Quality Representative Poll

[Dawn]

We would like to know about the organization of your facility.

[luhubert]

There used to be a Quality Department but then there was reorganization and the Blood Bank supervisor took over doing all the blood bank oversite and statistics which are reported to the Blood Utilization Review Committee. She determines if the C:T ratio is OK and if transfused blood meets criteria - if it doesn't, the chart is taken to the Committee where peer review is done. She also looks at low hgb. which aren't transfused and why. She also reports those results to the B.U.R.C. along with trans. reactions, reports on Quality Indicators and the kitchen sink.

[Lcsmrz]

I think the trend throughout the US and in all industries has been to reorganize quality positions out of existence. In a way, the quality industry has always said that they want to push quality management down to the process level in the interest of getting real-time feedback. I appluad the effort of quality personnel to educate everyone in quality techniques.

The only downside is the loss of oversight independence, and we're reverting back to a single gatekeeper of all data coming out of an area, usually a supervisor who is already overworked. So, I have to question the quality of the data being collected and analyzed.

Are quality positions really redundant, or is this just an excuse by upper management to cut positions ???

Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ)

Indianapolis, IN

[John C. Staley]

I don't know what is happening in your part of the world but in my little corner, everytime we turn around the corporation is adding another QA position. We have QA folks in every facility as well as a corporate group for lab general and a second group for transfusion services. Around here you can't swing a cat without hitting QA people standing around watching your every move. Well, maybe not quite that bad but we are sure not seeing any cut back with the QA departments.

[David Saikin]

I'm seeing the same thing as John, QA dept is getting more staff. Unfortunately, I don't think they really know what quality is . . . from my perspective they seem to exist for compliance purposes. I have not seen one quality initiative that improves any process in the hospital. Of course, I am persona non grata . . . esp since I refuse to implement things and then fix them after the fact.

[Lcsmrz]

Hospitals are playing catch-up in the Quality field, spurred on only by the 2001 IOM report, Leapfrog, and various raised eyebrows in regulatory, accrediting and political bodies. Unfortunately, the new hospital positions seem to be filled with RNs that took a quality techniques class and are now the "experts." Their initiatives resemble non-statistical psuedoscience -- as I call it -- and input by MTs, who have been "doing" quality for 30 years, is usually ignored as irrelavent.

Quality plans in Blood Banking are almost 15 years old now. Think how long it took us to catch on, and how much progress we've made !!

But the rest of the quality field, esp in manufacturing and high-risk fields (ie, nuclear, aerospace), has progressed to where quality has been pushed down to the worker -- exactly where Deming said it should be !! And quality departments are declining ...

Larry Smrz, MBA, MT(ASCP)SBB, CQA (ASQ)

Indianapolis, IN

[Myella]

You're right, Larry. It may be true that it is declining in manufacturing and other sectors of industry. However, since I believe that Healthcare industry has been lagging in the quality movement, it is just creeping into our industry. This is probably due to the realization that medical errors is on the rise and something has to be done to correct and prevent it. Hopefully, this is what's happening so that it will be good for us who are already ahead in the quality field.

[Linda McWilliams]

We have a Quality Assurance Manager for the Lab and a Performance Improvement department for the hospital (handles hospital inspection /compliance). It seems that Quality positions are growing in the hospital where I work.

As the Transfusion Service Manager I drafted the Quality Plan and prepare statistics, audits and report at various meetings.

[Myella]

Can anybody explain to me the reason why in the healthcare setting, only nurses are qualified to be in the quality assurance department of the overall hospital?

It's always that you should have a BS in Nursing as the job requirement!

And from what I hear, the Hospital QA department where I work keeps on acquiring more people to do QA. No wonder there's a shortage of nurses!

Yet, in the Blood Bank, it's so difficult to get extra help to do QA activities.

I think Blood Bankers or CLS have a better perspective than Nurses anyways when it comes to quality and statistics. What do you people think?

[John C. Staley]

It's the same thing with infection control. Ever see a Microbiologist/MT in hospital infection control? Nurses have the high profile. I'll bet that one of the top positions in your hospital is the CNO (chief nursing officer) or something similar. It should not be a surprise that nurses have a much taller ladder to climb.

[Lcsmrz]

RN tends to be a requirement for QA and Infectious Disease positions, since most of their time is spend educating other nurses about QA and Infectious Disease control. Despite our superior knowledge about these areas, MT's would simply lack the credability with nurses about clinical practices.

Our Infectious Control nurse recently told me that, if she could just get physicians and nursing personnel to follow existing policies like handwashing, she'd be out of a job, and the lab have a third less work to do. I have no reason to doubt her.

To their credit, I'm finally seeing RNs with quality credentials (ie, black belts) and advanced degrees in a non-nursing field. Maybe by the time I retire, we'll see some illumination in hospital-wide QA departments and real progress toward the goals of the IOM. In the meantime, I just hope the samples I get have the correct patient name on them ...

Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ)

Indianapolis, IN