Canad's best laboratory Quality Seminar series

Over the years I have organized 22 Quality Seminars for what used to be called the Conjoint Meeting, an annual event in Canada that has brought all the interests of microbiology, infectious diseases, and public health together for the last 80 years or so.  Today it is called the AMMI Canada CACMID conference, named for the two principal host organizations.

The Quality Seminars have changed their name and purpose since their inception in 1992.  At first it was an opportunity for laboratory accreditation bodies and proficiency testing bodies that got together and discuss common interests.  When the accreditation bodies dropped out the proficiency testing groups continued on and we could chat about interesting PT issues.  Over time the focus started to move again more in the direction of standards development, and then finally very much into the areas of individual interest, such as international activities, education, and finally a whole slew of Quality oriented topics, that impacted mainly microbiology laboratories, but eventually the broader topics or error and culture and continual improvement. 

The Quality Seminar has always been seen as separate from the main meeting.  At the beginning it was an event that people could attend on the day after the conference was over, especially if they had a late flight on the next day.  Then it became one of the day-before events so that people would have something to do when they got to town a day early.  Both of these times worked out well because it was not competing with the chaos of the full meeting, and gave us lots of time as opposed to being limited to a slot of 45 to 90 minutes.  While others were being shoehorned in, we always had at least 4 hours to fill, enough for at least 4-5 speakers and discussion and coffee breaks.

The audience was always a select special group.  Even in the arena of laboratory and clinical medicine, the audience for Quality issues has never been huge.  But it was a faithful group and every year, pretty much we could fill a small or intermediate sized room for the whole session. 

Of interest, as the conference expanded, other groups began to see the day-before block as a desirable time slot and we found ourselves competing with other groups during our afternoon block, probably to the disadvantage of both.  The people having the competing time meeting locked up all access to the physicians-in-training (aka Residents), a group of people that prior to this change would benefit from being at the Quality Seminar and being exposed to a topic for which their routine training was (and still is) somewhere between inadequate and absent.  And we would have enjoyed having the Residents with us, because it would have increased the group size and expanded the group discussion.  But it just was not to be.  

So now after 22 years, I think it is time for me to call it quits.  I have kind of run the gambit of topics and I am not sure I see the value to me in continuing on.  That does not mean that Quality Seminar will end, indeed I hope that is not the case; it just means that someone else will need to take on the responsibility to organize it and lead it and keep it afloat and move it towards its next iteration. 

For those interested, the presentations from the meeting will be on-line at www.POLQM.ca under the title AMMI-Canada CACMID 2014. 

Another Successful Quality Seminar

Another Successful Quality Seminar

In Canada we have a variety of medical laboratorian organizations whose primary function is to bring people together for an annual meeting.  For microbiology technologists, scientists, and physicians the predominant organization is known as the Canadian Association for Clinical Microbiology and Infectious Disease, which is abbreviated as CACMID.  To some the word CACMID brings to mind hacking and gagging, not in a polite way.  The organization has been around and active since 1974.

In 1994, I proposed to create a side seminar to highlight the interests and activities of Canadian microbiology oriented Proficiency Testing programs.  It turned out to be pleasantly successful, and there was a thought that we should do it again.  Well we did, again and again, and yesterday we did it again, for the 20^th time.  

With the probable exception of the annual conference of the American Society for Quality, I would not be surprised if our 20 year run is the longest run of conferences dedicated solely to Quality in any industry.  If someone knows of another series or other series, I would be interested in hearing.

Over the years both the hosting organization and the Quality seminar meeting has evolved.  Now there are two hosting organizations CACMID and AMMI-Canada (the Canadian Society for Infectious Diseases and Medical Microbiology).  The Quality seminar has moved from its focus exclusively microbiology and PT.  Over the years we have high-lighted accreditation, standards development, Quality education, and suppliers; in essence  we have covered the spectrum of Quality and the collective group of Quality Partners.  

This year was another evolution as we focused on a variety of laboratory Quality tools.  One speaker was a clinical chemist who gave a very interesting discussion of Six Sigma calculations and how they can be used to describe and monitor error in the medical laboratory, not only with respect to quantitative assays but also for qualitative ones.  In the medical laboratory we see six sigma as a valuable shorthand that can reduce very complex numbers to very small and simple numbers.  This is very analogous to pH as a measure of hydrogen concentration or logarithms for that reduce 1,000,000,000 down to 10⁹.  Already we hear laboratory folks talking about having an error rate around 4 (meaning an error rate around 0.5%) so we know that the shorthand is taking hold.

The second talk was one to which I am very committed.  In North America jurisdictions are falling over themselves consolidating many laboratories into 1 mega-laboratory; very financially efficient, but maybe questionable on effectiveness.  An adage in healthcare has long been “closer to home” meaning that the facility near you knows you as a person while the mega-lab doesn’t know much other than you as a number and a vial of blood.  Our second speaker was talking about implementing Quality into a laboratory in a small town hospital.  It we can keep these smaller facilities up-to-date and up-to-Quality, we extend and enrich their value far greater than shipping samples down the road to the big house.

The third presentation was on another subject that I enjoy; implementing internal audits in new formats that increase interest and attention and focus and knowledge.  It moves audits from the section called “mundane and boring” to “interesting and fun”.  Sara (the presenter) did a great job of conveying enthusiasm.

The fourth presentation was on a better way to look at Risk as it applies to decision making in the medical laboratory.  I have previously written in this blog about Risk and Uncertainty and Severity-Occurrence as a value monitoring tool.  This was my first time to do a live presentation on the subject of Risk.  I was pleased at how well it went, but it still has opportunities and potential for improvement.

For those interested we have posted 3 of the 4 presentations at www.POLQM.ca for public 

viewing.  

 One of the presentations is going through a review, because the spectre of copyright infringement has been raised.  I suspect it is more speculation than fact, but we are checking it out rather than facing off problems.  It likely will appear next week. 

So with another successful meeting under our belt, some decisions are being made about what happens next.  Personally I have to do a motivation check after every seminar these days.  The process of getting new and fresh speakers is getting tougher.  But at the moment, I am pleased with 20, but now we are thinking of shooting for 25. 

Time will tell.

A Report on our 19th CACMID Quality Seminar.

Over the years I have hosted about 30 seminars or seminar series or workshops, and I will admit that I have be pleased with how about 25 of them have gone.    

Yesterday I hosted my 19^th seminar with the Canadian Association for Clinical Microbiology and Infectious Diseases conference which is being held here is Vancouver, and in all due respect to all the other sessions, this one ranks NUMBER 1 in terms of Quality of Content, and overall Quality of Speakers.  It was the perfect blend of new information, controversy, and future visioning.   I have long since stopped worrying about numbers of attendees.  The people that came all enjoyed the discussion and information.

The themes covered included Pre-examination issues in laboratory testing, with some particular reference to Microbiology (it is a part of a microbiology conference), reported laboratory errors, with particular reference to breaches in confidentiality and a special focus on Post-examination reporting of laboratory reports.  

All the content was excellent and well delivered, but from my personal perspective, the number 1 presentation was the one by Krystyna Hommen on reporting of results directly to patients.  Ms. Hommen is the President and CEO of a company in this province that provides the electronic service that transmits over 8 million medical laboratory reports to hospitals, physicians and patients every year.  That, by my estimate, would likely make her company the largest purveyor of medical information in this province, but would likely rank her in the top 3 in Canada and I would guess the top 25 in North America.  

Starting in 2010 under a program called eHealth, her company started to provide information in a structure that allows patients to access their own medical laboratory information.  Now, barely 2 years later, the uptake of people participating is near 220,000.  What is stunning about that number is that the total population of British Columbia is about 4 million, of which about probably 2 million would be in the age range of 16-80.  That means that over 10 percent of people are taking advantage of the system.  Her experience is that the rate of new registrations is near 400 a day which means that by this time next year the people taking advantage of accessing their own information will be near 400,000.  Even at that rate, one can extrapolate that within 5 years near 100 percent of the adult population of this province will have direct access.  

To put that number in other perspective, BC has about 6000 physicians which means that today personal access overwhelms physician access by near 4:1.  By this time next year it will be much closer to 8:1.  

What is so important is that people don’t just gather their information; they go back again and again, studying their information.  They are becoming better self-informed.  As Ms. Hommen points to, as they review their results, they are becoming more engaged in their own health issues.  And they are picking up errors such as lost or missing information.  So it is fair to say that eHealth is contributing directly to laboratory quality improvement when the report these problems.  

It was interesting that the questions from the audience picked up many of the issues that I have mentioned previously on MMLQR.  How do people respond to corrected reports?  How do people protect their information from others, including those from previous personal relationships?  Who has access to information for children?  All these were addressed.

Ms. Hommen pointed out that while her company is a leader in this field, several other provinces are coming on board with similar services.  Likely by 2020 this will be the way in which laboratory information is transmitted.

This is truly the dawn of a new and exciting era of personal ownership and engagement in personal health.  If the laboratory wants to remain a healthy and relevant part of the equation, there is a lot of work to be done.  The format and structure of reported information has to improve.  The quality and reliability of the information will have to become much, much better.  The jargon will have to go and be replaced by new and better informative content.  And laboratories are going to have to learn to take a whole lot more responsibility of the quality of their samples, in particular the impacts of collection and transport errors.  

As pointed out before, in Canada the route to satisfaction for medical error is suit.  In Canada we talk about malpractice suing, but we don’t really do it all that much.   As people become more engaged, the level of interest in how errors affect health decisions will become greater and greater.  Our patients’ patience will meet its limits.  And as a fellow on the television (Kevin O’Leary) says, the result will be that folks will sue laboratories into the Stone Age.

For reference, the presentations are available at www.POLQM.ca

Don't Stretch for Quality

In our course today the term “Stretch Goal” came up for conversation. For the athletes this has nothing to do with Pilates or Yoga or muscle relaxation.  It is a term that describes having business goals that may or may not be necessary but require resources and abilities beyond current capabilities, but cannot be done  in incremental steps. A common expression is that one can’t take two steps to hurdle a fire pit.

The reality is that stretch goals sometimes are the only way to go when, for example, an organization sees itself collapsing due to a harsh economic environment or a massive competitive onslaught.  A rapid and major overall may be only way to survive.

But it is a truly lousy way to try to implement or coordinate Quality. 

In the medical laboratory unfortunately we see “Stretch Quality” all too often.  The director gets a letter saying “Dear Doctor.  This is to let you know that our accreditation team will be visiting you in 4 weeks.  Yours sincerely…”  The director looks around and sees that NOTHING has been done in the Quality area for years and tries to implement a massive fix-up.  Often it succeeds, only because the inspector group was sufficiently disinterested or ill-informed that they don’t actually bother to look around.  So the laboratory dodges a bullet and says, “Good thing that’s over.  Wake me up before the next inspection”. 

Incremental Quality is better.  A mini internal audit here and another one there and another one next month, and after a while you have a lot done.  We just did our third audit today and when we go into our external review in March we will have documented review of over 250 requirements.  Combined the mini audits took about 4 hours total.  We have reviewed our Strategic Quality Plan and developed 2 new policies and 4 revisions since our last inspection; and two customer audits.  And none of it was panic or painful.  Even with our small but very busy operation we can find the time to get this stuff done. 

I am not suggesting that we have it all together, in fact our assessment overall was 94.7% compliance which means we had missed a bunch of things that need to be fixed.  But this incremental approach meant that we caught the problems before they became institutional or blew up in our face.  So that is a good thing. 

And speaking about good things…

We have set the final agenda for our Quality Seminar to be held in Vancouver on Wednesday May 2^nd at the Sheraton Wall Hotel in conjunction with the conjoint meeting of the Association for Medical Microbiology and Infectious Diseases – Canada and the Canadian Association for Clinical Microbiology and Infectious Diseases (how can one country have two organizations with nearly the same name and serving the same constituency!; long story!!). 

We will be talking about:

·       New national standard created through the Canadian Standards Association for procurement, handling and transport of samples for the medical laboratory.

·       Microbiology application annex for the new Canadian standard.

·       Monitoring Laboratory Error using a provincial on-line reporting system.

·       Direct-to-Patient reporting of laboratory test results

·        Challenges to Patient Confidentiality in the Medical Laboratory.

The meeting is only a half day (costs $100 Canadian for attendance, copy of the files, and coffee break), but for those interested in microbiology the AMMI-CACMID meeting is always brilliant.  You can find out more about the meeting at www.cacmid.ca or www.ammi.ca

May is a great time of the year to be in the Canadian South-West and Vancouver is one of the best destinations in North America at that time of the year.  Amazing scenery, golf, skiing, boating, and the widest variety of incredible restaurants. 

Come join us!

In case you cannot, I plan to have the Quality Seminar on YouTube.

M