Resident Quality Seminars as Adult Education

A few weeks ago I wrote (See “Communicating Quality and the Principles of Adult Education - January 30th 2011) that adults learn what they want, and  how they want and accept the knowledge if it makes sense and is consistent with what we already know.  The educator needed to be seen to be organized and pragmatic and relevant and interesting.  If adults are motivated they learn better.  

So with this in mind, can I make any objective comments about my own teaching capabilities?

I got back the results from my Resident Seminar Series.  
 
Background 
To summarize, I put on a seminar series for anatomic and general pathology residents.  The series begins the week after New Years and my sessions start at 08:00 AM.  A draw to the academic half day program is that they get a free breakfast when they attend.  
Before I start the seminar series  I create an anonymous on-line survey that includes a series of 10 questions on quality facts, along with some demographic information.  I then present 7 hours of seminars over 4 sessions and give 1 hour to a guest presenter, and after that asked the group to respond to a second on-line survey which asked the same questions as before and added some additional comments on the series based on a 7 point Likert ranked scale with a maximum value of 6.0

Attendance
The pre-seminar survey had 25 responders.  
On average there were 29-31 attenders to the seminar series.  Nearly everyone attended all 4 sessions.
The post-seminar survey had 14 responders.

Findings
So my first point.  Adult learners do what they want and respond to surveys if there is something on the table.  After the series we were able to get 14 responders (despite repeated requests).  Not getting a better response rate in the post-survey was annoying, but it is what is is.  

My second point:  There was improvement in the responses to all the fact based questions.  There was significant improvement (yates corrected p<0.05) in 2 questions.

My third point:  The responders found the information relevant to their career (5.5/6.0)  informative (5.36/6.0), relevant to their residency (5.29/6/0), and relevant to preparation for examinations (5.07/6.0)  The weakest response was when the group found the information interesting (5.0/6.0).  

Interpretation.  
Overall I can this a success.  Not an overwhelming success, but a success none the less.  

What was encouraging was that after the series, one resident  approached the hospital quality manager to get engaged in a project, and one resident approached me on a similar topic.

The increase in knowledge performance was ojectively positive and in part significantly so.  And there is a powerful opinion and recognition that knowing something about quality is important in a laboratory career.

Discussion and Conclusion
The objective measures point to the seminar series as a measurable success with opportunities for improvement.

Teaching my on;line course is the ideal adult education situation.  The participants seek us out because they want the information.  There is money on the table.  They feel free to participate actively.
With residents, they are present because they feel required to be there, even if they don’t care.  At worst they still get a free breakfast.  There is no money on the table.  They feel free to drop out if they are not being entertained.   

Note to myself:  
Look forward to doing the seminar series again, maybe next year, more likely in 2 years.  
Make some changes to beef up interest.  
And importantly don’t take the weak response rate too personally.  If they really thought the series stunk they probably would have taken full advantage to let me know.  

PS:
The information will be presented more completely and formally during the POLQM Quality Weekend Workshop in June.  There will be an education breakout session.

Measuring ISO Objectives

In the world of standards development there are folks that participate at every level, from institutional, to regional, to provincial to national to international.  At each level the documents developed become more generalizable, more applicable in a greater cross-section of environments.  That doesn’t necessarily make them better, but it does create a closer connection to international truth.  

At the top of the pyramid is the International Organization for Standardization.  
The ISO has been the crown of the standards development structure since 1946 (or 1926, depending on when you start counting).  It has as one of its mandates to create voluntary consensus standards that once applied assist the World Trade Organization promote international trade in the absence of non-tariff barriers.   I have been a volunteer Canadian representative on ISO technical committees since 1995 and am currently a member of ISO TC 212 (the committee responsible for 15189) and ISO TC 176 (the committee responsible for 9001).  Over the years I have seen both the positives and challenges of developing high level documents.  

Which brings me to the recent publication of the official ISO magazine known as ISO Focus+. This is a great magazine that I suspect most of you have never seen or heard of, much less read.  It is available at www.ISO.org, or is available through your national standards body.  In Canada that is the Standards Council of Canada (SCC); in the US it is the American National Standards Institute (ANSI).  The January 2011 issue is all about the ISO Strategic Plan for 2011-2015.  Within it are the defined strategic objectives that ISO has set for itself over the next 4 years.  

If you are interested in Quality, you need to read this magazine.  

ISO has defined the following objectives.

1: ISO deliverables meet customer needs
2: Promote innovation and provide solutions to address global challenges
3: Enhance capacity and participation of developing countries in international standardization.
4: Reach out to and engage with stakeholders.
5: Foster partnerships that increase the value of international standards
6: Improve ISO processes
7: Improve understanding of the general public, stakeholders and customers of value of voluntary international standards.

But for those of us that have set objectives for our own organizations in the past, we recognize that objectives need to meet a number of tests:
A: Are they appropriate? Are they consistent with the organization’s Quality Policy?
B: Are they measurable?  Can you by the end of the time period objectively document if you met the objective?
C: Are they achievable?  Does the organization have the resources and capabilities required to meet the objectives in the time frame that has been defined?

So how, in my opinion, do the new objectives measure up, and what will ISO need to do to meet the objectives successfully.

Objective	Quality Policy	Measurable	Achievable	CHANGE MANAGEMENT
Meet customer needs	YES	YES	YES	Process improvement
Promote innovation	YES	YES	YES	Process improvement
Developing Countries	YES	YES	NO	Communication
Engage stakeholders	YES	YES	YES	Communication
Foster partnerships	YES	YES	YES	Communication
Improve processes	YES	YES	YES	Process Improvement
Improve understanding	YES	YES	YES	Communication

Most of the work that ISO needs to do focuses on improved communication.  ISO certainly needs to do that.  The organization has become elite and presumes far  too often that the world will come banging on their door  Congratulations on recognizing that is not how it works any more.  

The other changes will come from acknowledging tat ISO has some internal work to do to tidy up its own processes.  Where there are rules, ISO needs to make sure that (A) they make sense, (B) the communicate them and (C ) they are applied consistently.

About the “NO”.  ISO can ask developing countries to be involved, but small countries don’t have the resources to attend and participate meetings. Fixing that is by-and-large outside the power of ISO.

So congratulations to the ISO.  This is a big step forward.

We will watch to see if this is "just words" or a "call to action".

m

Communicating Quality and the Principles of Adult Education

In recent while, I have been engaged in the active promotion of  medical laboratory quality in a variety of forums, including writing this web-log, providing an on-line course, hosting single-site lunch time education,  hosting the resident seminar series, and organizing and participating in workshops and conferences.  All of them have provided me with the opportunity to consolidate my own philosophy towards Quality.  

There is a lot of differences between all these activities; some have been held in Canada and others are international, some are one-off events while others short-term multiple events, and others yet are long multiple events, some of them are at no-charge to the participants while others are at substantial cost. Some of the participants want to be participating while others they are there because they feel compelled for one reason or another.  It would be easy to say that the only thing they have in common is a common topic, but there is something of far greater commonality; all the participants are adults.

Teaching adults is a special event because adults learn in their own special way.  There is tons written on adult learning.   For a quick summary you can visit Principles of Adult Learning at the University of Hawaii site.  

There are lots of reasons that people attend courses.  For learning, the most successful reasons are when they believe there is something in it for them; it is a topic of interest or there is an opportunity for career advancement.  Sometimes it is less about knowledge, and more about the social aspects; is a way to meet and connect with others, or is better than just being bored.  These folks may not be focused on learning, but they might connect.  Sometimes folks attend solely because they have to; it is a requirement and attendance is being taken.  This never turns out well.

Adults are autonomous and self-directed, and learn on top of their accumulated knowledge and life experiences, which means we learn what we want and how we want and accept the knowledge if it makes sense and is consistent with what we already know.  And we learn if we see the purpose to the information and especially it is meets our own goals.  And we are practical and pragmatic learners; if the information is not organized and timely then we turn-off. 

Adults tend to learn best if motivated, especially if we can link the information to what we do as a matter of competence or promotion, or job enrichment.  (Some say we learn better if there is money on the line.)  

For the educator, this means that the successful ones make the information relevant to what people do, is consistent with what they already know and link the knowledge to competence and enrichment.  Keep the information organized and timely and interesting.  For me, I have been involved as an adult educator for over 30 years.  When I think back to what I was like when I started, I can say with confidence that I am a lot better today than I was back then.  And one of these days I may actually get it right.  

One of the most successful educators I know has a formula.  He has 3 points to make (4 points a maximum).  He makes his points and reinforces them with stories and humor.  When he has delivered his points and told his stories, he stops.  I’m pretty good at the selecting 3-4 points and the telling stories.  I am pretty weak at the humor, and tend talk until I run out of time, rather that knowing when to stop.

Memo to self:  with widely divergent groups, some folks are there because they want to be there; others are not.  Remember the motivation; point of why knowing about Quality is an important   component of competency and enrichment, and can have an impact on promotion.  Be organized and know when to stop talking.  After than, the rest is largely out of your control, so don't worry about it.

m

PS: I am accumulating the post seminar series data now.  Will share the results soon.

PPS:  Big changes at www.POLQMWeekendWorkshop.ca  Lots of NEW information.

Communicating Quality

About 15 years ago I decided that if CMPT was going to progress we had to develop an electronic presence, so with the assistance of my son, we created www.CMPT.ca.  I was so pleased that I had made this huge jump into the future, or at least the very current present.   I had a web site.  It took about a month for me to realize that a website had to be fed new material on a regular basis, and gradually it started to take over as a major preoccupation.  Gradually, what started as a hobby became the full time work of a number of people.  The problem, of course, was that we had never budgeted for the expenses.  The message to self was that you need to make sure that your organization gets benefit from electronic presence because it is going to become time (and money) expensive.  

Well the world has changed since the early times.  Web presence has become common.  Today, folks can spend their whole work day and their social life in the web world.  Communication outreach is world wide and immediate.  But the old messages continue to be true.  To be effective, the electronic world consumes TEEM (time, effort, energy and money).

I state the obvious because progress in Quality in every organization, regardless of size needs communication.  In an earlier time, Deming, Crosby, Juran were committed to quality communication by way of books and lectures.  They were prolific communicators.  If they were working today, they would have been within the first wave to embrace the Internet because it would have expanded their outreach.  
Evidence this by the myriad of sites that promote and communicate quality; www.darkdaily.com. www.iso.org, www.csa.ca, www.qualitydigest.com, www.westgard.com, www.asq.org, and medlab-eqas.blogspot.com, just to name just the ones that I get to follow on some sort of regular basis.

But what is so interesting to me is that communicating quality has evolved so far from the organizational website.  Outside communication is now about the website and the vehicles that transport to the website, like the web-log (I have taken on an aversion to the “b” word) and social media like Twitter and Facebook, all of which have become destination sites with their own messages.  
Outside communication has on-line courses and on-line conferences, extending beyond information and on to knowledge.  And  Inside communication is about intranets, and organizational email blast outs.

This is not to say that the concept of holding a meeting so that people can meet is now obsolete.  Meeting in person has powerful effects that Skype or GotoMeeting or videoconferencing will never duplicate.  But many organizations are shying away because of obvious costs.

And that brings me to my message to self:

1: The laboratory cannot succeed without Quality and Quality cannot succeed without Communication.
 
2: Communication is critical valuable and at the same time can be hugely TEEM consumptive.
 
3: For Communication to be implemented it requires the same level of rigor of Quality implementation and management as every other laboratory essential.  It has to be planned, and be implemented with forethought.  The implementation requires study and opportunities for improvement acted upon.  Over and over.

4:Quality requires Communication and Communication requires Quality.

A brilliant Quality seminar.

This is a notice that will  be considerable interest to the microbiology community across Canada and in the US especially the North East, but should have special mega appeal to Medical Laboratory Qualitologists in the same regions. Maybe even bigger.

The clinical microbiology crowd is already aware of the annual Canadian Association for Clinical Microbiology and Infectious Diseases (CACMID) conjoint conference.  This meeting has been an annual event in one form or another since (I think) 1965.  It is the premier Canadian microbiology conference.  The Canadian Association for Medical Microbiologists and the Canadian Infectious Diseases Society (now collectively named AMMI-Canada) holds its meeting conjointly.
This year this conjoint meeting will be in Montreal from April 6-9, 2011 (visit http://www.ammi.ca/annual_conference/index.php)

Every year for the last 16 years we have hosted a Quality Seminar in conjunction with CACMID, usually on the first day (or pre-conference day).  This year it will be a 4-hour seminar on  April 6, 2011 starting at 1:00 PM.  The theme of the conference will be Communicating Quality.

I have to tell you that as good as all the seminars in this series  have been, I am especially proud of this one.

The meeting will have 4 presentations:
Michael Noble - Developing a comprehensive communication strategy for Quality.
Julie Coffey from Quality Management Program - Laboratory Services Ontario will present on on-line education in Quality.
Robert Michel the Editor of the Dark Report and the creator of the Dark Daily will present on developing a comprehensive Quality Communication Information Strategy
Sara Garcha of LifeLabs BC will present on Communications as an integral part of Quality Culture.

This seminar is a must see for anyone charged with developing and promoting a quality system in their own laboratory, or as is happening more and more, a network of laboratory sites.

The session is cheap ($80 Canadian), indeed under valued.
If you are involved in clinical microbiology you probably will come for the pre-conference seminar and stay for the whole meeting.
If you are interested in Quality, but maybe not from a microbiology perspective, I strongly recommend that you consider this meeting, even if it is only half a day.
At best you participate in a brilliant education seminar with knowledgeable excellent speaker-presenters  that will give you ideas that will change your quality practice for years to come.
At worst you attend an excellent meeting and get to have dinner in Montreal. 

It is difficult to see the downside.

You can register for the quality seminar on the CACMID website
https://notes.htgsports.com/HTGM.nsf/Reg?OpenForm&hoteleventid=&ParentUNID=6734DD638B69D28C852577A8004DA067&lang=EN

m

Resolutions 2011

I used to think that New Year’s resolutions were pretty much a waste of time. Most people that I know still do. I vow to be good; I resolve to quit eating; I resolve to quit smoking:   I resolve to get more exercise.  I resolve to stop being sarcastic. Yeah, yeah, and ...yeah.

But over the 5 or 6 years, the concept of resolutions started to make a little more sense. New Year's Resolutions are just a variation on the theme of setting Objectives and Goal.
I mentioned before that CMPT`s quality system has been certified to ISO9001: (2000 - 2008) since 2002. Every year in October we set quality and programmatic goals and objectives and then monitor to ensure that we meet our goals.  When we started we did this so that we would continue to get certified, but after a while we saw the value in the exercise, and did it for us... to keep CMPT on path and on track.  And it seems to actually be effective.

So it started to make sense that if we can do this positively and painlessly for a proficiency testing program, we should be able to do the same thing for the Program Office for Laboratory Quality Management, and for my teaching commitments, and also for the medical laboratory at which I worked as a medical director for Quality. And again, the experience reinforced itself by actually being productive. 

Go figure.  Those guys like Deming and Crosby actually knew what they were talking about.

And now that MMLQR goes though its first New Year,  it is time to start setting some objectives for it too.  Actually MMLQR has only been running for 6 months, but this is sort of like setting or re-setting an organization's fiscal or operational calendar.

Just to make sure we are on the same page, I use the term Objective to mean a large scale outcome that may take a number of steps to reach, and I use the term Goal to identify the individual steps.  To be credible the objectives should be achievable and the goals should be measurable.

So here are my goals and objectives for MMLQR for calendar year 2011

Objective 1:

MMLQR will be recognized as an active and credible and readable website to promote diversity of opinion and discussion for the full range of issues that surround quality management of medical laboratories.


Goal 1
To meet the measure of "recognized" I will promote MMLQR to support current readership and to encourage a broader audience.

Goal 2
To meet the measure of ``active``, I will generate at least one new entry each week.

Goal 3
To meet the measure of ``credible`` I will actively seek review and comment by others with long term interest in medical laboratory Qualitology.  This might be in the form of another shot at an electronic survey, or in the form of an external-internal audit.

Goal 4
To meet the measure of ``readable`` I will reduce the number of spelling and editing errors per entry.  (This one will be tough because I am terrible at proof-reading).

Goal 5
To meet the measure of ``diversity of opinion and discussion" I will invite and publish comments and commentary of differing opinion (as long as words like "jerk" and "pinhead" are not included) . 

Goal 6
To meet the measure of "full range of issues that surround quality management"  I will expand the topics covered including more commentary on politics and quality partners, as I see it.

So that is a good start with an achievable objective and a series of measurable goals.  MMLQR is a young start-up which has met reached a certain level of fragile stability (similar to how they describe the Canadian economy).  Going to the next step will take the discipline of setting some objectives and goals and PDSA.  We will see how I do by the end on the year.

See you in 2011.

m