Monday, November 11, 2013

The Meaning of Quality

The Meaning of Quality

At our Quality Management Conference for Medical Laboratories last month, one of our speakers made a throw-away comment, that the word “Quality” is so overused these days that he was no longer sure what people meant by the term.  What intrigued me was that a similar comment was made by another speaker as well, and indeed the concept became an on-going recurrent theme throughout the meeting.
I understand where they are coming from, and I feel a certain empathy, but in all due respect, I think that the sentiment is wrong.  Quality does have meaning.

On the other hand, one of our speakers reached back into the past and made a relevant comment:  “Quality is not a word, it is a journey” [ note: a variant from Ralph Waldo Emerson (?) dated around 1854 – life is a journey not a destination.  The Quality variant has been used since the early 1990s] ,  As much as this sounds like an old truism, I think it is still valid and still an appropriate attitude and approach towards understanding the discipline in which we work.

Let me pull a few things together here.  

With regret we still see all too many laboratories with a track record of repeat  accreditation as far back as the early 1970s.  If you applied the Crosby definition of Quality being defined as meeting requirements, then you would call repeated accreditation meaning Quality.  But you could be wrong.  

Many repeat accreditations were a joke.  Laboratories doing nothing for 4 years and 9 months manifesting no evidence of improvement, and then spending 3 months to tidy up manuals and fill in QC charts.  An accreditation visit, lasting maybe 4 hours done haphazardly, which is then followed by an approval process, perhaps with some recommendations for improvement which don’t occur.  The laboratory then takes a post accreditation breather hiatus of about 4 years and 9 months, and then gets started again.  There is no evidence of a journey here.  It is Quality in name only.  That theme gets carried out in so many ways.  Quality Manuals are beautifully created, only to be locked up in an office more as a trophy on display than as a useful and usable document.  Quality in word only; no journey here. 

We see laboratories where management hands off the Quality portfolio to the senior staff (or worse the junior staff) expecting receive a report of quality indicators for signature once a month, but never actually doing anything with the information; and calling that Quality.

We see laboratories where management receives continuing education funds from institutional resources, but 90 percent or more is spent on management level travel, and 10 percent goes to technologist training.   Again, static words.

We see laboratories that bring in consultants to review and propose grandiose plans for leaning and implementing quality software or purchasing new bells and whistles, but little happens to justify the expenditure, with little consequence.  

We see evidence of static quality all the time; it is no wonder folks fatigue of hearing the word.  

Quality is about progress, about continual improvement, about setting goals for change and making the commitment to follow through.  Quality is about giving voice to both compliments  and critiques to discover what you are doing well and more importantly discovering what you can do better.  

So I agree there is lots of evidence that if action without meaning continues to be the norm, then the term Quality has lost its meaning.  So if you are fatigued by the “journey not a destination” homily, let me offer another more functional definition. 

Quality is the commitment to continuous positive change.  

PS:  If you are interested in viewing the presentations from our conference follow:
Go to the LEFT margin and click on SCHEDULE
Each presentation is linked to the author’s title.

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