The Error Cost Dynamic

The Error Cost Dynamic

We have started our new season for our UBC Certificate Course in Laboratory Quality Management and I have to say that this year is perhaps the most animated, most adventuresome group to date.  Day 3 and there is already a lot of mingling and interaction, which is incredibly special in an on-line virtual classroom course. It truly feels like if I should not be surprised if I were to have a tap on the door or a call on the phone.  This is a good thing.

One of the questions that has ready come up is on the impact of communication, or lack thereof, on laboratory error.  This is a very interesting topic  because communication is so multidimensional; there is communication in the form of person to person chitchat or communication in the form of information sharing or communication in the form of instruction - guidance - requirement.  Regardless of which form we are talking about communication can be either very positive or very not-positive depending on the clarity, understanding and intent.  Said in a way that is clear and precise in-laboratory communication is very helpful.  Said in a way that is muddled and ambiguous and a whole lot of bad consequences ensue.

That is a long way to get to the topic of error.  The point I am struggling to get to (talk about poor communication skills) is that in Quality, concepts that are expressed with clarity and brevity lead to new insights and new understanding.  Concepts presented as subtle nuanced and complicated are a struggle and are often dismissed. 

For me, I think I have developed a helpful way to express the dynamic impact of errors and causes of error on the costs of poor quality.

All organizations experience daily work pressures, many of which are addressable and potentially controllable: noise, crowdedness, clutter, work volume, time pressures, stress and anxiety, miscommunication, accidents and injury, and finances.  

As daily pressures rise, the risk of error rises in the same time or compounding at a faster rate.  

As the risk of error migrates to being the actually of error, the impact of error becomes an additional source of daily pressure, sometime impacting on finance, but more often on stress, anxiety, accident and injury, and time pressures. 

Increasing error is a leading indicator of deteriorating Quality, contributing to management dissatisfaction, customer dissatisfaction, staff dissatisfaction, more remediation and increased cost and usually reduced revenue streams, all of which are can be measured and compiled as the rising costs of poor quality. 

Recognizing this dynamic, leads to an important conclusion; addressing daily pressures before they lead to problems is the easiest way to prevent error and reduce poor quality costs.  

One can appreciate the dynamic graphically as a series of gears all moving in concert. 

It seems to me that thinking about quality from this dynamic there are some useful valuable insights and conclusions, the first of which is that the easiest way to reduce error and cost is to reduce pressures that lead to mistakes.  Many of them would be addressed through an active Lean campaign (think especially about Sorting, Streamlining, Shining, and Standardization) which would go a long way towards reducing noise, crowdedness, clutter, and time pressures. My guess is that the impact this would have on an organization’s work culture would be so powerful, that the drive to sustain the improvements would come from within rather than requiring management motivation.

My second conclusion is that trying to implement a new Quality system without first addressing these pressures would not solve the quality problems; indeed it would make them worse.

I wonder if that is why some many organizations that try to implement Quality systems through ISO9001, and probably 17025 and 15189 fail.  It’s not that these are bad systems, but if you don’t create the culture and  time-space in which the Quality system can grow, you can be surprised when it doesn’t.

TEEM Presentation Available.

Yesterday I had the opportunity to give a presentation at the National Society for Histotechnologists at their Annual Meeting in Vancouver.  This was the second time that NSH as met in Canada.   This was a good time to have a meeting in Vancouver.  I don’t know what is and what is not a manifestation of climate change, but this has been one magnificent late summer and fall in British Columbia.  

The meeting had by my estimate maybe 700 attendees (?) with a nice group attending my presentation on Costs of Poor Quality with a focus on TEEM impact factors.   If you have visited here before, TEEM describes the impacts and consequences of error in terms of Time, Effort, Energy and Money, where effort describes physical strain and Energy describes mental stress.

This was my first oral presentation on the concept of TEEM impact on Quality.  It describes the impacts of Effort and Energy on medical laboratory error.  

I started with the argument that most laboratory errors are the result of slips and distractions, and sometimes poor judgements.  But these don’t just happen in a vacuum.  Sometimes, stressing and straining systems factors like noise and crowding and workflow increase the likelihood of error.  

In addition, I drew on the literature from laboratory safety.  An old and small but very insightful study by G. Briggs Phillips on the human factors associated with laboratory accidents [ see: Laboratory Safety: Principles and Practices, published by ASM Press in 1986] pointed out that attitude and situation  impact the risk of error and accidents significantly.

My central point was that underlying factors that cause stress and strain can increase the likelihood of error that gets described as a human foible or slip, but slips often increase the level of stress and strain which in turn increases the risk of error.  What I have added is some scales that can (once validated) be used as measures of stress and strain, that the astute manager will be able to apply as an indicator of rising risk for error.

Brilliant?; no.  Inventive?; no.  But I think it has the potential of being a good example of an innovative tool for Quality and Risk managers.

I promised the attendees of the conference that I would post the presentation on-line in lieu of giving a handout.  (I hate giving handouts.  They are expensive, and always distracting, and usually end up in the proverbial round file.)

For those interested, you can see the presentation at: http://www.polqm.ca/pdf/NSH2012%20-%20Counting%20the%20Costs_F.pdf

Invite comments.

Note:

I have re-activated my Twitter ® account.  @Qualitology for a number of reasons which I will explain later.