Healthcare Customer Satisfaction: More Talk AND More Action

Healthcare Customer Satisfaction: More Talk AND More Action

Customer satisfaction (Voice of the customer) is a recurrent theme at this blog.  Usually I focus on developing a better satisfaction survey.  Sometimes I focus on my personal experiences with the apparent absence of interest by healthcare institutions who should know better.

Recently I have been busy speaking on the topic in a variety of settings, both national and international and I realized what probably is intuitively obvious to most of you. 

1. Very large healthcare organizations often have a program of monitoring customer opinion, but it is common this is an intellectual exercise that does not really result in changes.
2. The most common strategy for gathering customer opinion in most of these large healthcare organizations is that there is a counter somewhere with a neat pile of  four-by-six cards with “tell us what you think” in bold print.  Patients are invited to fill this in and put it in a box with a slot. 
3. Most community based healthcare organizations say that monitoring opinions is something on their agenda, but at the moment it is not at the top of the pile; but we're going to get to it soon.
4. Most smaller healthcare organizations say that monitoring opinions is not necessary because the place serves more as a community or family centre where everybody knows everybody else.  “We hear everything we need just by being here.
5. Rare is the training centre that trains any healthcare professionals about what customer satisfaction means.  Rare is the trainee (or trained professional) that gets beyond “our customers are our patients” or “we don’t have customers.  We don’t make widgets; we treat patients.” 
   

I guess that was OK back in the 1950’s but none of that works today, at least if you are interested in improving healthcare, not just making a living from it.  

(Parenthetically I have previously commented that the greatest killer of quality in healthcare is having a constant flow of new patients, with no kudos or benefits for doing well, and no real consequences for doing poorly.  I still think that is true).

So after going through this “revelation” I decided that if I wasn’t trying to implement something better, then I was a part of the problem.  

So we are going to take a two prong approach.

• We are putting on a conference/workshop on the subject and inviting students, residents, educator to participate.

• We are introducing a module in our Certificate Course for Laboratory Quality Management that will introduce Customer Satisfaction / VoC as a key discussion point.

More on the workshop.

I have found a set of very impressive speakers who can talk with authority on the subject of monitoring healthcare customers, mainly from the perspective of the medical laboratory, but also from the broader perspective.  We have a speaker from ASQ speaking to the topic “Customer Satisfaction is THE Quality Imperative”.   We have a speaker talking to the topic “Customer satisfaction; what we have learned, and what are our opportunities for improvement”. 

This will be a great introduction and give a good foundation for discussion.

The conference will be in Vancouver BC on October 5, 2016 on the UBC campus.   Registration is very low, to no introduce a barrier to attendance.

For more information visit: 

 http://conference2016.polqm.ca/

At some point you have to decide: 
Part of the Problem or Part of the Solution

The Clash Between Laboratory Quality and Personal Study?

It seems to me to be inherently obvious that Quality is a collective group activity.  

 Quality is measured by response to customer (the public) needs.  Quality is empowered by the collective Culture of Quality, meaning the power of the total group drives Quality benefits of continual improvement and continuing education.  Quality is the product of peer groups working together to find opportunities for innovation, improvement and success.  Quality is driven by the sense of openness associated with acknowledging errors and other opportunities for improvement (OFIs). Quality is predicated on standards and guidelines which are  the product of consensus and compromise.  

I think as a general experience, the least successful approach towards making positive change for improvement is to have someone sit alone in their office and draw charts and diagrams and write strategies without the input of others.  

So I think that the people who would be attracted to working in the Quality arena would be folks that enjoy the group collective experience.  They would be the folks that enjoy working with others; discuss, maybe debate, but to come to a consensus opinion and a collective plan for going forward.  Quality people, you would think, should be people persons.

I raise this because we have put on a university based certificate course in laboratory quality management every year since 2002.  I have mentioned it before.  It has evolved into a 21-week on-line course in what we call a VCOLE format (virtual classroom on-line education) where the central essence of the course is that most of the course is in the form of small-group discussion and most of the assignments are in the form of small-group team (collective) efforts.   

We do it this way because the best way for adults to learn is to work in groups and bounce ideas back and forth.  Increasingly there is evidence that the worst way to learn is to sit in front of a computer screen by yourself and study by yourself and do your assignments by yourself.  

Apparently the duration of time that information retained (persistence)  in the discussion based model is much greater than the individual learning model.  For reference see “Effects of Small-Group Learning on Undergraduates in Science, Mathematics, Engineering, and Technology: A Meta-Analysis  (2013)[https://www.math.upenn.edu/~pemantle/active-papers/springer-stanne-donovan.pdf ]

So imagine my disappointment when in our collective survey of opinions on the course (Yes, we do a lot of customer satisfaction surveying in this Quality Management course) I receive the following comment:

“The group work was challenging, and some members definitely did not do their fair share. … I certainly did not appreciate putting so much effort on an assignment, and then have someone parachute in, and ride on the coat tails, contributing very little, but still getting the same mark as everyone else.”

I have to say that that is not a comment would likely come from a consensus oriented, collective driven, people person.   It sounds more that an academic competitive person for whom sharing and participation is far less important than getting an “A”.  If I wanted to be pejorative I would refer to it as being very high-school. 

But that would be very rude of me, and probably inappropriate (Donald Trumpish?).  

Our opinion surveys are intentionally done in a manner that does not allow me to know or find out who wrote the comment might be.  So I don’t know how well or unwell this person did, other than to say that most people who take the course do very well.  As to whether this person stood first, or in the first 10 percent, or the middle or the last 10 percent, I have no idea.

But to that person let me just say the following…  I

When you find work in the Quality arena, you will find yourself working in small groups all the time.  It is the nature of Quality.  

 Some people will get really engaged and do a ton of work. (That might be you.) Others will be less interested and do less.  And some will pop in-and-out and not contribute much at all.  That is the nature of small groups.  

You had a great experience, you learned some new information, and new skills and probably did well.  Why does it matter how others scored or not scored (actually we keep a close eye on how much individual participants actually participate and their overall participation score reflects their degree of activity)

If you are uncomfortable with small group dynamics, you probably should stay far away from the quality arena.  You will be miserable every day on every project.  If you can’t cope with small group committee dynamics in a simple learning environment, it sure won’t work for you in the real world.  

Too bad.

Note:  The preceding may be interpreted by some as a betrayal of confidentiality because it contains participant comments from our course.  Please note that all the comments are submitted anonymously and cannot be traced to any individual or IP address. 

PS:  If you are interested in university based on-line education for medical laboratory quality management that is open to Canadian AND international students, please go to www.polqm.ca  Our next course starts in January 2017. 

Innovation and the Modern Medical Laboratory 2016

A number of years ago I was invited to give a presentation on Quality practices for the research laboratory.  I recommended at good practices would include (1) adherence to established standards (2) Calibrate your equipment regularly (2) strict adherence to quality control (3) ensure that graduate students are properly trained and competency assessed before performing assays (4) where feasible work with a partner laboratory or participate in existing applicable proficiency testing programs to ensure that your procedures are working properly and (5) on a regular basis arrange for some form of external assessment.  

A senior person at the presentation said that he was very successful in funding awards, and never did any of those steps.  

Is it any wonder that only about 10-30 percent of published research is reproducible (see: www.jove.com August 2013).

I raise this story because it relates to a recent threat on LinkedIn by the ASQ “What Do you think? Is Quality shifting to be the Driver of Innovation? .  I have previously commented that Quality is not so much the driver of Innovation, but may be making Innovation better.

Medical laboratories are largely populated by folks who are creative by nature, and always ready to try out something new.  Sometimes it resembles innovation by distraction by the shiny bauble.  But most of the time it is about a self-driven desire to tweak existing processes, as in “if I do “this”, I bet I can make this assay easier, or faster, or better.  

 

The reality is that usually, the assay is not improved, and sometimes it is made worse.  At the very least what happens all too often is that even critical basics of accountable change do NOT occur.  There is little or no verification that the changes result in consistent values, or validation that changes don’t have unsuspected impacts due to age, gender, medications, or geography.  A few studies get done, some basic statistics are generated, and off we go.  We have another new Laboratory Developed Test (LDT) that gets presented as an abstract at a meeting, or gets published in a journal, and everyone is happy, except maybe the clinician who gets a wrong test interpretation, or the patient that gets put on a wrong treatment track.  

 

Stories come to mind.  The first is the tragic story of misinterpreted test results for her2 (breast tumor responsiveness to the drug Herceptin) that resulted in patient mistreatment and death and led to the hugely expensive and public Cameron Commission in Newfoundland.  

 

Over recent years, medical laboratories have been galloping forward creating new tests to find new information, largely based on new molecular (i.e. DNA based) assays in the disciplines of genetics, and detection of microbial pathogens of all sorts.  

 

New laboratory ideas are being generated on a daily basis and new procedures are being created almost as quickly, most commonly using DNA strands that are created in-house.  Laboratories often do a side-by-side comparison of the information generated by the “standard” test, and if the new assay is pretty much in line with the standard assay, then the transition is made.  And if there was not previous assay, but the test worked for other targets, and it seems to work well here, then that is good enough evidence to go forward. The result of this is more tests, more results, new knowledge, and better and faster patient information. And some of the information is very good and very helpful. 

The problem of course is that sometimes results don’t quite go as planned. 

 

In our Quality course we talk about Quality Partners helping laboratories advance their Quality improvement.  But we point out that the impact of the partners on laboratory performance pales in comparison to the power of an unhappy public who gets fatigued with new ideas bad outcomes and demands something with a lot more rigor.  Today it is the US Food and Drug Administration (FDA) that has made it really clear that the day of free-reign LDTs is over, at least in the US.  The sheriff is going to be laying down some new rules.  If laboratories are not going to discipline themselves, the gov’ment is going to do it for them. 

Needless to say lots of laboratories are unhappy.  Definitions are being made that may or may not work well.  Restrictions are being imposed, and delays are inevitable. 

Gee whiz.  What did they think was going to happen?  When you upset the public enough, you have little control over what happens next.  

But just to be clear, medical laboratories are not the only organizations that have fallen into the rush to innovation trap.  Think Theranos. 

Without going too far into the story (you can read it everywhere and anywhere) this was a new-tech company that figured they could revolutionize all blood sample testing; less blood, easy collection, faster results, simpler testing, better than the best sliced bread.  Going to revolutionize and take over the laboratory industry.

If only it had worked, which it turns out it did not.  And now there are enough bad outcomes to bring in the gov’ment and the lawyers.  It is going to be a very ugly summer for Theranos.

 

There are tons of opportunity and need for research and improvement and innovation in the medical laboratory arena. But there are some basics (PDSA and basic quality management come to mind) that would increase the odds for success.  

There is always a need for new ideas and improvement, and some basic application of Quality Management would go a long way to move the needle in the right direction.