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Thread: The Cost of Quality

  1. #1
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    The Cost of Quality

    How many times do we hear senior managers refer to the cost of quality, regulation and accreditation, but never about the impact of not addressing poor quality practices?
    With adequate staffing, skill mix, training , supervision, resources and allowing properly supported development as per UKTLC standards, we can:

    1. Reduce inappropriate blood use = improve patient care = Reduce £££.
    2. Improved training =reduce wastage of blood, reagents, consumables= Reduce £££
    3. Improve job satisfaction= reduce staff turnover , sickness, loss of expertise = Reduce £££
    4. Improved training and knowledge- Reduce errors and time to investigate=Reduce £££
    5. Reduce errors= reduce the impact on staff / second victims , patients ,society, reduce litigation costs = Reduce £££
    6. Allow staff to fulfill their roles = increased job satisfaction, pride , morale ,productivity ,patient safety, reputation etc.= Reduce £££

    Why is the age old concept of poor quality/culture= increased costs still not understood within some Pathology services?

    W Edwards Deming: You canít exhort, beat, in cent a workforce to achieve excellence. You can achieve compliance but not excellence.



    Last edited by Orr; 14th Apr 2018 at 10:32 PM.

  2. #2
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    During recent discussions with colleagues it is of concern to hear that staff numbers are being further cut at some sites due to the transfusion teams instigating good patient blood management practices. For senior management to define a transfusion lab staffing levels based merely on number of units issued/ transfused is very short sighted, and will not help to achieve the quality practices we are aiming for . The amount of work to supervise, train,educate, mentor staff to help our clinicians make the correct transfusion decisions and prevent inappropriate blood use, and suggesting more appropriate treatments is far more important- and reduces overall blood use, which in turn promotes better patient care.
    Again, another example where short term cost savings in pathology are the priority and patient care is not.
    Be good to hear from sites where this is happening.
    Best wishes
    Rashmi

  3. #3
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    Send them a copy of the Barnes report

  4. #4
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    Thanks for the reference EClarke- the Barnes report ( Pathology Quality Assurance Review -2014) has some interesting references I could use. Little disappointed that even though this refers to CQC , these inspections don't appear to look into Pathology services accreditation or loss/ suspension- as this this is a significant KPI of service culture. Perhaps a bit more joined-up thinking with various inspection bodies could identify sites that are at risk much earlier.

  5. #5
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    Without sounding too angry I blame the Carter report for making accountants (Execs) think that there is money to make (save) out of Pathology. Size isn't everything! When a department is run with the appropriate numbers of properly trained staff at the appropriate level using the right equipment being used safely as per the QMS etc, THEN it reduces the level of risk as everyone is on it! Reduced numbers of incidents means that the TRUST can reduce it insurance premium and PAY outs to affected patients. Using a LEAN perspective quality will shake out the savings/income generation as better ways are found to work and do more work quicker but we must be careful not to sell our birth right as we do this i.e. dumb everything down e.g. x matching on machines.......

  6. #6
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    Interesting points Simon. Many others have commented on Carter being misinterpreted and contributing to the state of Pathology, but no one is about to stand up and say that it’s time for a full and honest review of the impact. Instead, these changes continue with a lemming-like march to the cliff edge. Invest in the labs, teach lean/ Kaizan methods, think of different staffing structures and some cooperative working and then we will see improvements and make savings.
    How can it be right to give individuals so many responsibilities without the tools to achieve success?
    Why are so many BBMS stepping down from posts , going-off sick or feeling stressed most of the time? This is an indicator that should be looked at.


    Is no one looking at the bigger picture?


    There is a need to invest and teach and not create these massive factories where everyone is expendable and no one really cares about the people. This loss of camaraderie certainly contributes to overall culture issues.
    If we look after our staff, they will look after the patients with the same dignity ,respect and compassion shown to them.Simple really.

  7. #7
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    Interesting to note that documents on the creation of the 29 Networks in the UK shows insignificant cost-savings involved. Considering that staffing levels in transfusion depts in particular to address regulatory needs and across pathology as a whole have never been properly calculated- resulting in massive staff deficits. These plans were flawed at the start when no consideration was given to the quality or training structures and individual training needs.
    The introduction of so-called 'shifts'- which are in fact mostly lone working without staff having proper rest breaks, and are introduced without increasing the core day staffing levels is a major issue. This will result in having to eventually increase staff levels- which will negate the alleged 'cost-savings'.

    Additional layers of management within these structures without the understanding and ability to carry out roles is also a contributory factor.

    Apart from this, the IT infrastructures that should have been the priority are an afterthought.

    Is it any wonder we have a demoralised,demotivated and highly stressed workforce that is also becoming an inexperienced pool of staff, as many are leaving these conditions? No doubt we will all soon see patient safety incidents escalate as a result of inadequate time to train and expose staff to managing these inadequate 'shift' conditions. Transfusion staff must have access to the right out of hours technical support as well as learning to cope with increasing workload demands-which requires time to acquire this.

    At what cost to everyone involved?

    So I now challenge all involved across the organisations and regulatory bodies, to properly and honestly perform a full review on these Networks- looking at realistic staffing levels, skill mix, efficiencies, cost of correct IT infrastructures and every aspect of the service.

    It would have been easy to make savings and improvements without the damage caused to the teams involved.
    Last edited by Orr; 25th Sep 2018 at 10:17 PM.

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