The Meaning of Quality

The Meaning of Quality

At our Quality Management Conference for Medical Laboratories last month, one of our speakers made a throw-away comment, that the word “Quality” is so overused these days that he was no longer sure what people meant by the term.  What intrigued me was that a similar comment was made by another speaker as well, and indeed the concept became an on-going recurrent theme throughout the meeting.

I understand where they are coming from, and I feel a certain empathy, but in all due respect, I think that the sentiment is wrong.  Quality does have meaning.

On the other hand, one of our speakers reached back into the past and made a relevant comment:  “Quality is not a word, it is a journey” [ note: a variant from Ralph Waldo Emerson (?) dated around 1854 – life is a journey not a destination.  The Quality variant has been used since the early 1990s] ,  As much as this sounds like an old truism, I think it is still valid and still an appropriate attitude and approach towards understanding the discipline in which we work.

Let me pull a few things together here.  

With regret we still see all too many laboratories with a track record of repeat  accreditation as far back as the early 1970s.  If you applied the Crosby definition of Quality being defined as meeting requirements, then you would call repeated accreditation meaning Quality.  But you could be wrong.  

Many repeat accreditations were a joke.  Laboratories doing nothing for 4 years and 9 months manifesting no evidence of improvement, and then spending 3 months to tidy up manuals and fill in QC charts.  An accreditation visit, lasting maybe 4 hours done haphazardly, which is then followed by an approval process, perhaps with some recommendations for improvement which don’t occur.  The laboratory then takes a post accreditation breather hiatus of about 4 years and 9 months, and then gets started again.  There is no evidence of a journey here.  It is Quality in name only.  That theme gets carried out in so many ways.  Quality Manuals are beautifully created, only to be locked up in an office more as a trophy on display than as a useful and usable document.  Quality in word only; no journey here. 

We see laboratories where management hands off the Quality portfolio to the senior staff (or worse the junior staff) expecting receive a report of quality indicators for signature once a month, but never actually doing anything with the information; and calling that Quality.

We see laboratories where management receives continuing education funds from institutional resources, but 90 percent or more is spent on management level travel, and 10 percent goes to technologist training.   Again, static words.

We see laboratories that bring in consultants to review and propose grandiose plans for leaning and implementing quality software or purchasing new bells and whistles, but little happens to justify the expenditure, with little consequence.  

We see evidence of static quality all the time; it is no wonder folks fatigue of hearing the word.  

Quality is about progress, about continual improvement, about setting goals for change and making the commitment to follow through.  Quality is about giving voice to both compliments  and critiques to discover what you are doing well and more importantly discovering what you can do better.  

So I agree there is lots of evidence that if action without meaning continues to be the norm, then the term Quality has lost its meaning.  So if you are fatigued by the “journey not a destination” homily, let me offer another more functional definition. 

Quality is the commitment to continuous positive change.  

PS:  If you are interested in viewing the presentations from our conference follow:  http://polqm.ca/conference_2013/conference_2013/conference_home.htm

Go to the LEFT margin and click on SCHEDULE

Each presentation is linked to the author’s title.

Quality Management Education

In 1994 I was invited to become the Chair of the Canadian Advisory Committee to the ISO Technical Committee 212 and to become a member of working group that was to design a new quality standard for medical laboratories.  That document became known as ISO 15189:2003 – Medical laboratories - particular requirements for quality and competency.

One of the requirements of 15189 was that since quality initiatives would likely not be effectively incorporated into medical laboratories if we continued with quality being an “off the side of the desk” task of the senior technologist, medical laboratories should identify a person who could commit more time and effort to the process.  That position was called a Quality Manager.  It was a good idea.

In Canada this was going to be a bit of a problem because more laboratories or schools of technology had no idea about what a quality manager was going to do, and what sort of information they would require.  So at the University of British Columbia we decided to take on the task of creating a course.  A few decisions were made.  The program should be available for people who worked in medical laboratories for at least 5 years, regardless of their background.  A prior BSc degree would not a requirement.   The course should be available as an on-line program so that people could take it without having to quit working or travel to Vancouver.  The course should be interactive so that the people taking the course were part of a discussion group rather than being at home alone with a computer.  The course should be useful for working with 15189 but should be focussed solely on 15189.  Quality should be addressed as a broader subject. 

So once we went through the university process, a faculty was developed and the course created, and was first offered for enrolment in 2004.  The course structure is a 20 week on-line course with opportunity for interactive discussion, either by chat or by asynchronous interaction.  The course provides a library of all the required text books, including a variety of recommended and required readings.  The course is objectively monitored and assessed and a certificate is provided for successful participants. 

The course has continued on ever since, with continual review and improvement.  Course reviews are open and transparent and available on-line.

In January 2012 we will be offering the course for its ninth year.  

The on-line start date is Wednesday January 11, 2012.   

The course continues to be driven by the same principles.  This year in addition to addressing ISO15189, it also looks at ISO 9001:2008 and ISO9004:2009.  We look at Quality Partners and the roles that they play.  We also look at Costs of Quality (and poor Quality).  We address Root Cause Analysis, FMEA, Quality Indicators, Implementing Quality, and a variety of other topics.  Most participants find that the course requires a certain commitment of some 6-12 hours a week for reading and discussion.

What started as a course primarily for British Columbian laboratorians has become popular across Canada, and internationally with participants from China, Africa, South America, Central America, Saudi Arabia, and the United States.  It has been taken by technologists, laboratory assistants, pathologists and residents. 

We will start to accept enrolments in September 2011.

For people interested, please visit www.POLQM.ca or contact our coordinator at ubcpolqm@gmail.com                   

People who have take  the course are welcome to make comments.

Embracing Quality

I was putting in time sitting on the airplane, reading their airline magazine and came across an interesting note ascribed to an hotelier Jaume Tapies.  “People only embrace what they help to create.  It’s important to share projects with those who are invested in them. “   This caught my eye for a number of reasons in part because I was just returning from a successful quality assessment project and second because I know that successful hoteliers understand the importance of customer satisfaction as part of the quality process.

The notion of people embracing what they create is a really important concept as we build laboratory quality systems.  Many laboratories create quality teams who create documents and quality system trees either on-paper or on-line that are consistent with one organization or another, without ever engaging the people who are going to be expected to use the system.  Then they spend their time “communicating the system” by talking at the staff or worse emailing the staff about how user friendly the system is.  “This is how to read our new SOP.  I know it seems long and looks complicated, but it has everything you will ever need.  Trust me.  Trust me.”

This is rarely a path to embracing and engaging in the quality system.

How often do you hear comments in your organization like “Oh that’s quality.  Talk to Pat.  She’s the quality person”, or “Talk to Shirley.  I know where the Quality stuff is, but I never actually use it”.  Even worse, “this stuff is a joke.  I do it because I have to, but what a waste .  I could be doing real things, important things”.

Laboratory quality teams need to keep a few concepts in mind.  Quality is based on a very few guiding principles.  How they get manifested is up to the organization.  The quality system does not exist to meet the expectations of qualitologists or ISO or accreditation bodies; it exists to help the staff prevent errors from occurring and when they do, to catch them early, and fix them and learn from them and move on.  Quality systems that capture the guiding principles and at the same time fit the needs of the staff are good systems; and more to the point, quality systems that don’t fit the needs of the people who are supposed to use it are bad systems. 

There is another concept to keep in mind.  Embracing quality is different than being engaged in quality.  Being engaged is doing the steps you have to do.  Embracing is understanding the concepts behind doing the steps you have to do.  For lots of situations if you can get folks engaged that is pretty good.  There are all sorts of ways to get staff engaged.  You can give them pizza prizes, you can give them little gold stars.  You can remind them about filling in the forms when they forget.

Getting folks engaged can be a lot of work, but will get things done. 
Getting folks engaged is a success.

But getting the message shared and having folks understand why it’s important and how it makes their lives easier and improves the outcome of their effort is always better.  Getting folks to embrace quality is an accomplishment.

So I am interested in receiving comments from folks who have ideas about the things that we can do to get laboratory staff to embrace quality.  Twitter length (140 characters) is good but not essential.