Teaching Quality. Spoiler alert - it is NOT about you.

For the 12 years we have offered our VCOLE (virtual classroom on-line education) course The Program Office for Laboratory Quality Management’s Certificate Course on Quality Management.  Each year is essentially it presents as a new course because of all the refinements that are implemented based on our experience as faculty and the information that we gain from all the participant surveys that we run throughout 7 modules of the course.  The course information is based on Quality principles, key to which is Deming’s Plan – Do – Check – Act and Repeat.  

 

From the very beginning we were assisted by a course design expert who ensured that we focus on established Andragogy (Adult Learner) theory.  It is, or should be intuitively obvious that when it comes to learning, adults are not just big children.   Child learning is diffuse, adult learning is focused.   Adult learning has been a focus of study for almost 200 years, developed by Kapp in 1830s.  In North America, Kapp’s theories were popularized by Malcolm Knowles in the 1970 is his Principles of Adult Learning which include:

·       Adults are internally motivated and self-directed

·       Adults bring life experiences and knowledge to learning experiences

·       Adults are goal oriented

·       Adults are relevancy oriented

·       Adults are practical

·       Adult learners like to be respected

To translate these principles into practical terms, adults know what they want to learn, and how they want to learn.  If the subject does not have purpose, is not relevant, or practical, adult learners move on.  And they bring a lot of experience and expertise to the table; not acknowledging that is foolish and destructive.  Encouraging the sharing of experience and experience is always a good thing.

We work very hard in the course to teach to those principles.

Recently I found a couple books by Jane John-Nwankwo an American nurse who focuses a lot of attention to Adult Learning Principles, from the perspective of a Nurse Educator.  They are short (maybe too short) but certainly to the point.  They are available on amazon.com and if you have an e-book are very inexpensive.

So what is the point?  

Quality is not intuitive, and is not something that is any part of any curriculum while we are growing up.  Adults come to work with some very mixed Quality messages which are usually very mixed and usually negative.  The common message is that Quality is about writing documents and CAPA software and telling staff they aren’t trying hard enough.  “If only you had done it right the first time!”

If a Quality Manager wants to be successful, they need to figure out how to encourage staff to build a Culture of Quality.  They need to figure out how to motivate and teach effectively; and that means they need to know something about how adults learn.  

Being an effective adult teacher was not something that I came to the table with.  I had to learn, and I will tell you that it was painful.  Over time I used the trial-and-error approach, the theatrical approach (scripts, choreography) and the down-home-folks approach.  Ultimately I figured out the real secret; teaching is not about me.

Teaching is about applying the principles and giving the audience what they want and need: practical, relevant information that is to the point.  Fill it in with a few stories that tie to my own personal experience and expertise, and then over to the audience for dialogue and discussion.  

Done well and maybe you will motivate some to want to come back.  Done really well and maybe you will develop a core group who engage with comment and get stimulated to action.  

Over the years I have learned a few things not to do:

• ·       Don’t equate a big crowd with success.

• ·       Don’t drone on.  Keep to the point.

• ·       Don’t speak to slides.  Use slides to highlight, not as script.

• ·       And, while it is always an ego boost, to the extent possible avoid all invitations to speak at meetings where no one speaks your language or understands what you are saying.  

Being a Quality motivator is all about sharing the message.  It is not about you.  If the audience comes out engaged, you win. 

When the Public turns against Quality

I regularly refer to Quality Partners, as organizations committed to improving laboratory Quality.  At the same time, the single greatest impact on Quality comes from the public through its agents: the media, the regulators, and the legislators.  The following describes when the public conspires to kill Quality. 

For those outside Canada, Saskatchewan is a province just west of the true geographic centre of Canada.  It is a province big in size, small in population with a growing economy based largely on agriculture and resources.  It is currently run by a centre-right party (the Saskatchewan Party) with a substantial majority with a centre-left party in opposition (49 seats versus 9 seats).  Most would not be surprised knowing that the government is interested in being financially efficient through error and cost reduction. 

To do that it has turned to Quality and Lean, with particular attention on Healthcare (that is a good thing).  To accomplish this they decided to hire an American consultant group (not sure why; there are many Canadian organizations that could have done equally well) to investigate, advise, implement and train a team of Lean leaders throughout the province.  

One aspect of the implementation was right out of 5S (as in Sort - Straighten - Shine (clean) – Standardize – Sustain); they supplied templates and guides on how to Standardize procedures in Healthcare.  So that was what the team of Lean Leaders did.  They went through the healthcare system and wrote “SOPs” to standardize process.  To anyone reading this story on this site, that would all seem to make a lot of sense; Yes? (of course Yes!).

So now we enter into the politics.  The opposition party (remember their very weak position) decides to take a swipe at government because they say the contract with the American consultant was too rich.   Well, politicians are politicians and opposition parties are supposed to say bad things; so I can live with that.  Besides I’m still annoyed by a decision to go American, when there are lots of good Canadian organizations that can implement Lean programs.

But then things get stupid.  

First the opposition party report through the media that they found a standardized procedure for making coffee.  This, the media jump all over.  The coffee instruction became a major scandal.  The fact that it was not in a healthcare facility was irrelevant.  

Then they went on to complain that over the last few months the amount of savings due to Lean was paltry.  Then they complained that the problem with Lean is that uses too much jargon and is disliked by many front line health care workers [see: http://www.cbc.ca/news/canada/saskatchewan/sask-nurses-say-they-re-being-intimidated-over-lean-program-1.2610542 ].  This too becomes fodder for the cross-Canada media.  Then it is reported that the Lean program was implemented not only in acute care but also in nursing homes.  Shock upon shock.  

To be fair, there were some stupid things done, like deciding to import Japanese senseis to help in the Lean training [see: http://www.cbc.ca/news/canada/saskatchewan/wanted-japanese-translators-to-assist-lean-consultants-1.2816341 ], and an apparent decision to replace nursing home residents' facilities with space for health-care bureaucrats [see: http://www.leaderpost.com/news/Mandryk+Wall+must+avoid+another+lean+mess/10704492/story.html ], but by the end of all this, the opposition centre-Left and the hard left media (the Canadian Broadcasting Corporation – the CBC) have done the province of Saskatchewan and the Canadian news watching population a great disservice.

The outcome of all this is that with all the negative media attention, the government decides to back away from the Lean consultants and terminate the contract early.  No mention is made about if they plan to walk away from the Lean activities they have implemented.

Canadian healthcare is financially out of control and needs significant action, not only in Saskatchewan but all across the country.  One of the reasons that Canadian healthcare has so many problems is that it is controlled by healthcare unions that have no interest in addressing cost effectiveness, especially if it means reducing positions or union wages.  (Gee is it any wonder that these unions would resist and dislike a program like Lean.)   

Recently I wrote that Quality will inevitably fail when an organization has an endless supply of customers, with essentially no threat or consequence to counteract indifferent behavior [see: http://www.medicallaboratoryquality.com/2014/12/competition-and-quality-partner-dynamic.html ].  This is the very definition of Canadian healthcare system 

Going after a government plan to implement continuous improvement through a program like Lean, is easy, just blame it on a mean government being hard on those poor front line workers and point out some trivia like a scandalous instruction about coffee.  

But if this Quality initiative gets killed before it gets started, there will be blood on people hands, and everyone including the government, the opposition, the unions, and the media will all have to wear it.

At least that is my opinion.