Organizing a Quality Conference

Organizing a Quality Conference

I was watching a professional golf tournament this afternoon.  Given a choice I would rather play golf, but when that is not possible, I enjoy watching golf.  I like golf because it is first and foremost a personal activity with a direct reward system.  You play well and you are rewarded;  you play poorly and you are not.  But there is an important caveat;  you can play well but still not win because there can always be another player who not only played as well as you, but also managed to score better and got an even bigger reward.  

Despite what you do, there are always additional factors that you cannot control, but have an influence on outcome.  Call them luck, or Karma, they are part of the process.  They fit into the Knightian model as immeasurable risk or what Donald Rumsfeld called the “unknown unknowns”.   They always lead to the sense of gamble and excitement of every decision we make.

The same thing holds true when it comes to putting together conferences. 

In two weeks we will be hosting our fifth Medical Laboratory Quality Conference in Vancouver.  (see : http://polqm.ca/conference_2015/home.html) .  In many regards this meeting has the best plan that I have ever put together.  

We have reviewed our experiences from the past and found the things that we can do better.  We have have tapped into all the right topics and have brought together a brilliant set of speakers.  We have a great venue in a great city and have a great time schedule.  We did a great promotion program, and most people that I wanted to inform about the meeting have heard about it and have seen the conference website.   
Importantly we have found the ways to reduce our costs in a way that do not impede on the things that are important to our sponsors, our speakers, or our audience.

 I have absolute confidence that everyone who attends will comment on what a great meeting it was. 

Everything that I can do to make the meeting a great success, I have done.

But there is one thing that I cannot control and that is getting people to “pull the trigger” and sign up at the conference registration site (again at: http://polqm.ca/conference_2015/home.html).  And in that is the final piece where luck, karma, or devine intervention come into play.  

The reality is that the economy is not what it could or should be and there are lots of companies are cutting back on supporting conferences and sending people to conferences.   There are many people who would like to attend and participate but for whom air travel and hoteling is very expensive.    Personally, when we looked at our crystal ball 18 months ago I would have guessed that we would be further along the road to economic improvement than we are today.  

But we will see how many decide to attend.  I know that we have enough resources to cover our expenses and so at our absolute baseline, we are covered.  It is mostly around having enough of an audience to generate a culture of enthusiasm  and contribution.  

Regardless of what happens now, I know that those folks who attend will come away with a lot of pearls.  For them it will be truly an inspiring two-and-a-half days.   

The rest is beyond my control.

Quality and the Quality Conference

Quality oriented conferences have become prolific these days, even in the Medical Laboratory arena.  This actually makes a lot of sense because Quality has become a very relevant issue at almost every level.  It is a HOT topic.

There are so many aspects of Quality that touch the Laboratory arena include Costs, Clinical Relevancy, Patient Safety, Culture, Risk.  It has become near impossible to keep up with moving trends and recent advances if you are not connected to the Quality community.  

For those of you that visit this site from time to time, you may recall a post that I wrote about 9 months ago:  see http://www.medicallaboratoryquality.com/2014/07/quality-standardization-and-mh17.html  in which I argued the downsides of conference travel including cost, and risk.  Perhaps you may think that my now planning on hosting a meeting might seem a bit hypocritical.  

I would not agree.  Thinking in terms of Risk, one can look at conferences from both a occurrence/severity perspective and a risk/benefit perspective, and I can argue that if a meeting has high enough value of information and is held in a really nice and low risk environment and at a fair cost then the balance of factors leans strongly to the side of hosting and attending.  

So I will start from the positive high value side, or as Crosby would say it “Quality has to be defined as conformance to requirements”.  Will the meeting meet customer requirements?

In a short 2 and a half days, we will have speakers talking on Health-Quality-and the Law, on Safety as the Quality Imperative, on Modern Tools for the Modern Quality Manager, and on techniques to solidify the Culture of Quality.   It will be difficult to find a meeting that will provide a better array of topics.  Within those subjects we will talk about Teaching Quality to Adult Learners, reducing risk through Conflict Resolution, Establishing real time inventories of laboratory error and safety accidents and injuries,  We will look at calculating true costs of poor Quality (how Crosbyesque is that!) and determining risk in pre-and post examination processes.  

We will have presentations and roundtable discussions, and presenter contact time and the opportunities for posters and sponsor interactions.  All in all, this will be a high content conference.  This is exactly the structure that meets the Andragogy criteria for Adult Learning. 

In terms of the potential for bad outcomes by every measure they are very small.  The conference is being held in one of the most picturesque cities in North America (Vancouver BC) at a time with little risk for inclement weather, and essentially no risk for personal adversity.  Vancouver is an ideal city; big enough to be world class, but not so big that you get swamped and hit with major costs.  It is a major travel destination, with easy access from across Canada, the United States, Western Europe and Asia.   Thanks to the recent Olympics there is a truly beautiful and efficient airport, to be sure.  

 So it would be fair, reasonable and accurate to say with conviction that the potential for downside risk from either the occurrence or severity perspective is low-low-low.  

Some of you will want to know more and for those of you interested the preliminary website is available now at:  http://polqm.ca/conference_2015/home.html .

I look forward to meeting with some of you in Vancouver from October 28-30, 2015.  

More information will be available shortly. 

I will keep you informed.

Think Strategic and Global but Act Pragmatic and Local

Think Strategic and Global but Act Pragmatic and “Local”

This month Paul Borawski, the CEO of the American Society for Quality (ASQ) asks leading questions in his blog A View from the Q [see http://asq.org/blog/2013/06/quality-today-questions-and-challenges/?goback=.gde_3618260_member_247938106 ]

• What is the most important challenge the quality community faces in ensuring that the value of quality is fully realized for the benefit of society
• And, what question does the quality community most need answered in order to advance the state of quality practice in the world?

Good questions, but from my perspective unanswerable.  That is not to denigrate either Paul or the Questions; but the reality is that the “quality community” is so diffuse and so complex that no single answer is going to address the needs for the whole community. There are too many variables that include geography, resources, sector, culture, and on and on…  So I won’t even try.

What I can do is talk about my own little world of Quality for the Medical laboratory. 

In many respects Medical Laboratory Quality is still very much in its infancy.  We can date the current advances back to 2003.   Most laboratorians if they think of Quality at all, view it as far too fuzzy and anything but evidence-based.  For most practitioners Quality means doing Quality Control or maybe gathering information for some a Quality Indicator that usually has nothing to do with Quality or being an Indicator.  For others it means begrudgingly expending time and money on Accreditation and maybe Proficiency Testing.  For a very few it means having the satisfaction of being in compliance with international standards, especially ISO15189:2012.

What Quality doesn’t yet mean is saving tangible money through reducing Error, and reducing Costs of Poor Quality.

Medical laboratorians perceive themselves as pretty much fact-based folks, and that is a very challenging measure, because while we can say with confidence that adherence to Quality requirements will improve laboratory performance and outcome, what we are still lacking is the evidence to prove it.  

Part of the problem is that generating the fact-based evidence requires specific well-designed study and that means having access to grant-based revenue and graduate students and these are hard to come by.  Across North America and Europe the number of graduate studies programs that focus on laboratory quality issues are few and far between.  In the competition for funding, granting agencies tend to favor the traditional laboratory sciences based on molecular techniques.  I am aware of only one person who has been able to capture the revenues required to look at testing standardization and its potential impact on patient care and poor quality costs.

We have talked about our own data on TEEM costs in which we observed that the average laboratory error consumed an average of 140 minutes to repair (range 20 -1000 minutes) with external failure errors that involve having to contact physicians and patients being the most costly.  That is not a surprise and is consistent with all cost of poor quality data going back to Juran.  That is a start, but we need a lot more to create and provide a platform of data that supports the Quality benefit.  That will take time.

In the past, and even in the present, most laboratories are not creating a position for a Quality manager.  That is a problem, but I can also see their reluctance.  Healthcare is costly and budgets are becoming increasingly limited.  The Quality community is going to need to demonstrate that having a Quality manager will result in savings greater than the costs incurred.  That will not work as an article of faith; it will take hard data.  In the early days of antibiotic resistance, and indiscriminate ordering of antibiotics, hospitals were able to save often double the costs of the clinical pharmacist programs.  That was clearly a measurable success (We will see if the modern “Antibiotic Stewardship” programs are as successful). 

It will not be sufficient to say that having a Quality Manager is a good thing to do.  We will have to have measurable success.    We are starting to develop the metrics to answer this. 

PS:  Our October Quality Conference for Medical Laboratories is coming along well.  A great line-up of speakers and topics:

• The impact of Stress on Quality and Error.
• The Sources of Error in the Pathology Laboratory
• Competency Testing
• Quality for the Rural Laboratory
• Measurement Uncertainty
• The Science of Sample Collection
• A 20/20 view of Medical Laboratory Quality
• Canadian Standards in Transfusion Medicine.
• And many more

For more information and registration visit: http://polqm.ca/conference_2013/conference_2013/conference_home.html

ASM Quality Workshop

ASM Quality Workshop

Today we participated in the Quality Workshop at the Annual General Meeting (ASM) for the American Society for Microbiology.  In some respects this is the perfect union.  The ASM attracts about a bazillion people from around the world.  It is big enough to fill almost every hotel in Denver.  The Quality Workshop is a bit of a niche interest, but we managed to have people from across the US, Canada Lebanon, South Africa, Australia and the Republic of Cameroon.  Small conferences will attract interested folks, and mega-meetings will attract broad international crowds.  We were lucky to end up with the best of both.

Without wanting to overstate the situation, I think the light has gone on  in the United States.  While at one time the CLIA regulations were the vanguard leaders in the world, many would say at 25 years old, CLIA has become a tired millstone in serious need of revision.  While there are many US laboratories that don’t give a damn to quality, those that are recognize that being accredited to CLIA provides no evidence of interest in making their laboratory better.  

Fast, cheap, east, mandatory and sufficient; good-enough is good-enough.

The folks that attended the workshop were of a different mindset; interested in learning about international quality, with higher aspirations for their laboratory’s reputation and recognition.

The meeting was put together by CDC and included two CDC speakers, a well-informed speaker from another laboratory and me.  One can find the names of the other speakers by going to the ASM Annual General Meeting site and looking for speakers at workshop WS:04.

It was an excellent meeting full of practical tips, and perspective. 

I gave a good overview of why Quality Management belongs in every laboratory. 

 A very good presentation was given on CLSI and that organization’s participation in the Quality area.  A very good crosswalk was presented on how CLSI guidelines lined up with the requirements of ISO standards.  It was pretty clear that CLSI is contributing to US medical laboratories by providing a series of documents that help implement Quality.   

What was really interesting to me was the presentation on measurement uncertainty from a laboratory in the US that had decided to get accredited to ISO/IEC 17025 very early on, had has had to struggle with MU.  A model for application of MU for quantitation of urine cultures was presented.  

I thought it truly excellent.  We all agreed that MU is an irrelevant waste of time, but has to be dealt with if a laboratory wants to benefit from the achievement of ISO accreditation.  Having to jump through hoops purely to satisfy accreditation bodies may be stupid and evil, but it unfortunately an unavoidable stupid evil.    What Alice presented was a model that would get it done in as painless a manner possible.  And that probably is the best way forward.  

And more to the point, the information is generated solely for internal  holding.  Do not present the information to anyone, other than the accrediting body. 

What I thought amusing was her mentioning that the accrediting body required her to actually to through the arithmetic during their site visit.  Just sad.

The last presentation was unfortunately cut short because so many questions were being asked.  It was too bad because it was shaping up as an excellent presentation fo some practical tips on implementing Quality on an voluntary level.  As mentioned, it your laboratory is not going to go for full ISO accreditation, you are still better off implementing some easy steps along the way, and gradually building your Quality inventory.  It is not the best way to implement Quality but if management and staff are committed, it can work.  I am thinking of inviting her to give the presentation again in Vancouver at the POLQM Medical Laboratory Quality Conference Meeting October 16-17-18 2013.

If you want to meeting an impressive faculty, plan to come to the meeting.  If you want to learn and discuss and debate Quality with peers, plan to come to the meeting.  It you want to participate in a World Standards Day celebration, plan to come to the meeting.

More info VERY SOON.

M