Sunday, March 11, 2012
BC Quality Forum 2012
I had the opportunity to attend an interesting conference earlier this week. It was the British Columbia Quality Forum, hosted and supported by the British Columbia Patient Safety and Quality Council. It was an interesting meeting with lots of positives, and maybe, as we say in the Quality arena some room for improvement.
We can start with the positives. This was primarily a local crowd from my home province. There must have been the better part of 500 people attending. When you consider that in British Columbia in total there are about 4 million people and in clinical health care there are maybe 50 thousand workers, having a group of 500 come out to a 2-day conference on Quality represents a pretty substantial level of interest..
Most of the attendees were nurses or hospital or ministry related bureaucrats and administrators. A few physicians. I think I was the only person from the laboratory world. So you can see there was a strongly clinical bent in the crowd.
Watching what happens as a new movement starts to catch a lot of attention and enthusiasm can be a lot like watching a novice rider sitting atop a galloping horse; arms and legs all akimbo, holding on to the reins, trying to stay in control but very much just trying to stay atop. There was a large scatter of projects, most of them (in my opinion) basic and trivial, but with all sorts of enthusiasm and a far too much jargon talk about “PDSAing” and Kaizen and Just Culture. The over-riding sense is lots of trial and lots more error; all the finger prints of faddism.
One presentation stands out as the poster child of enthusiasm without substance. A pediatric hospital saw a need to develop a new pathway to alert the team when a child was seen to be taking a “turn for the worse”. That’s a good idea. So after many versions and revisions (PDSAing) the document was released for use. After two years they looked at the number of bad events there had been and saw a substantial drop the first year, but a return the next. They would like to point to the use of their protocol as the base for success, but as they pointed out, many staff didn’t like to use the document, most of the new staff were not trained on how to use it, and none of the doctors knew anything about it. So having learned this what had they done about it? Well not much, but they had plans. So while there was some good intention and lots of audience and self-congratulation on a task so well done, when it came down to the crunch, the real point of the exercise had been missed. Having recognized a need, there had been a Plan to create a solution, and an implementation (Do) and an examination on how it was working (Study) but no follow through; all this revision and revising of the form, but no tangible steps to implement improvement.
If that sounds negative and pessimistic and petty, that would be a poor and unfair choice of words on my part because on balance I have more cautionary enthusiasm than discouragement. Having been involved in a LOT of conference at every level from institutional to international, I have seen many weak presentations. From that perspective, this presentation is a fairly typical example of a neophyte group grappling to experiment with something new.
I have been working in the Quality arena now for near 30 years, and it is great to see that clinically oriented healthcare is both aware and constructively starting to catch on. If I have a concern, it would be that superficial dappling that uses up TEEM resources without tangible will result in disappointment and if it becomes a flash it will quickly become a burned-out fad.
Memo to self: By its history, development and quantitative nature, the medical laboratory is much further along the path to Quality implementation than clinical service, but typical of the introvert nature of laboratorians there was virtually no presence. It is consistent with the absence of laboratory presentations at the annual conference on resident education. Not participating in these Education and Quality forums is a poor decision. If you don’t get engaged in the community, you can’t be disappoint when it doesn’t appreciate your accomplishments.).
Next year, if the BC Patient Safety and Quality Council decides to put on a forum again, I am going to ensure there are at least 10 laboratory presentations. My group will do four.
Now all I have to do is convince some of my colleagues to submit the other six.