Fishing and Proficiency Testing

Fishing and Proficiency Testing

In our UBC Certificate Course in Laboratory Quality Management we introduced a concept which we call Quality Partners.  These are agencies and organizations whose primary purpose is to enhance the quality of medical laboratories.  Without these partners, the likelihood of a medical laboratory developing any semblance of quality enhancement and error reduction for all intents and purposes, negligible.  The primary Quality Partners are Accreditation, Proficiency Testing providers, Standards Development organizations, Education providers, Professional Organizations, and Suppliers.  While I am biased, of this group, the only  partner that has ever demonstrated the ability to actually reduce errors is the Proficiency Testing provider group.

When PT exists with good and competent programs, laboratories receive samples that closely resemble actual samples, with the singular but essential difference being that the sample has been pre-tested and stabilized so that the correct result is known by the provider.  The challenge to the laboratory is to test the sample and come to the same value.  If the laboratory can do that they are told they are proficient; if they cannot they are told they have opportunities for improvement to learn how and why they made mistakes, and to determine how they can avoid such errors going forward.  

PT providers are a committed group of people, dedicated to the premise that helping laboratories overcome errors directly contributes to patient care and patient safety. 

While my own personal focus in on water testing and patient care microbiology sample testing, most developed countries have PT providers not only for medical laboratory testing and water, they also test for food and engineering, and many many other types of laboratory tests. 

Unfortunately, developing countries see the value of developed medical laboratory testing, and see the value of quality partners, but they do not have local access to PT.  And that is a problem.

For many, the solution is to purchase PT samples from a larger country, who is always more than happy to provide them.  That the samples were never designed to address the issues of developing countries and that to get the samples to the laboratories at considerable distance they have to compromise their quality by freeze-drying the samples is of little concern.  When they write the informative sheets, they are written from the perspective of the large parent country and without any perspective for the developing region.  

So the product they receive is costly, not designed for their purpose, not optimised for their purpose, and not assessed or graded for their purpose.   That does not seem to be much of a deal, and from what I have seen, the success rates on the samples is rarely barely close to acceptable. 

 

We have taken a different approach.

Rather than just shipping samples, we bring one (or preferably two) able persons to our centre and give them intensive training in producing samples and setting up a basic program that will allow them to start a program, select, produce, transport samples relevant to their setting, and show them how to grade them and produce a critique.   As mentioned it is an intensive program.  Some get the information they want in one session, others come back for a second session.  

Over the duration of our program we have usually had one country participate each year.  This year we will have had representatives from 3 countries.  And we are getting contacts and expressions of interest for next year.  So by an awareness scale we seem to be having success.  

This summer we will be doing a survey to see if the countries that have visited us  have implemented programs and if those programs are still in operation.  (Satisfaction and Loyalty).

Without getting too sophomoric, the whole experience reminds me the proverb “Give a man a fish, and you feed him for a day; show him how to catch fish, and you feed him for a lifetime.”  Contrary to popular myth, this is not biblical nor Greek or by Confucius in origin, although I can understand the foundation for the various myths. 

The original version was “…give a man a fish he is hungry again in an hour; if you teach him to catch a fish you do him a good turn."  This was written originally by a British author, Anne Isabella Ritchie and published within a story entitled Mrs. Dymond, in an American magazine Littell's Living Age printed in September 1885.

Personally I prefer the original version.

PS:  If you want to know more contact us through www.cmpt.ca

The Power of On-line Courses

Once again I am in the middle of my on-line teaching commitment for the UBC Certificate Course in Laboratory Quality Management, and once again, I am loving it.

When I graduated from medical school and residency, I enjoyed working as an Infectious Disease specialist because it created the opportunity for a 1-to-1 relationship with patients.  It was satisfying to provide service and care in a truly direct fashion.  

But as my career progressed and I became more engaged in the laboratory and infection control, I found that my opportunities for impact and decision influencing were on a wider level – groups of patients distributed over wards and institutions.  What I sacrificed in terms of satisfaction with direct patient contact I picked up with system influence.  

With proficiency testing, if the direct patient impact was even further away, the system influence was much broader and covered health authorities and provinces and countries, and I was addressing quality assessment, quality improvement and education all at the same time. And as time marched on the education component grew from critiques to newsletter articles, to international training.  And the level of satisfaction grew even larger. 

But with the Program Office and the Certificate Course, the interaction scale has a whole new dimension to the dynamic.  While there is another layer that separates the laboratorian from patients, and sense of connection is much greater because the amount of interaction with laboratorians is much more intense.  Often we are communicating on a daily basis about Quality and Education and Laboratory improvement with folks taking the course are from across Canada and around the world.  The intensity and intimacy combined with the level of system influence can almost seem overwhelming.  

Over the years it has become very rewarding to attend meetings in many places and have people come up to me and say, “You may not remember, but I participated in your course in 2008 (or whatever) and I want you to know that it opened up a whole new career path for me.  Thank you so much”.  In the first 2 months of this year, I have run into people in 3 meetings with this same story.  And then there are the people who have contacted me through Linked_in.

It is very satisfying to know that so many people are pleased they took the opportunity to learn about laboratory Quality through our course.  I almost feel like Mr. Chips, if you know who that was.  

Recently we have been approached to consider developing a companion course which would cover another whole set of Quality related concepts not covered in the first course.  It is an intriguing idea.  As the whole arena of medical laboratory Quality grows (Thank you Institute of Medicine and To Err is Human.  Thank you ISO 15189) the body of essential knowledge continues to expand.  This is not information that is addressed in medical residency, nor in health administration, nor in the traditional MBA.  Increasingly people want it and institutions need it.  

I don’t know if this is a career path for everybody.  But it is a great path for me.

Deming and the diversity of healthcare Quality

Deming and the diversity of healthcare Quality

I am going through a personal evolution in my Quality career.  It is starting to get very complicated.  

In many ways I am very typical of people of my age and era in that given the opportunity to get involved, my first instinct is always to say “Yes!”  Part of this reflects my personal interest in the Quality process, part of it my ego that still leads me to believe that I can do everything and do it all very well.  And part of it is a protection strategy; given a choice between having to deal with a standard that someone else has written and having the opportunity to inject my own beliefs, I would rather fight the battle early rather than fight it late.  This strategy has stood me more in good stead than bad over the years, although it does take a certain toll on my time.

But as I get closer to thinking about going to the next phase, I do reflect on what I do and what it says about Quality.  The reality is that most of what I do is done on a volunteer or a small honorarium basis.  Most of it does not generate direct revenue.  Most of it exists because I have a position that provides me with an income base and a fair amount of flexible time.  It all keeps me very busy, but not of it is “busy work”.

As far as income generating activities, I have a faculty position at a university and as part of that position I operate a proficiency testing program that works across Canada and provides international training to personnel in developing countries so that they can learn how to develop similar PT programs in their own country.  I also teach an on-line course in medical laboratory Quality.  Both these activities   can take a lot of time.  I have learned that a program or a course that stands still and rests of success and laurels is a dead program or course, soon to become very obsolete and mowed over by competition.  Operating both of these activities has allowed me to develop and hone my innovation chops in order to stay one step ahead, or at least not two steps behind.   

But in order to support these two programs I have become directly involved with a variety of Quality Partner activities, primarily in the standards development and the educator/communicator arenas.  I sit on a variety of standards development technical committees on both the national and international level, in part developing documents which my programs are intimately involved with.  In my opinion I know of no better way of knowing exactly what and why a standard requires certain expectations than being involved in the writing.  

I also get a lot of opportunities to get involved in networking through education/communicator process.  Over the years we have trained and certified near 300 people as medical laboratory quality managers, many of whom have remained in contact, and some have remained close.  We regularly put on Quality oriented conferences which brings me together with the former group and creates connections with new and interesting speakers.  Of interest we are now in the planning phase for our next conference which will occur next year, and I have already got a collection of speakers who will be new and unique to our audience community.  

In addition I have just finished one book chapter and I have been asked to write a new book as part of a series focused on medical laboratory Quality and patient safety which will create potentially a broader audience for  the conference.   

And next week I get to travel internationally to a meeting on Excellence in Medical Laboratory Quality and give a presentation which likely will help foster both meeting attenders and course takers.   

My point is not to blow my own horn about how busy I am (well maybe a little bit), but rather to make a few points: 

1. First and foremost the arena of medical laboratory Quality is very alive and very busy.  If you are bored with what you are doing, you aren’t trying.
2. Second, if you want to have success in this arena you have to keep new and fresh and diversified but with clear links to your foundational base.   

And lest you miss the point, all of this is totally consistent with Deming and 5 of his 14 absolutes:

• Create constancy of purpose for improving products and services.
• Improve constantly and forever every process for planning, production and service.
• Adopt and institute leadership.
• Institute a vigorous program of education and self-improvement for everyone.
• Put everybody in the company to work accomplishing the transformation.

I always have thought that if W.E.D. had taken the opportunity to adapt his list of absolutes he would have included “Plan for success by getting busy and staying busy”.

The Meaning of Quality

The Meaning of Quality

At our Quality Management Conference for Medical Laboratories last month, one of our speakers made a throw-away comment, that the word “Quality” is so overused these days that he was no longer sure what people meant by the term.  What intrigued me was that a similar comment was made by another speaker as well, and indeed the concept became an on-going recurrent theme throughout the meeting.

I understand where they are coming from, and I feel a certain empathy, but in all due respect, I think that the sentiment is wrong.  Quality does have meaning.

On the other hand, one of our speakers reached back into the past and made a relevant comment:  “Quality is not a word, it is a journey” [ note: a variant from Ralph Waldo Emerson (?) dated around 1854 – life is a journey not a destination.  The Quality variant has been used since the early 1990s] ,  As much as this sounds like an old truism, I think it is still valid and still an appropriate attitude and approach towards understanding the discipline in which we work.

Let me pull a few things together here.  

With regret we still see all too many laboratories with a track record of repeat  accreditation as far back as the early 1970s.  If you applied the Crosby definition of Quality being defined as meeting requirements, then you would call repeated accreditation meaning Quality.  But you could be wrong.  

Many repeat accreditations were a joke.  Laboratories doing nothing for 4 years and 9 months manifesting no evidence of improvement, and then spending 3 months to tidy up manuals and fill in QC charts.  An accreditation visit, lasting maybe 4 hours done haphazardly, which is then followed by an approval process, perhaps with some recommendations for improvement which don’t occur.  The laboratory then takes a post accreditation breather hiatus of about 4 years and 9 months, and then gets started again.  There is no evidence of a journey here.  It is Quality in name only.  That theme gets carried out in so many ways.  Quality Manuals are beautifully created, only to be locked up in an office more as a trophy on display than as a useful and usable document.  Quality in word only; no journey here. 

We see laboratories where management hands off the Quality portfolio to the senior staff (or worse the junior staff) expecting receive a report of quality indicators for signature once a month, but never actually doing anything with the information; and calling that Quality.

We see laboratories where management receives continuing education funds from institutional resources, but 90 percent or more is spent on management level travel, and 10 percent goes to technologist training.   Again, static words.

We see laboratories that bring in consultants to review and propose grandiose plans for leaning and implementing quality software or purchasing new bells and whistles, but little happens to justify the expenditure, with little consequence.  

We see evidence of static quality all the time; it is no wonder folks fatigue of hearing the word.  

Quality is about progress, about continual improvement, about setting goals for change and making the commitment to follow through.  Quality is about giving voice to both compliments  and critiques to discover what you are doing well and more importantly discovering what you can do better.  

So I agree there is lots of evidence that if action without meaning continues to be the norm, then the term Quality has lost its meaning.  So if you are fatigued by the “journey not a destination” homily, let me offer another more functional definition. 

Quality is the commitment to continuous positive change.  

PS:  If you are interested in viewing the presentations from our conference follow:  http://polqm.ca/conference_2013/conference_2013/conference_home.htm

Go to the LEFT margin and click on SCHEDULE

Each presentation is linked to the author’s title.