I have started the process of transferring older posts, which were in my now defunct website, to this blog. It will take a little while and additionally it will take some time for the search engines to catch up.
As of the end of 2016, I stopped consulting. I still follow lab medicine topics that interest me, and will still publish both papers in journals and entries on my blog.
I ended my website KrouwerConsulting.com – it doesn’t work anymore – and I realize that some of my earlier blog entries can’t be accessed because they were on KrouwerConsulting.com (written before I started my current blog). I will fix this and transfer all of these entries to my current blog, as soon as I figure it out!
I want to thank all of my clients. Their problems kept me thinking and I enjoyed both the technical tasks and meeting people to discuss a variety of issues.
Most people have seen the video of a passenger being forcibly pulled off a United flight. After some missteps, one would think that the CEO would say the right thing. But he said the following (as seen on CBS news on 4/27).
“Our policies were placed ahead of our shared values and procedures got in the way of what we know is right.”
To people like me, who have worked in industry, “shared values” sounds like a mission or vision statement. The problem is that a mission statement is supposed to dictate policies and procedures and of course, it is management that defines policies and procedures. Hence, the quote sounds hollow.
What a company does can be considered its mission. If it conflicts with its mission statement, then the mission statement is out of whack.
“The following list presents 10 persons who have made a significant impact on the IVD industry.” This is how the magazine IVD Technology begins and then gives a short description of each of the 10 people (1). Two of the people listed in the top 10 happen to be on the editorial advisory board of IVD Technology (2). Hmmm…..
About half of the editorial advisory board are in regulatory affairs and four of the top 10 are also in regulatory affairs (including the two above). In case you’re wondering, Leonard Skeggs, the inventor of the auto-analyzer didn’t make the list! OK, to be fair, the text also says “Efforts were made to ensure that this list reflects contributions in both the regulatory and scientific areas.”, but the title and first sentence are misleading.
- Top 10 Persons in the IVD Industry IVD Technology April 2005, see http://www.devicelink.com/ivdt/archive/05/04/002.html
- See, http://www.devicelink.com/ivdt/eab.html
A Wall Street Journal article discusses the role of the New England Journal of Medicine in the Vioxx affair (1). An aspect of the article that caught my attention was the attempt by a pharmacist, Dr. Jennifer Hrachovec, to make known the dangers of Vioxx.
She first tried to do this during a radio call in show which had as one of its guests, Jeffrey Drazen, the editor of the New England Journal of Medicine. He blew off her comments.
She next submitted a Letter to the editor to the New England Journal of Medicine. It was rejected.
Finally, she was able to get a Letter published in JAMA, the Journal of the American Medical Association.
I can relate to this sequence of events and suggest that part of the problem is that however relevant and correct a person is on an issue, the person’s issue may not be taken seriously if that person is not “a member of the club”. Journals such as the New England Journal of Medicine have so many submissions that they are always looking for ways to reject papers. I suspect that one criteria used is simply the status of the person submitting the paper. Fortunately, Dr. Hrachovec persisted. For me, when someone blows off my comments, it is a source of motivation, and I have had my share of rejected Letters.
- Bitter Pill How the New England Journal Missed Warning Signs on Vioxx. David Armstrong Wall Street Journal, May 15, 2006, page A1.
Facilitators play an important role in quality activities. For example, they often lead training and brainstorming sessions. Brainstorming is a key part of FMEA (Failure Mode Effects Analysis) and fault trees. Whereas this blog entry is not meant to be a summary of what makes a good facilitator, I was recently reminded of a problem with some facilitators; namely that of the filter.
Filters are people who while serving as facilitators, feel compelled to have all information go through them. The filter then re-releases the information but in a changed form. That is, whatever was originally submitted to the filter becomes changed into a form that the facilitator understands (which may or may not be the same as the person who had the original idea). In some cases the facilitator changes the way the information is presented by rewriting it or restating it (e.g., out loud). The latter must be familiar as one often hears, “now let me make sure I understand what you’ve said, you mean that, …., “.
There is nothing wrong with the concept of a filter, since in principle, a filter could make ideas more clear and if nothing else ensures that an idea is understood as intended. Whereas this is often useful – sometimes essential – between two people, the danger is when the filter is used in a group setting and the filter makes ideas less clear, changes ideas, or omits ideas.
I recall a CLSI (formerly NCCLS) strategy session a few years ago. I had prepared a list of issues which the facilitator rewrote. My list had already been read by the head of the organization with a few minor changes so this rewrite by the facilitator seemed completely unnecessary and more importantly, it failed to capture the issues as clearly as I had and at the same time dropped some issues. So the strategy session took place without the right list of issues and during the strategy session, all material went through the facilitator, as in “now let me make sure I understand what you’ve said, you mean that, …., “. The facilitator of course also wrote up the results of the meeting. In all, this was a lost opportunity, largely driven by a filter.
So a better way is for the facilitator to assemble all ideas through a consensus process. The final product may have some editing for readability but without the effects of a filter.
From a perspective on the AHRQ web site, Dr. Robert Wachter wrote in September of 2005: “It strikes me that much of the progress that we have made in the patient safety field over the past decade reflects a different kind of translational research: the translation not of basic research discoveries into clinical applications, but of insights and practices from non–health care fields into health care. To highlight the movement from non-medical fields into medicine, I propose that we call this translocational research.” (1).
I submitted the following comment about this perspective, but it got translocated into the recycle bin.
Dr. Wachter proposes that the mechanism of transferring practices from non healthcare fields into healthcare be called “translocational research”. Yet, this practice already has a name: “technology transfer.” If one puts the words “technology transfer” (with quotes) into the Google search engine, one gets over 32 million hits. Much has been written on the subject (2).
As someone who has spent time transferring engineering reliability tools into healthcare, I note whenever possible, the terminology should remain the same so that it is understandable to practitioners in the original field. Hence, I don’t see the need for inventing a new term.
- See http://www.webmm.ahrq.gov/perspective.aspx?perspectiveID=9&searchStr=wachter
- Davenport H and Prusak L. Working knowledge: How organizations manage what they know. Cambridge, MA: Harvard Business School Press, 1998.