The sine wave of Quality change

Bill Troy raises an interesting discussion on the future of Quality on ASQ’s blog “A view from the Q”.  Will Quality change arise by Revolution (leaps and bounds) or Evolution (inch by inch).  It is an important question as the world’s premier Quality organization plans and prepares for the steps forward into the next era of Quality advancement.

Discussion on the progress of Quality reminds me of a discussion with my mentor almost 40 years ago.  We were talking about the creation, rise, and fall of new antibiotics.  As new drugs come along they go through a certain predictable path; first they are the newest and hottest silver bullet, better than sliced bread.  With the first few treatment failures or complications, they almost immediately reverse direction and are viewed as terrible and trash, even worse than poison.  But over time we learn to recognize that these agents are neither perfect nor poison, and fall into their own individual niche within the armamentarium of treatment agents.  He called it the sine wave of medical progress. 

In my experience this is a commentary not only relevant to chemotherapy, but applies generally.   We have seen Six Sigma touted both high and low in our own Quality Progress, but it continues on as a valuable tool in the Quality Tool Box.  We have seen ISO 9001 declared as “broken”, yet it too remains as a valuable standard for implementing Quality.  And in 2010 writers in the Wall Street Journal wrote “What do weight-loss plans and process-improvement programs such as Six Sigma and "lean manufacturing" have in common?  They typically start off well, generating excitement and great progress, but all too often fail to have a lasting impact as participants gradually lose motivation and fall back into old habits.”  But Lean is not dead, and many see great value.

Attitudes come and go as people jump on and off the bandwagon of what’s hot and what’s not.  But the Quality movement continues on because society sees inherent value in confidence and competence and understands the true importance and security and safety that the Quality process brings.  

Change will come because nothing remains static.  Some will result as old guard folks retire and are replaced by newer, younger voices that  emerge.  Some will come as we attempt to fine-tune the subtleties within our standards.  Some will lurch onto the scene with new technologies.  

But let me argue that ultimately change will not be driven just from within the professional community because the real driver of change comes from public demand on one issue or another.   

Want to know the future of Quality? Keep your ear close to the ground and listen to what your customers, your workers, and the public are talking and maybe even complaining about.  

Quality change evokes better solutions.

  

Benefits of a Quality Success

.

Clinical Microbiology Proficiency Testing (CMPT), the PT program that I chair, has just successfully undergone our 10^th annual assessment visit by our certification body (SAI Global).  We are the only Proficiency Testing program in Canada or the United States serving medical laboratories with a continuous 10 year track record of successful external evaluation. 

Congratulations to us.

Voluntary oversight is an interesting activity in which to be engaged.  In Canada, at least for the time being, proficiency testing bodies providing services and challenges for medical laboratories are not required to be externally audited by any agency in any jurisdiction.  We can be accredited to ISO 17043:2010 if we want, or we can be certified to ISO9001:2008, or we can do nothing.   It is our choice.  If some authorities know what we choose, nobody officially seems to care.  To the best of my knowledge, we have one organization that is voluntarily accredited to ISO 17043, and there is one organization certified to ISO 9001 (that is us).  The remaining programs, large and small have to date decided that oversight provides them no particular benefit.

I suspect that the laboratories to which we provide service see the world a little differently.  When we surveyed our laboratories, they reported that most see our certification as providing evidence of our Quality and provided a basis for trusting our Quality and Competence.  That being said, there is no evidence that laboratories make any decisions in which PT program they will participate, based on Quality oversight.  Further, there is little doubt that if the cost of our program  was perceived as too high, or if some of our “competitors” decided to become more aggressive, many of our laboratories would drop our program.  Loyalty goes only so far.

More to the point, I suspect it would be exceedingly difficult, to develop any evidence that would suggest or support that laboratories that participate with over-sighted PT programs make fewer errors or provide a higher level of patient safety.

I will take this one step further.  I am aware of only one medical laboratory accreditation body in Canada that has sought external assessment, and I can see no evidence that would suggest that laboratories accredited to that program are safer or better than those accredited by non-oversighted accreditation bodies.  [That being said, we do have some anecdotal evidence that laboratories with NO accreditation may be inferior].

So there is a reality that if we think we are following our Quality journey for some tangible benefit to patient safety or medical laboratory improvement, we probably would be wrong.  The benefits of Quality lie almost exclusively for us, with some intangibles that go outside the house.

First off, by working through a structured quality process we catch our mistakes earlier, and prevent most from repeating.  By learning from our mistakes and keeping our errors in–house, we save substantial amounts of time, and energy and money.  I estimate this saves our bottom line probably 5-7 percent.

Second, we are a real-life example of the phrase “Quality improves Culture and Culture improves Quality”.  CMPT has a very powerful Culture of Quality.  After 10 years, our Quality system is at the core of everything we do.  It is the basis of our innovation efforts, our internal communication, our discipline of continual improvement, and our dedication to providing the best service that we can for the laboratories that work with us.

When we plot our culture map we are very high on Market (customer awareness) and Adhocracy (innovation) and Clan (intergroup dynamics) and a lower on Hierarchy (internal leadership and requirements).  We are exactly where we want to be. 

There are some lesser tangibles that result from our Quality strategy.  We get a lot of recognition from other countries and are perceived by many as a leader in method development and innovation for proficiency testing.  Considering that we are really a small group, that recognition is a real plus and driver for us. 

And perhaps very importantly, had CMPT not embraced Quality, then we would never have reached the point of opening our sister program, the Program Office for Laboratory Quality Management, and would not have experienced all the huge pluses that have accrued from that.

With all that said, we are absolutely certain that going down the Quality path when we did has given us a level of success that is off-the-scales. 

A truly brilliant decision of which I have absolutely no doubt.