The Fun Side of Standards Development.

The Fun Side of Standards Development.

Today I am at a semi-annual meeting of our Working Group for development of ISO standards.  I am in London at the British Standards Institute’s Chiswick Building.  I am sure that some (maybe many) see this as a scam to get to travel around the world while using other people’s money (OPM).  [As an aside I have always thought that it is not by coincidence that the two most powerful addictions in the world are spending OPM (in the sense of money) and consuming OPiuM (the drug)].  I will also tell you that while it is true that ISO standards meetings are held around the world, in most resource wealthy countries, governments most often provide financial assistance for about 25 percent or less of costs.  Many governments provide no support at all.  The rest often comes from delegates’ employers who may recognize some corporate advantage in participating in standards development.   A large chunk comes from personal resources.  

People interested in the process of standards development are similar to athletes at the national level; they do what they do because they are driven by personal satisfaction and personal passion and ambition. There is something satisfying in being involved in the development of  documents that are likely to be used around the world.  For me, I am not particularly driven by altruism; I also enjoy the travel and meeting with like-minded people, and I also  find standards development personally intellectually stimulating and challenging.  

There are all sorts of hobbies in which adults can get engaged.  For some it is buying art or cars or bicycles or boats, for others it is travel or sports or collecting stamps; for me it is getting into the nitty-gritty of creating documents that I know will be used around the world, and I am prepared to use some of my own resources, to some extent, to get the opportunity to be engaged in the process.  But I would not recommend this as a plan for folks on a fixed income.  

I will say that being engaged in standards development is not purely an intellectual exercise; in some regards it is a self-preservation exercise.  I spend a lot of time involved providing proficiency testing materials and education for medical laboratories.  PT is driven by requirements and expectations that are largely driven by standards that focus on quality performance.  Our program is driven by these standards.  If I am going to be expected to live by these standards, they by gosh I want to make sure that they are written in a way that I can live with.  If I choose to ignore standards development I may be stuck with requirements that I don’t agree with and don’t work with my vision of the activities with which I am engaged.  

I will give you an example.  In one of the drafts of a document being written now there was a phrase that said that laboratories should not allow financial or political considerations impact decisions on laboratory performance and test selection.  It was inserted by a delegation from a large country with a strong socialist political bent.  Their belief is that entrepreneurial activity in the laboratory arena leads to unethical practices at the expense of the poor and sick and public coffers.  

Well that sounds nice but in my world that is an unreasonable expectation.  My employer is clearly not-for-profit, but at the same time makes it really clear that it certainly is not-for-loss.  If my program offers surveys and challenges or courses that cost money to develop without a chance of recouping expenses, then my program will not last for very long.  Every decision that I make has to include financial consideration.     

I, and other like-minded folks could not let a toss-away phrase about being indifferent to financial considerations, no matter how well intentioned end up in a standard which could impact on my operation, and we were pretty vigorous at making the point that the phrase had to be removed.  

So for me standards development is a perfect activity; it is intellectually stimulating, and involves meeting and discussing and debating with similarly involved people with a full range of opinions.  I get to assert my knowledge and opinions and get to influence documents that can have local, and national and international impact, and I get to travel and see the world or sometimes invite the world to Canada. 

All things being equal it is a very good activity.  

PS:   Registration for the POLQM Quality Management Conference for Medical Laboratories is now open.  Visit our web-site (and click on the link for the conference announcement now to get registered.  

Attendance will be limited, so register early.

www.POLQM.ca

Final Summary of the Workshop 2011

I have mentioned before my ambivalence about satisfaction surveys and their real usefulness, but my reality is that they are almost a personal addiction.  If I don't get to do a survey every couple of months I start to show all sorts of nervous twitches (not really!). But at least I keep things under better control these days with my rules:

1. 1.    Focus them to a single issue
2. 2.    Limit the survey to only a few questions , best is to keep it to 5-6 and NEVER more than 10, and make them as uncomplicated as possible .
3. 3.    Pre-test the questions to reduce (you can never avoid) ambiguity and
4. 4.    Make sure that it can always be completed in 3 minutes or less.
5. 5.    Never require an answer. That is a guaranteed invitation to bogus information.
6. 6.    Decide in advance which slice of your audience you are interested in and then only focus your energy on that group. General send-outs are a total waste of time. 
7. 7.    Don't ask a question if you don't know what you are going to do with the information. (I forgot to mention that one before).

Note that 7 (above) is not about not asking questions where you might be afraid of the answer.  It is about not gathering information that you don’t know how to use or analyze.

So with those rules in mind, we did an exit survey of the participants of our Quality Weekend Workshop.  We focused our questions in 2 areas, General Organization and Workshop Presentations

The requested response was a check mark on a Likert Scale with 1 as the least positive (poor satisfaction) and 5 as the most positive (high satisfaction).  We also left room for optional comments.

The survey was optionally anonymous and took about a minute to complete, unless the person felt compelled to leave notes and comments.  Quality oriented folks LOVE to leave notes and comments.  It is in our DNA.

So here are the results.  In total we got a response from about 60percent of participants.  We generally encouraged participation but did not solicit from anyone, or discourage anyone.  (See Table).  Satisfaction was pretty high with some concerns about the registration fee, and maybe some issues about the length of presentations.

I suspect that the registration fee may have been a tad high, and we will address that next time, although we did not get to survey people who chose to not attend.  Maybe they would not have attended even if the workshop was free!

With respect to the comments on the workshop, we added all the comments to a single table and then submitted them to Word Cloud analysis, a semi-quantitative techniques where the most common words become most central and largest in the picture. 

We interpret this as a positive cloud and consistent with the tabular data.

So the bottom line was an enjoyed interactive meeting with high positives, and some concerns about fees and a cold room.  And we did not lose any money in putting it on.  So I call that a success.

Planning for 2012 and 2013 is already underway and we the conference PDSA cycle begins again.  

M

PS: we have taken the conference website down, but the information and the presentations are all available on www.POLQM.ca

Quality Weekend Workshop - the day after

So this weekend we had our POLQM Quality Weekend Workshop and while I may be accused of being a little biased, I have to say that it was terrific.  I am sorry that many people that I would have liked to have attend the meeting were not able to be there.   On the other hand we got the chance to connect with some old friends that I did not expect to see. 

Too bad because we had brought together some of the most significant quality gurus from around the world, including Jane Carter from Keyna, Richard Zarbo and Michael Astion and Robert Martin and Luci Berte from the US, Dr. Elisabeth Dequeker from Belgium, and George Cembrowski and David Seccombe from Canada.  David Hardwick, a visionary laboratorian with international expertise in Planning and Research in Pathology and Laboratory Medicine gave an incredible presentation on the Medical Laboratory, Past, Present, and Future... the core message being continuation of the 250 year  steady state increase in knowledge and information at 2% compounded year over year. 

Denise Dudzinski gave a thought provoking presentation on ethical issues that surround disclosure of laboratory error  to physicians and patients.  Where is the balance point between the right to know and unncessary anxiety?  This was one presentation that will have me thinking for the next year.


What was so exciting to me about this meeting was the focus on Quality Partners, something that readers of MMLQR are very much aware, but a concept emerging from shadows to prominence in the medical laboratory world.  Between Bio-Rad, BD, CSA, and DAP and a number of proficiency testing providers, a huge light was shed. 

The second theme was the growing opportunity for quality positions in medical laboratories in Canada, and around the world.  Clearly the clinical healthcare community has awoken its interest and awareness in quality.  Quality teams, Quality managers, and Quality lead positions are becoming a MAJOR growth point. As the total number of positions in laboratories gradually decreases, the positions in Quality are highly likely to remain stable or increase. 

Jane Carter gave a brilliant presentation on the Quality activities that she is involved with in Kenya, and throughout eastern and southern Africa.    She and some of her staff were able to come to Canada on support from AMREF Canada, an international office of the African Medical Research Foundation.  (More on this later).


There was a lot of discussion about making the meeting a regular event on the annual calendar, and I have had some significant discussions with two potential partners.  We would have to think about it for a while. 

From a Quality perspective, we have had a lot of success which are seen in the responses to the satisfaction comment sheets.  On a scale of 1 (poor) to 5(very positive) the meeting rates somewhere near 4.8, which high marks for speakers, and theme, presentations, staff and catering.  The registration fee was down a bit (about 4.2) but on review it would be difficult to do too much about that.  The biggest complaint was that the lecture room air conditioner was too strong.   

On the opportunity for improvement side, the biggest issue that I have to work through is in marketing.  Despite what I thought was a wide distribution of notices, we were not very successful at attracting the size of audience that I wanted.  Some suggestions have been made (such as having the meeting on Father's Day weekend).  We will have to do some significant Study (as in PDSA) before we do the next one. 

Bottom line is that the meeting was a pretty positive experience, and we have a lot of reason to be pleased. 

We have a file of presentation precis which will be available at www.polqm.ca

M

PS
I have been asked to create the opportunity for email notification for posts to MMLQR.  You can register for that in the new box on the top right (FOLLOW BY EMAIL).  If you want to give this a try, this feed is fully confidential, and is not designed or intended for any activity other than email notification of posts. 

Communicating Quality - the conference

So we had our Communicating Quality Seminar today, and I have to say (patting myself on my own back), it   was a brilliant conference.  The audience was a little small, but the conference to which it was attached was the annual meeting for  Microbiology laboratorians
There were some non-microbiology types, one in particular was my friend Luc, a Quality guy and MMLQR reader who I first met  through the Certification Course a couple years ago 
.

But back to the conference.  There were four speakers each speaking on a different aspect of communicating Quality throughout an organization.  One (me) presented  an overview.  The next (Robert Michel)  was on creating an mixed media  megacenter of Quality information, a combination of paper and electronics and conference, all linked skillfully to a common message.  Julie Coffey talked about an educational package that she has developed for ISO15189, again an excellent talk on an excellent topic.  And finally Sara Garcha talked on the topic of looking at an an organization’s  culture structure using the well published culture assessment tool, and discussed how organizations can use that information to adopt change that would be condusive to Quality.  
The presentations were well received, and some generated a fair amount of question and conversation.

Each of the presentations was excellent and all the information was valuable.  For me, the personal highlights were  Robert Michel’s recounting the time that he spent attending W. Edwards Deming’s 4-day seminar in 1991 and Sara’s discussion of changing organizational culture.  Julie’s presentation of the work she has done on de-coding 15189 was impressive.  I reinforced that Quality costs can be measured on  TEEM scales (TIME - EFFORT - ENERGY - MONEY).  Of all the approaches to keep the Quality conversation going in the laboratory, there are many effective techniques that score low on all scales, meaning they take little time to generate, are easy to implement, and cost little or nothing to put on. 


Normally I try to do some form of informal survey following a seminar to get a sense of satisfaction.  Generating numerical data is always interesting, even when the numbers are very soft.  This time I did not, in part because I will send out sn electronic survey in a few days.  At this point I have some “key” indicators, the kind that lecturers use.  Nobody walked out.  Nobody fell asleep.  Nobody developed competing cross-talk, and there were some questions and comments following the presentations.  4-5 came up afterwards and congratulated us on a successful  afternoon.  So, those are positive indicators.  

All in all, a success.


I got a number of personal insights.  First and foremost, the idea of a discussion on a very narrow topic of how to talk about Quality in the laboratory was a good idea.  As a meeting organizer, one does a dis-service to shy away from sophisticated topics.
 

I have permission from all the speakers to post their presentations at www.POLQM.ca  They should be there by Friday. 

 Four happy speakers,  post presentation.


For an additional look, visit www.darkdaily.com

Communicating Quality - one more time.

I have mentioned the Montreal Conference a few times.  Since it occurs on Wednesday this week, writing about it today is not to encourage more folks to attend.  That ship has gone.  We anticipate an audience which will be about 70 percent of what we had hoped for, but well over our break-even point. Since the point of this conference was not about generating revenue, I am satisfied with what we have.

Our objective was to get the message out about improving Quality communication in Canada.  Between the people who come, and the coverage that we will generate between 3 web-log (blog) sites and offerings of the powerpoint files, and the academic presentations that get generated, we will get our messsage out.

I will provide a conference summary article and make the powerpoint presentations available for sharing after Wednesday April 5 at www.POLQM.ca.    While ISO9001 and ISO15189 speak to communication, I perceive these requirements under the classification of “necessary, but not sufficient”.  In the Canadian Standards Association’s book 15189 Essentials: an implementation guide we speak in more detail about how to implement a quality communication program (you can order the book through www.csa.ca through the on-line bookstore.  
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Developing  an effective quality communication program in the medical laboratory has to look at developing both an in-house information program plus bringing in materials from outside.  Laboratorians have a lot of choice; we can make this as expensive or as cheap as we want, and realize that the depth of the quality communication system does not necessarily have a linear relationship with cost.  Expensive is not necessarily better.  

What is an  interesting consideration is  that as an early adopter, laboratories develop a third arm and major opportunity.  Gaining experience leads to sharing the message, and sharing the message creates opportunity for revenue generation, which can be put back into the quality program to reduce it as a cost centre, and moves towards being revenue neutral, or even better.  Even in a socialist single-payer health care system, generating revenues to promote quality for bringing in speakers or for sending people away is a good thing.  We cover this in a variety of ways at the conference.

What the quality program needs is time.  In my presentation I suggest components that would add up to 30-40 hours a month, which pretty much reinforces the imperative of creating Quality Manager and Quality Team positions.  To make it clear, I don’t expect every laboratory around the world to put in a communication program that consumes 25 percent or more of a person’s full time, but in every laboratory sharing information with staff on some regular schedule improves knowledge and engagement.  Even in laboratories in developing countries, this improves the focus of care and reduces poor care.

I know and understand this leads to the obvious question of whether improved communication results in improved quality and secondly, will improved quality result in reduced cost and improved laboratory services.    Fortunately there is a lot of published material that supports positive responses to both.

If you are planning to go to the meeting at Le Westin Hotel in Montreal, come on over and let me know that you are a MMLQR reader.  If we have a moment to chat, the coffee is on me.

Communicating Quality and the Principles of Adult Education

In recent while, I have been engaged in the active promotion of  medical laboratory quality in a variety of forums, including writing this web-log, providing an on-line course, hosting single-site lunch time education,  hosting the resident seminar series, and organizing and participating in workshops and conferences.  All of them have provided me with the opportunity to consolidate my own philosophy towards Quality.  

There is a lot of differences between all these activities; some have been held in Canada and others are international, some are one-off events while others short-term multiple events, and others yet are long multiple events, some of them are at no-charge to the participants while others are at substantial cost. Some of the participants want to be participating while others they are there because they feel compelled for one reason or another.  It would be easy to say that the only thing they have in common is a common topic, but there is something of far greater commonality; all the participants are adults.

Teaching adults is a special event because adults learn in their own special way.  There is tons written on adult learning.   For a quick summary you can visit Principles of Adult Learning at the University of Hawaii site.  

There are lots of reasons that people attend courses.  For learning, the most successful reasons are when they believe there is something in it for them; it is a topic of interest or there is an opportunity for career advancement.  Sometimes it is less about knowledge, and more about the social aspects; is a way to meet and connect with others, or is better than just being bored.  These folks may not be focused on learning, but they might connect.  Sometimes folks attend solely because they have to; it is a requirement and attendance is being taken.  This never turns out well.

Adults are autonomous and self-directed, and learn on top of their accumulated knowledge and life experiences, which means we learn what we want and how we want and accept the knowledge if it makes sense and is consistent with what we already know.  And we learn if we see the purpose to the information and especially it is meets our own goals.  And we are practical and pragmatic learners; if the information is not organized and timely then we turn-off. 

Adults tend to learn best if motivated, especially if we can link the information to what we do as a matter of competence or promotion, or job enrichment.  (Some say we learn better if there is money on the line.)  

For the educator, this means that the successful ones make the information relevant to what people do, is consistent with what they already know and link the knowledge to competence and enrichment.  Keep the information organized and timely and interesting.  For me, I have been involved as an adult educator for over 30 years.  When I think back to what I was like when I started, I can say with confidence that I am a lot better today than I was back then.  And one of these days I may actually get it right.  

One of the most successful educators I know has a formula.  He has 3 points to make (4 points a maximum).  He makes his points and reinforces them with stories and humor.  When he has delivered his points and told his stories, he stops.  I’m pretty good at the selecting 3-4 points and the telling stories.  I am pretty weak at the humor, and tend talk until I run out of time, rather that knowing when to stop.

Memo to self:  with widely divergent groups, some folks are there because they want to be there; others are not.  Remember the motivation; point of why knowing about Quality is an important   component of competency and enrichment, and can have an impact on promotion.  Be organized and know when to stop talking.  After than, the rest is largely out of your control, so don't worry about it.

m

PS: I am accumulating the post seminar series data now.  Will share the results soon.

PPS:  Big changes at www.POLQMWeekendWorkshop.ca  Lots of NEW information.