11 keys to quality management in the lab.
It is clear to all that clinical laboratories play an important role in the quality assurance of any health care institution. We have also come to realize that if we are to overhaul old work habits, it will take more than a mandated personnel policy to insure top performance and laboratory work.
In "Quality, Productivity, and Competitive Position," W.E. Deming offers basic principles for quality management.(1) I believe this is "must" reading for anyone serious about lab management. Deming describes an organization committed to quality and paints a vivid picture of "how things ought to be." He also notes that few articles address how the transformation toward quality begins.
I was struck by Deming's view that the approach must be based on pragmatic realities of business life. Change, he observes, is difficult, and resistance to change is often strong and persistent. Additionally, no matter how much an organization may want to transform itself into some new order, it must continue doing business during the transformation, and in the way that it currently knows best.(2)
Several of Deming's guidelines for quality(3) merit a closer look: *Quality begins with delighting the customer. In today's competitive climate, it is no surprise that the customer (physician and patient) must come first. It is critical that we identify our customers. Though physicians - and subsequently their patients - may not necessarily utilize our services sensibly, they are always our customers. So if physicians - and subsequently their patients - are displeased with our services, we have not truly achieved quality. * The quality organization must learn how to listen to its customers. And then we must help them identify and articulate their needs. Frequent and meaningful communication with physicians and other consumers of laboratory services facilitates the flow of pertinent and timely information needed to provide a better product: timely, accurate, and cost-effective service. This process also yields firsthand feedback on the customers' concerns and problems. Soliciting this type of information is essential to establishing the priorities of a quality lab service. * The quality organization leads customers into the future. A topnotch lab not only maintains its state-of-the-art technology but must also adopt a visionary approach toward the future. This strategy implies that research and development are of utmost importance to the quality of service in the future and that funding for such endeavors must continue. * Flawless customer-pleasing products result from well-planned systems that function flawlessly. QC and proficiency testing do catch mistakes, but this is not the bottom line in achieving a total quality service. A flawless system provides what the customer wants, when the customer wants it. And it does so efficiently, cost-effectively, precisely, and consistently. There is no waste, or defects, or repeat testing. As Deming states, a quality system "is continuously being improved." We should not "wait until something's broke" to fix it! * The vision, value systems, and processes of a quality organization must be consistent and complementary. The laboratory's mission statement becomes a key definition, spelling out the nature of its business. Objectives delineating policy and procedures simply describe how we conduct our business. The workflow, technology, and methodology are the sequences of activities that get the job done. Therefore the laboratory mission - including defined goals and objectives - are part of the process that must be well defined and perfectly clear to the staff before management can proceed in its true quest for quality. * Everyone in the organization must work in concert. Team spirit is critical to a healthy environment. Cooperation among administrators, directors, managers, supervisors, and technologists is essential. Highly motivated leaders must exhibit a strong attachment to those performing the daily work if we are to change the entire health care team's mind-set from "job" to "profession." That means laboratorians, too. * Teamwork must be based on commitment to the customer and to constant improvement. Deming describes teamwork as a two-part process in the quality organization: It refers to a spirit of loyalty and collegiality throughout the organization and to the greater use of teams and participative processes in conducting business. Teamwork, then, results from a common understanding of the lab's vision and values. It also comes from understanding the organization's systems and processes and a universal desire to please physician clients. This teamwork, in turn, aids in developing what Deming calls a "bond of commitment to ongoing improvement." * In a quality organization, everyone knows his or her role. Jobs are not performed simply by staff members' reading their respective job descriptions or instrumentation manuals. All pathologists, technicians, and support staff members must understand the following: where where they (and their work) fit into the laboratory system; how their work relates to lab data and subsequently to customer (physician) use; why competency (along with technical skills) is necessary to perform their assigned tasks in an acceptable manner; and an understanding of lab technology (instrumentation) in terms of its functions and capabilities. Technologists must understand the concept of reference values and know what the lab considers acceptable variables. There must also be a clear understanding of what they are (and are not) allowed to troubleshoot. * The quality organization uses data and a concerted approach to plan work, solve problems, make decisions, and pursue improvements. With this attitude - and an organized approach - difficult situations become simply "business as usual." * The quality organization develops a partnership with suppliers. Reading Deming's work, makes it apparent that many labs fall short in this regard. Deming holds that the quality-minded company exercises great care over all the materials and services it receives. He urges a long-term collaborative relationship with suppliers. We need better communication with the laboratory industry. * The quality organization supports and nourishes the improvement efforts of every one of its members. The lab that focuses on precision and data, internal team spirit, respect, recognition, and pride is effectively seeking constant improvement. The end result affects both processes and products - and the customer's being happy with the quality of service. This means including physician and patient satisfaction as part of the lab QA program. It sounds simple and logical - and it is.
As we continue to face new and increasing regulatory demands, quality moves rapidly to the health care forefront. Knowing whom we must please - and by what method - demonstrates a systematic view of a laboratory that truly cares about quality. Clinical laboratories must further develop and focus attention on their human resources. That is, we must further educate our staff about the value of quality. Only then can we boast that we care about quality transformation.
I firmly believe that people don't resist change; they resist the manner in which they are changed. Human beings need to feel included in the decision-making process leading to change. At the very least, they need to understand the change and the rationale for making it. This process alleviates fear and anxiety and fosters motivation and enthusiasm.
Finally, Deming assigns responsibility for quality to those at the apex of the pyramid. Management, he charges, must lead the transformation. This step cannot be delegated. Without the active leadership of top managers, efforts toward profound change may flourish for a while, but they will not endure.
QA will continue to improve the overall quality of health care delivery. While such a plan begins with a well-defined written program, it ends with commitment - starting at the very top.
(1.) Deming, W.E. "Quality, Productivity, and Competitive Postion." Cambridge, Mass., MIT Center for Advanced Engineering Study, 1982. (2.) Scholtes, P.R., and Hacquebord, H. Beginning the quality transformation (Part 1). Qual. Prog. 21(7): 28-33, July 1988. (3.) Deming, W.E. "Out of the Crisis." Cambridge, Mass., MIT Center for Advanced Engineering Study, 1985.
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|Author:||Martin, Bettina G.|
|Publication:||Medical Laboratory Observer|
|Date:||Jan 1, 1990|
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