Every year at this time my Clinical Microbiology Proficiency Testing (CMPT) program hosts its Annual General Meeting and I get a chance to look back over the last year. This year ww have a special meeting because it is our 30th anniversary.
As much as we have stayed with our roots as a university department based PT program, over the years CMPT has certainly changed from being a small program primarily for the large laboratories in British Columbia to a whole province program, and then going regional and then pan-Canadian and finally international. We started with very basic samples with lyophilized single bacteria, and have morphed into a very different format with live closely simulated clinical and water-testing samples, plus a broad range of targets including gram stains, bacterial toxins, Antigen testing, etc. If samples are not typical of true samples, then what ever we are measuring, it is not proficiency or competency.
Like most programs in North America we have had to deal with laboratory consolidation and public sector financial cutbacks, but have managed to remain active and relevant to the laboratory community and continue to be financially sustainable.
Perhaps the single most important decision that we have made in the last 15 years was our commitment to structure ourselves around a Quality Management model. That decision has had some consequences especially around the consumption of time and energy and money, and it has not generated much interest within the university department, and so it is important for me to regularly review and reflect upon whether I have put us upon the right path.
I imagine that we could have reached the same point of success had we not focused on ISO 9001 as a road map, but I doubt it. I suspect we never would have been able to sustain our integral practices.
Strategic Quality Plan (aka Quality Manual)
Every year we look at our policy base and reinforce or refine it and use it as our foundation for action going forward. Having the policy base available has actually made making decisions on go-forward plans much easier. Indeed when we were really getting hammered by consolidation and a dropping Canadian dollar (down to 62 cents at one time), our policies with respect to staffing and financial responsibilities made a lot of decisions about what is and what is not important much easier.
Today the policy set is very encompassing, but even in the last 3 months we were faced with some issues with respect to succession planning, and we found that while we had some broad and basic ideas, we had no policies or formalized plans. That became a reason to reflect more broadly, and now we have a documented policies, and have been able to create a strategy and plan. Good for us.
We have a regular process of internal audit that looks at the organization from both a technical and management perspective, and we can count how many times it has “saved-our-bacon” over the years. It is amazing how often small weaknesses creep in. Sometimes they reach to point of manifested errors which I think we pick up quicker because of the audit. More often we pick up potential problems before they erupt and we get to make changes before the bad thing happens. Every year we identify around 8 OFIs, the majority through the internal audit process.
We focus a lot of time on customer satisfaction. We monitor opinion and suggestions through surveys, and we monitor concerns, complaints, appeals and resolutions. We have become very adept at gathering information and have developed very successful survey models that I see many others would benefit from. [How often do you click out of an electronic survey because it is too long and too boring?] And we make a lot of decisions based on the information. Many of our most innovative changes, including product improvements, new products, and new programs have arisen from this information.
Every year I take the time to review all our reports in all aspects of our program, including our annual goals and objectives. It takes me a few days. It lets me know if we are staying on track or doing what most organizations do… good ideas, good plans, no follow-through. I know with confidence that nearly 90 percent of annual goals are met within a year, the about 90 percent of the remaining are met within the next year. Over the last 10 years we have failed to meet only one of our established goals, and that one we have put on hold and on a new time table.
Overall with all the pressures that come from being a small education oriented self sustaining university based program, I suspect that had we not got serious about our management model, the most likely outcome is that we would have disappeared years ago. That we are still active and thriving and providing creative and innovative education, research and outreach because of our QM model. We might have been able to get into a process of internal audit or management review on our own. We never would have figured out monitoring of customer satisfaction. From my perspective our success and sustainability is directly related to our commitment to Quality Management.
So to address the question “is Quality Management window-dressing?” for me the answer is simple and direct. Absolutely. But more importantly it is also the window, and the wall, and the foundation, and the whole darn house.