were putting the knowledge into practice.  There was a good discussion about how to promote the idea that residents have a role and responsibility of working within their laboratory on improvement projects.  They provided a list of participation opportunities that residents should consider:
  • ·        Reading and reviewing SOPs in detail
  • ·        Participating in Accreditation preparation
  • ·        Monitoring proficiency testing performance trends
  • ·        Providing presentations
  • ·        Participating in internal bench audits
  • ·        Taking on Quality oriented projects

It was a real treat, and was for me a key affirmation that we are starting to have a tangible impact on the knowledge and focus of resident education.  We are making a difference. 

When I left the teaching session I went to a meeting for planning the process of moving our Masters program through the morass of university requirements and approvals.  One of the concerns and complications that came up was that a senior medical laboratorian has had conversations that suggest he may be opposed to our Masters program because it is his belief that a Masters to train laboratory quality managers would create an intrusion in the role of the medical laboratory lead. 

It was a one-step-forward and one-step-back afternoon.

What interested me here was how much this one-step-back represented a point of view that so inconsistent with fact and reality.  It suggested that this person’s perception that Quality managers were by definition not medical laboratorians; Becoming knowledgeable about Quality was something that only technologists or administrator types did.  Well that’s what we call obsolete thinking on all sorts of levels.  It denigrates both Quality and all the laboratory professionals that are committed to making laboratories work more effectively through having better Quality management.  

And it is inconsistent with the facts.  In my course there are several pathologists from a number of countries, including Canada, that have taken our course because they see advantage both to themselves and to their laboratories for them to learn to become Quality leaders.  More importantly every year for the last 4 years we have had medical laboratory residents taking the course and in addition we provide a quality seminar series for residents.  These men and women will walk into their first professional positions as pathologists and medical laboratorians far better trained and far more capable to providing laboratory leadership. 

Increasingly we are seeing working professionals seeking out opportunities for supplemental education as part of the own improvement strategy.  Some are doing Masters of Public Health, others are doing Masters of Health Administration and others are doing MBAs.  And once our Masters in Laboratory Quality Management (MLQM) is in place they will take that as well. 

Modern education choices have changed from the old days and old ways when someone had to quit working to take extra courses.  Not any longer; Masters course can be done on-line or on-weekends or in sessional blocks.  Education now accommodates the working professional.  Our MLQM will fit in that same mold.

So to make it clear.  Our commitment is focused on improving laboratories through Quality Systems.  We will train near every person interested in getting engaged in Quality.  We believe in Acceptance criteria (or perhaps in this situation Rejection criteria).  We require people with at least 5 years of work experience in the laboratory arena so that they know and understand the laboratory setting.  We need people who are comfortable with English as their working and learning knowledge and we need people who like people and enjoy being engaged in group education.  And we need people who are committed to adding a Quality dimension to their busy careers.  

PS: Our course is starting to fill up.  If you are interested, it is time to go to

Sunday, November 13, 2011

Leadership and Quality – Part 2

I mentioned previously that I have been going through The Harvard Business Review must read book, The Essentials.  I am intrigued by the theme of Leadership and its parallels to Quality.  The article in The Essentials, first written by Daniel Goleman in 1996 was a seminal paper on the topic.  Its publication in 2011 continues to show its influence in the leadership arena, even though Goleman past away in 2010.

Anyone who works in an organization knows and understands that some folks are better leaders than others.  While it has something to do with skill and talent and knowledge and problem solving, it is also their ability to interact with people.  In the 1920’s (at the same time as Shewhart was setting the foundations of Quality) Thorndike was introducing the concept of social intelligence.  In the 1940’s (at the same time as Deming and Juran and Crosby were defining Quality) Wechsler was defining the impacts of social-emotional intelligence on intellectual behaviour.  In the 1980’s and 1990’s (while Galvin was creating Quality measurement tools – Six Sigma) Goleman and others were creating tools to measure Emotional Intelligence (EI), and reporting strong correlations between EI and performance.

As Goleman saw the world, when he studied leaders in near 200 organizations around the world, what he observed was that intellect was a given key driver, as were the ability to think long term and to see the big picture, but the single biggest factor that distinguished high performance leaders from the rest of the pack was their ability to be self motivated and their ability to motivate others, as components of EI.

He defined five components to EI including the abilities to be self aware (self assessment and self confidence), the ability to self-regulate (trust and ability to deal with stress and change), motivation (in this sense, self-motivation and work passion), being empathetic (considering others) and having the social skills to move people.  Importantly will the right psychology tools all these were measurable and interpretable.  Even more importantly all these skills were both teachable and learnable.  

In Goleman’s world, leaders were not necessarily born, they actually could be created.  And seen another way, with sufficient motivation, a person could learn the talents necessary to become a better leader.  

Gradually as we went through the last 10-15 years, some (maybe much) of what studies about EI had eroded.  Not all the original research on the impact of EI and leadership has been reproducible; this as been especially true with respect to the studies between EI and performance.  Similar to Six Sigma, some of the so-called bloom has come off the rose.  Extending the parallels with Quality, see Noble MA.  2007 Does external evaluation of laboratories improve patient safety?  Clin Chem Lab Med. 2007;45(6):753-5.

There are a lot of parallels between Leadership and Quality.  Both of them are associated with helping organizations get the most and best performance from people.  Both of them focus attention on the seeing the primary task at hand and seeing the best way to achieve it.  While I am more in the camp that leaders are born category, but I will say that I have met people who have improved their leadership skills and talents over time.  Goleman put some of it down to maturity, the combination of age and experience.  I can buy that. 
Even if the measuring tools at the moment have some challenges in making the case for either EI or external evaluation (accreditation or proficiency testing), it does not mean that either hypothesis is wrong.  It can also mean that the systems of data are in constant change and have a huge number of variables which the current measurement tools have difficulty in addressing.  From my personal perspective, at the end of the aforementioned paper, I mentioned that just because we can’t prove the value of accreditation or PT is not a good reason to stop either.  I suspect the same is true for trying to be objective when seeking good leaders. 

I have been in sufficient laboratories to know and understand and buy-into the reality that some laboratories make more errors than others and some laboratories work to prevent errors from recurring while others do not.  Laboratories can learn about Quality and implement Quality effectively.  And while I can’t prove it, it is my observation that leaders that permit and encourage and motivate the creation of a Culture of Quality are better leaders of better laboratories.  

Leaders that don’t give a damn are not.  

Wednesday, November 9, 2011

Innovation and the Medical Laboratory - part 2

Innovation and the Medical Laboratory – Part 2
In the early 19th Century (around 1811-12) a group of textile (artisans) workers became concerned that the use of mechanized looms were going to interfere with their artistry and their profession.  Their employers were using fewer people with lesser capability.  They saw this as an affront to their talent and skill.  Their response was to damage the looms.  

This act of protest was interpreted as a public statement about the broad changes associated with the Industrial revolution.  The British government response was to make an equally public statement about the hazards of interfering with industrial change and either shipped the perpetrators off to Australia or had them executed.  The group (henceforth called a movement) was tagged with the label Luddites (named after another loom destroyer on an earlier age).  

Over the years the term Luddite has shifted from one identifying folks involved in job-protection to a more general concept of resistance to change, with particular reference to resistance to technological change.

I am not a Luddite, in the modern sense.  I am by-and-large an “early-adopter” of new technologies.  But I also watched the impact of a lot of new technologies have done to the medical laboratory. 

My first connections with the medical laboratory were in the late 1960’s when most tests were done manually and with next to no standardization or quality monitoring (read the works of  F.W. Sunderman on Proficiency Testing in the 1940’s and 50’s).  In 1957 the Autoanalyzer was invented and let to the introduction of equipment into the medical laboratory shortly after (Technicon, SMA, SMAC) all of which created a platform that ultimately lead to more consistency in testing, but also changed test order practices with more patients having more tests more frequently.  

Changes in microbiology followed suit, about 10 years after chemistry with early equipment as the Sensititre, Radiometric Bactec.   The laboratory business exploded with activity. 

More recently (and by that I mean very recently) Anatomic Pathology is now going through a dimension of change that will have profound effects.  As we move towards increased automated digital pathology there will be higher consistency in performance with broader distribution of knowledge and a striking decrease in the number of AP pathologists required to do what they do now.  A single room in virtually any city will be able to service the interpretive needs for thousands, if not millions of patients around the world.  Maybe not today, but soon.

With each generation of change came increased capability, increased speed, and from a strictly technical perspective better analytic sensitivity, more sophisticated data handling, and some levels of data management. 

Unfortunately a lot of this progress has had its dark side as well: more and more liberal testing patterns with inappropriate testing of patients both in terms of poor patient and test selection.  Increased numbers of laboratories using fewer and fewer staff with decreasing technical training.  [Note: The Luddites of 200 years ago were actually visionaries].  And all that has led to substantial levels of laboratory errors and continuing challenges to laboratory Quality.  Not to be excessive, but one can argue that many of the problems that we have today would be avoided if we had a better control on the frequency of testing and they procedures requested.  [As I hear it, this may not be too far off, as organizations such as the US Congress and HHS look at restructuring the fees for laboratory testing.]

My point is this.  Medical laboratories have a long and distinguished history of innovative technical automation change that has improved the lives of many through better and more available diagnostics and monitoring.  It would probably be a fair and honest statement that innovative change has been the single-most powerful driver in medical laboratory.  

But it has occurred all too frequently within a technology and enterprise silo, and in many regards absent from critical planning such as human resources training and management, quality management, and risk. 

A theoretical calculation:  if introduction of technical change had been more effectively controlled and we were now doing fewer but better selected tests, would we be further ahead, about even, or behind if we consider the impacts of proper diagnosis, along with the impacts of no diagnosis and also the number of people that are harmed or inconvenienced by excessive inappropriate and uninterpretable testing.

As I work through my awakening to the impacts of innovation and quality on a personal level, I have come to two understandings.  First, being a cautious Luddite is  maybe not such a bad thing, and second, that Pogo might have been more right than we would want to acknowledge:  "We have met the enemy and he is us."

Sunday, November 6, 2011

Pitfalls to Innovation in the medical laboratory.

I have been reading a new and interesting book entitled HBR’s 10 Must Reads: The Essentials: An introduction to the most enduring ideas on management for Harvard Business Review.  (Harvard Business School Publishing 2011).  I don’t expect it will be on the reading list of most medical laboratory Qualitologists.  Most of it is pretty hard-core profit and loss, but one chapter that I found thought provoking (and comprehensible for a neophyte) is on Innovation: The Classic Traps. 

Innovation is concept of considerable interest to me.  We have built and grown our CMPT Proficiency Testing program around innovation, and are trying to do the same thing with our Program Office for Laboratory Quality Management.  Almost by definition, university-based programs must be engaged in innovation.

There are lots of definitions of Innovation; most agree that it is the process by which new ideas in product, service and process are developed that result in an enriching experience through new or improved products and services with improved efficiency and effectiveness, including greater profit.  The customer may not always be aware of innovation, but either directly or indirectly they always benefit.

“Innovation: the Classic Traps” talks about some of the killers of innovation, such as inappropriate development teams, inflexible budgets and performance reviews, and the expectations that innovation should only focus on major “out-of-the-park” change. 
There have always been medical laboratorians that are interested in innovation and improvement.  My first thought always goes to Bauer, Kirby, Sherris and Turk for developing and standardizing disk-diffusion method for antibiotic susceptibility testing some 45 years ago.  The Kirby-Bauer assay allowed laboratories large and small to detect antibiotic resistance that otherwise would have been missed.  Their simple assay changed the diagnosis and treatment of infectious diseases world wide.  I have always been astounded that the Nobel Prize committee has overlooked the significance of their work.

But anyways, all this thinking about innovation got me reflecting upon changes that have occurred in medical laboratories over the years.  There is no doubt there has been a lot of positive change.  Better environment, better staff safety, faster test turnaround, and better standardization.  Some of this has been the result of newer safer equipment, and more consistent reagent quality.  A lot more is due to better knowledge and competence levels of staff.  Progress has not been in a straight line, or always positive and we still make far too many errors.  Quality partners have contributed more to the positive than to the negative. 

Like most profession groups we have learned through trial and error about what we do well, and what we don’t.  I present four pitfalls to innovation and positive change.

1: Don’t fool around with Quality Control. 
A common, recurring idea is that laboratories can be innovative and save money by fiddling with reagents and quality control.  If we reduce down the control on reagents, we will speed up the testing process and save money to boot.  This is a genuinely dumb idea.  Lots have tried, and all have failed.   More money gets lost on poor quality when tests results have to be stopped, or worse, recalled because the checks on equipment and reagents were reduced or stopped.  Any changes that you introduce to save time or money are far more likely to make things far, far worse.

2: Inventing your own procedure is rarely successful and never appropriate.
We do this all the time (including me!).  We dream up a new assay, or a modification of an old assay, and put it into operation without actually validating that the new procedure provides appropriate and meaningful information.  It’s all very satisfying to the inventive part of the soul, but creating bogus and uninterpretable information is never a good idea.  For me it was a type of time-kill modification to the serum-cidal assay.  (Clinical microbiologists with 25 years of experience will be the only ones that will know what I am talking about). 
ISO 15189 is very clear about the dangers of introducing un-validated tests.

3: Bells and Whistles are not innovations.
Laboratory equipment has a long track record of introducing “new” advances that solves one problem and creates another, all too often resulting in either a net zero, or sometimes a negative score, usually all done using public monies.  It always seems like a good idea (“everybody has one.  If we don’t get it we will be left behind”) until the new problems start to emerge.  It is another example of the FAD-FADE-FAIL or FAD-FAIL-FIND curve (see MMLQR Quality Anxiety)
It is no wonder that hospital administrators have trouble with laboratorian credibility.

4:  Arrogance is the innovation killer.
Actually there are tons of good ideas that get created in medical laboratories all the time, but most of them get killed or lost because of process.  Usually they come from the hands and heads of bench technologists who see ways to improve the “official” SOP.  Sometimes these “a-ha” moments can lead to major improvements, but more times than not they get stifled.  Usually they don’t tell anyone because they know they will be ignored or worse.  Usually the improvements stay underground until someone finds out that they are not following the SOP. The problem all too often is poor laboratory communication that only goes top-down.  

Thursday, November 3, 2011

"Quality Anxiety

Many men can attest to a physiologic phenomenon known as “performance anxiety” when over-thinking interferes with sexual performance.  For most, it is a short-term problem.  For a very few it can be disabling for a long, long time. 

Recently, I have been reading and hearing about a new management phenomenon which I think can be analogous.  I refer to it as “Quality Anxiety”.  “Lean is Dead” “ISO9000 is Dead” “Is Six Sigma  Dead?” “Baldrige is Dead”, “the term Quality is out of vogue”.  All these titles and phrases come directly out of recent Quality literature.  It’s enough to make a Qualitologist nervous.

The reality is, of course, that what is happening is that Quality tools are going through an acceptance curve, commonly seen almost every service and product sector. (see below.  These curves represent product uptake over time.  They are not to scale).   One type, Fad-Fade-Fail (think buggy whips) comes and goes and can not adapt to change.  The second type, Fad-Fade-Find (think pharmaceuticals) comes, goes, and eventually finds its stable marketplace.  The third type, Fad-Fade-Fight (think women’s fashion industry) comes, goes, and then gets a second bump when styles come back.  The point is every product and service has a come-and-go cycle.  Depending on other variables, they may get a second wave (or not).

One of the points made is that 53 of 58 large companies that used Six Sigma trailed the S&P 500 since implementing Six Sigma.  This does not surprise me.  A few years back Boiral and Amara looked at the relationships that affected successful effective ISO9000 certifications (27%) from unsuccessful ones (73%).  Organizations that were successful (like mine) are internally motivated, focused on product improvement, and are open to change.  I have also worked in institutions that have none of those characteristics.  For large organizations, change is slow and laborious, and far too diffuse to have any sense of cohesive motivation.  This is a guaranteed formula for failure.  

Six Sigma consultants have a lot of short term ride-the-fad success and revenue with little on the back side.  Time will tell is these organizations can figure out how to deal with change.

In this month’s QP, Dean Hubbard and Paul Klute have written an article about the Baldrige which has recently lost its funding base and, according to the authors, has also lost its way because the program went through Fad-Fade-Fail (?) for the manufacturing and service industries, Overall, however, the program has never been healthier because they were smart enough to attract the education and healthcare sectors.  Healthcare is surging, probably because organizations see that Quality will save time, effort, energy and money (TEEM) and protect again patient safety liability. 

If the next administration is smart, they will recognize that Quality saves lives and money and will go back to funding Baldrige, but from healthcare – Medicare Medicaid sources. 
Finally, on the subject that the word “Quality” is going out of vogue.  There are a group of people within the conformity assessment group in ISO (ISO CASCO) who see no point to the term “Quality Management”.  As far as they can see things, management is management.  The concept that organizations address Quality, and Risk, and Finances, and Safety all very differently seems to be lost on them.  But then again, they continue to support a document that is effectively unchanged since 1999.   

In Baldrige, the word Quality was dropped and replaced with “performance excellence” which doubles the word count and triples the letter count, both of which “don’t impress me much”.

In my world, the term “Quality” has a lot of significance still.  Quality is the meeting of requirements, which links “Quality” to customer needs and to assessment criteria and most importantly to innovation.  Just because I am flexible and open to change, doesn’t mean I have to support every change.

So to come back to Quality Anxiety, there are lots of ways to reduce stress.  Do the same steps that are recommended for overcoming performance anxiety.  Take up exercise and relaxing baths.  Stop focussing on the Fads and failures.  And put some flexibility in your life.