Thursday, July 21, 2016

Noble’s 11 Rules: How to NOT DIE working in your laboratory (PART 2)

Noble’s 11 Rules: How to NOT DIE working in your laboratory (PART 2)

In my previous entry I offered you Noble’s first 5 safety rules.  The following is the next six.  

6.         Safety is more important than lunch.
        Previous study has pointed out the single most significant causative factor for laboratory accidents and injuries is rushing, especially just before lunch and breaks.  I can believe that.   Apparently rushing is not gender or age biased; anyone can find themselves rushing, and usually getting away with it.  But when the bad thing happens, there you are;  what a risk and what a cost. 
        In my institution, rushing to a cafeteria lunch would not be digestively defensible.  

7.         Think lean.  Work clean.
        There is a lot of Lean thinking that does not translate well from industry and the factory floor to the laboratory, but 5S most certainly does.  Working without a lot of extra stuff around  (sort) and having an expectation of finding you equipment in the right place AND returning them back there after you use them (straighten) and regularly tidying up and getting rid of all the clutter (shine) will make your work less stressful and will likely reduce all sorts of accidents from needle sticks, and twisted ankles and chemical burns.

8.         Pick your information sources.
        In the olden days (pre-internet) the sources of safety information were limited to textbooks, journals, standards, and regulations.  They were pretty good in the day, even if they were a bit biased and dated.  Today we are awash with information from a wide variety of sources (yes, including blogs!).  Much of the information is rapid access-rapid disposal, and some of it is untested, opinionated nonsense that may sound great but don't work out and can even conflict with existing established requirements.  Be selective before implementing a lot of this stuff (including this stuff!) until you determine that if is appropriate for your laboratory.  Confused messages increase confusion, and confusion leads to error.

9.         Surround and Protect yourself with safety.
        This is something like Rule 5 (If you are not prepared, you may pay severely) but is different.     
        If you don’t have immediate access to personal protective equipment or it is not convenient, then you probably won’t use it.  Deciding for the sake of time and convenience to pull boxes out of a -80oC freezer without freezer gloves, puts you at risk for freezer burns.  Choosing to work with tissue damaging and volatile reagents without chemical resistant gloves and respirator mask because they weren’t immediately accessible can lead to all sorts of immediate and long term problems.    Not bothering with a calibration and maintenance program for your equipment can result in aerosols and all sorts of other problems.  I could keep going, but I think you get the idea.
        And there is another thing that fits in here.  (This gets personal).  Every laboratory usually has people who rush, who work distracted, and who don’t bother with detail.  (If you look around and don’t see one in your laboratory, maybe its you!)  There may also be some people who have a couple drinks or a toke at lunch time.   These are people we call accident-prone hazards.  There are some who think that practical jokes in the laboratory break the tension (We call these people jerks.) 
        If you have one of these disaster-waiting-to-happen folks in your laboratory, it would be better if you could figure out how to keep these folks at distance.  When their bad thing happens, it is really a plan to NOT get caught up in their disasters.  

10.     There must be no doubt about when to get OUT.
        Sooner or later someone will drop a tube of blood, or a bottle of reagent, or a beaker of E. coli or something much worse.  For most small spills you can tidy this up with your spill kit (do you know where it is and how to use it?)  But if the spill is substantial and generates aerosols or contains bad bugs or toxins, or volatiles or potential explosives, you are not being a hero trying to fix it.  Get everyone out and call the HAZMAT guys. 
        Just as you probably have fire drills, consider some spill drills.

11.     OPP:  Organization-Personal-Partnership
        Safety is a team sport.  Your organization has an obligation to provide you with a safe environment and the tools to keep it clean and safe.  You have an obligation to work within the rules, to work responsibly and not create hazards for the sake of expediency.  Working together increases your odds of having a long and interesting and safe and healthy career as a laboratorian.  Not doing your part increases your risk. 
        And you always have options if your organization is made aware of safety hazards and chooses to do nothing about them.

If these 11 Rules make sense to you and your laboratory, then enjoy and let me know. 
If they are, in your opinion, the meaningless meanderings of a lost soul, then that’s OK too.  We can always agree to disagree.

Sunday, July 17, 2016

Noble’s 11 Rules: How to NOT DIE while working in your laboratory (PART 1)

Over the years I have worked in many laboratories.  One of my first jobs in the early 1960’s was in a quality control laboratory in a paint factory.  Since then I have been in university laboratories and medical laboratories around the world.  All laboratories one thing in common; they can be dangerous places.  They have toxic chemicals, dangerous microbes, breakable glassware, and equipment that can spew high voltage or spray dangerous bugs.  Laboratory workers put themselves at risk on a regular basis and odds are that at some point a bad thing can happen.

Lots of sources, private, government and otherwise make a lot of rules, but in my experience most of them are so technical and so boring, and sometimes so arbitrary that is understandable why some times some folks don’t read them and adhere to them as faithfully as they could or should.
So from my vantage point of understanding quality management and risk management and the laboratory working environment, and being an admirer of giants like Deming and Crosby,  I have come up with the following. 

I think they are more encompassing and easier to understand and accept and adopt.

1.    If you are not competent, you are incompetent.
This first rule is specifically for the academic laboratory, because they are the single group with the highest failure rate and represent the most dangerous laboratory environments.    Most studies going back 50-60 years point to research laboratories as where the bad things usually happen.

If you have not been trained thoroughly before being asked to take on research laboratory tasks, and have not been assessed by a knowledgeable and competent person as knowing what you are doing, you are a hazard to yourself, your colleagues, your worksite and the rest of the world.  You cost money, and you cost study validity.  You are a hazard.  What you are being asked to do would not happen in an industrial or medical laboratory.

By and large it is usually not your fault.  Most of the time your principle investigator is similarly incompetent because they never learned or understood about safety either.  It is all too often the blind leading the blind.  The old adage of “See one, Do one Teach one” is, was, and always will be nonsense.

If you are not sure what you are doing, and do not feel you are properly prepared, do not allow yourself to be pressured into barging forward,

2.    If you don’t look, you won’t see.
Every laboratory for the last 50 years has understood that some form of internal audit of equipment, reagents, housekeeping, competence is essential on a regular basis.  Maybe it is once a month of maybe one a quarter.  But it is a sad reality that audits frequently are not done, or if they are, it is a five-minute exercise. 

OK; most times nothing new happens, but when they do, if you don’t detect the problems before the cause the bad thing, you will probably detect them AFTER the bad thing has happened.  So its worth the extra 10 minutes one a month to make a screening audit, and if you pick up a problem, fix it. 

3.    OFI and learn.
In Quality management we understand that the single most important way to stop repeated error it to report when you have a problem, write it down, and then fix it.  We call that OPPORTUNITIES FOR IMPROVEMENT.  If laboratory staff are afraid that some one is going to go nuts or punish or belittle for reporting an error, it is not surprising that they never get reported.    We call that OPPORTUNITY LOST. 

4.    Be a mensch
Being a mensch is an Yiddish term for being an adult responsible person.  It distinguishes from being a fool.  A mensch does what is the right thing while the fool does not.  In the laboratory setting a mensch does the sensible and obvious things that prevents harm to themselves and others.  It is being the sort of person that you would like to work with.  A shortd list of what a mensch does in the laboratory includes:

  • Washes their hands
  • Is not embarrassed to wear appropriate personal protective equipemt.
  • Leaves their lab coat in a safe place
  • Doesn’t bring food or drink into the work zone
  • Avoids short cuts
  • Offers a helping hand
  • Supports and encourages reporting OFI.

5.    If you are not prepared, you can pay severely.
If there was a fire, would you know how to get out of your laboratory safely and where to meet, so that you can be accounted for?  If there was a small spill that needed to be cleaned up, would you know where the spill kit is?  If you got a splash in the face, would you know where the eye wash station is?  If there was a bad event, would you know who to call?  If you can’t answer these questions in the affirmative, you and your laboratory are not prepared.

This is the top five.

Wednesday, July 6, 2016

Healthcare Customer Satisfaction: More Talk AND More Action

Healthcare Customer Satisfaction: More Talk AND More Action

Customer satisfaction (Voice of the customer) is a recurrent theme at this blog.  Usually I focus on developing a better satisfaction survey.  Sometimes I focus on my personal experiences with the apparent absence of interest by healthcare institutions who should know better.
Recently I have been busy speaking on the topic in a variety of settings, both national and international and I realized what probably is intuitively obvious to most of you. 

  1. Very large healthcare organizations often have a program of monitoring customer opinion, but it is common this is an intellectual exercise that does not really result in changes.
  2. The most common strategy for gathering customer opinion in most of these large healthcare organizations is that there is a counter somewhere with a neat pile of  four-by-six cards with “tell us what you think” in bold print.  Patients are invited to fill this in and put it in a box with a slot. 
  3. Most community based healthcare organizations say that monitoring opinions is something on their agenda, but at the moment it is not at the top of the pile; but we're going to get to it soon.
  4. Most smaller healthcare organizations say that monitoring opinions is not necessary because the place serves more as a community or family centre where everybody knows everybody else.  “We hear everything we need just by being here.
  5. Rare is the training centre that trains any healthcare professionals about what customer satisfaction means.  Rare is the trainee (or trained professional) that gets beyond “our customers are our patients” or “we don’t have customers.  We don’t make widgets; we treat patients.” 

I guess that was OK back in the 1950’s but none of that works today, at least if you are interested in improving healthcare, not just making a living from it.  

(Parenthetically I have previously commented that the greatest killer of quality in healthcare is having a constant flow of new patients, with no kudos or benefits for doing well, and no real consequences for doing poorly.  I still think that is true).

So after going through this “revelation” I decided that if I wasn’t trying to implement something better, then I was a part of the problem.  

So we are going to take a two prong approach.

  • We are putting on a conference/workshop on the subject and inviting students, residents, educator to participate.

  • We are introducing a module in our Certificate Course for Laboratory Quality Management that will introduce Customer Satisfaction / VoC as a key discussion point.

More on the workshop.

I have found a set of very impressive speakers who can talk with authority on the subject of monitoring healthcare customers, mainly from the perspective of the medical laboratory, but also from the broader perspective.  We have a speaker from ASQ speaking to the topic “Customer Satisfaction is THE Quality Imperative”.   We have a speaker talking to the topic “Customer satisfaction; what we have learned, and what are our opportunities for improvement”. 
This will be a great introduction and give a good foundation for discussion.
The conference will be in Vancouver BC on October 5, 2016 on the UBC campus.   Registration is very low, to no introduce a barrier to attendance.

For more information visit: 

At some point you have to decide: 
Part of the Problem or Part of the Solution