Tuesday, September 26, 2017

Motivation and Inspiration in Quality Teaching

I have a personal story about my quality adventure.  I have mentioned it before, but it is worth repeating. 

 In 2002 I was shamed into pursuing international recognition for CMPT, my proficiency testing program by a laboratory technologist who accused me and others associated with laboratory oversight as being FRAUDS because we exerted our authority over laboratories making performance demands while at the same time requiring no similar demands on ourselves.  She was disturbingly  but absolutely correct because back then neither my province nor my country required or expected either  accreditation bodies or proficiency testing bodies to demonstrate competence through objective oversight.
In the absence of an established credible laboratory quality standard (at the time) we immediately started our process towards have our quality system developed and certified to ISO9001:2000. 

[Note: while ILAC guide 25 for testing laboratories and ILAC guide 43 for proficiency testing bodies existed, there were no Canadian bodies that would assess against either guideline at the time. There were however Canadian certification bodies that could assess against ISO9001].

In order to implement our voluntarily imposed quality system, we hired a quality consultant but things were not going well.  One day he called me aside and pointed out that when he was around, I would work with him on the QMS.  When he was NOT around I would STOP working.  Josef made it clear: “This was NOT his QMS, and was NOT his laboratory.  If I wanted this to actually happen, I would have to take ownership and get my act in gear”.  Again, he was right and I was definitely wrong.
With the appropriate well placed kick, we got ourselves going, completed our certification and have maintained it ever since, most recently to ISO9001:2015. 
By every measure CMPT improved substantially and has grown from being a local program to a national and now international EQA provider.  In 2014 we extended our commitment to quality and added international accreditation (ISO/IEC17043:2010).

The reason that I recount this story is because it is a very personal good example of a general truth: the impetus and inspiration to Quality can come from the most unexpected of places, but the drive and motivation to Quality must come from within.   

The story has relevance for me because over the years we taken that same passion and commitment and put it into creating our Certificate Course in Laboratory Quality Management.  We have now trained close to 400 people.  Most have come from Canada or the United States or some of the wealthy developed countries in the middle East.  Some have come from much less wealthy regions. 

While about 95 percent do well enough to earn their certificate and by survey enjoy what we offer, by my estimate less than half leave the course with the sort of commitment and drive to make an inspired career in the Quality arena.   

We occasionally get folks that folks who come uninspired and leave uninspired.  Recently we had a person, very senior in laboratory hierarchy, who paid the tuition money, started the course but hardly ever participated and then quit showing up after about a month and then just disappeared.  I wonder how the employer felt about frittered money. 

I will tell you that every once in a while, we get a note that something has happened and they were unable to continue. Sometimes we can offer a rebate, or an invitation to come back and continue next year.  In this situation, they didn’t ask and we didn’t offer.

But because we are aware of  and pay attention to those who don’t move forward, we spend a lot of time and energy focusing on course improvements and the changing picture of quality.  We promote leadership and innovation and their impact on culture of quality and the development of quality tools.  We focus as much (or more) attention on challenging participants to look for and find positive and progressive opportunities for improvement as we charge them to monitor and identify and remediate and correct findings of non-conformities.

And sometimes we get our special rewards for the effort when we receive letters and notes from the enthusiastic participants who tell us about how our course inspired them to take their laboratory quality to the next level.  

So here is the point that I am making.  Despite our efforts at continual improvement and promoting communication and participation and learning and teaching new skills, taking our course can not guarantee to imbue all participants with the drive and motivation to engage in quality passionately, but I sure am pleased that we have been able to provide more than our fair share with the impetus and drive (and in some instances, passion) to help make laboratories better.

There is much to be gained being committed to providing quality Quality education. 

Monday, September 4, 2017

Medical Laboratories in Challenging Times.

In many respects in today’s medical laboratory reminds me of Charles Dickens: “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair…”
(Well maybe winter of despair is a little excessive!)

When those of us old enough to compare where we were in laboratory quality and error in the 1970s, we can certainly say that compared to then, these are indeed the “best of times”.  In many countries, Quality management programs which are based on international standards and monitored by accreditation bodies.  None of these existed prior to 1975, or indeed for much of this improvement even before  2005.  

But it far too early for us to pride ourselves with a high-five “problem solved”.  

Indeed many of the problems are not solved, they are brushed over, and the errors that do occur, harm a lot of people.  If these are not the worst of times, I think we can all say that we can and should be doing a lot better.

In my opinion across many developed countries we continue to put pressure of improvements by continuing with laboratory consolidation [see:
http://www.medicallaboratoryquality.com/2016/03/cum-minus-facerent-malum.html ] which for the sake of efficiencies we reduce contact and interaction with our prime customers resulting in poorer service, poor care, more error and more cost.  Not only is our system less effective than it could and should be it is even less efficient than before we started down this pathway.
But rather that looking down the spiraling whirlpool, we can look to  the evolution of some distinct opportunities for improvement.  The concept of patient centred care has come to the fore in both private and public sector healthcare, in large part being driven by vocal and activist patient demands.  

We see professional assistance initiatives such as antibiotic stewardship programs, helping to promote better antibiotic usage as an approach to contain emerging antibiotic resistance.

We see more organizations hiring more better trained Quality team managers and members working through the complexities of laboratory testing.  And as a large step in this direction, we see more laboratories dropping the “project approach” towards quality and better implementation of programs that introduce a better local culture of quality based on more sustained quality improvement.  Quality Management has become a focus and interest of leadership and in places has spawned leadership training.

We see innovation and initiative at improving how we can monitor and advise laboratories to allow for better attention to potential areas of needing more improvement. 

We see stronger bonds between laboratories and their quality partners, especially in developing countries resulting in real and present growth and improvement in laboratory performance.  We see sustained on-site mentoring programs which promote better education, better practice, better communications and a stronger sense of leadership and accomplishment and culture.  (From my perspective, what I am seeing is that in terms of rate of growth the focus on quality and improvement in the developing country laboratory education and training is rapidly outstripping what is happening here in Canada, and as best as I can tell in most of the developed world.  We will have to do something about that soon).

We are now living in the era of disruptor technologies that are rapidly changing how the world sees laboratory function.  In 2001, President Bush of the United States saw the crisis of HIV destroying African population.  Through the development of the President’s Emergency Program for AIDS Relief (PEPFAR) laboratories in Africa jumped from being incapable to doing anything for patients to being able to diagnose and monitor patients through doing Point of Care Testing and Viral Load testing, indeed in many situations faster than the same technologies became available here. 
Today we are going through a similar revolutionary leap in bacterial diagnosis through the use genetic examination of mass body flora (the microbiome) and the use of Matrix Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (can you blame anyone for bypassing all that science stuff and saying MALDI TOF MS !). 
Rather than continuing along the path developed by Pasteur and Koch, laboratories can now identify bacteria in minutes as opposed to days or weeks, based on analysis of mass amounts of nucleic acids and minute amounts of proteins.  These giant leaps have heralded a new era for laboratory innovation which can lead to untold advances in disease understanding and diagnosis.  It is indeed an exciting time, provided that we can protect ourselves from the past follies and flaws of laboratory developed tests.

For those interested in these and many more related topics I encourage you to attend our POLQM October Quality Conference in Vancouver BC Canada – October 1-3, 2017.  

It will be the most important days you have immersed yourself in the Quality arena – EVER!!!