Quality and Excellence

Still enjoying summer but with a lot of projects and proposals on the go.  Hopefully they will all be ready by September.  Will talk more about them later. 

But today I received another email from the American Society of Quality (ASQ) with concern that the US government has put the congressional financial support of the Baldrige Performance Excellence Program on the chopping block.  The ASQ is asking its members (presumably just the American members) to write letters of support demanding the cuts can be prevented.

I understand that every organization needs financial resources to exist, and that the Baldrige Program is a P3 program (Public Private Partnership) which implies public support, but I certainly hope that along with this rally-the-troops email solicitation program, there is also a Plan B abrewing. 

In my opinion smart, forward-looking organizations make the decision that their operation will be enhanced by a Quality program and implementation is based on internal decisions.  Being seen as a best-in-class organization creates huge goodwill and creates a significant competitive advantage.  Given the choice between mandated quality and internal (volunteer) quality, the latter has a much greater chance of impact.  There clearly is a role for regulated Quality through mandated accreditation but Quality-by-force is a constant battle.   

When an organization sees benefit in Quality and implements because it wants to, the level of enthusiasm is higher and the level of activity is greater.  That is why I strongly see advantage in the US Baldrige or the Canadian National Quality Award programs.  Whether the program is funded or not, I suspect there always will be US organizations that will be prepared to implement some version of improved Quality and Excellence on a volunteer basis. 

But there are a number of key issues of which folks should be aware.  The Malcolm Baldrige program has been in place near 25 years as a public-private partnership.  The major private partner is the Malcolm Baldrige Foundation (MBF).  After 25 years if a foundation can not survive without government handouts then I would argue either the foundation is inept or the idea is not one worth supporting.  Second, the amount of money that is going to be withdrawn after 25 years is about nine million dollars ($9M), which again I would argue for a foundation the size and maturity of the MBF should be small potatoes, especially with all its very high 
 profile and the additional support it gets from professional organizations, including the ASQ.  

These days, if they still really need the $9M, there are tons of ways to raise that kind of money.  Remember that the Baldrige Foundation is supposed to be about organizational performance excellence through innovation and improvement. 

They could have a lottery for a Malcolm Mercedes or a Baldrige Buick.  They could have bake sales for Baldrige Bagels.  ASQ and all the other organizations could a 5% fee on memberships and book sales (Buy a book for Baldrige).  How about Malcolm mugs or Baldrige buttons? 

For a country with a 15 million-million dollar debt ($15T), another $9M represents the pocket lint found on the penny in the jacket pocket, but cutbacks are an inevitable political reality. Instead of having 600 assessment staff, could they get along with 540?   A drop of 10 percent could easily have a cost reduction worth millions.  A little LEAN thinking may be in order for the MBF.

So from my perspective, it is time to stop whining and time to start showing some of that innovation and improvement that the organization so strongly endorses and supports.  Put me down for two Malcolm mugs.

Keeping Busy

Ah, summertime; time to lay back and relax.  Well, kind of.  Actually for both CMPT and the Program Office, this is our big time for Acting and Planning.  Summer is when our PDSA cycle tends to end and start.

For example, our CMPT business cycle starts in May and ends in April.  Our last send-out for the year is in February, and our first is in May.  So the summer is our time for Management Review and for making our go-forward plans, keeping in mind that our reporting time comes around with our regular Annual Meeting in October.  For the Program Office, our course runs from January to June, which means that we have June and July and maybe August to do our evaluations and planning so that we can start to implement change in September so that we will be ready to go in January.

For CMPT we have some significant considerations on the table, but clearly the biggest one is our decision to join the international collaboration of EQA providers under the banner of Health Metrix.  This has been a long time in coming. We first started discussions with the group nearly 10 years ago.  Today there are too many good reasons to join and no good reasons to hold back.  First off, CMPT has already worked with many of the programs that participate in the collaboration in Asia, Africa, the Middle East, so this is not a situation where we (or they) are working with unknown entities.  Second, for a long time CMPT has worked as a stand-alone organization, which provides both benefits and risks.  Being part of a collaboration of like-interested programs provides some opportunities for common purchasing and research and development programs that can impact on revenues, on expenses, and academic pursuit.     

On the other side CMPT brings a lot to the collaboration, including our commitments to innovation and clinical relevancy and education.  Even within a collaboration where individual programs have choice, I think that we can put forward a compelling argument for our style of clinically oriented proficiency testing. 

So we are looking forward to participating as our linkages within the Health Metrix collaboration matures.

With respect to the Program Office, we completed another very successful year.  This has been a very eventful year with having our eighth year of the course, plus the creation of our first research collaboration, plus the Quality Weekend Workshop.  That has kept us very busy.

As usual, the comments and critiques from the course participants are available at www.POLQM.ca  There are two going forward messages to us.  First, it has been pointed out again that the course in very intensive.  It has been strongly suggested that we recommend participants to begin reading some of the background materials before the course actually starts. 

I think this is an excellent idea, and I will introduce that idea at our faculty meeting this week.  The second one may be a little harder.  During the progress of the course some minor changes got introduced which resulted in a necessity for purposes of fairness to make some minor changes to the grading formula.  Some of the participants saw this less in terms of accommodation, and more as a breach of commitment.  I can see that the truth lies somewhere in the middle.  As much as I am a strong supporter of Phillip Crosby and DIRFT (do it right the first time) a commitment to quality understand that sometimes deviations happen and when they do, there is a requirement for review of the events that lead to the problem, and an open and transparent speedy solution, and a process to avoid repetition.  That is what we have implemented. 

Finally, I have some key changes that I will propose at our annual faculty meeting which will create even more value in the course.      More on this next week.  So much for the lazy hazy days of summer.   

OFIs for ISO9004:2009

For the last few presentations I made the argument that ISO 9004: 2009 provides a valuable second look at its parent document ISO9001:2008 and suggests a way that Quality Management can be used  not only as a way to improve policy and procedure, but also to lead to a level of sustained success in meeting long term objectives.    

Learning through preventive action, and evidence-finding and focussing on the people in the organization not only makes sense, it also has a track record of success, at least from my personal experience within a small R&D compact Quality oriented organization.

Even if it is not an accreditation or certification document, I suggest that it is worth a look at by medical laboratory qualitologists and management.

But clearly, as much as many or maybe even most ISO documents come from a solid basis of consensus, there is always room for improvement. 

The first sentence of the introduction in 9004 says that the document provides guidance to support the achievement of sustained success for any organization by a quality management approach.  I think that sentence is supposed to mean that organizations can achieve sustained success by doing the right things. 

But sustained success is not something that any organization can have total control over. 

Consider Research in Motion (RIM) the pioneer in the smart phone environment; the creator of the BlackBerry.  For the longest period of time, there was only one smart phone, of at least a few models, but they all were variations of the BlackBerry.  BlackBerry defined the gadget market.    Life at RIM was good.   
But RIM got caught with its “pants down” when all of a sudden Apple decided to enter the market with a better smart phone, the iPhone (is the “I” in iPhone for  “innovation”), and then pulled off “innovation-squared” (I²) with the iPad.  Short of industrial espionage, I don’t think that there was anything that RIM could have done to quickly respond to this undeniable stroke of marketing genius. 

Today RIM stock is down about 70% from its highs.  Profits are still being made, but nothing like they were like before.  Shareholders are trying to force out the co-CEOs.  Rumors abound about RIM becoming a target of take-over.

All the study and adherence to 9001 and 9004 in the world would not have protected or prevented another company deciding to take a run at the Blackberry market and win.     

So in regard to ignoring the impact of competition on long term success, ISO 9004:2008 leaves a pretty big gap.

So as to not confuse the issue about the role and impact of competition as a success determinant for our Canadian publically funded medical laboratories, I also recognize the reality is that there is no competition in the medical laboratory field.  What we have instead is a Mafia-like carving up of communities which results in Medical laboratories have locked-in clientele without any form of competition.  Even if the laboratory was completely unresponsive to the needs of clinicians and patients, it would take almost divine intervention to have a competing laboratory allowed to provide testing in competition.  Personally I see this as a real weakness to our laboratory system.  The issues that prevail against competition are essentially the same as those that make it difficult for medical laboratories to define and measure success.  And absence of measures of success contributes to lacklustre activity.  Think about the problems as manifested at its most egregious level in Eastern Health in Newfoundland.

My other main concern about 9004, as well its parent (9001) and sister document (15189) is that they expect top management have control over resources and infrastructure.  Top management is expected to establish and provide sufficient resources, infrastructure and work environment to meet the needs of sustained success.  Well best of luck with that. 

I can’t imagine any organization being able to ensure sufficient money, personnel and resources to do all the things that think are necessary and lead to innovation, learning and sustained success.  Well maybe some provincial and federal ministers can do that for their personal offices can pull that off, but I don’t expect that as a realistic reasonable recommendation for any private sector organization (Microsoft or Google excluded) or the public sector, and certainly not a medical laboratory.

The reality is that throughout near the whole of the economy, budgeting is pretty much a wish-list exercise with too many variables and moving parts.  No one can ensure that appropriate money and resources are available.  The best we can do is try to focus something approximating real needs and then try to look at what has to be done to stop the bleeding of money that results from poor quality losses.

So what does all this mean? 

ISO 9004:2009 has some overly idealist points of view with respect to self-sufficiency and supply side resources.  It makes certain excessive assumptions on what top management can and cannot do.  It overstates what is achievable. 

Nonetheless I still see it as a valuable contribution.  It is not an accreditation requirement, and it is not a legal requirement, but it provides an interesting and valuable approach for organizations interested in adopting and working within a quality management approach.

Overall this is still a very good thing, even for the for the medical laboratory.

   

9004 - once more with passion

In 2009, Boiral and Amara published in Quality Management Journal (QMJ VOL. 16, 2009, ASQ: 36-60) that only about 25 percent of adoptions of ISO 9001 were effective, with the ineffective ones marred by internal or external barriers, or by little evidence of ongoing activity.  Those situations where there was little activity but few barriers to explain the failure were referred to as Managerial adoptions (the manager may care but no one else does).  Those with lots of activity but huge road blocks and pitfalls were referred to as Ceremonial (we adopted it, but we have no intention of allowing this to actually work).   Those where there was poor activity and huge barriers were called Ineffective (why did you even bother?), and the remainder showed ongoing success (Effective…Hooray!). 

I raise this because I suspect a similar pattern with ISO 9004:2009  Managing for the sustained success of an organization – A quality management approach.  There will be those (some) who become aware of ISO 9004:2009, and progress towards sustained success, but the majority will be unsuccessful.

ISO 9004 provides a useful approach to take the requirements of ISO 9001, but help enhance the view of shifting from just implementing because you have to in order to maintain your certification, to seeing value and purpose.  It promotes the use of factual evidence, awareness of changing environment, valuing employees, and monitoring customer satisfaction as tools to keep the organization moving forward towards success.  Success is enhanced not by creating a strategic plan and policies, but by communicating the strategic plan and policies, and setting forth to action and implement.  And succeed through success, meaning learning from your experiences and adopting  innovation for progress through positive change. 

One can see the influences behind 9004.  Focus on measurement (Six Sigma); focus on involvement and motivation of staff (Toyota) and focus on analysis and review (PDSA).  It completes the loop back to the beginnings of quality management.

9004 should be a roadmap to success. 

So why do I think that adoption and success will be small, especially in medical laboratories?  First and foremost, at least in Canada – and indeed probably most or all public sector funded organizations - there are no longer any traditional measures of success, because there is no incentive for success.  Medical laboratories will always “succeed” in the sense that patients will always come for care, and physicians will always send samples.  And the budget will always be there.  Closures don’t result from doing bad things, or bankruptcy; they come from higher level “efficiencies”.  And in a union shop environment, the concepts of personal pay-for-performance or bonus-for-excellence have been wiped off the table.  Laboratorians in institutional laboratories no longer know what success looks like.

The only real measure for effective success is, in my opinion, professional pride, and the sense that MY laboratory is the best, a concept much more of the ‘60s and ‘70s than of today.  Today the notion of organizational pride and the spark of competitive edge are all but completely wiped out.  That is not to say there are not still organizations committed to National Quality Awards and the Baldrige Award, but they are truly few and far between.

So does that mean that Qualitologists should write this document off as “interesting but not realistic”?  I don’t think so.   Read it, and think about it.  There are some pearls here.  Some of them may even be enough to help overcome some of the afore-mentioned barriers which could contribute to some of the ceremonial adoptions may shift over to being more effective.  Some of the practices may improve to the point where more than just the manager cares. 

Long term hopes and aspirations? Absolutely.  That is what we call strategic planning for long term success.

PS:       I am aware that few medical laboratories focus on 9001 as their source document for quality.  9004 is fully compatible with ISO 15189, and as far as I can tell, with CLIA.

Next time.  The two major holes in ISO 9004:2009.  

Innovation and Education and a new document

Our External Quality Assessment / Proficiency Testing program (CMPT) began in 1983 to fulfil some local needs.  As years progressed, CMPT changed, increasing in scope of geography, increasing the quality and variety and complexity of samples, improving the assessment scales, and providing better critiques, and expanding our education activities nationally and internationally. 

By 2003 when we made the decision to introduce our quality management system under ISO 9001, it was clear that the first two components of our Mission State would be Innovation and Education.  From my very narrow and personally biased perspective, I was pretty convinced that we had the concepts of innovation in proficiency testing down pat.

So it was with interest when we started to read about a new version of an old document, ISO 9004:2009, Managing for the sustained success of an organization – A quality management approach. 
(Note: for the sake of brevity, I will refer to this document simply as 9004.  Don’t tell the folks at ISO.  They hate it when their documents are abbreviated to a single number.)

9004 is a newly developed companion document to ISO 9001:2008 on Quality Management, but it is not itself a standard in the traditional sense: it is much more a guidance or advisory document. It is stripped of the directive, normative term “shall” and usually replaces it with “should”.  It describes how any organization can use their ISO 9001 quality management system to increase their opportunities for sustained success.

I spent the last few days looking closely at ISO 9004, in part to see how well it describes our the path over the past 28 years, and second to see if it could have anything more to contribute to CMPT.     

Actually I am pretty impressed.  9004 does not really add anything to 9001, but it reshapes it, and provides a focus on how to organize the requirements in a way that can lead an organization along a successful pathway.  For example, 9004 talks a lot about Learning. 

 Learning comes from knowledge, and knowledge comes from a myriad of directions: from the information that you collect from your own organization including opportunities for improvement, internal assessments, external assessment, your evaluations and experiences of your suppliers and partners, your KPIs and indicators, and importantly both your successes and failures.  And knowledge also comes from the experiences, past and present of your staff.  Organizational learning comes when that knowledge is integrated into the capabilities and thinking and behaviours and values of the people within your organization.  But for all that to happen, you have to be prepared to SHARE your organizational knowledge with your staff.  If you are very active in collecting the information, but fail in the sharing part, then don’t expect the organization to grow.  

9004 also talks about my favourite topic of innovation.  9004 suffers from a lack of definition for the term, but a short search describes innovation as “the act of introduction of change, creation, novelty with the connotations of “advance” and “leading-edge”.  With that in mind, 9004 talks about innovation not only being about new products, but also about introduction of quality management, or new organizational structure, or new technology, or new processes, the point being change with a positive point of view.  

But for those of us that focus on innovation, 9004 also makes the key points that change carries its own risks because not everyone is always comfortable or positive about change, and change may uncover some previously hidden conflicts.  Plans for introduction should address timing and resources as critical and ALWAYS follow with an impact study (PDSA)  and always have a contingency plan (Plan B).

So far, I am pretty impressed with the document in my setting and situation, and plan to spend a little more in depth coverage, for example where I see 9004 having traction, and where I see it likely not. 

PS: I got my copy of ISO 9004:2009  from the on-line ISO bookstore (www.ISO.org).  It cost 150 Swiss Francs (about $150 CAN)

PART B

On another completely different topic, the beginning of July is always a good time.  On the west coast, lots of Canadians spend Canada Day visiting malls in Bellingham Washington, and there are lots of Americans cars here in Vancouver.  Kind of like going to your neighbours for a holiday BBQ.

Final Summary of the Workshop 2011

I have mentioned before my ambivalence about satisfaction surveys and their real usefulness, but my reality is that they are almost a personal addiction.  If I don't get to do a survey every couple of months I start to show all sorts of nervous twitches (not really!). But at least I keep things under better control these days with my rules:

1. 1.    Focus them to a single issue
2. 2.    Limit the survey to only a few questions , best is to keep it to 5-6 and NEVER more than 10, and make them as uncomplicated as possible .
3. 3.    Pre-test the questions to reduce (you can never avoid) ambiguity and
4. 4.    Make sure that it can always be completed in 3 minutes or less.
5. 5.    Never require an answer. That is a guaranteed invitation to bogus information.
6. 6.    Decide in advance which slice of your audience you are interested in and then only focus your energy on that group. General send-outs are a total waste of time. 
7. 7.    Don't ask a question if you don't know what you are going to do with the information. (I forgot to mention that one before).

Note that 7 (above) is not about not asking questions where you might be afraid of the answer.  It is about not gathering information that you don’t know how to use or analyze.

So with those rules in mind, we did an exit survey of the participants of our Quality Weekend Workshop.  We focused our questions in 2 areas, General Organization and Workshop Presentations

The requested response was a check mark on a Likert Scale with 1 as the least positive (poor satisfaction) and 5 as the most positive (high satisfaction).  We also left room for optional comments.

The survey was optionally anonymous and took about a minute to complete, unless the person felt compelled to leave notes and comments.  Quality oriented folks LOVE to leave notes and comments.  It is in our DNA.

So here are the results.  In total we got a response from about 60percent of participants.  We generally encouraged participation but did not solicit from anyone, or discourage anyone.  (See Table).  Satisfaction was pretty high with some concerns about the registration fee, and maybe some issues about the length of presentations.

I suspect that the registration fee may have been a tad high, and we will address that next time, although we did not get to survey people who chose to not attend.  Maybe they would not have attended even if the workshop was free!

With respect to the comments on the workshop, we added all the comments to a single table and then submitted them to Word Cloud analysis, a semi-quantitative techniques where the most common words become most central and largest in the picture. 

We interpret this as a positive cloud and consistent with the tabular data.

So the bottom line was an enjoyed interactive meeting with high positives, and some concerns about fees and a cold room.  And we did not lose any money in putting it on.  So I call that a success.

Planning for 2012 and 2013 is already underway and we the conference PDSA cycle begins again.  

M

PS: we have taken the conference website down, but the information and the presentations are all available on www.POLQM.ca

Two sides of the Clinical - Laboratory divide.

I saw with appreciation Charlie’s reminiscences of having phlebotomy duties and how it was such an important connector to the patient behind the bar label.  I agree.  It was then and could still be today an important way to link the disconnected laboratorian back to the reason that many of us got involved in health care.   In many respects it was a triple-win strategy.  The laboratorian collected the sample they needed for testing having connected directly with the patient.  Since the laboratorian was more aware of the specifics with respect to sample volume and timing and transport conditions, the patient benefited from the increased likelihood of a correctly collected sample.  This created the conditions for minimized risk of pre-examination error.

My background was similar, but from the opposite direction and with the exact opposite effect because it create the greatest risk for examination error, over and over and over.  In the sixties’ and seventies’ and a little into the eighties’ hospitals seeking to keep their laboratory budgets down required interns and residents to perform laboratory tests, rather than have technologists do them, especially in the Emergency Rooms (ER) and in the evenings and on weekends. 

The ER would have a broom-closet converted to a cubby-hole laboratory with a centrifuge, a microscope, a urinometer, and a hemoglobinometer and a counting chamber.  Usually the room was full of tons of junk and debris and old samples dating back for the several weeks, creating an indelible odour of stale urine and God knows what else.   The available stain reagents were contaminated and loaded with crystal shards.  There we would do our own urinalysis, and haemoglobin and white counts and gram stains.  On evenings we would plant our own urine cultures. 

I know that this sounds like much less than what we see the house staff doing on the television show House, but it was a total waste of time.  (It is probably an equal waste on House as well!)  First none of us had any real training, and even if we did, the microscope and centrifuge and urinometer were so badly cared for, the chance that we could perform any test accurately was essentially zero.  And what was scary was that we actually used to make clinical decisions based upon those results.   The risk of examination error was near 100 percent.

The justification for all this was said to be that we were learning skills invaluable for being a clinician, but the real reason was that we were cheap labour.  And the clinical consequences of erroneous testing never showed on anyone’s radar.    Fortunately over time the cubby-hole reverted back to being broom closets. 

Over the last 10 years we have seen these mini labs return with a vengeance with more-and-more point of care testing.  We are told that the situation is totally different because the equipment is self-controlling and “idiot-proof”.  Not only that, but there are international standards (ISO 22870:2006) that dictate the appropriate quality requirements when operating point-of-care equipment.  Maybe that’s all true, but if facilities have not learned the lessons of ensuring competency and training for point-of-care testing, then they deserve all the incumbent risks.  At our recent Quality Weekend Workshop, one of our presenters showed data demonstrating the bias and the degree of deviation on duplicate testing with several point-of-care instruments.

Manufacturers sell on simplicity of use, but they also work from a quality of use perspective.  It is not in their interest when poor usage by inexperienced or untrained personnel gets results that lead to negative outcomes.

The message here is not that laboratorians should be venturing into the clinical arena but clinicians should stay out of the laboratory.  I see a too many advantages to addressing the gap between these two spheres of activity. 

But can we agree that training and competency and commitment to Quality have to not only be a part of the process, they have to be the process.

Ariely and Astion - bringing meaning back to the laboratory worker

I am reading “The Upside of Irrationality” by Dan Ariely (2010.  HarperCollins Publishers) and came upon a chapter that struck a chord.  It was one of those very satisfying moments. 

Ariely is a psychologist and behaviour economist; one of those guys who works in experimental design to address basic issues in behaviour.  In this one study he was interested in what motivates people to work diligently. 

The experiments involves asking folks to build some complex characters using the toy building blocks Legos or playing word games on paper.   The study design is essentially giving money for completing the task (either building something or completing the word game) giving more money for completing, but giving but progressively less money each time it is repeated.  The variable is whether the person sees some additional recognition.  In one scenario, the person’s building or word game is saved with they name, in another their work goes into a pile, and in the third, their work is shredded immediately. 

Turns out that folks will repeat the task multiple times, even though they are making relatively less money as they continue if they see the characters are connected to them by name or by preservation.  When their output is ignored destroyed, they do less repetitions, and follow the procedure with less accuracy.   People work more and more accurately when their work is not ignored or dismantled.  People work better when their work has meaning.   

When we put it that way, there is no surprise here.  But this begs the question about working in a modern medical laboratory.  One person receives a requisition and enters data into a computer, over and over.  Another takes the sample, now identified by a bar code and puts it into a tube or cuvette over and over.  Another pushes a button on a machine that makes the machine test the sample.  And another transcribes the machine result into report.  If workers name is collected, it is not for recognition, but rather who to blame when there is a problem.  This is a system that might make Henry Ford or Frederick Taylor happy (2 guys that built assembly lines) but it is tough to find a lot of meaningful recognition in this type of work.

In the microbiology laboratory, the technologist today receives a set of plates that have been incubating overnight, disconnected from the sample, disconnected from the requisition, disconnected from any clinical information.   Total disconnection. 

At our POLQM Quality Weekend Workshop, Mike Astion from Seattle was presenting on human resource issues in the medical laboratory and discussed this very scenario.  He was talking about laboratory workers being disconnected from their work… bored and making mistakes.  We need to connect the technologist back to the real live and living patient.  We need to connect the technologist with a reason for feeling like they are contributing to patient care.  We need to have meetings where the laboratory people actually meet and talk with the patients.  We need to make the laboratory people feel connected and meaningful. 

We need to ensure that laboratorians are clinically relevant.

There are all sorts of ways to make the reconnection.  In one laboratory that I have visited in Tanzania, they have put patient’s pictures on the walls.  Clinical technologist positions send the technologist out to participate in ward rounds.  Clinical-laboratory conferences with patients participating. 

These are all old ideas that were common practice in the 1960’s.  It is time to bring them back.

I love it when information from many sources all comes together.

Quality Weekend Workshop - the day after

So this weekend we had our POLQM Quality Weekend Workshop and while I may be accused of being a little biased, I have to say that it was terrific.  I am sorry that many people that I would have liked to have attend the meeting were not able to be there.   On the other hand we got the chance to connect with some old friends that I did not expect to see. 

Too bad because we had brought together some of the most significant quality gurus from around the world, including Jane Carter from Keyna, Richard Zarbo and Michael Astion and Robert Martin and Luci Berte from the US, Dr. Elisabeth Dequeker from Belgium, and George Cembrowski and David Seccombe from Canada.  David Hardwick, a visionary laboratorian with international expertise in Planning and Research in Pathology and Laboratory Medicine gave an incredible presentation on the Medical Laboratory, Past, Present, and Future... the core message being continuation of the 250 year  steady state increase in knowledge and information at 2% compounded year over year. 

Denise Dudzinski gave a thought provoking presentation on ethical issues that surround disclosure of laboratory error  to physicians and patients.  Where is the balance point between the right to know and unncessary anxiety?  This was one presentation that will have me thinking for the next year.


What was so exciting to me about this meeting was the focus on Quality Partners, something that readers of MMLQR are very much aware, but a concept emerging from shadows to prominence in the medical laboratory world.  Between Bio-Rad, BD, CSA, and DAP and a number of proficiency testing providers, a huge light was shed. 

The second theme was the growing opportunity for quality positions in medical laboratories in Canada, and around the world.  Clearly the clinical healthcare community has awoken its interest and awareness in quality.  Quality teams, Quality managers, and Quality lead positions are becoming a MAJOR growth point. As the total number of positions in laboratories gradually decreases, the positions in Quality are highly likely to remain stable or increase. 

Jane Carter gave a brilliant presentation on the Quality activities that she is involved with in Kenya, and throughout eastern and southern Africa.    She and some of her staff were able to come to Canada on support from AMREF Canada, an international office of the African Medical Research Foundation.  (More on this later).


There was a lot of discussion about making the meeting a regular event on the annual calendar, and I have had some significant discussions with two potential partners.  We would have to think about it for a while. 

From a Quality perspective, we have had a lot of success which are seen in the responses to the satisfaction comment sheets.  On a scale of 1 (poor) to 5(very positive) the meeting rates somewhere near 4.8, which high marks for speakers, and theme, presentations, staff and catering.  The registration fee was down a bit (about 4.2) but on review it would be difficult to do too much about that.  The biggest complaint was that the lecture room air conditioner was too strong.   

On the opportunity for improvement side, the biggest issue that I have to work through is in marketing.  Despite what I thought was a wide distribution of notices, we were not very successful at attracting the size of audience that I wanted.  Some suggestions have been made (such as having the meeting on Father's Day weekend).  We will have to do some significant Study (as in PDSA) before we do the next one. 

Bottom line is that the meeting was a pretty positive experience, and we have a lot of reason to be pleased. 

We have a file of presentation precis which will be available at www.polqm.ca

M

PS
I have been asked to create the opportunity for email notification for posts to MMLQR.  You can register for that in the new box on the top right (FOLLOW BY EMAIL).  If you want to give this a try, this feed is fully confidential, and is not designed or intended for any activity other than email notification of posts. 

More Musings on Quality Partners.

I have been working harder on the concept of Quality Partners and have created a trial definition: 

The network of organizations that develop and promote and provide services and assistance with the goal of supporting an effective laboratory foundation that is conducive of better patient safety and care. 

It is a little long but as a definition I think it is not a bad start. It contains all the key elements. The partners are not laboratories but are organizations intended to work with laboratories. The partners do not create an effective laboratory, but support the efforts of those responsible for creating effectiveness. The partners do not directly improve patient safety and quality of care, but are conducive. Ultimately it is the head of the laboratory that makes the decisions that will make or break laboratory quality, but they must know that they do not have to make those decisions alone and without support.

The definition still has some weak points that need to be addressed. Some of the partners are engaged totally on a voluntary basis, others on a function of administration, and others by virtue of their regulatory or statutory function. And it does not incorporate the most important partner, the PUBLIC as manifested by the MEDIA, the Regulators, the Legislators, and the Litigators.

The same can be said about the Graphic. It is still a work in progress, but worth sharing if others want to get engaged in discussion. (see below).

Tomorrow we begin our POLQM Quality Weekend Workshop with Quality Partners as one of the two core themes. It will be interesting to see how this all plays out. If I am the only one in the room that thinks this is an important concept, I will feel badly. Not wrong; just badly.

The meeting should go well this weekend. I personally think it is going to be a GREAT meeting. I hope that some of the speakers are not too disappointed by the size of the group. There is nothing that I can do about it now, and indeed I think that we did every thing we could to draw a bigger crowd. But the time for recriminations is not now. It is after we have had the meeting, and after we have had the opportunity to do the “S” of PDSA. We need to study the information that we amass as and after the meeting transpires.

It become important because there already is dicussion about another meeting in 2002 or 2012 (more definitely).
More later.