The Canadian Standards Association: Impact versus Awareness

I am putting together a presentation for a meeting in Quebec City in June.  I was invited to talk about the impact of Canadian Standards Association (CSA) documents on Canadian healthcare.  As I am putting it together I recall a conversation that I had at another meeting about 10 years where a Canadian microbiologist spoke up asking why I would put in any time with the CSA because they did so little for healthcare other than to check that the electrical plugs on radios and equipment were OK.  I suspect that at that time vast majority of my colleagues probably thought this same way.  We will see if things have changed.    


To be fair to my colleagues, most of their time is spend being hands-on technical laboratorians and most of the documents that they look are written by the Clinical and Laboratory Standards Institute.  The CLSI is a developer of many documents of critical interest for the laboratory worker.  Many of their documents are used world wide.  CLSI documents fill a specific niche extremely well.  But if you think about spheres of influence as a form of Venn diagram, the areas where CLSI and CSA cross over is quite narrow, and there are many health related documents that are addressed by CSA that are not addressed by other organizations, including CLSI.


I have spent a lot of career time working around the CSA.  I helped develop and chair the technical committee to focus on medical laboratory Quality Systems, and with CSA support lead the Canadian delegation to the ISO.  Through that committee we participated in writing key documents for laboratory Quality (ISO 15189), laboratory safety (ISO 15190), and point-of-care (ISO 22870) all of which became national documents.  We have shared in developing documents on medical laboratory Risk Management, antimicrobial testing, and packaging labelling.  So from that point of view alone I could justify the time spent working with CSA was time well spent.


But it was when I moved up a step to being a part of the Strategic Steering Committee for Heath Care Technologies and Services that I truly appreciated how much CSA is a health standards body.  Today there are hundreds of healthcare related CSA documents that impact medical devices, facilities engineering, anaesthetic gases, peri-operative procedures, renal dialysis, blood transfusion, tissue transplantation, equipment cleaning and sterilization and infection control, radiology, ultra sound, dentistry, caring for disabilities and medication packaging.  There are essential standards that impact every aspect of the medical laboratory.  Indeed it is hard to think of any part of healthcare inside or outside of health care facilities that is not directly influenced by CSA standards.  


I wonder why after 50 years of engagement in healthcare, there continues to be this huge disconnect between impact and awareness.  


My guess is that there are a variety of reasons that come down to a few root causes.  First is that CSA works in the arena of documents creation, and to many in healthcare this is just plain BORING.  Additionally there are so many organizations that truly believe that document development is a “nickel-dime” process and that they can do it themselves.  And they can and do.  It is just that they do it very badly.  I sat on the standards and guidelines committee for a medical organization for a number of years.  The number of trash documents was tragic.   Recent experiences tell me that little has changed.  The consequence is that there is little regard or even awareness in document source or relevancy.  Just photocopy it and be done with it.
A contributing factor is that Quality issues have almost no play in any aspect of medical education at any level; it is for all intents absent from undergraduate and post graduate education.  The words like “standards development organizations” or “quality partners” or “accreditation” or “proficiency” never come up; ever.  Quality means newer or fancier, not better.  Certainly no one would ever discuss an essential quality partner like the CSA.  Healthcare professionals have little idea about what is a document and what is a standard until well into their career.  It is a stumbling-bumbling process. Perhaps the fact that there is a meeting for laboratorians and I have been invited to present on the topic is a key step forward.


But in the meantime, for us that are interested, the field remains wide open, filled with opportunity and promise.  And a real sense of accomplishment, knowing that we contribute to greater healthcare and society in truly essential ways that others can not understand.  


For those interested, I will post the presentation file after the meeting.


Also, you can visit the CSA on-line store catalogue at:  www.shop.csa.ca  Click on the Publications link at the top.

Learning the Past or Learning from the Past?

Paul Borawski is the CEO of the American Society for Quality.  He writes a blog “A view from the Q” which can be found through the ASQ website (www.ASQ.org).  In his offering from August 16^th, he asked an interesting question.

“The philosophy of modern quality reaches back to the late 1930s and 1940s. That’s not so long ago, but it might be ancient history. I’ve been in three large quality gatherings in the past year where the question was asked, “How many of you have heard of W. Edwards Deming?” I was shocked and saddened when less than a third of the hands went up. “How about Joseph M. Juran?” Fewer hands. It occurs to me that something isn’t right about that. Am I being nostalgic, or does the quality community bear some responsibility for making sure its philosophic foundations are not lost to history?”

It is an interesting comment that reflects as much on the author as it does on his observations. 

My guess is that Paul and I are about the same age, which is one very vulnerable to nostalgia.  In my day, things were better, or tougher.  My teachers were wiser, or more indifferent.   I had to walk 20 miles to school in the snow without boots carrying my lunch box in one hand and fighting off wolves with the other.   And in my day we know our history and were proud of it.  And don’t let me ever get started on those university students of today.

All good stuff, but it is not only fluff, it is almost always wrong.  We were just as illiterate about our history as kids are today.  Probably worse.  Back in our day all we had was the Encyclopaedia Britannica which was usually at least 10 years old.  And maybe a stack of Life magazines in the garage.  Today the kids have Google and Wikipedia and virtual instant access to the past, or at least the past as we recorded it.  I would venture that the 35 year olders are far more knowledgeable about things that occurred 40 year ago, than were we.  And more importantly, if they want to find out about that stuff they can Google it in a heartbeat.

While some of our generation may know about Frederick Taylor, how many ever knew who Levey and Jennings or Dodge and Romig were, even though some of us still use their charts and tables today. 

There is value in knowing the names within in our historical roots; Shewhart, Deming, Juran, Crosby, but more as an aid to knowing about planning and doing and studying and acting.  If the names get lost in time or get mixed up with certain mythologies that is OK as long as their messages remain.  I know we all want to be remembered, but can we agree that the real issue is appreciating the concepts for monitoring for error, implementing corrective actions, and applying all this to create an continuum of Quality improvement.

By the way, I have been teaching an on-line course in Laboratory Quality Management through the University of British Columbia for 10 years and still include The Deming Management Method by Mary Walton and Quality Without Tears by Phillip Crosby on the required reading list.

Assessment , Assessment , and Assessment

Note: Some of you may be aware that Blogger had a crash over the last 24 hours.  Recent posts were lost.  This one was posted on Wednesday May 11.  I am reposting it. 

If you buy into the concept that we learn from experience, then it is an easy step forward to accept that there is much value in assessments that objectively measure what we have done in the recent past.  Objective assessment distinguishes between what we have done and what we believe we have done and points out, sometimes painfully what we have not done.  .  It is an integral component of Quality and learning and improvement.  Today we are heavily engaged in the assessment process, in a variety of aspects.  

PART A.
A few weeks back I mentioned that we at CMPT has screwed up and were found to have a non-conformance in our assessment for compliance to ISO9001:2008.  We have re-organized and got our internal audit completed.  We identified the areas that need improvement and submitted our records and plans for going forward.  
Today we were notified that our evidence has been accepted and our certificate for re-registration has been granted, recognizing that we will have a visit to demonstrate that the action plan is indeed an action action plan.  Hooray for us.

PART B.
In many situations, (see above for example)  we can and should do our own internal assessments and learn our own lessons.  But there are some times when an  external assessment works better.  
Consider for example, in the area of education.  When students, including adult learners, take courses, before we can say they have studied and absorbed content, we do an assessment, sometimes referred to as an examination.  We don’t leave it up to the students to do their own personal assessment and then get back to us (at least most of us don’t do that!).  We measure their knowledge through pre-tested questions, and determine if their responses are consistent with the new knowledge that we expect them to have learned.  Internal personal assessment is an important self-learning tool, but when it comes to certification, personal evaluation is not enough.  We base assessment on external evaluation.  
I mention this because we are about to go into final exam season for our Certificate Course in Laboratory Quality Management.  
We are confident that everyone will demonstrate their new knowledge in exemplary fashion.

PART C.
But just as we don’t rely on students to evaluate their knowledge, we don’t depend on ourselves to evaluate the course that we teach and the manner in which we teach it.  Our certificate course is in its eighth year, and has reached a level of mature stability.  We are confident that we know what we are doing.  It is now time for use to find out if others agree.
In part we have done this regularly throughout because we have done student surveys after each module and at year’s end almost from the beginning.  And we have made changes each year, in large part, based on the surveys.  But at some point, that approach is not enough.  Student participants tend to have a short term view, and their assessment as valuable as it may be, is an immediate reaction in a manner that they may perceive as not totally anonymous.  So they may be telling us what we want to hear.
So this year we have brought in the expertise of a group that spend a lot of their time doing external evaluations of courses and programs.  They look at content, and delivery, and interview faculty and students.  They look at course objectives and determine if we are meeting what we commited to meet.  
All of this is voluntary.  We don’t have to do this.  The university does not require it.  Our department does not require it.  But we require it.  How can we give a message of commitment to Quality if we don’t take the extra step.  
So I am looking forward to the exercise, and expect that we will do well.  I will be surprised if we are deemed as so perfect that we have no areas for improvement, and will be similarly surprised (perhaps hugely surprised) if we end up at the other end of the spectrum.

All this takes time and effort and energy and money (TEEM expenses).  It  is all part of the Quality exercise.