Monday, November 3, 2014

Multitasking in the Quality Arena

In 1977, on the television show M.A.S.H. a new character was introduced, an ill-place army surgeon named Charles Emerson Winchester lll.  Wanting to define the character as Bostonian, elitist, and arrogant, a brilliant (in my opinion) writer gave the character the line “I do one thing, I do it very well, and then I move on.”
Every time I make an error, or I see someone else around me trying to multitask and result in inconvenience, accident, or injury, my mind wanders back to “I do one thing…”  (Over the weekend I saw a young man riding his bicycle while talking on his cell phone, ride into the back of a parked car.)

Unfortunately “piling on” task over task has become for me a chronic and persistent bad habit, and I leave myself overly vulnerable to making too many distracted errors.  Over the last month we have held our CMPT Annual General Meeting, started our annual review of the POLQM Certificate Course in Laboratory Quality Management, attended the ISO Technical Committee 212 annual Plenary Meeting (this year in Toronto!!), attended the annual conference for the European Association for EQA providers, (EQALM), written a new manuscript, been a reviewer of 2 journals, signed a commitment for CMPT to seek accreditation to the ISO standard 17043:2010, and prepared a Competency Assessment for a laboratory physician renewing their licence.  I mention the list, not so much to impress, but to point out to myself that as continue along the path of excessive commitment, I create the increased opportunities for distracted error, the potential for dropping the ball or making errors that could have serious impact on my career and others in a major way is unacceptably high.  (Memo to self:  I need to focus one thing, to do it well, and then move on!!).

Knowing myself as I do, I know that I will never stop being a “piling-oner”,  it is therefore important to ensure that I incorporate some protections that should decrease my doing serious harm to the programs that are important. 

For me, the most significant protection is the implementation of standards and backing that up with external assessment, in this case meaning on-site accreditation visits.  In my opinion, our adding in the requirements for ISO/IEC17043 (Conformity assessment - General requirements for proficiency testing) is an important step forward in our path towards improved Quality.  Our strict adherence to ISO9001:2008 (Quality Management systems – Requirements) has bought our program to an extremely effective management level.  Adding to this the more vertical (drill down) requirements for proficiency testing programs will ensure that our skills remain focused and sharp, to the betterment of our program and by extension the betterment of the laboratories that we serve and for the patients that use their services. 

I am not sure that a non-academic program would see particular value in putting expectations on themselves to meet two international standards (one more horizontal in nature, and the other more vertical).  It might seem to be abusive and inappropriately expensive.  But for me, I see sufficient clear benefit.  I find that during assessments, the folks responsible for ISO9001 are excellent in understanding and reviewing our activities with respect to organizational management, risk, personnel, quality improvement, error detection, quality improvement, customer satisfaction, management review.  They have a strong sense of these topics and review them well both in context of the standard, also in context of common best practice.  On the other hand, the laboratory assessors focus very well on the finer aspects of Quality Control, and aspects critical to PT users, like committee structure, instruction information, cautionary information,  and statistical analysis. It creates a healthy blend of practical and pragmatic, of ying and yang, of masculine and feminine.

If we can continue to afford to run both accreditation (17043) and certification (9001) we will continue to do so. 

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