Organizational Quality and Competence (Part 1)

 

Organizational Quality and Competence (Part 1)

There is an international standard in my area of interest (Quality Assessment) that is undergoing its review and revision.  One “minor” revision proposed is the addition of the word “competence” into the title (requirements for the competence of proficiency testing providers).  This is NOT a minor revision. because it changes the use and intent of the standards document from defining what a provider is required to do as a provider, to providing a blueprint for the providers and the accreditation bodies on how the provider will demonstrate competence. 

Turns out, competent competency assessment standards are difficult to develop and use.  (More on this in Part 2)

There are many definitions that can define competence.   From its early roots, competence is linked to the notion of competition and sufficiency.  Common parlance would describes competence as the ability to do a task successfully and  efficiently.   The International Organization for Standardization goes further, defining competence as “ability to apply knowledge and skills to achieve intended results making the point there are some expected elements (knowledge and skills) that are relevant to do the job as intended, which fits with the Juran phraseology – “fit for purpose”. 

 Merriam-Webster goes further … having sufficient knowledge, judgement, skill, (or strength) for a particular duty.  By adding the element  “judgement” takes competence to yet another level.   Requiring judgement requires having sufficient grasp of the job expected, the person can consider situation and nuance and make decisions about when or how to perform the process or adjust as circumstances require. This is the true hallmark of modern thinking of competence. 

So how do people reach that level of ability? Hard to say, but not everyone in every organization reaches that point.  It comes in part from staff interest and understanding and part from management developing opportunities to delegate authorities for decision making.  This puts the onus on management to allow their staff to learn through continuing education and contributing to continual improvement. Developing staff competence means creating a work environment that supports learning and rewards success.

This definition puts a additional context on identify staff as competent.  Competent does is a derisive meaning adequate for the job.  Competence  goes beyond adequate.   It means that that management knows them to be knowledgeable, skilled, and understand their job well enough to show good judgement while making decisions and performing intended tasks in order to reach the expected results. 

 

So here is a question: If we have redefined competent to mean something like “the complete package”, how can we describe staff who are not there yet?

I found an interesting blog written by a Tom Graves, a self-described “Enterprise architect, business-anarchist, confusionist (?)” ( http://weblog.tetradian.com/2012/02/04/competence-noncompetence-incompetence/ ).  He defines 3 competence categories, which can form sort of a framework.

Competence: is where someone knows what they’re doing, and does it.
[These are staff members we call valued and competent].

Non-competence: is where someone doesn’t know what they’re doing (completely), and will either not do it, or will do it, but only after clearly make the point that they not exactly skilled, but will go ahead if it is understood they are learning to improve. 
[ Non-competent may be an acceptable category but is too negatively charged  as a character description.  A more useful term might be a valued staff member well along the path to being fully aware and able].

Incompetence: is where someone doesn’t know what they’re doing but will do it anyways, concealing their gaps, perhaps to both the organization and themselves, creating the potential for all sorts of risks, damages and liabilities.   
[I think that incompetence is one correct word for these staff workers.  Perhaps another more transactional term might be “former staff workers”].

So in this definition of Quality and Competence, to get a position, you need to show you have the appropriate knowledge and skills to perform at a satisfactory, capable level.  But to hold and grow the position you need the impetus and initiative and encouragement to develop the judgement and nuance that distinguishes excellence.  You can call this competent or proficient or skilled.

Yes?

 

PS1: There is another interesting synonym for competent, from the Latin (“proficere": to accomplish, make progress; have success) – proficiency.  A discussion for another time.

PS2: I have purposely left out describing an individual’s competence in terms of meeting a checklist of defined competencies.  There will be more on that topic in Part 2.

 

 

 

 

Trust me is not good enough

One of my passions over the last 35 years has been laboratory proficiency testing (PT aka External Quality Assessment or EQA).  

PT/EQA is a requirement for all laboratories that are accredited to CLIA requirements, mainly in the United States and ISO15189:2012 almost everywhere else.  This is because PT/EQA programs provide objective, measurable, and reportable information on the Quality, Competence and Performance of laboratories in all disciplines.  In this broader context PT/EQA addresses the need of laboratories including but cerrtainly not limited to water and food testing, ore sampling, cement composition and compression, and industrial dyes, and ship steel.  

That laboratory workers are required by regulation and standard is interesting.  I suspect they are the largest group of workers in the world of whom it is required to have regular quality assessment testing in order to demonstrate performance competence.  There are few other groups that are monitored in this way, such as airline pilots, police (gun practice), and I think, bus drivers.  It is interesting and I think significant that physicians, nurses, teachers, lawyers, judges, dentists, and car mechanics, and scientists have no such requirement.  Once they finish their final training examination, there are no more required objective measures unless they choose to take a new course, or do a refresher course.

ISO/IEC17043:2010 the Quality and competence standard for proficiency testing providers, it is interesting to me that there is the following: “The need for ongoing confidence in laboratory performance is not only essential for laboratories and their customers but also for other interested parties, such as regulators, laboratory accreditation bodies and other organizations that specify requirements for laboratories”.

So my point is that while PT/EQA may be performed by the laboratory, an essential reason that happens is so that their customers and interested parties can be confident they take Quality seriously.

A number of years ago during a laboratory conference I raised some questions about what laboratories do with our Annual Certificate of Participation from our CMPT proficiency testing (PT/EQA) program.  Without going into details, the collective opinion was that (a) the Certificates were important to the laboratories and (b) most laboratories (I was surprised about this!) posted their certificates, usually framed, usually in a common area within the laboratory confines, where technologists and pathologists and scientists could view the certificates.  A small number of laboratories posted the certificates in public areas, such as the Patient Waiting Room.  

While for the most part, these were results better than I expected, I also saw this as an example of opportunity lost, because most of the laboratories were missing the opportunity to promote their Quality monitoring to a critical audience.  While it is nice that laboratory staff can see the affirmation they need about their Quality focus, the public, in most facilities gets no exposure or awareness to the information.  

In the “olden days” laboratory competence and quality was self-assured on little information.  (Of course we are a quality laboratory. Our laboratory is run by the finest scientists.  They would never make a mistake.  TRUST me!, trust ME!).  Today we appreciate how empty and self-serving that was.   

In today’s reality “trust me” doesn’t cut it.  Put up or shut up.

Today, laboratory tests have become increasingly more sophisticated, and often critical decisions are made solely on the basis of test results.  Often there are no correlating physical signs to support or reject the test result, until it is too late.  (think antimicrobial resistance or tumor drug resistance).  

If the laboratory gets it wrong, there can be consequences that ripple through the patient, the physician, the community and the public.   

So Proficiency Testing Providers primary function is to DEMONSTRATE  or ASSURE the community and all interested parties that the laboratory can be trusted to be proficient and competent, not based on inappropriate trust, but on OBJECTIVE, MEASURABLE, REPORTABLE EVIDENCE.  

PT/EQA Providers should be much more active in advising / informing the public that they provide their services as a way to advise laboratories when their assays are not properly, as a way to protect the public.  I am not saying that PT/EQA providers can or should be public whistle-blowers or be in the business of pointing fingers at laboratories that are not fulfilling their professional duty, but the public does need to know that their confidence in the health care is supported by objective measurable evidence.

Laboratories are better off when they can say “of course we are a quality laboratory. Our laboratory is run by the finest scientists, all of whom are closely monitored for their performance and competency on a regular and repeated basis.  You can have confidence because we have confidence and we have the evidence to back that confidence up.”

And that brings be back to my story of several years ago, and let me suggest that laboratories these days could go a long way to better strengthen their trust and credibility, I understand that this is a very small part of the exercise, but instead of putting their Quality Assessment certificates where they can be seen only by laboratory staff, but rather where they can be seen by patients, physicians, and administration.

And PT/EQA providers need to make a much bigger issue of their role in protecting the integrity of the laboratory in specific and healthcare in general.  We need to remind ourselves up front that laboratories’ clients are our customers too.  Yes we are science guys, but we are also Public Guardians.

And perhaps the time is coming that physicians and nurses and lawyers and teachers and scientists need to step up to the plate of regular Quality Assessment for continual improvement.

It has to be better than TRUST me, Trust ME!!