It's CHANGE TIME for HEALTHCARE

I'M BACK!!!

It has been a while since I have been active in MMLQR.  I retired from my position as a Professor in Pathology and Laboratory Medicine with my major focus on Quality Managment and External Quality Assessment.   I was able to find a brilliant scholar with stong Quality Interests, and decided the best way to address change was to WALK AWAY.

My university, was generous and honoured me by granting  my Emeritus Professorship.   While I have not been actively active in the university I have continued in my interests in the arena of Quality, both inside and outside the medical laboratory, and have been active with the American Society for Quality (ASQ).  

I have been away but (I hope) I have kept my brain and interests intact.  

I have returned to MMLQR  because I would like to think I will be able to provide some interesting and perhaps provocative thoughts.

As a starter, I am looking at a BRAND NEW INTERNATIONAL standard based on a foundational  document now nearly 30 years old.

Just Culture

For those of you involved in the Quality arena, you know this phrase.  It does not mean "Just" in the sense of "merely culture".  "Just Culture" was introduced into Quality discussion around 1997 by James Reason (see Managing the Risks of Organizational Accidents 1997) when he was talking about organizations that have a work environment in which people may create problems, but work in an environment of trust in which people are encouraged, and rewarded(?) for drawing attention to what has happened, knowing that at some level there can be and will be a line between acceptable and unaccpetabl behaviour.  Just Culture was intended to provide a safe place to ensure that "messing up" was not always going to end up with someone being punished or fired.   Sydney Dekker embraced the concept in 2007 (see Just Culture: Balancing Safety and Accountability) and again new books on the theme near every 5 years (the last and latest was in 2024)   

All are good reads.  If you can find them, they are nice written, and conversational in tone. 

The books put forward the notion that if the environment is safe and "just", workers will be forthcoming of all their errors, goofs, and near misses, a notion with which I have some struggles.  Without going into detail at this time,  my experience and observation is that many workers are oblivious of their errors, and for those that do notice them,  often the errors are self  interpreted as minor or likely inconsequential. 

I will tell you a story.  A few years back I was given an opportunity to look at files that were gathered by my province (British Columbia) on errors identified in medical laboratories.  The concept was that if people identified they have caused a problem, they would self report into the laboratory computer and the information was then stratified by type of error, interpreted severity of error etc.  I was able to create a number of manuscripts from the data (look for Noble et all, in Diagnosis (Berl) 2017 and 2018).  Anyways, during a presentation on the topic, one laboratory technologist told me that in her laboratory staff would sometimes, create a report, but put another staff persons name on it, NOT because they were afraid of repercussions of reporting, but because it was considered as SAFE MISCHIEF!!

Anyways, the reason that I have picked this up is because Just Culture is about to go international in a big way because the International Organization for Standardization (ISO) has just published a new standard ISO 7101:2023 entitled "Healthcare organization management — Management systems for quality in healthcare organizations — Requirements" which is predicated on these organizations (mostly hospital) embracing (or requiring) the use of Just Culture as the foundation of hospital environment and safety.  

Maybe this will happen, but it certainly won't happen over night.

More on this later.

M

Feels Good To Be Back.