Accreditation, Consultant, Laboratory Disconnect.

In the previous entry I mentioned that we were putting on a survey about a Technical Report written by ISO to assist in the implementation of the standard on Quality and Competence for medical laboratories.   The power of on-line surveys is how rapidly people respond.  By 24 hours we had almost 50 percent of our target audience numbers.  

As I took an early look at the information one question jumped out.   

A cautionary note before proceeding.  We had no control over who would and would not respond, so from my perspective that makes the audience a random selection.  Second, and I will have to check with my son, the math/statistics guru, to validate this, but in my experience with these surveys, once you have more than 15-20 percent of the audience pattern responses by and large are set.  So while we will continue to collect information, the early impressions are likely (but not assured) to remain fairly consistent.

So one question asked if the responder was aware of the Technical Report, and how well they knew it.   There were 4 choices:  (a) I know of it, have read it and use it regularly- RED, or (b) I know of it, have read it, but don’t use it- GREEN, or (c ) I know of it, but have not read it - BLUE  or (d) I am not aware of it - BLACK.
 In the graph below, you can see how three groups responded: people that work in laboratory accreditation, people who work as laboratory quality consultants, and people who work in laboratories.  

What I found interesting is that in this early cut, of people working as consultants or as accrediters, about 80 percent had aware and had read it, however for people working in laboratories that group dropped down to about only 25 percent.  Considering that the document was intended to be used by laboratory people, it would seem that the ISO committee had missed its target audience by a large margin.  

This could be interpreted in a number of ways.  The most likely response is that for people who work as consultants or as accrediters, it is their business to know about these documents, and they are more likely the ones with the time to read.  So we might even think that having 20 percent not being aware of barely aware says there is a problem. On the other side, laboratory folk usually don’t go looking for Quality standards unless they are planning to make a shift to a formal Quality program.  So we might think that having 25 percent awareness is pretty good.  


But another, perhaps more concerning interpretation, is that the folks at ISO may be missing a big part of their mission.  There is no doubt that ISO is the “top-of-the-heap” when it comes to standards development, but it is also likely that when it comes to marketing the product they stink.  If the target audience is not finding or using your documents , then why spend all that money and time and energy if you don’t plan to let people know.  

But consider, if there are about 5-10 accrediting organizations, and maybe 100 consultants and 25000 laboratories.  getting a lot of response from the former two and not the latter is kind of missing the point.

Imagine if General Motors, or Ford, or Hyundai took that approach to car manufacturing.  “Our cars are so good that we don’t have to advertise.  Folks will just beat a path to our doorstep.  We will save a ton of money”.   NOT.

There are organizations that don’t need to advertise.  Organizations like government run hospitals, or government run schools.  They just have to exist.  People will find them; and if they don’t it will take government 50 years before they will decide to shut them down.  

But the private service sector can not work that way.  If you don’t let people know that you have a door, or where the door is, then it is pretty hard to beat the proverbial path.  Is it any wonder that standards development is not the way that people or organizations make their millions?  And when they do, you can be pretty assured that they spend a lot of time and energy keeping their name in the face of every target audience they can find.

Marketing is not the only thing, but its too important to be left to luck and the good will of others.  
Message to standards developers: if you are in business, then do what business does.  Identify your target audience and then go after them aggressively.   Be a business. 
And if you would rather be “above” all that, then don’t come back to your volunteers whining about the poor response and your weak finances.  

If the pattern changes with more responses, I will comment again.

Invitation to Participate with ISO

Greetings 

Those interested in medical laboratory Quality are aware that the cornerstone standard for Quality and Competency in the medical laboratory is ISO15189:2007 (now, but soon to be :2013).  In 2005, ISO published a document numbered ISO/TR22869 - Medical laboratories - Guidance on laboratory implementation of ISO 15189: 2003 that could assist some medical laboratories implement a Quality system.

This document is now outdated and  indeed should have been addressed at least 2 years ago.  

At this point the ISO Technical Committee has two opinions, one to terminate the document, the other to revise and refresh it.  Before a decision is made, they are interested in hearing the opinions of people who know something about medical laboratories and quality and the value of implementation guides.  

It is for this reason that I am posting a link to the survey that is being done for ISO TC 212.  Anyone interested in participation can go to:

http://www.surveymonkey.com/s/ISO22869

The survey has 9 questions, and should take less than 3 minutes to complete.

Thanks

Laboratory Physicians and Competency Assessment

On two occasions in the recent past I have been asked about how we would establish a system of competency testing for pathologists and clinical laboratory physicians.  I see just asking the question as a positive and maturing step forward along the Quality pathway.  By and large laboratory docs lead a charmed and protected life, being immune to requirements, except in the first 6 months of probationary hiring, and as we will experience more and more in the upcoming years, at the end of their career.  It is an anomaly, since near every one else in the laboratory is expected to demonstrate competency, and further, in the corporate arena, even the CEO is held accountable.  Perform and survive.  And even ISO 15189 makes it clear that everyone should be assessed for competency on a regular basis.  

So it is not a question of whether, it is a question of how.

But to be clear, I am a strong supporter of Samuel Culbert who wrote “Get Rid of the Performance Review”.  However named, and regardless of how many degrees (360?) are involved, Performance Reviews rarely, if ever, create an objective and accurate and productive product.  Pretty much a waste of time.

It seems to me that the natural place to start is with the job description.  Most laboratory physicians are hired to perform certain functions, and it follows that performance on each of those functions can be monitored and performance can be objectively assessed.  

My list of tasks includes:
1. To perform certain tests and functions that require special training.
a. Function as a discipline leader
b. To perform knowledge specific skills.
c. To provide interpretive skills for highly specific laboratory test results.
d. To provide  interpretive insights on all test results as required.
e. Function as a discipline educator

2. To perform certain supplemental skills including 
a. To be aware and up-to-date on new advancements within their discipline.
b. To provide innovative change within their specific discipline.
c. To meet customer satisfaction
d. To be a contributor to Quality improvement 

If that is an acceptable task list, we can start with the ones that should be easy  to monitor.  

The physicians are either reading and interpreting slides or they are not (1c,d,e).  Similarly, the microbiologists are making bench rounds or they are not.  Or they are involved in infection control.   The chemists and geneticists are either looking at specific electrophoretic patterns or they are not.  If they are taking responsibility for these high skill tests, they get a score of (PLUS1); if not, then they get a score of Zero.  For almost all these tests, there is usually proficiency testing challenges available to supplement the score.  For those tests where PT does not exist, then there should be an expectation for them to develop and alternative.  

On a similar note, laboratory physicians either put on formal education sessions or they do not (1e).  Maybe not every day or every week, or even every month, but there should be an expectation that laboratory leaders share their knowledge on some sort of a regular basis, either alone or through invited presentations with others.  

Keeping up to date (2a) is a common measure in many assessment schemes.  Docs have to participate in CME in some form regularly and all the time.  It may be passively by attending meetings or viewing on-line information, or actively by being a meeting or on-line information sharer, or a manuscript writer, but there must be evidence that the person is thinking about their professionally duties, and keeping up or in some instances ahead of their peers.  [Note to self: I wonder if writing this blog would count?]  Again, marks given for performance.

Being a part of Quality (2c,d) can be similarly examined:  Is there evidence that complaints are being followed up, or worse, that they are not?  Is there evidence of supporting, endorsing, and participating in internal audits in their discipline?  Is there evidence that they have worked actively in the preparation for accreditation?  Get marks for each.

That leaves two more difficult issues, being a leader (1a) and an innovator (2b).  In some regards these can be linked at the point of “change” and “change management”.  If a laboratory is doing everything the same today as it did 10 years ago, there is something wrong at the top.  No new tests? No new work flow? Not new reporting structure?  No new learning initiatives?  Count all that as evidence of No Leadership.  Leadership and Innovation are not the same as buying new equipment and spending tons of money.  Both are about being creative.  Given time, I would expand the options here,  but “change” is a pretty good place to start.

Want to make things more demanding; consider weighting leadership and innovation and Quality as twice as important as performance of specialized tests.  Create a composite score and monitor on a year-over-year basis, and set certain expectation levels.  

I am interested in thoughts and comments, and perhaps alternative approaches.

Quality Education 2013

I have mentioned before about our Certificate Course in Laboratory Quality Management.   This course is about to start its eleventh season in January 2013.  It is an amazing course and one that I strongly recommend for people interested in laboratory quality to consider.  

You might say that I am biased, and you would definitely be right, but this is one situation where it is possible to be both biased and accurate at the same time.  

This course covers a lot that you would want and need a medical laboratory quality manager to know about.  The list is extensive and includes: everything from international standards, to Culture of Quality to Document Management, Continual Improvement and beyond.    You can see the list in the enclosed brochure below.

This is an on-line course, but is not your typical on-line course.  It is much more a hybid-course with all the convenience of being on-line, but still provides all the discipline and connectivity that a small group classroom experience provides.  There are conversations, discussions, assignments and quizzes and examinations. This is not like your usual college classroom lecture with 700-100 all sitting bored or sleeping in the lecture hall.  It is a group of 40, the perfect size for adult discussion.  

The course was primarily focussed on people who wanted to be medical laboratory Quality Managers.   Initially the course participants were medical laboratory technologists thinking of a career change.  Over time the audience has changed: today the course has pathologists and residents, scientists and investigators, technologists and administrators. 

The course is taught in English.

The course tuition is $1950 dollars, and I agree that may seem expensive.  But the course is 21 weeks long, and the tuition covers a broad library and access to many international standards.    Most students score the course very strongly as providing value.

Philip Crosby once wrote "Quality is Free", and I agree.  Unfortunately Quality Education does have to have a cost.

For further information go to www.POLQM.ca and click on “Course Description”.  To see what last year’s students said about the course, click on “Enter to view the student satisfaction survey for LQM 2012”

Testing for System Integrity.

I was part of an examination panel for a PhD candidate this week.  Her discipline was on the testing of water to ensure that it was microbiologically safe for drinking.  

One of the research areas focused on the relationships between seemingly random events and came to the conclusion that the events may not be so random, and indeed one event (contamination of water with primarily vegetation related bacteria) may in time herald the future of a second, perhaps more dangerous outcome (contamination of water with human or animal fecal content).  

During the examination, I was pretty dismissive of the hypothesis, and suggested that random events are random events, and correlations between random events can sometimes occur more frequently than normally expected, but it doesn’t mean that they are anything other than random events.  

Now, upon reflection, I am not so sure I got it right.  Indeed I think I not only overstated my objection, I might have indeed got it wrong.  Darn.

Cities and towns test their drinking water on a regular basis, based on regulatory requirements, and also after some people get sick.  They can not test for every microorganism, so they test mainly for bacteria which may not in themselves cause illness, but which may be associated with other microorganisms that can cause illness.  It is cause “surrogate testing” and is the norm for drinking water cleanliness testing all around the world. 

When they test the water, it is usually done after the water has been drawn from its source, gone through a form of filtration, then after chemical treatment, and then gone through water pipes out to a tap.  By the time the water reaches that point, it may not be sterile, but it should be sufficiently clean that the surrogate bacteria associate with vegetation or waste should not be there.  

Intermittently (and rarely) a problem occurs and sufficient bacteria survive the process and end up being detected.

The place where I got it wrong, was that I assumed that when the bacteria appear in a test sample it was only because a massive dump, either of vegetation or waste occurred in the water at its source.  What I had not considered was that even if a dump occurs, the system of filtration and treatment should take care of it.  
But if the system is malfunctioning for any reason, then the bacteria can sneak through and show up as a positive test.  

Testing drinking water is not only about testing the quality of the water, but is about testing the integrity of the cleaning system.  It is a simple, but largely effective Quality challenge of a complex system.    
It fundamentally is like keeping a thermometer in a refrigerator to make sure the temperature is staying down, or testing an autoclave to make sure that it is getter sufficiently hot.  

When a positive test comes through that should be a signal to the folks along the water system that there may be a problem.  They may have been lucky if only vegetation bacteria got through, the next time it might be waste related bacteria.  Don’t think “reprieve”, think “check the system for weakness”.  

Water contamination events may occur at random, but if the testing suggests a problem, and the system ignores the warning, then when the bad thing occurs, the randomness is gone. 

I was thinking product and not system.  I was thinking too narrow and too concrete.  

I feel badly about it because I preach “think system” all the time.  Proficiency Testing is not about getting a test wrong it is about challenging the system to make sure it is working properly.  System testing is about error prevention and warning of potential risk.  That is why proficiency testing, and systems checks can be so valuable.

It is not about product integrity; it is system integrity that matters.

Many years ago there was a character on television that would go off on a crazy tangent argument based on her own confusion about what someone had said.  When the point was made clear, she would face the camera and say.  “Oh, well that’s different.  Never mind!”.

That’s how I feel now.

Quick Quality

Question:  What do you think about "Quick Quality"?  Should we create the "Quality Olympics"; higher-faster-stronger?  Maybe we should require a new version of ISO standards every year.  How how about the 20 minute assessment?

I like to read Wikipedia.  I know that smart writers are not supposed to say that, because Wikipedia may be accessible and popular and quick and biased more towards opinions than irrefutable fact, but I like it for all those same reasons.  When I read through their articles I am not so sure of the verification of all the information, but it gives a sense of the scope of people’s thinking on a subject.

Take for example the word oxymoron.  It has nothing to do with stupid bovines (moronic oxen?)  

Wikipedia tells me that it is derived from an example of a Greek oxymoron basically interpreted as “sharply-dull”, and means a phrase of two juxtaposed that appear to constitute  an internal conflict, but which most commonly is seemingly accurate.  Examples include “bitter sweet” or “deafening silence”.  Relevant to this discussion, Wikipedia talks about “false oxymora” in which two words are put together in a way that expresses no inherent contradiction, but at the same time implies a condition that cannot occur.  This can be done for example as a way to express humor or an ideological conviction (“government worker”), or cynicism (“honest broker”).

It is within this context that I raise the term “Quick Quality”. 

From the discussion above, it seems to me that this is a phrase that the authors of the Wikipedia discussion would call a false oxymoron.  It may not be ideological and cynical; it is just a good example of alliterative and false language construct and a really bad idea.   

You can put the two words together but it generates a nonsense term.  Quick Quality may be something quickly but, for certain it does not derive from Quality, nor does it lead to Quality.  

You can look at the impact of Quickness at virtually every step along the way.

At the international and national standards development level quick decisions result in clauses like measurement uncertainty being put into standards like 17025 or 15189.  Here we are 10-15 years later and most of the laboratories of which I am aware (food and water laboratories) being accredited to the standards still don’t know or understand or support measurement uncertainty.  Clearly the inclusion of the clause was not given the time to be properly reflected upon.  Quick output of standards development inhibits the discussion and dialogue that is essential to ensure that the standards are actually recognizing and representing the key and core principles.  

It may be acceptable in consumer marketing to just get the thing out today.  Whatever is wrong, we can fix it with the next version.  That is not acceptable in standards development.

How about speeding up the implementation of Quality in the organization?  That seems like a good idea.  Why takes so long, we should be able to do it in 6 months, maybe less.  The implementation of Quality by management dictate is easy to say and easy to force.  But there is lots of experience and information on how not well that works out.  Quick in …Quick out.  

On a number of times I have referred to Boiral and Amara and their article on the high rate of certification failure  [see Boiral,O and Amara,N.  2009. Paradoxes of ISO 9000 Performance: A Configurational Approach.  QMJ VOL. 16, 36-60.]

Large internal barriers lead to failure, either as ineffective certification (when implementation never got started) or as ceremonial (when implementation occurred but actions were blocked).  I have seen both.

Those working in laboratories know and understand our accreditation cycle, fortunately now becoming a construct much in the past tense:

And wouldn't we all be happy if we could get those external assessments done in 20-30 minutes, maybe over coffee and lunch.  Quick and confident.  Right?

The reality is that Quality relies on the presence of leadership and planning and culture.  And it  takes time to be done right.  Rushing to get the quick Quality infusion gives the message that the organization is not really serious about this.  More likely this is more about a quarterly report or a requirement for an upcoming project or a decision to lead the charge to the next flavor-of-the-month.  Whatever it is, it is not about learning or improving or being engaged over the long haul.

So there may be areas where quick action is good action, but implementing Quick Quality is not one of them.

Quality - the Consumer and Point-of-Care

One of the advantages of having worked in and around a field like healthcare for a long time, is that you have the opportunity to have seen what trends are sticking and which are flash faux-trends.   Training technologists was redundant because there was a glut of readily available personnel, and the laboratory was likely to disappear anyways.  Microbiology culture plates were going to be replaced by the monoclonal antibodies and/or microarrays.  Distributed laboratory services could be consolidated to a single facility.  All are good examples of faux-trends and bad ideas.
But there are some trends that have sustained over the long haul.  Every once in a while it is necessary to make sure that we are aligned to the trends, especially within the Quality Partner community. 

Some examples include:
• In many countries people are living longer and healthier.
• Healthcare facilities are more specialized and sophisticated.
• Healthcare service delivery is being provided less often in hospitals.
• Consumer healthcare (eye care, lifestyle management, cosmetic care, supportive care, pharmaceutical alternatives, point-of-care testing, etc) is becoming increasingly available and more mainstream.
• Consumer is becoming more knowledgeable and assertive in care and management
• Immigration patterns create diversity  to healthcare delivery

In health delivery some of these trends are having a monumental effect.   “Elder care” now accommodates a much broader level of health from the fit-and-trim, to the metabolic-syndrome sufferers and on to those with significant age-related mental and physical impairments.  The demand for knowledgeable and skilled geriatric specialists has put huge demands on the education providers for nurses, physicians, dentists, physiotherapists, nutrition therapists, and occupational therapists.  

For hospitals the transitions of the last 25 years may equal the impacts of change as they occurred in the 19th and most of the 20th centuries.  In the early years with the growth and development of modern surgery and obstetrics and antibiotics for infants and children, hospitals grew larger and larger, sometime creating as many problems as they solved.  Patients came into hospitals for weeks and months, sometimes to die due to hospital complications.  Today hospitals beds are getting fewer and fewer.  Nightingale wards are gone, soon to be followed by the elimination of 4-bed and 2-bed rooms, with only single rooms and special care units being available.  People come into hospital not for weeks, indeed often not for days; more often now only for hours.  Much of the residential or “hotelling” nature of hospitals is gone.  

So how do these trends impact on the laboratory?  

First and most obvious, is that as pressure on hospitals to reduce has increased, the cut-backs and consolidation to laboratories have compounded.  This has not had much effect on the care for the urban dweller, but has not been particularly beneficial for the rural community.  I have mentioned this before, and will again, later.

And immigration and age have created all sorts of challenges for the medical laboratory with impacts on reference ranges, on diagnostic requirements, and interpretations.  (Again, more on this later.)

But again I want to focus on a key interest of mine: the impacts of consumer power.  I have mentioned before that the demands and expectations for Quality have never been greater, and the impacts of poor quality explode in the media, and the courtroom and the halls of the regulators.  Laboratorians need more and better tools to ensure that they can demonstrate their quality systems are intact.  That creates pressure on the accreditation bodies, the proficiency testing bodies, the suppliers and the educators; making mistakes is a problem, failure to address mistakes is disastrous.   As the level of Risk and liability climbs, the option to opt out becomes more viable.  

But there is opportunity too.  Consumers don’t care if a test is done by point-of-care or in a reference facility; either way they expect to get a meaningful and interpretable result.  A wrong result that leads to a bad outcome is a problem regardless.  Point-of-care users have as many demands for Quality as do the laboratories.  There are lots of examples of the impact of poor point-of-care quality [see http://sanfrancisco.cbslocal.com/2012/03/05/sfpd-breathalyzer-error-puts-hundreds-of-dui-convictions-in-doubt/ ]   A recent article in Medical News Today points to the increasing issues medical error associated with poor point of care practices and the absence of sufficient guidelines see http://www.medicalnewstoday.com/articles/239960.php] .   I argue that as point-of-care becomes more prevalent and more outside the traditional medical and laboratory settings, consumers expectations will become greater.  The pressures on storefronts and non-traditional clinics will increase, and the demands for standards and guidelines and challenge materials will increase.

As an addendum, I note with interest that the US Joint Commission is cutting back on its Quality requirements for tests waived by CLIA [see http://www.jcrinc.com/Joint-Commission-Requirements/Laboratories/#WT]  .  

Clearly their view is different from mine.  

Malcolm Baldrige National Quality Award

Paul Borawski writes in A view from the Q on the topic 25 years of the Baldrige program  (http://asq.org/blog/2012/08/25-years-of-the-baldrige-program/).  Quite justifiably  ASQ sees the Malcolm Baldrige National Quality Award as an American program worth honouring.  

I agree.  

The MBNQA program was developed in 1987 during Ronald Reagan’s second term as president.  It has been a cornerstone for American Quality ever since.  Paul speaks of the legion of Baldrige zealots (not just fans and admirers, but zealots!).  I might even include myself in that group; well maybe a mini-zealot.  The Malcolm Baldrige Award is, at least in my mind, the highest level of Quality and excellence achievable in the United States, and a symbol that says that striving for the best can and will be rewarded.  

I once contacted the Baldrige organization to see if I could apply for an assessment of my combined CMPT proficiency testing program and POLQM program office.  I was told that would not be possible, because the MBNQA could only be awarded to American organizations, but perhaps I could consider contacting our Canadian counterpart, Excellence Canada.  Excellence Canada is a not-for-profit private organization that supports itself, at least in part, through a partners program.  You can read about Excellence Canada at their site www.NQI.ca.  

Excellence Canada has been active in Canada since 1992 (this is its 20 year anniversary!) and is responsible for the Canada Awards for Excellence program, which predates the organization itself, going back as far as 1984.  

In recent years, healthcare organizations have been a disproportionately large part of the applicants to both the US and Canadian programs.  From my perspective, inside healthcare, I see that as a good thing because it means the threat and danger of patient safety violations is sinking in.  

Paul asks an interesting state-of-the-nation question about why the number of organizations getting involved with the Baldrige process is low.  I feel compelled to respond.  

I suspect that behind the question lies the fact that as much as healthcare organizations are showing a very large interest, perhaps other industries are showing less.  I suspect that a large part of the answer is money, especially during a slow recession recovery.  In many industries, if the exercise is about Quality, there are a lot of options including lean, six sigma, ISO9000.  In an era when cash flow is slow, Quality  can be done in pieces and with relatively controllable cost and some incremental improvement.   

On the other hand, in healthcare, cash flow is usually not a problem and the costs of poor quality are massive when you take into consideration the impacts of liability including malpractice litigation.  The argument for a substantial move to quality is substantial and compelling.

When it comes to winning awards, private sector industries need to see that the gains from the award outweigh the cost of earning it.  Their view can be relatively short sighted, looking forward on a quarter-by-quarter basis.  
In healthcare the dynamic may be different.  Winning awards can have long term benefits in patient referrals.  It is easier to see the appeal and benefit.


 But I think the question undervalues the degree of change that we have seen in the Quality arena between where we were before the Malcolm Baldrige award program and where we are now.  It would be fair to call the change a major international game changer.


The Malcolm Baldrige National Quality Award began in 1987.  Since then:

• ISO9000 first published in 1987, 
• In the United States, the Clinical Laboratory Improvement Act was passed in 1988 setting legislated Quality thresholds for all US medical laboratories.  
• ISO 17025 followed in 1999, 
• ISO 15189 in 2003 

This growth in volunteer standards changed the face of Quality through clarity of expectation and as a foundation for external assessment of a huge number of testing and calibration and medical laboratories, reducing error and improving confidence in test results around the world.  

• These standards lead to accreditation of laboratories critical to health (food, water, medical) becoming the norm throughout North America, Europe, Australia and New Zealand, Japan, and is rapidly establishing its place in Brazil, Argentina, China, India, South and East Africa.  

• And most notably, similar programs for Quality and Excellence have sprouted up around the world.
Would all this have happened without the impetus of Malcolm Baldrige?; maybe, but unlikely at the same timetable or pace.  I personally would go further.  The development of the Malcolm Baldrige National Quality Award is an example of US innovation having impact on quality around the world.


PS: To date, I have not yet contacted Excellence Canada to find out more about eligibility and requirements for applying for assessment of CMPT and POLQM and pursuing a Canadian Award for Excellence.  But I have included it in my CMPT Quality Plan for 2012-2013. 

PPS: I wrote last year critically about the ASQ  [see http://www.medicallaboratoryquality.com/2011/07/quality-and-excellence.html ] when there was concerns that congressional funding for the awards program might be lost.  I was critical of ASQ going public because the amount of funding that was being discussed was small,   When a government is in massive debt, some cutbacks are inevitably going to happen, and the better Quality response is to look to innovation for the solution.  I have scoured the web to find a follow-up on the issue of funding, and found nothing, which suggests to me that the issue has met some level of negotiated compromise, or have sought a new solution.

ASQ and Influential Voices

I have been invited to participate in an interesting program, Influential Voices, organized by the American Society for Quality (ASQ).  

The program is straight forward.  The CEO of ASQ, Paul Borawski,  has a blog (http://asq.org/blog/) entitled A View from the Q.  I have entered the blog into my interesting sites to visit page, because it is an interest site to visit.  
Members of the Influential Voices group agree to comment on Paul’s entry within their own writings.  

No commitment is made to agree with Paul, only to write respectfully on the topic and comment.  That seems fair and transparent to me. Any process that fosters discussion on Quality in all its spheres is a good thing.

Congratulations to ASQ for a new and interesting and BRAVE initiative.

On a regular basis I will be writing my Influential Voices commentary.