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.

The Science of Qualitology

I like the ASQ’s Quality Management Journal because it publishes articles in a science and experimental structure that I understand and expect to see in a journal.  The article that I was looking at was analyzing factors associated with Quality in hospital settings. (seeR.E Carter, S.C. Lonial, and P.S. Raju.  2010.  Impact of Quality Management on Hospital Performance: An Empirical Investigation.  QMJ.  17(4): 8-24).

The study design was based on a survey sent to hospital executives in 175 organizations in mid-US (Kentucky, Ohio, Tennessee, Minnesota, and Mississippi)). The surveys were sent to Hospital CEOs who were in turn supposed to pass them on to senior folks like the VP administration, Quality manager, Support services manager, Director of nursing.  This was very ambitious.

The conclusions they came to were what I would expect; when it comes to quality size and stress matter.  The more uncertainty in the institution, the larger the institution, the less likely they were to have “measurable” evidence of Quality. 

The “measure” of Quality in this study looked at 5 markers for financial performance, 4 markers of market/service development and 4 markers of quality outcomes.  That, in my opinion was a set unlikely to give a clear picture of hospital quality.

And that brings me to my point. 
What are the objective measures that one can monitor as an indicator for success or failure for introduction of Quality activities in medical laboratories?
Not success in accreditation or proficiency testing scores. They are too readily manipulated  (see   M.A. Noble.  2007.  Does External Evaluation of Laboratories Improve Patient Safety?    Clinical Chemistry and Laboratory Medicine.  Clin Chem Lab Med.  45(6):753-756). 

Not numbers of reported incidents or OFI’s.  They are too open to flexible interpretation.  OFI reports, if anything are like unemployment rates.  A downward movement in rates may mean more people are being employed, or it may mean that fewer people are bothering to look.  And a rise may mean more people are unemployed, or it may mean more people are hopeful and are again more actively looking.  In the same way  a rise in the OFI’s rate may mean more problems are being identified and reported meaning poorer Quality, or it may mean more engagement leading to more reporting meaning better Quality.

How about client or staff satisfaction?  Maybe, but again, very manipulatable and too vague.
And in Canada, financial stability or instability are completely inappropriate since 99 percent (or more) of resources come from the government purse.

So we have a dilemma.  For good studies we need measurable and interpretable and  monitorable outcomes on both a micro- and macro-  basis. We do this on a micro- scale all the time (call that Quality Indicators).  But to move from interesting to convincing and compelling, we will need to define our macro- outcomes as well. 

For Quality to create a lasting imprint in medical laboratories, we are going to have to speak the language of laboratory personnel, pathologists and technologists.  We will need the language of science and experimentation. outcome and conclusion. 

Any and all ideas are most certainly welcome.
m

PS: Absence of strong interpretable measures makes grant funding difficult, maybe impossible.  I have learned this the hard way.