Sunday, June 25, 2023

The renaming of Quality Improvement?


I have had the opportunity to be actively involved with the American Society for Quality (ASQ).  I am the current Chair of the Healthcare Quality and Improvement Committee (HQIC).  I truly enjoy being  actively involved  because Healthcare Quality has become a personal passion.  Through HQIC I collaborate with like-minded people with a similar sense of passion. 

Last month the World Conference on Quality and Improvement was held in Philadelphia.  Unfortunately, I missed it because of another commitment.  Next year. 

But wait a second… in the last 3 sentences I used a phrase “Quality and Improvement” twice.  Prior to the last little while, I don’t think I have ever said or written Quality AND Improvement before.  I have talked and taught for years about Quality Improvement and Continual Quality Improvement and Continuous Quality Improvement, but never has the phrase Quality AND Improvement been part of that process.   Joseph Juran wrote volumes about Quality Improvement as did W. Edwards Deming, and Philip Crosby and while all of them were involved in ASQ they never used the interloping AND.

So where did it come from?

In 1947 the American Society for Quality Control (ASQC) was created as a union of some seven small organizations.   Each year they would hold an annual meeting (the ASQC Congress).

In 1997, on the 50th anniversary of ASQC, the name of the organization was shorted to American Society for Quality (ASQ), I imagine because the organization appreciated that Quality had become more diverse and involved many more aspects than just Quality Control.

Along with the conference name change, the  meeting name similarly changed to Annual ASQ Congress.

Then eight years later in 2004, ASQ joined forces with several Quality organizations for other countries around the world, and they collectively decided there was value in merging all their congresses into a single world event which they called the World Congress on Quality AND Improvement;  and the interloping "AND" first appeared!

I wonder perhaps that was done to accommodate a common English translation for a conference including primary English and non-English speaking  countries.

In any event, jump forward anther 15 years to 2019, the ASQ goes through another modernizing name exercise.  Within the Healthcare Division there is a committee named Healthcare Technical Committee that needed a name revision.  They decided that a good name would  not be Healthcare Quality Improvement Committee (HQIC) but rather Healthcare Quality and Improvement Committee, still with the acronym HQIC.   

I don’t think any other committee in ASQ followed a similar path.   I did a global check of and found only one reference to an ASQ Committee with the phrase Quality and Improvement in its title, the aforementioned HQIC

Five years ago is not that long ago, however none of the people I have asked can remember why they opted for Quality AND Improvement.  Was there an ASQ organizational directive (now lost and forgotten) that recommended that all committees addressing Quality Improvement harmonize  their names with the conference name? 

So in the absence of a human memory, I decided to go the non-human route,  specifically  ChatGPT.  If AI doesn’t know the answer, then no answer exists.

So I asked the following… “What is the difference between ‘Quality Improvement’  and ‘Quality AND Improvement’? and in about 2 seconds, I got the following:

"Quality improvement" is a systematic, formal approach to the analysis of performance and efforts to improve it. In healthcare, for instance, it involves methodologies to improve care, patient outcomes, and other systems processes with an aim to reduce errors.

On the other hand, "quality and improvement" isn't a recognized term in the same sense but can be understood literally. It refers to the two distinct concepts of "quality" (the standard of something as measured against other things of a similar kind) and "improvement" (the act of making something better). This phrase might be used in a general context where one is talking about both the quality of something and the improvement of something, but they may not necessarily be related.

In my opinion this is an amazingly intuitive and nuanced response.  Scary that it comes from a machine.   Even if it is only the computations of a non-thinking machine, I don’t think it can be disregarded.  Somewhere in its algorithm  the machine recognized that Quality and Improvement are two separate processes that can function either together or  independently.  Just because an organization implements a Quality Improvement exercise doesn’t necessarily ensure there will be a measurable or meaningful improvement in the organization's  Quality. 

Seems to me there are two explanations for the interloping "AND"; either the folks back in that meeting in 2019 were truly visionary and  insightful, or it was a typographical error that never got caught. 

Or maybe they were just being smart alecs.

What I find interesting is that the term Quality and Improvement rings true in my ear, and I find the argument of recognizing the two activities as distinct compelling.  Maybe it is time for all references to Quality Improvement to adjust to the new AI standard.

I suspect Joseph and Edwards and Philip would enjoy the discussion.

Friday, June 2, 2023

Giving Back and Paying Forward - 2023

In the sciences, Quality is NOT about Elegance or Specialness or Brilliant Ideas. Quality, especially in laboratories, is defined by the specifics of meeting requirements and performance. Quality provides the cornerstone for confidence through error awareness and prevention for precision, accuracy, and reproducibility, and relevance. 

The Quality Tools are essential in medical laboratory research and performance.  People's lives may depend on laboratory information.  Done well, laboratory research promotes new knowledge, new understandings, new vision.  Done poorly, it wastes time, wastes money, wastes resources, and creates harm.

I would like to think that understanding the importance of Quality is innate, but that would be expecting too much, but it most certainly is a skill that can be learned and passed on from one-to-another. 

Our university department is quietly worked at promoting laboratory quality improvement through the creation and management of 3 separate laboratory quality assessment (PT/EQA) programs, one in microbiology, one in clinical chemistry and one in tumor marker testing, all of them active in across Canada and international. We created an intense program for assisting countries already with EQA programs how to upgrade their offerings to link their programs with the expectations cited in ISO15189 (ISO15189 does NOT specify the requirements of EQA, but it does point out what medical laboratories should be expecting and looking for in EQA programs). And most recently we have been working with another program to help developing countries develop more EQA tools for their local laboratories, thus freeing themselves of the foreign programs with large costs and little relevance. 

This was not the career that I envisioned when I started my laboratory training in 1975, but I personally feel much pride in carving out was has turned out to be a very successful path for myself and for laboratory quality. I am thankful for having had the opportunity to work in a truly inspiring field,  and am proud of what I have been able to do to influence and (hopefully) inspire hundreds of students. 

So now I am starting on a new path of giving back and of paying forward. Over the last year we have developed the Michael A Noble and Family Award in Laboratory Quality which is founded on a sustained endowment to our department to highlight and reward Quality focused projects and presentations of graduate students and medical residents and course takers in our department. Last night we presented our first award to a student who has been looking at factors that can impact the survival of donor platelets, necessary for people with bleeding due to severely low platelet counts (thrombocytopenia). 

By highlighting projects and presentations that lead to new understanding and knowledge and insights in Laboratory Quality and Improvement we can help lead to further advances in Pathology and Laboratory Medicine. More importantly (in my opinion) through this recognition, we can spawn lifelong commitments to addressing and highlighting and embracing laboratory quality as an essential component of laboratory discovery. 

We look forward next year's Pathology Day 2024.