Even committed Qualitologists can make mistakes.

Even committed Qualitologists can make mistakes.  Darn. 

This is the 10^th season of our virtual classroom on-line course, and one might think that we have the process down pat.  Each year we review the information from the previous year, retain what is still relevant and appropriate, and make revisions where needed. 

Every year we make a few “big changes”.  This year it is a new Module on modern tools for Quality and an additional Quiz.  These “big” things take a little more time and attention and care.  And that is where I messed up.  (Again, Darn!).

Quiz 1 is completed at the end of Module 1.  It is an on-line auto-graded multiple choice exercise of 10 questions that should take no more than 30 minutes.  We allot an hour.

When the Quiz 1 was completed, the grades were surprisingly and disappointingly low.  Considering the pre-selection process we undergo to ensure we have the right participants, they should have done better.  Once we confirmed that the problem was not a computer grading technical error, or a connection error or a transcription error, we had to go back further to when I wrote and set the questions and responses.

On one question, I had defined a wrong answer choice as the correct response, thus everyone answering correctly got a wrong result flag.  This was annoying because the right answer was obvious and apparent.  I had just messed up.

Additionally, two other questions were so subtle, so nuanced, that even I who had set the questions could barely figure them out.  No wonder we were getting some very unhappy messages.  

I remember clearly sitting in my office and setting the questions.  I remember the process was being slow and arduous.  The quiz muse was staying away and I was struggling.  Then I had a rush of ideas and got the questions completed in a hurry.  Clearly the rush was not necessarily lucid.  

Message to self: Hurrying is a bad thing.

A decision was made that we could not let the quiz stand, if possible without inconveniencing the participants.  This was completed through adjusting the auto-marking software and re-evaluating the response.   The marks climbed to exactly the level we anticipated.  Then we informed the participants of the error that had taken place and described the remediation process and told them to recheck their results.  Then I had a discussion with the coordinator on how I would try to avoid making the same mistake of pushing to finish.  I have created a check list that all quiz and examination writers will need to go through before questions can be submitted for final posting.  

Four lessons learned:

 Setting quiz questions without deliberate and sufficient re-check and conformation time is an unnecessary risk taking procedure than increases potential error production. 

Remediation and Correction takes a lot more time than error causation.

Quiz errors hurt program credibility

This simple hurry-up slip has been a TEEM loss event.  The gross cost to us has been 6 hours of emails and discussions and IT labor shared by 3 people, plus we have had to make the check-list and revise our procedure manual.  And then we need to do the preventive thing and re-check Quiz 2 and the final examination to make sure that we (I) didn’t mess them as well.  And to that we have to add my frustration and a whole bunch of participant unhappiness.

Still, having a detection - remediation – correction and prevention process that can and does pick up and analyze (study) mistakes and amend (act) them “expeditiously” makes the point that Quality works.  

Hooray.

The Greying and Tsunami of Quality

I work with a number of committees on medical laboratory Quality, some of them solely within the framework of the medical laboratory specialists, some from without.  With some I have been engaged for a very long time, up to 30 years, while others I am the “new guy in town”, which is a bit humorous considering that by no measure would anyone ever suggest that I am a “new guy”.  All these committees are active and generating new and interesting information that will be significantly contributory to the medical laboratory over the next many years.

The problem is that as you look at these committees, everyone, or near everyone is well over 55 years old, and many are over 60, and a few are over 65.  Not only are we getting older, we are refusing to leave.  Many ISO committees have members that have hogged spots for 12-15-20 years, insinuating that only they have the right and proper ideas. 

Fortunately our generation by and large has given up smoking, and some of us are eating better and remaining relatively fit, and so 60 is much akin to the “new 50”.  But the reality is that we cannot and will not go one for ever.  While we can sustain our elder statesman status maybe for another 5 or so years, in the intermediate term and definitely in the long term, this greying of Quality will be a very unhealthy situation for the Quality process.  We do no good service holding on to our positions until they are pried out of our cold dead fingers.

I see the challenge from two main perspectives.  
In my own situation, I have been working in the Medical Laboratory Quality arena since the early 1980s, with most the time in virtual obscurity.  The number of folks even remotely interested in what I was doing was at best few and far between.  We were a very small community of interested parties, largely talking among ourselves.  But in the last 10-12 years, things have changed and the amount of interest by our colleagues and public has changed considerably.  Today we are the right folks in the right place at the right time.

Some of us are enjoying the opportunity to share what we have found so interesting for a long time.  We are not ready to leave just yet (or said another way, we are not ready to let go) and even if we were, we have been ineffective at succession planning.  

Speaking solely for my situation in healthcare, for a number of reasons, our colleagues now between 40 and 55 years with 10-20 years of experience has been very slow to adopt or adapt to Quality Management as an essential component of health care practice.  From their perspective, Quality was boring when they started and is boring today.  Accreditation and Proficiency Testing and Quality Audits just take away from doing whatever they do and perceive as the interesting thing.  And generally speaking that is what they convey to the group coming up behind them.  That is not to say that there are no interested folks coming up; that would be unfair and invalid.  It is just that they are still few and far between.

But at the same time, the Quality message appears to be gathering momentum with recent graduates who have just completed their education and training and are in the first 5-10 years of their new career.  That is the group within which we are finding people interested in Quality as a pursuit for graduate studies, or seeing opportunity to effect professional change.  Every month we get more and more interest in our proposed Masters program and in PhD studies, and increasing interest in our certificate course.  

This is the group that has more command of a more diversified social media, and less reliance on traditional information sources.  This is the group with a sufficient degree of pre-mature cynicism and is very cognizant of public exposure of the impacts of poor practices.  Given a choice believing that testing disasters are just part of the “price of doing business” and “seeing them as a insult to patient safety and care, they are more likely to side to the latter. 

And the evidence is compelling.  Canadian Standards Association now has an academic challenge, and International Standards has a World Standards Academic Day.  In North America there are new university based program opening every quarter.  The light has been turned on, and both programs and students are responding.

From my perspective I see this as a strong positive outlook. Sooner rather than later, the spot-hoggers are going to be gone.   Over the short term there are probably enough up-and-coming folks to take over from us older guys who are ready to go do other things.  But there is a tsunami wave of interested and keen Qualitologists training up now that will sweep over healthcare in all its manifestations in only a few years time.

And that is a good thing.