Sunday, May 27, 2012

The Canadian Standards Association: Impact versus Awareness

I am putting together a presentation for a meeting in Quebec City in June.  I was invited to talk about the impact of Canadian Standards Association (CSA) documents on Canadian healthcare.  As I am putting it together I recall a conversation that I had at another meeting about 10 years where a Canadian microbiologist spoke up asking why I would put in any time with the CSA because they did so little for healthcare other than to check that the electrical plugs on radios and equipment were OK.  I suspect that at that time vast majority of my colleagues probably thought this same way.  We will see if things have changed.    

To be fair to my colleagues, most of their time is spend being hands-on technical laboratorians and most of the documents that they look are written by the Clinical and Laboratory Standards Institute.  The CLSI is a developer of many documents of critical interest for the laboratory worker.  Many of their documents are used world wide.  CLSI documents fill a specific niche extremely well.  But if you think about spheres of influence as a form of Venn diagram, the areas where CLSI and CSA cross over is quite narrow, and there are many health related documents that are addressed by CSA that are not addressed by other organizations, including CLSI.

I have spent a lot of career time working around the CSA.  I helped develop and chair the technical committee to focus on medical laboratory Quality Systems, and with CSA support lead the Canadian delegation to the ISO.  Through that committee we participated in writing key documents for laboratory Quality (ISO 15189), laboratory safety (ISO 15190), and point-of-care (ISO 22870) all of which became national documents.  We have shared in developing documents on medical laboratory Risk Management, antimicrobial testing, and packaging labelling.  So from that point of view alone I could justify the time spent working with CSA was time well spent.

But it was when I moved up a step to being a part of the Strategic Steering Committee for Heath Care Technologies and Services that I truly appreciated how much CSA is a health standards body.  Today there are hundreds of healthcare related CSA documents that impact medical devices, facilities engineering, anaesthetic gases, peri-operative procedures, renal dialysis, blood transfusion, tissue transplantation, equipment cleaning and sterilization and infection control, radiology, ultra sound, dentistry, caring for disabilities and medication packaging.  There are essential standards that impact every aspect of the medical laboratory.  Indeed it is hard to think of any part of healthcare inside or outside of health care facilities that is not directly influenced by CSA standards.  

I wonder why after 50 years of engagement in healthcare, there continues to be this huge disconnect between impact and awareness.  

My guess is that there are a variety of reasons that come down to a few root causes.  First is that CSA works in the arena of documents creation, and to many in healthcare this is just plain BORING.  Additionally there are so many organizations that truly believe that document development is a “nickel-dime” process and that they can do it themselves.  And they can and do.  It is just that they do it very badly.  I sat on the standards and guidelines committee for a medical organization for a number of years.  The number of trash documents was tragic.   Recent experiences tell me that little has changed.  The consequence is that there is little regard or even awareness in document source or relevancy.  Just photocopy it and be done with it.
A contributing factor is that Quality issues have almost no play in any aspect of medical education at any level; it is for all intents absent from undergraduate and post graduate education.  The words like “standards development organizations” or “quality partners” or “accreditation” or “proficiency” never come up; ever.  Quality means newer or fancier, not better.  Certainly no one would ever discuss an essential quality partner like the CSA.  Healthcare professionals have little idea about what is a document and what is a standard until well into their career.  It is a stumbling-bumbling process. Perhaps the fact that there is a meeting for laboratorians and I have been invited to present on the topic is a key step forward.

But in the meantime, for us that are interested, the field remains wide open, filled with opportunity and promise.  And a real sense of accomplishment, knowing that we contribute to greater healthcare and society in truly essential ways that others can not understand.  

For those interested, I will post the presentation file after the meeting.

Also, you can visit the CSA on-line store catalogue at:  Click on the Publications link at the top.

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