A Great Quality Read

As we prepare for the 15^th year of our Program Office for Laboratory Quality Management Certificate Course we have made our regular fine-tuning changes in order to ensure the course continues to be relevant and up to date. 

This year, in addition, we have made a major change; we have adopted Juran's Quality Handbook: The Complete Guide to Performance Excellence, Seventh Edition as our primary reference text.  

There are several reasons for this.  For one, it has just been published and became available in November 2016; it is as current as a textbook can be. 

More importantly it is an excellent read; well designed and laid out.  The text is straight forward and laid out in a well-organized style .  The content is presented in the style commonly referred to as “plain language” (hurray!).  It is both complete and sophisticated and appropriately nuanced.  

In my mind this new Quality Handbook has all the hallmarks of an excellent textbook.  

Granted I am a little further along in my knowledge and motivation on the topic of quality, but even I (with my mild dyslexia and a tendency to easy distraction) can get into reading full chapters at a single go.  If I can do this, I imagine that so will many (or most) of our course participants.

To give credit where credit is definitely due, Joseph A Defeo, the President and CEO of the Juran Institute, not only took on the role of Editor, he also wrote about half (?) of the chapters.  While taking nothing away from the other contributors, having done both writing and editing myself, I know this dual tasking was a major consumer of many, many hours.

My course audience is very focused in healthcare and medical laboratories.  While this book is intended for a more general audience, I find it covers all our key topics, including Culture for Excellence and Quality, Leadership, Costs of Quality and Poor Quality, Risk, Process monitoring, Process improvement, plus, plus, plus in a manner that we will be able to appreciate in the context of  laboratory setting, just as someone in retail, or manufacturing will appreciate in their context.

While the key medical laboratory quality standard ISO15189:2012 (medical laboratories – requirements for quality and competence) does not come up (not even once), the content is this book with respect to ISO 9001:2015 (Quality Management Systems – Requirements) is stunning in its completeness and thoroughness.  For my two cents, I have long advocated that while medical laboratories should  appropriately be formally accredited to ISO 15189 (or to the requirements of the College of American Pathologists and CLIA), I think that many (many all) laboratories would be strongly improved if they were to supplement their accreditation with voluntary certification to ISO 9001 [see:  http://www.medicallaboratoryquality.com/2014/09/is-public-sector-place-for-iso-9001.html ].

There are a few places where the book could be modified to make it a little more relevant to healthcare.  The list includes failure costs such as satisfying warranty claims, investigating complaints, offsetting customer dissatisfaction with a recovery strategy, collecting bad debts and correcting billing errors, which are all reasonable in a manufacturing or retail sector.  But the primary external failure cost in medical laboratories is the time spent in tracing back similarly wrong results, notification of physicians, recall of patients, and potential liability because of actions taken on faulty information.

This book is going to be a great enhancement for our course.  In addition to the fore mentioned there were several other important reasons that we decided to add it to our course library (The cost of the book is built into the course registration.  There is no separate or additional cost to the participants).  

First and foremost it has great content.

Second, all our participants will undoubtedly recognize it as an essential quality reference for years to come. 

Third, it is available both in hardcopy and as an e-book, which means that we can reduce our costs and time losses when shipping books around the world. Delivery of e-books is virtually instantaneous. 

Fourth (an important feature for those participants that are sometimes challenged by things technical, this e-book is very easy to set up on any device.  For eyes, much younger than mine, it will also load on a smart phone).

So for my vote, I give Juran's Quality Handbook: The Complete Guide to Performance Excellence, Seventh Edition a 5 star rating.

Well done.

PS...

For those interested,
the POLQM Certificate Course

begins January 11, 2017.

For more information visit ...

www.POLQM.ca

and click on the 

LQM2017 link

Healthcare Customer Satisfaction: More Talk AND More Action

Healthcare Customer Satisfaction: More Talk AND More Action

Customer satisfaction (Voice of the customer) is a recurrent theme at this blog.  Usually I focus on developing a better satisfaction survey.  Sometimes I focus on my personal experiences with the apparent absence of interest by healthcare institutions who should know better.

Recently I have been busy speaking on the topic in a variety of settings, both national and international and I realized what probably is intuitively obvious to most of you. 

1. Very large healthcare organizations often have a program of monitoring customer opinion, but it is common this is an intellectual exercise that does not really result in changes.
2. The most common strategy for gathering customer opinion in most of these large healthcare organizations is that there is a counter somewhere with a neat pile of  four-by-six cards with “tell us what you think” in bold print.  Patients are invited to fill this in and put it in a box with a slot. 
3. Most community based healthcare organizations say that monitoring opinions is something on their agenda, but at the moment it is not at the top of the pile; but we're going to get to it soon.
4. Most smaller healthcare organizations say that monitoring opinions is not necessary because the place serves more as a community or family centre where everybody knows everybody else.  “We hear everything we need just by being here.
5. Rare is the training centre that trains any healthcare professionals about what customer satisfaction means.  Rare is the trainee (or trained professional) that gets beyond “our customers are our patients” or “we don’t have customers.  We don’t make widgets; we treat patients.” 
   

I guess that was OK back in the 1950’s but none of that works today, at least if you are interested in improving healthcare, not just making a living from it.  

(Parenthetically I have previously commented that the greatest killer of quality in healthcare is having a constant flow of new patients, with no kudos or benefits for doing well, and no real consequences for doing poorly.  I still think that is true).

So after going through this “revelation” I decided that if I wasn’t trying to implement something better, then I was a part of the problem.  

So we are going to take a two prong approach.

• We are putting on a conference/workshop on the subject and inviting students, residents, educator to participate.

• We are introducing a module in our Certificate Course for Laboratory Quality Management that will introduce Customer Satisfaction / VoC as a key discussion point.

More on the workshop.

I have found a set of very impressive speakers who can talk with authority on the subject of monitoring healthcare customers, mainly from the perspective of the medical laboratory, but also from the broader perspective.  We have a speaker from ASQ speaking to the topic “Customer Satisfaction is THE Quality Imperative”.   We have a speaker talking to the topic “Customer satisfaction; what we have learned, and what are our opportunities for improvement”. 

This will be a great introduction and give a good foundation for discussion.

The conference will be in Vancouver BC on October 5, 2016 on the UBC campus.   Registration is very low, to no introduce a barrier to attendance.

For more information visit: 

 http://conference2016.polqm.ca/

At some point you have to decide: 
Part of the Problem or Part of the Solution

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.