The Clash Between Laboratory Quality and Personal Study?

It seems to me to be inherently obvious that Quality is a collective group activity.  

 Quality is measured by response to customer (the public) needs.  Quality is empowered by the collective Culture of Quality, meaning the power of the total group drives Quality benefits of continual improvement and continuing education.  Quality is the product of peer groups working together to find opportunities for innovation, improvement and success.  Quality is driven by the sense of openness associated with acknowledging errors and other opportunities for improvement (OFIs). Quality is predicated on standards and guidelines which are  the product of consensus and compromise.  

I think as a general experience, the least successful approach towards making positive change for improvement is to have someone sit alone in their office and draw charts and diagrams and write strategies without the input of others.  

So I think that the people who would be attracted to working in the Quality arena would be folks that enjoy the group collective experience.  They would be the folks that enjoy working with others; discuss, maybe debate, but to come to a consensus opinion and a collective plan for going forward.  Quality people, you would think, should be people persons.

I raise this because we have put on a university based certificate course in laboratory quality management every year since 2002.  I have mentioned it before.  It has evolved into a 21-week on-line course in what we call a VCOLE format (virtual classroom on-line education) where the central essence of the course is that most of the course is in the form of small-group discussion and most of the assignments are in the form of small-group team (collective) efforts.   

We do it this way because the best way for adults to learn is to work in groups and bounce ideas back and forth.  Increasingly there is evidence that the worst way to learn is to sit in front of a computer screen by yourself and study by yourself and do your assignments by yourself.  

Apparently the duration of time that information retained (persistence)  in the discussion based model is much greater than the individual learning model.  For reference see “Effects of Small-Group Learning on Undergraduates in Science, Mathematics, Engineering, and Technology: A Meta-Analysis  (2013)[https://www.math.upenn.edu/~pemantle/active-papers/springer-stanne-donovan.pdf ]

So imagine my disappointment when in our collective survey of opinions on the course (Yes, we do a lot of customer satisfaction surveying in this Quality Management course) I receive the following comment:

“The group work was challenging, and some members definitely did not do their fair share. … I certainly did not appreciate putting so much effort on an assignment, and then have someone parachute in, and ride on the coat tails, contributing very little, but still getting the same mark as everyone else.”

I have to say that that is not a comment would likely come from a consensus oriented, collective driven, people person.   It sounds more that an academic competitive person for whom sharing and participation is far less important than getting an “A”.  If I wanted to be pejorative I would refer to it as being very high-school. 

But that would be very rude of me, and probably inappropriate (Donald Trumpish?).  

Our opinion surveys are intentionally done in a manner that does not allow me to know or find out who wrote the comment might be.  So I don’t know how well or unwell this person did, other than to say that most people who take the course do very well.  As to whether this person stood first, or in the first 10 percent, or the middle or the last 10 percent, I have no idea.

But to that person let me just say the following…  I

When you find work in the Quality arena, you will find yourself working in small groups all the time.  It is the nature of Quality.  

 Some people will get really engaged and do a ton of work. (That might be you.) Others will be less interested and do less.  And some will pop in-and-out and not contribute much at all.  That is the nature of small groups.  

You had a great experience, you learned some new information, and new skills and probably did well.  Why does it matter how others scored or not scored (actually we keep a close eye on how much individual participants actually participate and their overall participation score reflects their degree of activity)

If you are uncomfortable with small group dynamics, you probably should stay far away from the quality arena.  You will be miserable every day on every project.  If you can’t cope with small group committee dynamics in a simple learning environment, it sure won’t work for you in the real world.  

Too bad.

Note:  The preceding may be interpreted by some as a betrayal of confidentiality because it contains participant comments from our course.  Please note that all the comments are submitted anonymously and cannot be traced to any individual or IP address. 

PS:  If you are interested in university based on-line education for medical laboratory quality management that is open to Canadian AND international students, please go to www.polqm.ca  Our next course starts in January 2017. 

Quality and the Quality Conference

Quality oriented conferences have become prolific these days, even in the Medical Laboratory arena.  This actually makes a lot of sense because Quality has become a very relevant issue at almost every level.  It is a HOT topic.

There are so many aspects of Quality that touch the Laboratory arena include Costs, Clinical Relevancy, Patient Safety, Culture, Risk.  It has become near impossible to keep up with moving trends and recent advances if you are not connected to the Quality community.  

For those of you that visit this site from time to time, you may recall a post that I wrote about 9 months ago:  see http://www.medicallaboratoryquality.com/2014/07/quality-standardization-and-mh17.html  in which I argued the downsides of conference travel including cost, and risk.  Perhaps you may think that my now planning on hosting a meeting might seem a bit hypocritical.  

I would not agree.  Thinking in terms of Risk, one can look at conferences from both a occurrence/severity perspective and a risk/benefit perspective, and I can argue that if a meeting has high enough value of information and is held in a really nice and low risk environment and at a fair cost then the balance of factors leans strongly to the side of hosting and attending.  

So I will start from the positive high value side, or as Crosby would say it “Quality has to be defined as conformance to requirements”.  Will the meeting meet customer requirements?

In a short 2 and a half days, we will have speakers talking on Health-Quality-and the Law, on Safety as the Quality Imperative, on Modern Tools for the Modern Quality Manager, and on techniques to solidify the Culture of Quality.   It will be difficult to find a meeting that will provide a better array of topics.  Within those subjects we will talk about Teaching Quality to Adult Learners, reducing risk through Conflict Resolution, Establishing real time inventories of laboratory error and safety accidents and injuries,  We will look at calculating true costs of poor Quality (how Crosbyesque is that!) and determining risk in pre-and post examination processes.  

We will have presentations and roundtable discussions, and presenter contact time and the opportunities for posters and sponsor interactions.  All in all, this will be a high content conference.  This is exactly the structure that meets the Andragogy criteria for Adult Learning. 

In terms of the potential for bad outcomes by every measure they are very small.  The conference is being held in one of the most picturesque cities in North America (Vancouver BC) at a time with little risk for inclement weather, and essentially no risk for personal adversity.  Vancouver is an ideal city; big enough to be world class, but not so big that you get swamped and hit with major costs.  It is a major travel destination, with easy access from across Canada, the United States, Western Europe and Asia.   Thanks to the recent Olympics there is a truly beautiful and efficient airport, to be sure.  

 So it would be fair, reasonable and accurate to say with conviction that the potential for downside risk from either the occurrence or severity perspective is low-low-low.  

Some of you will want to know more and for those of you interested the preliminary website is available now at:  http://polqm.ca/conference_2015/home.html .

I look forward to meeting with some of you in Vancouver from October 28-30, 2015.  

More information will be available shortly. 

I will keep you informed.

Teaching Quality_Part 2

If we believe that communicating Quality is the cornerstone to implementing and developing a Culture of Quality, then we have to accept that those responsible to doing that communicating know what to do.  But with regret, that is what we call wishful thinking.  

I am almost certain that most Quality leaders have little to no training in effective teaching/communicating, and rely mostly on their previous experiences as a student (when they learned mainly from people with little training).  That, with regret sets us up for a potential problem.  

 So let’s look at this as a problem that needs to be solved.  Most people come to Quality later in their career rather than sooner.  It is an adult choice.  Most of their experience has come from being a laboratorian, perhaps a technologist or a pathologist, maybe a nurse.  But one thing is almost certain, few if any come to Laboratory Quality Management after being a teacher.  Most of us have little training in public speaking, much less teaching.  Indeed if there is any truth behind the stereotype of laboratory workers, many of us are not very comfortable in speaking in front of an audience. 

The result of this incompatibility is that either we tend to do the prerequisite teaching not particularly well, or worse, we find all sorts of ways to avoid it, or not even raise it as an issue.  And that is not good.

So there are a few things that we can do.  The first thing actually is not learning about content; rather it is about learning how to talk.  The content can wait.   For those that get tongue tied or stress out at the thought of talking in front of a bunch of people, consider taking an adult public speaking course or participating in evening acting classes at a local community centre or joining Toastmasters, or start practicing at home with family or in safe social settings.  Find a speaking coach.  Approach this in the same way as you would learning how to drive, or how to operate a new analyzer.  For most of us it won’t take long before we get the hang of it, maybe a month or two.  But if you are not comfortable with standing on your feet and talking out loud to others, communicating Quality will be a painful process, both for you and your audience.   

Another thing to do is look at andragogy (adult learning) and imbed some of the insights that others have garnered along the way.  Some of the classic ones are to be found in part 1 [see: http://www.medicallaboratoryquality.com/2015/01/teaching-quality-spoiler-alert-it-is.html ]

More recently I have been scoping our more of the andragogy literature, and found another excellent author (Roberta Silfen – Teaching the Adult Learner – 2011).

Here are some things that Dr. Silfen brings to the table:

1:  The Knowles principles are REALLY important.  Perhaps most important is that adults view their past experiences as universal truths.  They are very powerful and influence what they will gain from what they are learning today.  Challenging those past experiences can only be done with caution.  Adults want their past experiences to be respected and valued by others.  

2:   Given a choice between didactically presenting information and then asking if there are any questions, versus posing problem solving questions and then discussing the responses, adult learners prefer the latter.  

3: Adults learn better at their own pace than at someone else’s pace.  You have to be flexible.

4: Adults learning works best when teachers are comfortable in sometimes sitting back and letting others take the lead.  

These can be really tough.  For many of us (me, especially?) we love showing others what we know and love being the lead.  For those of us like that (again me, especially) the title of Part one is really important (Spoiler alert – it is NOT about you).  

To my mind, if building a Culture of Quality is important, then sharing the Quality message in a manner that invites your work colleagues to pick up the ideas to the point where they can apply them to their own work experience is absolutely critical.  We have two choices; doing that messaging well or doing it not so well.  One has a better chance of working than the other.  

Next time (Part 3) I will address the question about to present information in a variety of cost efficient and cost effective techniques.  Some are from my own experience, others are from Dr. Silfen.  

PS: Dr. Silfen’s book Teaching the Adult Learner is available on Amazon.com for a truly under-valued cost.

Teaching Quality. Spoiler alert - it is NOT about you.

For the 12 years we have offered our VCOLE (virtual classroom on-line education) course The Program Office for Laboratory Quality Management’s Certificate Course on Quality Management.  Each year is essentially it presents as a new course because of all the refinements that are implemented based on our experience as faculty and the information that we gain from all the participant surveys that we run throughout 7 modules of the course.  The course information is based on Quality principles, key to which is Deming’s Plan – Do – Check – Act and Repeat.  

 

From the very beginning we were assisted by a course design expert who ensured that we focus on established Andragogy (Adult Learner) theory.  It is, or should be intuitively obvious that when it comes to learning, adults are not just big children.   Child learning is diffuse, adult learning is focused.   Adult learning has been a focus of study for almost 200 years, developed by Kapp in 1830s.  In North America, Kapp’s theories were popularized by Malcolm Knowles in the 1970 is his Principles of Adult Learning which include:

·       Adults are internally motivated and self-directed

·       Adults bring life experiences and knowledge to learning experiences

·       Adults are goal oriented

·       Adults are relevancy oriented

·       Adults are practical

·       Adult learners like to be respected

To translate these principles into practical terms, adults know what they want to learn, and how they want to learn.  If the subject does not have purpose, is not relevant, or practical, adult learners move on.  And they bring a lot of experience and expertise to the table; not acknowledging that is foolish and destructive.  Encouraging the sharing of experience and experience is always a good thing.

We work very hard in the course to teach to those principles.

Recently I found a couple books by Jane John-Nwankwo an American nurse who focuses a lot of attention to Adult Learning Principles, from the perspective of a Nurse Educator.  They are short (maybe too short) but certainly to the point.  They are available on amazon.com and if you have an e-book are very inexpensive.

So what is the point?  

Quality is not intuitive, and is not something that is any part of any curriculum while we are growing up.  Adults come to work with some very mixed Quality messages which are usually very mixed and usually negative.  The common message is that Quality is about writing documents and CAPA software and telling staff they aren’t trying hard enough.  “If only you had done it right the first time!”

If a Quality Manager wants to be successful, they need to figure out how to encourage staff to build a Culture of Quality.  They need to figure out how to motivate and teach effectively; and that means they need to know something about how adults learn.  

Being an effective adult teacher was not something that I came to the table with.  I had to learn, and I will tell you that it was painful.  Over time I used the trial-and-error approach, the theatrical approach (scripts, choreography) and the down-home-folks approach.  Ultimately I figured out the real secret; teaching is not about me.

Teaching is about applying the principles and giving the audience what they want and need: practical, relevant information that is to the point.  Fill it in with a few stories that tie to my own personal experience and expertise, and then over to the audience for dialogue and discussion.  

Done well and maybe you will motivate some to want to come back.  Done really well and maybe you will develop a core group who engage with comment and get stimulated to action.  

Over the years I have learned a few things not to do:

• ·       Don’t equate a big crowd with success.

• ·       Don’t drone on.  Keep to the point.

• ·       Don’t speak to slides.  Use slides to highlight, not as script.

• ·       And, while it is always an ego boost, to the extent possible avoid all invitations to speak at meetings where no one speaks your language or understands what you are saying.  

Being a Quality motivator is all about sharing the message.  It is not about you.  If the audience comes out engaged, you win.