Saturday, June 15, 2013

Think Strategic and Global but Act Pragmatic and Local

Think Strategic and Global but Act Pragmatic and “Local”
This month Paul Borawski, the CEO of the American Society for Quality (ASQ) asks leading questions in his blog A View from the Q [see ]
  • What is the most important challenge the quality community faces in ensuring that the value of quality is fully realized for the benefit of society
  • And, what question does the quality community most need answered in order to advance the state of quality practice in the world?
Good questions, but from my perspective unanswerable.  That is not to denigrate either Paul or the Questions; but the reality is that the “quality community” is so diffuse and so complex that no single answer is going to address the needs for the whole community. There are too many variables that include geography, resources, sector, culture, and on and on…  So I won’t even try.

What I can do is talk about my own little world of Quality for the Medical laboratory. 
In many respects Medical Laboratory Quality is still very much in its infancy.  We can date the current advances back to 2003.   Most laboratorians if they think of Quality at all, view it as far too fuzzy and anything but evidence-based.  For most practitioners Quality means doing Quality Control or maybe gathering information for some a Quality Indicator that usually has nothing to do with Quality or being an Indicator.  For others it means begrudgingly expending time and money on Accreditation and maybe Proficiency Testing.  For a very few it means having the satisfaction of being in compliance with international standards, especially ISO15189:2012.

What Quality doesn’t yet mean is saving tangible money through reducing Error, and reducing Costs of Poor Quality.

Medical laboratorians perceive themselves as pretty much fact-based folks, and that is a very challenging measure, because while we can say with confidence that adherence to Quality requirements will improve laboratory performance and outcome, what we are still lacking is the evidence to prove it.  

Part of the problem is that generating the fact-based evidence requires specific well-designed study and that means having access to grant-based revenue and graduate students and these are hard to come by.  Across North America and Europe the number of graduate studies programs that focus on laboratory quality issues are few and far between.  In the competition for funding, granting agencies tend to favor the traditional laboratory sciences based on molecular techniques.  I am aware of only one person who has been able to capture the revenues required to look at testing standardization and its potential impact on patient care and poor quality costs.
We have talked about our own data on TEEM costs in which we observed that the average laboratory error consumed an average of 140 minutes to repair (range 20 -1000 minutes) with external failure errors that involve having to contact physicians and patients being the most costly.  That is not a surprise and is consistent with all cost of poor quality data going back to Juran.  That is a start, but we need a lot more to create and provide a platform of data that supports the Quality benefit.  That will take time.

In the past, and even in the present, most laboratories are not creating a position for a Quality manager.  That is a problem, but I can also see their reluctance.  Healthcare is costly and budgets are becoming increasingly limited.  The Quality community is going to need to demonstrate that having a Quality manager will result in savings greater than the costs incurred.  That will not work as an article of faith; it will take hard data.  In the early days of antibiotic resistance, and indiscriminate ordering of antibiotics, hospitals were able to save often double the costs of the clinical pharmacist programs.  That was clearly a measurable success (We will see if the modern “Antibiotic Stewardship” programs are as successful). 
It will not be sufficient to say that having a Quality Manager is a good thing to do.  We will have to have measurable success.    We are starting to develop the metrics to answer this. 

PS:  Our October Quality Conference for Medical Laboratories is coming along well.  A great line-up of speakers and topics:

  • The impact of Stress on Quality and Error.
  • The Sources of Error in the Pathology Laboratory
  • Competency Testing
  • Quality for the Rural Laboratory
  • Measurement Uncertainty
  • The Science of Sample Collection
  • A 20/20 view of Medical Laboratory Quality
  • Canadian Standards in Transfusion Medicine.
  • And many more

For more information and registration visit:

No comments:

Post a Comment

Comments, thoughts...