Standards Development and Social Media.

The International Organization for Standardization (ISO) and the collective body of world standards development bodies play an essential role for Quality.  Without them the documents that provide rules and guidelines for consistent practice and activities would not likely exist.   Standards based on the combined results of science, technology and experience and bound together by consensus are the foundation of trade, common societal goals which today includes consistent medical laboratory practices including quality management. 


I would like to think that there is some truth to the notion. 


As mentioned, the reason that standards can work is because they are developed using a consensus model in which there is a requirement for solid agreement that substantial objections are resolved.  This doesn’t mean that everyone has to be happy.  It only means that everyone has to be able to accept or at least live with the document.  While to some it may sound like an invitation to the “tyranny of the minority” consensus requires that every person who has legitimate concern needs to be heard and every attempt to resolve their major conflicts be resolved.

It sounds so good.

But all too often the process gets hijacked because everyone in the room is of like mind.  Get a group of scientists or engineers or industrial design folks in a room and it is very easy to come to common understanding.  It is not so much a nefarious plot, but rather you have people from a common background, common education, and generally a common point of view.  Even if you would want to extend the group, while you may introduce differences in politics or single issue differences, the pool continues to have consistency in the understanding  that matters the most.  Folks from disparate regions all too often can’t afford to participate, even if they get to know what is happening.  And often consumers and public representatives (patients, students, less educated, less funded, and people who don’t belong to the specific professional organization or folks with a longer range vision) do not get their point of view included.  In fact since most of the folks on the inside wouldn’t even know where to find these alternate opinions, they don’t even get asked.

So it should not be too surprising that sometimes standards or sections within standards  that look great on paper fall apart in practice.

And this is where new technology comes to play.  Organizations like the Canadian Standards Association have introduced public access points where the general public can visit and view documents and comment on them during the period of public consultation.  Truly different points of view can get raised and need to be considered and examined.  They can not be ignored.  In Canada it means that interested parties living in Iqaluit or Yellowknife or Regina (a joke; it’s just a joke!) can in the comfort of their home of office review documents and make informed comments before the document is actually published.  This may give a committee pause to consider or reconsider.  The committee may even consider contacting the person by phone for further discussion.  Or they may, upon reflection, decide that the issue is sufficiently off-topic or does not meet the level of substantial objection that it can be noted by rejected. 

Well you can say that this is not really a democratic or balanced extension to the consensus process because when push comes to shove all that they have done is figured how to include more people who (a) know where to look (b) have a computer (c) have an internet connection (d) can read and communicate in the common language and (e) can understand the language of standards development committees.  And that argument has some merit.  

But the public access sites can be promoted on Twitter© or Facebook© or blogs and forums.  Distribution of knowledge will get broader and deeper, as will the diversity of opinion.

But until the day comes that all the world governments widely dispense free  Google© glasses to all the world citizens at birth, I am satisfied that giving more consumers and other folks who potentially can be directly impacted new requirements a voice that they did not have before is a pretty big deal. 

So “good on ya” to the CSA and other standards development bodies taking a bold step forward.  And to the others, what’s taking you so long?

The dark side of customer satisfaction

Four stories:  

• On a recent television show in Canada on customer service, the most common complaint was that all too frequently Canadians could not find customer service staff, and when they did, all too often the staff were ill informed.  The comment was made that many large companies find that hiring and training customer service staff did not result in increased sales.  In a related story, retail outlets are losing business to on-line services.
  
• I did an inspection for a laboratory recently where I was given the names of two clients that account for a huge amount of the work done by the laboratory.  One gave an OK review of the laboratory and the other trashed them.  When I asked if the complaints had gone to the laboratory the response was something to the effect of they know how I feel.
  
• I booked a large chain hotel in the United States a little over 2 month ago for a meeting next week.  I thought everything was in place, but I was wrong.  I went to the ‘net and checked out reviews on travelocity, tripadvisor, and hotels.com and found that others had had similar dissatisfaction.  I decided to cut my losses and cancelled my reservation and stay elsewhere.
  
• In an informal survey of 20 accredited medical laboratories around the world, I identified only 5 that maintained a formal log of received/resolved complaints, and all the logs that did exist, were incomplete (they only recorded complaints submitted in writing).  Only one laboratory maintained and monitored received/resolved complaints as a regular metric.

A few questions came to mind.  Why do some very large retailers and apparently some laboratories and profession groups see so little return on investing in customer service?  I can understand part of it. 

In the public sector laboratory and indeed throughout all the civil service the work process is near always the same; work comes in and work goes out.  Workflow in most laboratories is not obviously associated with complaints.  Institutional budgets are set based on factors all independent of satisfaction.   As budgets become constrained, it is easier to focus on the issues that sit front of mind, which continues to mean stamping out fires and trying to keep up with technological and human resources change.

Even if laboratory management want to reward good service, it is very difficult, indeed often impossible.  While there is much discussion around reward programs such as pay-for-performance, most programs have either been blocked or have failed because they are seen as too subjective, or too easily manipulated.  Pay-for-performance in the teaching profession is viewed as striking right to the heart of unionism and the concepts of collective bargaining.

The observation that some (many?) medical laboratories do not maintain an active and complete complaints received/resolution log is troublesome especially since addressing complaints is identified as an accreditation issue in the United States (College of American Pathologists) and by ISO15189:2007.  An argument might be made that just because there is not a metric that monitors complaints doesn’t mean that complaints aren’t taken seriously.  But how would anyone, including an accreditation assessor know?

The unfortunate reality is that with larger institutions and organizations the only driver that pushes for more attention to customer satisfaction is certification and in some laboratories, accreditation.  And that is too bad.  The reality is that is unhappy customers have all sorts of ways of sharing their experiences these days that didn’t exist before.  Until about 10 years ago, complain options were fairly limited.  One could write a letter or make a phone call, but short of making a formal complaint to formal state or college authorities, or spending money on civil suit action, that was about all that could be done.  Both of these are processes that most of folks find either unduly bureaucratic and time consuming or expensive. 

Today people can complain far more broadly with less problems.  There is email, and Twitter, and Facebook, and blogs and public review sites.  In healthcare you can register both positives and negatives about pathologists and clinics and laboratories in a variety of sites (www.ratemds.com, www.ratemymd.ca, www.healthcarereviews.com).  Word can spread in a very public way in a heartbeat. 

By the way, as mentioned before, the increasingly present option that patients have for direct-to-patient reporting will inevitably mean more unhappy people, more complaints and more public awareness. The general public I suspect will be less tolerant of wrong identifications, late reports, misleading results, false positives, and false negatives.  Poor customer service is no longer remains a private issue.  It can become very public and very ugly.

Welcome to the dark side of unhappy folks with access to social media.

Quality and the Tower of Babel

For those of us in the Northern Hemisphere, September tends to be the end of summer and the return to more active work.  Welcome back.

According to the Bible (Book of Genesis) after the Great Flood all the people spoke a single language.  They migrated to the land of Shinar (modern Iraq?) and decided to build a city with a great tower.  God had distrust of this large group and their motives.  He confused their communication by creating the many different languages.  The work on the tower ceased and people scattered across the face of the earth.

Over the last while I have been communicating with a wide variety of groups that seem to have a common purpose to make health and patient care better.  But somewhere along the way they have become very fragmented and increasingly disconnected. 

Some of them fall into that collective group of quality partners.  This is the group of standards development organizations, accreditation bodies, proficiency testing providers, educator groups, professional organizations, and equipment and reagent suppliers.  Add to that the public representatives through the legislators, regulators, litigators, and the media.  More recently I have increasingly had activities with the groups, mainly in the clinical Patient Safety arena, and a new group (new to me) focused on Medical Diagnostic Errors.  

Some of these groups have splintered off even more distinctly, focused on Quality in resource limited regions while others are more interested in the opportunities in the wealthier countries, and others still fall somewhere in between because their interests are in the resource limited regions that are found within the wealthy countries. 

Like the aforementioned Babel, each group seems to be developing its own sets of definitions and jargon and discussion groups.  Each has its own set of meetings, which not surprisingly all occur at or around the same time of the year, but sufficiently distant that it would be difficult to combine.  
In Canada I recently discovered that three groups all with common interest have meetings planned for June 2012, two of them in the same hotel but a week apart and the third separated off by about a two hour drive and an additional week.  What was interesting to me was that none of the groups was aware that the others were meeting or even planning common discussions.  And Canada, while big in geography, doesn’t have all that many people.  How “Shinar-like” is that.  (Am I adding to the confusion by creating even more new words?). 

The problem (at least in my mind) is that as we all spin out further and more disparately, the opportunities for common goals get muddied and muddled.  Rather that building a large tower to the heavens we end up with a bunch of low-rises or maybe townhouses. Not that low-rises and townhouses are bad things, but I suspect that was not our collective primary purpose.  

As it turns out, all these groups appear to have a single vehicle that potentially can draw them together.  LinkedIn, the original social media has forums for all these groups.  If you have the time and inclination, a person can connect to all these interested parties and find the common links. 

To explore this further go to www.linkedin.com and hit the Group Directory.

While you are at it, for those interested in our on-line course in Laboratory Quality Management, go to www.polqm.ca.  Our registration for January 11, 2012 as begun.