Friday, January 13, 2017

LAMP OIL and Quality Indicators

So I got an opportunity to participate in a small but important workshop the other day on developing a large regional laboratory quality strategy and presented on the value and importance of developing Quality Indicators.  This was not a new topic for me, having first put on QI workshops and created a QI worksheet more than a decade ago. 
To put Qis in perspective, Mark Brown, who published Keeping Score: Using the Right Metrics to Drive World Class Performance in 1996 wrote “Many organizations spend thousands of hours collecting and interpreting data.  However many of these hours are nothing more than wasted time because they analyze the wrong measurements, leading to inaccurate decision making.” 
At the same time Philip Crosby wrote in his Reflections “ Quality Measurement is effective only when it is done in a manner that produces information that people can understand and use.

Both were true not only 20 years ago, but sadly, as we visit medical laboratories, it is still true today.  Folks faithfully monitoring “Turn Around Times”  and contamination rates.  They make their graphs, pat themselves on the back on a job well done.  But the results are far from understandable and usable.  Their customers don’t know or indeed care because they aren’t involved at any part of the process.  

And in the meantime, medical laboratories who have never been particularly open to public engagement are quietly losing ground to expanding Point-of-Care suppliers.
Of the five ways that laboratories assess performance (Accreditation, Proficiency Testing, Internal Audits, Quality Indicators, and Customer Service),  Quality Indicators can be the most focused, elegant, track-able, and telling (and available for public awareness and engagement), so it makes sense to focus energy on getting them right.

When I put my workshop materials together way back when, I proposed there were (are still are) seven critical criteria that developed Quality Indicators must meet in order to have any chance of being successful.  Leave one (any one) out, and you can pretty much guarantee failure.

OBJECTIVE:  Know what you want to measure and why, Be precise and specific. 

MEATHOD:  Indicators are by their nature be things, events that can be measured (counted or timed, or weighed).  And more specifically your QIs need to be measured by you.  If you don’t how you are going to capture the information, then don’t start.

LIMITS:  Before you start collecting, know what your level of acceptance is and what is a critical level of error.  Get input from your customers.  And take into account Risk.   Telling even one person they have HIV/AIDS when they do not is a BIG problem.  I understand that others may see this differently, but comparing your results against another organization (bench marking) rarely works, but they aren’t you and you aren’t them and too many variables get in the way.

INTERPRETATION:  When you gather your information, does it tell you, and others, something about your Quality?  If it does not, then it is hard to call it a Quality Indicator.

LIMITATIONS:  No measure is absolute and perfect.  That’s why we have Measurement Uncertainty.  (MU is also not absolute or perfect).  If you don’t appreciate that variables can impact on your indicator, you may go down the wrong rabbit hole.

PRESENTATION:  If you can’t express your results in an easy to comprehend manner then it is going to be tough to have impact to engage the people you need to engage.  Maybe it is a graph, maybe a picture, maybe a sentence – but definitely not a report.  

ACTION PLAN: If everything is pointing in the right direction, do you have a plan about what happens next.  More importantly when everything is pointing south, is the wrong time to be thinking about what to do.  Have you plan in place before you start.  

If you take the seven initials  OMLILPA and fiddle, you end up with LAMP-OIL, a rather perfect anagram

Done well Quality Indicators can shed a LAMP OIL  Bright Light on Quality Performance. 


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