Monday, January 30, 2012

In standards, every word is important.

I was in a conversation this week that reminded me of a conversation many years ago when I took freshman calculus.  My professor loved using the term “it is intuitively obvious that…” which was intend to mean that what he was about to say next should be immediately clear and obvious to anyone and everyone in the class. As it turned out, the only thing that became intuitively obvious was that neither mathematics nor engineering was going to become the path to my future career.

What I did learn however was that words are important and folks who write them have an obligation to create text that can be understood by the anticipated audience, and that the folks the read them have an obligation to read the text carefully in order to grasp the intended interpretation. 

Unfortunately when it comes to the creation and reading of guidance documents it may very well be “intuitively obvious” that commonly neither the writer nor the reader meets their obligation.

ISO 15189:2007 contains the phrase:  “The request form shall contain information sufficient to identify the patient”.  In an interpretive text I wrote the following:  “In North America, patient identification usually requires at least two unique identifiers, such as a name and a date of birth, recognizing that a name may not necessarily imply a traditional first name and surname. In certain situations, a coded number or word may be an acceptable substitute.”  Concern was raised because it was suggested that I had said that laboratories could rely on name and date of birth as sufficient identification.   
But that was not was said or implied.

OK, in retrospect I could have extended by my writing to be clearer and more illuminating.  What I could have written (and now in light of the discussion, should have written was something more akin to the following:

In North America, patient identification usually requires at least two unique identifiers, such as a name and a date of birth, recognizing that a name may not necessarily imply a traditional first name and surname. In certain situations, a coded number or word may be an acceptable substitute.  That being said the requirement states sufficient to identify the patient, and this may require using 3 or 4 or 5 or 10 pieces of information for example, one might consider adding, for example, a hospital number (if there is a hospital number) or a social security number (in Canada we call that a SIN number) plus an address.  But the organization will need to recognize that at a certain point the value of more input of information is offset by an increasing level of risk of information error or data entry error or the hazards associated with exposure of certain confidential information leading to the possibility of identification theft if the information gets into the wrong hands.

As mentioned, I could have written that, but I didn’t.  If I get a chance to write a third edition, I will include it.

My point here is that not seeing or misreading the phrase “at least” had a big impact on the readers reading and understanding.  And that can be a problem.

My take away message is that standards and guidance documents by necessity carry a lot of conditional phrases.  “National or regional requirements may apply”  or “including, but not limited to…” or “for example…” or “at least”  all are important words.  Readers trying to interpret and implement documents ignore them at their peril. 

Here is a suggestion (note that the word “suggestion” is also a conditional):  Reading of standards and guidelines is not something one can do casually.  In order to help focus on the text when reading a required standard in earnest, have two felt-tips.  Use a RED one to highlight wherever you see the word SHALL.  Use a YELLOW one to highlight wherever you see a conditional.   Then ask yourself, why did they use that here?  And how can I use that to my advantage?

I think you will find the exercise beneficial.   

Wednesday, January 25, 2012

Ins and Outs of Internal Audits.

We are committed to our Quality Management system.  It was implemented through our decision to adopt ISO 9001 as our basis for a Quality pathway.  We have helped maintain our motivation to Quality through annual annual audits since 2004.  It has been a very effective approach for us and our customers.

One of our techniques for keeping our system fresh is to introduce variation in our implementation and follow-through.  An example is in our approach to Quality Audits.    
In our course we talk about four different approaches to Quality Audits:

Internal Audits (IAs) are performed by our own staff to generate information for our own internal purposes including monitoring and improvement.
External Internal Audits (EIAs) are performed by people from outside our program, but under contract.  They are performed to generate information for our internal purposes. 
External Audits (EAs) are performed by people from outside our program, either people from our certification body or by customers requesting an audit to ensure compliance for their own purposes. 
Internal External Audits (IEAs) are often paper challenges or internal inspections requested of us by an authorized agency to comply with regulatory requirements.  In these situations we perform the inspection with our own staff and send the agency a completed and signed form.  Sometimes the agency may choose to do a follow-up with their own personnel.

This week as we start to prepare for our next certification (EA) audit, we are going through the process of our own internal audit.  In the past we have done this by contacting a friend or colleague to come in and do the audit for us (an external-internal).  We usually find this has a lot of advantages.  EIAs tend to be a little more thorough because we know that there are certain areas that we tend to gloss over because we are confident that they are intact and working properly.  EIAs are certainly more objective because outside eyes tend to see things that we don’t.  

Depending on who you invite to do these they don’t need to be particularly expensive.  If they can drive over rather than come by plane, travel expenses can be kept under control, and if they are a good friend, sometimes you can get it done for a cost of a good meal and a bottle of wine. 

As long as you make it clear that you are going through the exercise because you actually are seeking a critical and thoughtful eye, EIAs can be very effective.  Make sure that the person you invite is not only a friend a colleague but actually knows and understands your standard and knows what is involved in doing a constructive audit.

This time we are not doing our assessment externally.  This year we are going with our own internal audit, I am doing it primarily myself along with our program coordinator.  It’s kind of like combining a Top Management Review and an Internal Audit together at the same time.

It’s not so much about saving money as it is about re-engaging.  As we have worked through colleagues I was feeling that I was getting more removed from the actual hands-on activity than I really wanted.

I recognize that there is the risk of introducing my own personal bias, but the reality is that with practice and experience that I have had over the years, I am confident that we can be fairly objective in the exercise.  In all fairness, I also understand that our regular certification officer is to going to check our work when he comes for our true EA.  Any deviation that he detects between what we say on paper in our EIA and we he sees with his own eyes is going to come back and bite me in the neck.  

In the meantime this gives me a chance to get back into the laboratory and see on a first hand basis what we are actually doing.  And that seems to me to be a good thing.

Overall it is going to take me about 8 to 9 hours over 2 to 3 days.

We will see what we do next time, but for now I am enjoying getting hands-on.

Sunday, January 22, 2012

Canada’s Minister of Health calls for Innovation

Canada’s Minister of Health calls for Innovation

Late last week the Canadian Minister of Health Leona Aglukkaq wrote an open letter to her provincial counterparts proposing that it is time for greater collaboration to improve innovation and accountability in our collective health care system, including a better pan-Canadian approach for monitoring performance as a way to improve care and curb costs.
This is a concept that I would like to strongly get behind.  It is consistent with my personal philosophy of Quality Management.  It is consistent with my belief and commitment in national organizations such as the Canadian Standards Association, the Standards Council of Canada, and the Canadian General Standards Board.  It is consistent with my annual hosting of medical laboratory Quality seminars. 

It is also a total waste of time.

The problems of Canadian health are unsolvable for another 50 years, at least.  It is not the way it should be, but it is the way it is.  It is the product of bad luck, bad decision making and bad design.

We are not the only country that decentralized health at the time of carving up jurisdiction and responsibility.  The United States and Australia took a similar approach.  But when it came to global issues, in particular Quality, Canada stands alone at refusing to develop a structure for comprehensive national approach to Health and Quality.  One the federal side, the government sits and waits to be “allowed” to become engaged, knowing with the full confidence that the provinces will never engage in constitutional reform. On the provincial side, our provinces hold on to their jurisdictions more like fiefdoms.  Health is a mechanism that results in transfer of federal money to the provinces, and anything that could put that in jeopardy would be dead in the water.

Private and public organizations understand that our provinces do not cooperate with the federal government and they refuse to get along with or trade with each other or with any common external agency.

And so we sit.

I think there is a solution that might start the process of moving forward.  It replaces the idea of giving up with the idea of taking small baby steps.  Rather than shoot for the moon for a pan-Canadian approach, perhaps pan-Regionalism might be less threatening.  More like a series of mini-unions of comparables, such as a pan-Atlantic Quality Assurance Program and a pan-Prairie Quality Assurance Program to go along with a Quebec Program and an Ontario Program and a BC Program, with the Territories participating along with the provinces. 

There could be several advantages.  Canada has too many provinces with low population that cannot afford to set up and operate functional Quality Assurance.  For the programs that are currently working it would increase their access to personnel for improved audit timetables and decrease their costs.  In time a national board of the 5 parties could meet, and perhaps develop a common philosophy and code of standards.  Sometime down the road the party of 5 could unite. 

Personally I think that this is a poor approach, but on the other hand Leona Aglukkaq’s hoping for a provincial initiative on pan-Canadiana is a waste of time.  At least a five-Region strategy could be step forward.  A tiny, but constructive step forward. 

Either that or just forget all that amending formula stuff (nobody really cares anyways) override the constitution and change the law..

Thursday, January 19, 2012

What is a Quality Manager?

We have started our Certificate Course for 2012 and we have a very active and interested group.  Participants come from a number of countries around the world and with a variety of experiences and expertise.  Some are relatively new technologists and others very experienced.  Most work in medical laboratories while others work in Quality Partner organizations.  Everyone seems to be engaged.  In many respects it is the perfect group.  

In the first week we start off with a lot of reading and focus on the big issue which is what are the skills that distinguish a laboratory quality manager.  Throughout the next 20 weeks we get more focused on detail, but it is always valuable to set the goal at the very beginning.

So the Week 1 assignment is, having had the opportunity to read background materials including two classics (Deming and Crosby) and combine that with their own experience and expertise to answer the question "What should be the essential responsibilities and authorities of a medical laboratory quality manager?”.

What you see, aside from the predominance of Quality and manager are some the key words oversee, responsible, implementation, management, audits, monitor, compliance, and education.  Lots of others positives in smaller text as well: team, performance, improvement and understand.  

So all and all I think the group is starting with a pretty solid view of the uniformity and diversity that constitutes being a Quality Manager.

 Usually we get a bit of a slow start, but this time we had a strong response from most participants.  Some of the responses tend to be very task oriented, others more principles based.  It is in the aggregate that the best composite picture comes out.  And that brings us back to optimising adult education. 

As mentioned before adult learners have specific needs of focus and concrete information.  Adult learners tend to be visual learners more than text learners because reading tends to take a lot of time and time in adult learners is always at a premium.  As a generalization, adult education is about short and sweet, focused, and visual.  More often it is about reinforcement as opposed to new knowledge.  That is why tools like crosswords and word-search tend to work well.  And that is also why word clouds work so well.

Going back to the 1450’s Gutenberg bibles were visual art.  The message was enhanced through artistry.  Some of it is beautiful, some of it is hokey (see below)
And as long as there have been students and pencils text books we have doodled our way through school making graphic designs out of words.  Sign of boredom? Maybe; but also visual reinforcement of key ideas.  Think about logos. 

Computer word clouds generated by on-line software were first  designed about 5 years ago by Jonathan Feinberg (  They are in a sense an extension of a logo creating software in that they create a text message gestalt where the visual sum is greater than all the individual parts.  The graphic shape provides meaning and to some degree, insight.

While I suspect word clouds were designed more for fun and artistry, they do serve a purpose in education as well, recognizing at they can be over-used and lose there impact.  They are after all, a pretty simple  tool for placement and reinforcement of common words found in lists and text.  

That being said, in many respects I think they are as valuable to a Quality Manager for expressing complex ideas as are flow diagrams. 

Different purpose, but similar impact. 

At the end of the year we will repeat the exercise and compare the two pictures.

PS: wordle is  free and available on-line.

Tuesday, January 17, 2012

Protecting our Consumers

At a recent meeting I learned about an international organization whose primary mandate is to protect the rights of consumers of products and services.  While new to me, it is not a new organization.  It is called the International Organization for Standardization’s Committee on Consumer Policy or ISO COPOLCO.

It would not surprise me if this committee is new to most people.  Even Google has problems with a keyword search “consumer policy committee”.  And if you do go the effort to find it, as with all other ISO standards, your only chance to read one of their documents is if you buy it for 86 Swiss francs. 

What both interests and surprises me is that I have been in and around ISO since 1995 (you might call me an ISO insider) and that I have not been aware of COPOLCO until just now.  It would seem that they intentionally keep themselves to a very low profile, which I do not understand. 

But I think it may be worth going the extra distance to find out more by going to the ISO site ( and entering the term COPOLCO.

In 1978 the International Organization for Standardization (ISO) developed a committee known as ISO COPOLCO – the Committee on Consumer Policy.  The committee is designed to create the opportunities that will help consumers benefit from standards and importantly to provide a forum that allows consumer groups to become engaged in the broad aspects of standards development.  

Its mandate is to protect consumer fundamental rights which include:
  • The right to safety
  • The right to be informed
  • The right to choose
  • The right to be heard
  • The right to satisfaction of basic needs
  • The right to redress
  • The right to education
  • The right to a healthy environment
  • The right to sustainable consumption

These fundamental rights have been recognized by the United Nations since 1985.  Towards their goal to protect these rights, COPOLCO writes standards and guidelines within the ISO infrastructure and process which address packaging and symbols and instructions on packages to make them more consumer-friendly.  Fortunately COPOLCO does not work completely in anonymity; they do work with other committees with ISO. 

I note with interest that ISO uses both the word “fundamentals” and also the word “rights”.  In Canada we have certain rights protected by our federal Charter of Rights and Freedoms.   I suspect that an argument could be given that the consumer rights might be protected under Article 7 (security of the person).

I am intrigued by COPOLCO for all sorts of obvious reasons.  The first is that standards and Quality do not exist in a vacuum.  They exist to assist organizations improve in order to ensure the health of the organization and the benefit to their customers. If you start from Phillip Crosby, the definition of Quality is meeting customer requirements.

Significantly, our technical committee on medical laboratory quality does not work directly with COPLCO or indeed any consumer representative.  I think that is a shame because medical laboratories have customers and our customers have needs and expectations.  Clinicians that seek our services need to know that we will provide timely accurate relevant and interpretable information, and patients need to understand that we will not do them harm in the process of testing, and the community needs to know that we can ensure that our reagents will not be released in a way that could cause jeopardy to the environment or the community that exists around the laboratory.  And the community needs the assurance that we will share information vital to the health of the community without interfering with the confidentiality of individuals.  

As I look at the fundamental rights put forth by COPOLCO, I can see where some of them fit directly with what we need to consider.  Issues such as protection of personal safety and that the right to be informed make a lot of sense, as does the right to be heard, especially if there are concerns and complaints.  As we move more towards direct-to-patient reporting our obligation to provide an education service becomes more obvious as a benefit for both the patient and to the laboratory.  And with respect to the fundamental right to a healthy environment, I have visited too many laboratories that regularly flush reagents down common drains and put samples in common refuse that put the environment and community to risk. 

So I say congratulations to ISO in recognizing and acknowledging the importance of consumers in the Quality equation.  Giving a voice to the users of our services is NEVER a bad thing.

Now if only they can do some thing about their ultra-low profile

Thursday, January 12, 2012

Proficiency Testing and Gram Stains.

I have a recurrent dilemma.  I know there is a best answer but I wish I were more confident in sorting it out. 

Setting: In our microbiology proficiency testing program we create samples that look like and act like true clinical samples.  One of the sample we create is glass slide smears for microscopic analysis using Gram stain (For non-microbiology folks this is a 6-step procedure using 3 principle reagents that results in clear visualization of bacteria and yeast and host materials including cells and mucus.  It is a classical component of infectious disease diagnosis.)  Because we make the samples from their constituent components we know exactly what is in them, and by extension what is not.  We then confirm those results through repeated quality control.
In some samples we will add in bacteria and other times we will not.  In some samples we add neutrophils and other times we will  add lymphocytes and others we will add squamous epithelial cells.  Sometimes we will add a mix.  Generally neutrophils signify acute inflammation, and lymphocytes signify chronic inflammation and squamous epithelials signify inclusion of surface cells sometime associated with contamination. 

Challenge:  Near every time we create a slide with neutrophils and no other cells there will be some folks who will report either a mix of neutrophils and epithelial cells or more rarely epithelial cells alone. 

Why this is a problem:  Neutrophils do not look like epithelial cells and epithelial cells do not look like epithelial cells.  So reporting the presence of epithelial cells is clearly an reading and interpretation and reporting error.  Some on the committee believe this is a serious problem and should be pointed out as an opportunity for improvement and remediation.  I can certainly support that.

On the other hand: Others point out that while reporting the presence of epithelial cells is clearly wrong, it is not a big deal because a clinician who receives the report is not likely to consider this as an important aspect of the slide report and as such other than pointing out the discrepancy there should be no penalty.  I kind of understand that too.

But again on the other other hand: an important role of proficiency testing is to  pick up a competency errors and promote improvement.  And I support that too.
So the tension is between technical competency on the one side and the consequence of error on the other.  Without going too far into details I can say that this is not only a technical error seen in small remote laboratories, indeed it is reported across the whole spectrum of size and complexity.  For some of the laboratories it is a repetitious reporting style while for others it is a one-off event.  I suspect that the error comes from both the inexperienced readers who may take their time and still have interpretation problems, and the very experienced that do quick reads and quick reports. 

On my side it comes down to a principles issues, is Quality about being RIGHT even when it is of trivial consequence (that sounds a lot like Henry Ford’s “Quality is doing things right, even when no one this looking) or is Quality about being RELEVANT and accepting or at least tolerating minor discrepancy (It drives me crazy when people require track changes to be displayed to demonstrate that people have not made cross-outs.) 

I guess in my mind I don’t think that microscopists who mistake these two cell types are likely to read benign cells as malignant or vice versa.  But I could be wrong.

Personally, I am really torn.
Any thoughts?

Sunday, January 8, 2012

The dark side of customer satisfaction

Four stories:  

  • On a recent television show in Canada on customer service, the most common complaint was that all too frequently Canadians could not find customer service staff, and when they did, all too often the staff were ill informed.  The comment was made that many large companies find that hiring and training customer service staff did not result in increased sales.  In a related story, retail outlets are losing business to on-line services.
  • I did an inspection for a laboratory recently where I was given the names of two clients that account for a huge amount of the work done by the laboratory.  One gave an OK review of the laboratory and the other trashed them.  When I asked if the complaints had gone to the laboratory the response was something to the effect of they know how I feel.
  • I booked a large chain hotel in the United States a little over 2 month ago for a meeting next week.  I thought everything was in place, but I was wrong.  I went to the ‘net and checked out reviews on travelocity, tripadvisor, and and found that others had had similar dissatisfaction.  I decided to cut my losses and cancelled my reservation and stay elsewhere.
  • In an informal survey of 20 accredited medical laboratories around the world, I identified only 5 that maintained a formal log of received/resolved complaints, and all the logs that did exist, were incomplete (they only recorded complaints submitted in writing).  Only one laboratory maintained and monitored received/resolved complaints as a regular metric.

A few questions came to mind.  Why do some very large retailers and apparently some laboratories and profession groups see so little return on investing in customer service?  I can understand part of it. 

In the public sector laboratory and indeed throughout all the civil service the work process is near always the same; work comes in and work goes out.  Workflow in most laboratories is not obviously associated with complaints.  Institutional budgets are set based on factors all independent of satisfaction.   As budgets become constrained, it is easier to focus on the issues that sit front of mind, which continues to mean stamping out fires and trying to keep up with technological and human resources change.

Even if laboratory management want to reward good service, it is very difficult, indeed often impossible.  While there is much discussion around reward programs such as pay-for-performance, most programs have either been blocked or have failed because they are seen as too subjective, or too easily manipulated.  Pay-for-performance in the teaching profession is viewed as striking right to the heart of unionism and the concepts of collective bargaining.

The observation that some (many?) medical laboratories do not maintain an active and complete complaints received/resolution log is troublesome especially since addressing complaints is identified as an accreditation issue in the United States (College of American Pathologists) and by ISO15189:2007.  An argument might be made that just because there is not a metric that monitors complaints doesn’t mean that complaints aren’t taken seriously.  But how would anyone, including an accreditation assessor know?

The unfortunate reality is that with larger institutions and organizations the only driver that pushes for more attention to customer satisfaction is certification and in some laboratories, accreditation.  And that is too bad.  The reality is that is unhappy customers have all sorts of ways of sharing their experiences these days that didn’t exist before.  Until about 10 years ago, complain options were fairly limited.  One could write a letter or make a phone call, but short of making a formal complaint to formal state or college authorities, or spending money on civil suit action, that was about all that could be done.  Both of these are processes that most of folks find either unduly bureaucratic and time consuming or expensive. 

Today people can complain far more broadly with less problems.  There is email, and Twitter, and Facebook, and blogs and public review sites.  In healthcare you can register both positives and negatives about pathologists and clinics and laboratories in a variety of sites (,,  Word can spread in a very public way in a heartbeat. 

By the way, as mentioned before, the increasingly present option that patients have for direct-to-patient reporting will inevitably mean more unhappy people, more complaints and more public awareness. The general public I suspect will be less tolerant of wrong identifications, late reports, misleading results, false positives, and false negatives.  Poor customer service is no longer remains a private issue.  It can become very public and very ugly.

Welcome to the dark side of unhappy folks with access to social media.

Thursday, January 5, 2012

Modern Metric Morass.

First off, I personally am looking forward to a happy, healthy and successful 2012, and I wish the same to the readers of this blog.

To continue on, I have mentioned on a number of occasions David Axson’s  book The Management Mythbuster.  Today I will make my last commentary on this book.  First off, I want to say that this book is a valuable read for anyone interested in Quality, not because it is brilliant and agrees with everything that I believe, but rather because it is brilliant and puts forward some very compelling discussion points on organizational management.   That being said it is an opinion book. 

If there is one area where Axson falls down it is in his 10th chapter, Lies, Damn Lies and Performance Metrics.   It is not really his fault, we all are pretty schizoid when it comes to statistic and measurement.  On the one side we all recognize that if we don’t study (as in PDSA) then we can’t meaningfully Act. 

The problem is at the other end.  First there is a notion that if one metric is good then 10 is better and a thousand has to be even better (Axson’s first sentence is “we are drowning in metrics”).  Second we gather metrics based more on what seems to be popular (what we hear about or read about) rather than based on a strategic process.  (Axson calls them the Metric of the Month).  And third, even though many (most) of us are pretty statistics illiterate, we gather all sorts of analyses because we can.  The reality is that statistics software doesn’t require much statistics knowledge; all you do is fill in the fields and hit “return”. The computer doesn’t care if the result is meaningful or nonsense; it just spits out a number.

The result is that all too frequently we spend too much time measuring and not a lot of time testing the relevance and utility of the information.  Excessive metrics gathering is a classic form of TEEM (Time Effort Energy and Money) wasting.

Axson provides a pearl when he offers that the way out of the metrics morass is to focus first on what is really important (core) to the organization.  In business it is about profit and loss and in baseball is it about wins and losses.  I suggest that for the medical laboratory is about getting the right result to the right set of eyes at the right time.   

So if a good approach is to focus metrics on what matters, let me offer the following:

  • Right result:   Measure of pre-and analytic error reported in errors per million tests.
  • Right eyes:     Measure of misdirected reports reported in errors per million tests.
  • Right time:     Measure of late reports again reported in errors per million tests.

Actually that is a pretty good place to start.   All three should be straight-forward to capture and measure.  Since all calculations are calculated to a common base value, significant improvements or deterioration can be monitored.   If we have problems here we are not doing what we are supposed to be doing.

One can argue about whether one would need to bench mark results to industry standards, but the reality is that there are no or few benchmarks for medical laboratory quality other than the expectation for ZERO defects.   We will talk about the definition of what constitutes a late report another time. 

Now I would like it to be that simple; but I also recognize that I know that laboratory life tends to get more complicated.   There are other important issues like safety and competency and quality control performance that laboratories also need to monitor.  There will always be new issues that arise and require monitoring.  And there will always pressures to measure more.  That being said let me offer the following:

  1. Indicators implemented to follow up on a single point-in-time problem rarely need to be followed for any more than 4-6 months; at the very most a year.  
  2. If you have not used the information garnered by a metric for 2 years, then decide if the measurement is worth the time and effort it takes to generate.
  3. If you cannot explain in specific terms what a metric provides, then don’t measure it. 
  4. If there is no organizational memory about why you are measuring something, then it probably makes a lot of sense to stop immediately.
  5. If a metric does not fluctuate, either because it is always provides positive information or always provides negative information regardless of the amount of focused action, there is something wrong somewhere.  

Tuesday, January 3, 2012

POLQM Course 2012

Our course begins on January 11th and we have closed admissions.  This is going to be a great year.  We have had a 20 percent increase in participant intake and our geographical spread involves North America, Central America, the Middle East and Asia.  It is truly an around-the-world experience.

I get a number of messages from this.  First, that the interest in Quality in the medical laboratory continues to grow and second this growth is not limited to one country or one region.   I could say that experience says that this growth and interest is tied to the use of ISO15189:2007 (Medical laboratories – particular requirements for quality and competence) as an international foundation for Quality in the medical laboratory, but my argument would probably be biased.  ISO 15189 was first published in 2003, the year before our course began, so it would be more fair to say that the two have grown up together. The reality is that the course offers a broader view of Quality than just international standards.

Growing up or maturing is a good way to think about our course.  Over the years it has continued to evolve.  When we started it was mostly about international standards.  Over time we built in discussions about the Quality tool box (including Lean and Six Sigma) and Quality Partners and Costs of Poor Quality.  This year the addition has to do with Quality and sustainability and a bit on the US system known as Clinical Laboratory Improvement Amendments (CLIA)  In many ways the course today is very different from what we offered back in the beginning. 

On a technical side we have gone through 3 versions of course software, each with its own improvements.  And this year we are adding in private viewing course video clips via YouTube to help the course continue along a progress line. 

So to be fair, and albeit a little biased,  both technically and content wise the course is not only different, it is better.

To that point over the last few years we have offered a variety of renewal options for folks that took the course in the early years and who continue to be engaged in Quality management.  To date there have been no takers.  I could interpret this as a negative, but in the absence of information I prefer to interpret this more positively.  Because our course is less about a specific how-too and more about reading and thinking and engaging in conversation we strive to create a community of folks who do progressive learning.  By remaining in contact with the folks from their group (I know that happens) the group continues to teach itself.  Thus the reason that they do not feel the need to come back to us for a refresher is because they are doing that on their own. 

I understand that point of view.  While our course is not unfairly priced, it is not free, and for many getting access to education support is harder than it should be.  If money is going to be spent to upgrade knowledge, there should be an upgrade in qualification.  So with that in mind, we are making a lot of progress towards the University of British Columbia Masters in Laboratory Quality Management (MLQM).  I see this as an option to others Masters programs that the university offers including a Masters in Business Administration, a Masters in Health Administration, and a Masters in Public Health and a Masters in Management in Operational Research.  Some might see these as competitive but I see them as complementary, each with a different focus but all bringing a new dimension to Health environment. 

The UBC MLQM will be a two-year program of education, experience and research.  It will be available both as a primarily on-line and a primarily on-site experience suitable for people with backgrounds in Quality, administration, technology and medicine.  The Masters qualification will have the ability to lead to a PhD.

If we stay on track we will start to intake participants either in the fall of 2012 or the spring of 2013. 

Bottom line:  For those interested in learning more about Quality with a medical laboratory focus, there are now options which over the short term will grow.  The notion of learning on ones own or on the job or off the side of the desk is pretty much unnecessary, and might I add, not optimal.  We can do it better.

PS:    Registration for the 2012 UBC Certificate Course is now closed.

Sunday, January 1, 2012

Quality Teaching Aids

As much as we know that folks interested in laboratory quality are mostly adults with a focus on learning, we are also aware that adult learners just, just like kids, get bored easily, and bored folks stop learning.  Educators need to have a well stocked tool box filled with all sorts of education assists.

Word Searches work at almost every level as one way to introduce vocabulary.  Crossword Puzzles work to reinforce vocabulary.  Word Quizzes are another variation.

Attached, for your entertainment is Medical Laboratory Quality Word Search.     Print it out and enjoy.  It may take a little while to complete.  One way to prevent against boredom sneaking in is to set a time limit  (10 minutes) and see how many words can be found.  
This was created using a free-on-line teacher resource at

PS: I can't find DEMING.  If you find it, let me know where it is.