The Error Cost Dynamic

The Error Cost Dynamic

We have started our new season for our UBC Certificate Course in Laboratory Quality Management and I have to say that this year is perhaps the most animated, most adventuresome group to date.  Day 3 and there is already a lot of mingling and interaction, which is incredibly special in an on-line virtual classroom course. It truly feels like if I should not be surprised if I were to have a tap on the door or a call on the phone.  This is a good thing.

One of the questions that has ready come up is on the impact of communication, or lack thereof, on laboratory error.  This is a very interesting topic  because communication is so multidimensional; there is communication in the form of person to person chitchat or communication in the form of information sharing or communication in the form of instruction - guidance - requirement.  Regardless of which form we are talking about communication can be either very positive or very not-positive depending on the clarity, understanding and intent.  Said in a way that is clear and precise in-laboratory communication is very helpful.  Said in a way that is muddled and ambiguous and a whole lot of bad consequences ensue.

That is a long way to get to the topic of error.  The point I am struggling to get to (talk about poor communication skills) is that in Quality, concepts that are expressed with clarity and brevity lead to new insights and new understanding.  Concepts presented as subtle nuanced and complicated are a struggle and are often dismissed. 

For me, I think I have developed a helpful way to express the dynamic impact of errors and causes of error on the costs of poor quality.

All organizations experience daily work pressures, many of which are addressable and potentially controllable: noise, crowdedness, clutter, work volume, time pressures, stress and anxiety, miscommunication, accidents and injury, and finances.  

As daily pressures rise, the risk of error rises in the same time or compounding at a faster rate.  

As the risk of error migrates to being the actually of error, the impact of error becomes an additional source of daily pressure, sometime impacting on finance, but more often on stress, anxiety, accident and injury, and time pressures. 

Increasing error is a leading indicator of deteriorating Quality, contributing to management dissatisfaction, customer dissatisfaction, staff dissatisfaction, more remediation and increased cost and usually reduced revenue streams, all of which are can be measured and compiled as the rising costs of poor quality. 

Recognizing this dynamic, leads to an important conclusion; addressing daily pressures before they lead to problems is the easiest way to prevent error and reduce poor quality costs.  

One can appreciate the dynamic graphically as a series of gears all moving in concert. 

It seems to me that thinking about quality from this dynamic there are some useful valuable insights and conclusions, the first of which is that the easiest way to reduce error and cost is to reduce pressures that lead to mistakes.  Many of them would be addressed through an active Lean campaign (think especially about Sorting, Streamlining, Shining, and Standardization) which would go a long way towards reducing noise, crowdedness, clutter, and time pressures. My guess is that the impact this would have on an organization’s work culture would be so powerful, that the drive to sustain the improvements would come from within rather than requiring management motivation.

My second conclusion is that trying to implement a new Quality system without first addressing these pressures would not solve the quality problems; indeed it would make them worse.

I wonder if that is why some many organizations that try to implement Quality systems through ISO9001, and probably 17025 and 15189 fail.  It’s not that these are bad systems, but if you don’t create the culture and  time-space in which the Quality system can grow, you can be surprised when it doesn’t.

Quality and Adult Learning

In the past I have talked about the characteristics of adult learners [see http://www.medicallaboratoryquality.com/2011/01/communicating-quality-and-principles-of.html ].  Adult learners know what they want to learn, how they want to learn and when they want to learn, and most importantly how much time effort and energy it takes to acquire the information.  They are demanding with high motivation requirements that are very specific.  


In the arena of continuing education, while the cost of education is an important consideration at the beginning; adult learners make cost a factor in the decision making for registering for a course, but it is secondary to the other factors in the decision to follow through on a course.  If a course is not meeting their specific needs, the decision to walk away is relatively easy to make.  


Perception of overly expensive registration fees may be a barrier to entry, but when it comes to leaving prematurely, requirements of time, effort, and energy will trump financial issues for adult learners.   From my perspective, the notion of TEEM costs comes up in a number of situations.


In my own personal situation, I am taking a volunteer continuing education course in conversational French.  Despite a not-modest registration fee and a good faculty, we had a drop-out rate of 33 percent, once we got to the point where extra time and effort was needed for progress.


And a corollary of the “money is a barrier at entry and effort is the facilitator of early leaving” rule is that the lower the cost, the easier it is to make the decision to walk away.  You know that to be true when you consider all the free continuing education options that are available on-line.  Many people start, few people actually follow through.  


Based on that I suspect that course completion ratio is probably a useful Quality Indicator for assessment of adult education classes, either as a class-room or on-line exercise.   


In that regard, for our course our experience is that our final course completion rate is a little over 95 percent, and I interpret that as an indicator that we have found a good balance between registration and cost and effort and reward.  We are attracting the right people who are motivated to acquire new knowledge in the area of laboratory Quality, and we are charging a fee that those people perceive as reasonable, or at least not overly excessive.  And while the course does require participants to commit a fair block of time, and effort, the vast majority do not perceive it as excessive or unreasonable.  Almost everyone who registers and starts the course completes it.  


When I talk about our “final rate” it means that on a year by year basis we have a drop out rate closer to 12 percent, but we will allow people who have had work or personal issues arise (we have had deaths in the family, child-birth, divorces) to re-register the following year to complete the course, and earn their certification.  Almost everyone offered the option takes advantage of it.  


Part of our success so far I think comes from our applying principles of Quality Management to our course.  We pay close attention to our course objectives, and to our participant satisfaction survey information.  We maintain a pattern of continual improvement based in part on the survey results and on maintaining a grasp of changing available and relevant information on laboratory Quality.  And we go through the process of external evaluation.  So in a very strong sense we try to adhere to the requirements of ISO9001:2008, with the singular exception that we are too small and too focused to impose upon ourselves a formal annual “internal audit” exercise.  


For those interested in learning more about the UBC Certificate Course in Laboratory Quality Management, please follow the link to: http://www.polqm.ca/pdf/Registration/POLQM%20Advert2013.pdf