Competition and the Quality Partner dynamic

In 2011 I introduced into our Certificate Course the concept of medical laboratory Quality Partners to remind the participants that the laboratory is never alone when it comes to developing an shaping a quality managed laboratory.  [see http://www.medicallaboratoryquality.com/2011/06/more-musings-on-quality-partners.html ].  I created a definition for these Quality Partners as the network of organizations that develop and promote and provide services and assistance with the goal of supporting an effective laboratory foundation that is conducive of better patient safety and care.  The network includes Accreditation Bodies, Proficiency Testing Schemes, Education Providers, Professional Organizations, Materials Suppliers (including equipment and reagent bodies), and Standards Development Organizations.  These bodies surround the laboratory and provide documents and guidance and education, and assessment and support.  Taken as friends, these groups can help defray (mitigate) most of the risk of error that laboratorians bear when providing essential information that has direct impact on patient care and patient safety.  

But about a year or so later, I realized that I had left out an essential quality driver… the Public and its representatives including the media, the regulators, and the legislators.  As we have seen throughout many developed country, when the public experiences what it perceives as a loss of trust in the health system, change will inevitably result.  In the United States, that loss of trust resulted in CLIA.  In Canada it lead to a series of public enquiries including the Krever Commission and the Cameron Commission, both of which forced dramatic change.  We may not like the results of all the media attention and consequent change, but an angry public will always have its way.  

This lead to a revision of the Quality Partner graphic which indicates the light of public scrutiny exposing the potential warts and blemishes of laboratory error.

But recently I have realized that there is another driver that has great impact on Quality.  Competition.  I have written about this before.  Unfortunately we have lots of examples that indicate that when an organization has an endless supply of customers, with essentially no threat or consequence to counteract indifferent behavior, then performance may sink to the lowest level.  

I have mentioned before, the performance of some (but not all) public servants and other organizations.  When left to their own devices, it seems to become all to easy to stop meeting the Crosbyan and ISO definition of Quality. i.e. Meeting Requirements.  

Over the last while I have been on the road a lot, putting in a lot of air travel.  In the last few weeks I have spent well over 50 hours sitting in economy section seating, as airplanes have flown nearly 30,000 miles.

Now I understand that airlines are all now public corporations, with their primary responsibility being to generate profit and benefit to their shareholders.  And I also understand that running an airline is a risky and costly venture.  There is an old adage that says, the easiest way to become a millionaire is to start as a billionaire who runs an airline.  The reality is that while some airlines at the moment are experiencing a rise in stock value, this is not likely to be a permanent state of affairs.  Sooner or later, most airline companies will lose their value and their investors will lose their money.  

But as anyone who flies knows and understands, with the exception of the few business section travellers, customers are stuffed into seats too close together with little leg room.  Meals are either available only for purchase or if provided are of questionable quality and literally tossed.  There are insufficient toilets and insufficient cabin staff, insufficient luggage storage space and insufficient walking or exercise space.  

Don’t like it? Then you have two choices, either pony-up thousands of dollars or don’t travel.  Change to another airlines?  No difference.  They have you.  There is no tangible competition because they all work the very same way.  

But if you want to think of contrasting services in the travel industry, think about hotels and restaurants.  Those owners know and understand you can spend your travel dollars anywhere you want, and the place with the most comfortable bed or the best food wins, regardless of which price point you look at.  

So where there is competition the customer requirements are met, and where there is none, the customer has little choice but to tolerate the absence of meeting those needs or requirements.  

And so I have again revised the Quality Partner graphic.

And so here is my question to medical laboratory management.  We are a service industry, with by-and-large little competition.  We can, if we choose, ignore patients’ complaints and concerns with relative impunity.  

Which model do we want to follow, the airline or the restaurant/hotel? 

The choice is ours.

The Pain and Glory of AGMs

For the last 2 days we have met, chatted, planned and ate our way through our CMPT Annual General Meeting.  Twelve months of awareness, 6 months of meeting planning, 1 month of getting details into place and 2 days of presentations and questions and answers and stress, and it is over… for another year. Would someone please pass the Advil.

The gist of the meeting with all the pretty graphs and Management Report is available on line for all to see at www.CMPT.ca check in the left hand margin and click on Annual Report. 

As much as I stress over this annual event, having now done it for many years, I have to say that I can’t envision running any operation without it.  I am a little surprised that ISO90001 talks about Management Review (which is a good thing) and setting Goals and Objectives (and that too is a good thing), but is silent on the importance and value of an AGM.  AGMs bring all the players into a single room and create a moment in time to discuss strengths and weakness, and the opportunities and threats (a SWOT conversation!).

CMPT is actually in pretty good shape; we have new digs – good clean and open space, and we have resources and interested partners.  I can’t think of any time in our 31 year history when things have been better, keeping in mind we are still working with governments determined to shave medical laboratories slowly out of existence.  But as long as patient safety is considered a priority, quality and quality assessment will be central to whatever laboratories do exist.  So we are likely to survive in some form or another, provided that we can keep one step ahead, and focus more on the future than on the past.   

This year we had for the first time some lessons to be learned which are displayed on our composite customer satisfaction score.  A visit to the Annual Report will show what I mean.  

 We have created a unique composite satisfaction score that is based on survey results, written comments, complaints, and contracts and consultations.  The score has an intentional negative bias.  Positive findings have positive multipliers of (+5) while negative findings have negative multipliers of (-10 or -25 or -100).  The point is to allow negative comments and complaints to dramatically drive our score downward.  For the first time since 2002 this downward pressure actually kicked in the current year.  

This was primarily due to a survey of users’ opinions of our web-site as a method for data entry.  As much as the site scored very high on Quality and Usefulness, Navigation was seen as problematic, and Ease of data entry was not very good; lots of not so positive comments.

I suspected this was going to happen, and my suspicions bore out.  I guess if we had wanted our satisfaction score to indicate that everyone was happy with everything that we did, we could have picked another topic for our survey, but what’s the point of the exercise.  At least this way we know and have documented that we have a problem that needs to be addressed.  And so now we will.  And that is a good outcome. 

For us the bottom line is that Quality Management is a risky process.  When we look for problems we find them and then we have to deal with them.  Better to bring this out to the open than to let them sit in the background and fester until the whole program falls apart in one inglorious cloud of smoke. 

We are a very small not-for-profit service provider that has impact on patient care and medical services across Canada.  If we are not prepared to focus on Quality, then it becomes pretty hollow for us to make demands and expectations on others. 

So the planning for next years’ meeting has already begun. 

I invite you to visit www.CMPT.ca