When the noble science of Science degenerates into junk science the ripples of scepticism resulting from feelings of betrayal and anger have the potential to become a tsunami.
"In the U.S., the Federal Bureau of Investigation admitted last April that hair identification testimony from its forensic scientists was flawed in 95 per cent of the 268 cases before 2000 it has reviewed so far. In 32 of those cases, the defendant was sentenced to death."
The above is from an op-ed by criminal defence lawyer, Daniel Brown, in today's Toronto Star.
Before Canadians feel too smug here's another snippet:
"Bad science is an alarming thread that runs through almost two dozen Canadian wrongful murder convictions exposed in recent years by the Association in Defence of the Wrongly Convicted (AIDWYC). The roll call of errors in these cases includes clothing fibres mistakenly believed to match one another; experts who incorrectly concluded that dog bites on a dead child were knife wounds inflicted by her mother; inept autopsies that misinterpreted the cause of death; biology samples contaminated by a government lab technician; and hair samples that anchored a murder conviction, yet later turned out to be worthless."
The only consolation for Canadians is that Canada does not have a death penalty. Innocent people have not been killed; they have simply languished in jail while their children were removed and placed in group homes, foster care or adoption.
In his piece, Brown observes,
"Wealthy defendants are able to afford top lawyers and expert witnesses, but indigent accused or those from marginalized communities frequently bear the brunt of bad science evidence. They cannot match cases assembled by well-funded police and prosecutors, sometimes pleading guilty to obtain a reduced sentence in the face of superficially overwhelming evidence."
The Alchemist by Pieter Bruegel
Brown makes some conclusions that I think are predictable and precisely to my first point about scepticism:
At precisely the time we ought to be exercising heightened skepticism, a mistaken belief is developing that wrongful convictions are a thing of the past.
And again…
Judges must be better trained to weed out junk science and unwarranted opinions offered by experts. And they must warn juries about the perils of placing too much reliance on science or picking sides in a battle of experts.
This reminds me of manufacturers relying on inspectors to 'inspect in' quality. As W. Edwards Deming pointed out decades ago, that is far too late in the production cycle and way too susceptible to error. Would we fly to our vacation spots knowing the plane we are on did not have adequate requirements and design review, risk and failure modes analysis, verification and validation prior to 'inspection'? Heck, let alone fly, we don't even allow cars on the road that have not been built according to this process, and yet we trust that our 'scientists' all use correct scientific methods and design of experiment even though they often do not bother with peer review. Hello?
This fascinating article, A Look Back at the Early Days of Lean by John Dyer was published by Industry Week back in September. John is one of those people who was lucky enough to have done a (now famous) 4-day seminar with Dr. W. Edwards Deming.
Here are 3 of his Deming quotes that I particularly like.
“No knowledge without theory. Schools teach information, not knowledge. Information is not knowledge. People go to Japan (to copy what they are doing there) and don’t learn anything because they don’t understand the theories. I hope they enjoyed the ride!”
“We must focus on win-win. Would you want to be married to a loser? Would you want to be in business with a loser… work with a supplier that is a loser or employees that are losers? We must work as a system, Union and Management. Everybody wins.”
“What state of a company is in the best position to improve quality? A healthy company is in an excellent position to improve and has the greatest obligation to improve. A company on the rocks can only think of survival.”
If you know nothing, or just a very little, about Lean, here is a five part, easy-to-follow video series that will introduce you to all the major concepts and elements. The whole series takes just under 50 minutes to watch.
The first video on the history of lean is optional. stands alone and can be watched any time. I do recommend watching the others in sequence as they build on each other.
Can we claim an (ISO 13485) exemption to the requirement for a procedure for issuing advisory notices? We are not a finished medical device manufacturer, but we will supply components to customers who will assemble them into finished medical devices.
This is a good question and I like the response from Christopher Paris. You can see the full question and response in the LinkedIn discussion, Advisory Notices.
Just today, an old friend reminded me of this G. K. Chesterton saying that I used to quote more frequently and could profitably start using more frequently again. Our conversation was in the context of 'Kaizen' where I wrote: Even if it ain't broke, it can - and must - be improved. Imagine if the first wheel was never improved upon, or the first bicycle/car/plane... This, in turn, led me to do a search on the Chesterton quote and I found this excellent article, A Thing Worth Doing, on the American Chesterton Society web site.
Cutting costs as an emergency measure to cut losses to get you through this financial period is one thing. Cutting costs in order to boost profits and take you beyond your next financial report period requires a different strategy, My hero, Dr. W. Edwards Deming, helped Japanese businesses tackle that question very effectively. Focussing purely on cutting costs when the root issue is questionable quality, you may end up sacrificing the family farm to the god of cost reduction.
Profit, Costs and Quality: what's the relationship?
(I discovered too late a typo with 'collateral'. My apologies.)
Myostat Motion Control Inc. recently passed their certification audit for ISO 9001:2008 with flying colours. I am very appreciative of the recommendation that their CEO and President, Chris Murray, wrote on my LinkedIn page:
Myostat brought Terry on board to consult on our ISO 9001:2008 preparation and initial certification audits. The project was a great success due to his insightful observations and firm guiding hand. Everyone at Myostat appreciates the hard work, flexibility, expertise, and professional attitude that Terry brought to the team. I highly recommend having him on your side for any project management or quality management initiatives.
Thanks for the kind words, Chris. What a pleasure it is to work for a CEO who is, himself, the Management Representative for Quality.
Seeking admission to a long term care (nursing) home for yourself or a loved one in
Ontario, Canada is a process regulated by the Province of Ontario Ministry of Health and Long Term Care. The process is administered by the local CCAC (Community Care Access Centre) in the area where the person seeking admission
resides.
The above link will tell you how to do the next step: contact the CCAC (Community Care Access Centre) in the area where the person seeking admission resides. A care coordinator will help you determine
eligibility and whether an LTC home is the right decision. If it is, they will
then tell you to choose up to five homes. That is when your work really begins.
Assuming
all the above is now behind you, the rest of this article provides pointers for
some things to look at when making comparisons between homes.
Points
to compare between LTC homes
You can find a list of LTC homes in say, the Newmarket area, at the Ministry of Health and Long Term Care web page: Reports on Long-Term Care Homes. Go to the web page and click on the link, 'Find by location'. This takes you to the page Search for LTC Homes By Location
Enter
whatever town is of interest to you into City/Town and click next.
This
takes you to the page Long-Term Care Homes
Search Results. If you entered 'Newmarket' you would see a list of 4
homes to choose from and compare, each with a link that takes you to that
home's report page with two tabs, one for the home profile, the other for the
home's inspection reports in descending chronological order. You may want more
of a choice. In that case, instead of specifying the town, enter the
county/district.
Inspection Reports
The
inspection reports should be of particular interest to you.
1 Resident
Quality Inspection reports are reports from annual inspections by the
Ministry of Health and Long Term Care, and are the most thorough. Inspection
findings are presented as Written Notifications (WN). A WN may conclude with
a Voluntary Plan of Correction (VPC) or, more seriously, a Compliance Order, Director Referral or Work and Activity Order:
DR –
Director Referral
CO –
Compliance Order
WAO –
Work and Activity Order
Not all
WN's are equal. Use common sense to distinguish something like stained
upholstery or missing ceiling tiles or wrong menu courses from noncompliance that poses risk of harm to
residents as with improper control of drugs and medication and broken wheel
chairs or doors not locking with the correct protocols allowing dementia
residents to wander.
2 Critical
Incident Inspection reports are typically as a result of a resident
experiencing some harm. When this happens, the home administrator is required
by law to report the incident within a fixed period of time. The Ministry will
look at the report and decide whether or not to follow up with an inspection to
more fully investigate what happened and whether the home is following all
required procedures.
3 Complaints
inspection reports are as a result of Ministry follow up on an official
complaint lodged by a resident or family member. Complaints are often made in
confidence. There is a strict code against retaliation and abuse.
Sample list of inspection reports
In my casual observations I have found there is
generally, on average, an inverse proportion between the number of critical
incident and complaint reports and the length of the wait period for admission. It would appear that the most desirable and well-run homes typically have the longest queues for
admission.
Health Quality Ontario Reports
In
addition to the inspection reports which are focused purely on compliance with
the Long Term Care Homes Act and associated regulations, there are some other
important indicators that you will want to look at that focus more on quality of life. Health Quality Ontario (HQO) currently reports publicly on four quality indicators for individual long-term
care homes. These indicators relate to four health topics:
Click 'By Home' and then enter the first few words of
the home name to get a list to choose from. Choose the desired home and click 'Search'.
You will
see a table that shows how the home compares with the provincial average on
each quality of life indicator. You can also see whether the home is improving
over the previous year's performance and how it compares with the optimal
benchmark.
Example of Health Quality Indicators
So now,
you have looked at inspection reports and quality indicators for some homes and
discovered that comparing homes in this way is not a trivial undertaking.Once you find a 'maybe' home, phone the home
and arrange a tour. Web sites for most CCAC's offer a list of questions to enquire
on. You can find a very comprehensive tour checklist here: www.nursinghomeratings.ca/downloads/NursingHomeTourChecklist.pdf
Most
people who do the tour do not ask questions. Don't be timid or afraid. You
don't have to ask every question on the check-list, but know beforehand which
are the important questions for you. If you do not feel comfortable asking in
front of other people, confirm that you can phone later and ask your questions.
There is
a lot of information here. I sincerely hope this is not too confusing. Just
take your time to work through the steps.
Registration and Accreditation
All LTC homes in Ontario have to be registered with the Ministry of Health and Long Term Care and are subject to inspections by the Ministry. In addition, some homes seek accreditation from bodies such as CARF and Accreditation Canada. These are standards bodies that assert with accreditation that a long term care home has certain procedures and protocols in place and abides by them. These operational procedures and protocols are in addition to those required for registration by the Ministry of Health and Long Term Care. The Ministry does not require accreditation but encourages LTC homes to acquire accreditation by granting certain funding premiums to accredited homes. Intuitively one would think that this should be a good thing. However, when it comes to complaints and critical incidents there are both accredited and non-accredited homes with a high rate of these inspections just as there are both accredited and non-accredited homes with a low rate. I recommend placing a higher reliance on your own due diligence in reviewing inspection reports rather than merely presuming that an accredited home will automatically have a better record in this regard than a non-accredited home.
I base the above advice on a statistical analysis that I did comparing accredited and non-accredited homes. You can review the two-part analysis in the following videos.
Somebody asked for clarification in implementing Clauses 8.5.2 (Corrective Actions) & 8.5.3 (Preventive Actions).
I don't claim to know all the thinking behind the elimination of the term 'preventive action' in the soon to be released 2015 revision of the Standard, but I do know that many people of my acquaintance are not clear as to the distinction IN PRACTICAL TERMS between corrective and preventive action even though they can rattle off the definitions from ISO 9000 which I still find relevant and helpful: corrective action PREVENTS RECURRENCE of a nonconformity, preventive action prevents first time occurrence of potential nonconformities. The word 'prevent' is possibly the source of confusion. Indeed, if the action taken for a corrective action is to revise a process, that will likely prevent other, potential nonconformities as well as prevent the recurrence of the nonconformity or defect under consideration; that is, a preventive action comes as a by-product of the corrective action even if the potential nonconformities have not been explicitly identified, and quality will improve.
In my last position (medical devices) it was part of the process to consider the desirability of performing a preventive action after every corrective action. If the root cause analysis suggested a process change then this was usually done as a preventive action as that invariably went wider than just the nonconformity under consideration.
The practice of considering corrective actions when doing corrections is quite common in my experience and seems like common sense. Do not skimp the very important step of investigation to fully identify and describe the problem. What, where, when, who, how often, what is the impact? This is a prerequisite to root cause analysis and risk analysis.
Many of the best things in life, including in business and professional life, come as by-products of doing the right other things, and doing them rightly. Many activities that we enjoy and take for granted, such as playing with our kids or grand-children, are dependent upon our good health which, in turn, is largely dependent upon a healthy life-style - what we eat, exercise, mental attitudes, emotional IQ.
Our lives need a 'Life' Quality Management System to support our quality of life and health so that we can do the things we value - and so do businesses and service organizations, whether large or small. Are any of the following on your wish list?
I wish I could feel more in control of things
I wish we could prevent things going wrong unexpectedly so often
I wish our quality control was better
I wish we could reduce the number of defects/errors/critical incidents
I wish that fixed defects did not pop up again
I wish we did not have to do so much re-work/retooling
I wish we did not have so many changes 'on the fly'
I wish our clients or customers would make up their minds
I wish our clients or customers would do a better job telling us what they want
I wish we had a better handle on our contracts
I wish we could reduce the number of complaints
I wish we had a better history of complaints for clients or customers
I wish we could improve customer/client/resident satisfaction
I wish we could produce more useful quality metrics for our departments
I wish we did not have so many probing and burdensome site visits
I wish our suppliers were more reliable
I wish staff morale was better
I wish staff would stop passing the buck and blaming one another
I wish we could reduce staff turn-over
I wish we could reduce staff absenteeism
I wish it was easier to train new staff consistently
I wish it was easier to find the latest specifications/requirements
I wish it was easier to find the most up-to-date documents
I wish documents were kept updated
I wish documents were all in one place
If any of the above are on your wish list, a new or improved Quality Management System is probably what you really need. The rest will follow as a by-product!
I think that quality people are sometimes their own worst enemies when they focus on the bureaucratic aspect of the Quality Management System and try enforcing it as an end in itself. I used to be irritated by an Engineering manager who told me that what I was asking for was b-s. He would ask, what is the value add? He was right, of course, and today I am grateful for the irritating challenges he repeatedly presented. Can we join the dots between our QMS and the effectiveness, reliability and efficiency of our processes to produce good quality products and services that consistently exceed customer expectations? This, I believe, is the message we need to be getting across because then there should be dots connecting to cost effectiveness or, at least, to a door into the discussion on the relationship between quality and profitability.
At a minimum this requires that our processes be periodically reviewed by stakeholders for waste and for pain points. Is there a better way? Such reviews create opportunities for preaching quality as needing to be effective, reliable and efficient.
Watch this 9 minute video from The Deming Institute showing Dr. W. Edwards Deming talk about his 14 Points.
Deming: lead your team, don't supervise them, explain don't give orders. Every employee has a customer to satisfy and a supplier whose cooperation is nessary. Train and retrain, yes, but don't limit that to 'work related' stuff; encourage self improvement by elevating people's minds. I love this one: some people seem to think that putting out a fire in a burning building is improving the building. It's not. That's putting out a fire!
A report titled, Home solutions to our care crisis, was published in the United Kingdom by the Papworth Trust in November, 2012. The report is the distillation of 640 responses from their English Housing Survey conducted to see how unsuitable housing can affect people's lives. A secondary aim of the survey was to help increase awareness of home adaptations as a solution to the care crisis for the disabled being experienced in the UK.
Home adaptations would include such things as: bathroom conversions, grab rails, kitchen alterations, ramps and level access, widening doorways.
One in 4 respondents reported that they could not get around their home safely.
Two in 5 people said that a lack of facilities for the disabled in their home meant they needed help to do everyday things like cooking.
Two thirds of people who had not received a government Disabled Facilities Grant (DFG) had never heard of it.
Here in Ontario, or Canada generally, do we have any reason to think that we would not get responses similar to those in the UK?
Financial benefits of home adaptations
Analysis by the London School of Economics suggests that the annual spend on governmental Disabled Facilities Grants of around £270 million is worth up to £567 million in health and social care savings and quality of life gains. Put differently, every £1 spent on Disabled Facilities Grants is worth over £2 in care savings and quality of life gains.
A study by Bristol University, on behalf of the Office of Disability Issues, found that home adaptations can help prevent or defer entry into residential care. Just 1 year’s delay means a saving up to £26,000 per person, less the cost of the adaptation (which averages £6,000). (Can somebody tell me the cost per person per year for long-term care in Ontario?)
Falls by older people in the UK cost over £1 billion a year. A fractured hip can cost the state an estimated £28,665. Compare this with the cost of installing grab rails, one effective way of reducing risk of falls.
In Wales, the Government has estimated that a programme to help older people remain living independently in their own homes has saved the NHS and social care budgets over £101 million since it was set up 10 years previously.
Home Adaptations: A Cost or an Investment with a Return?
There is a common mindset that presumes any initiative requiring money is a money-grabbing cost to the tax payer that should be fought tooth and nail. It should be evident from the above that judicious implementation of home adaptations is actually an investment that should produce a return in both financial savings and quality of life.
(This report titled, Home solutions to our care crisis, was published in the United Kingdom by the Papworth Trust in November, 2012. Does anyone know of any similar studies conducted anywhere in Canada, especially Ontario?)
A process approach is key to good quality management. Taking a process approach is tough if you are not familiar with key concepts and tools associated with processes.
This fun and easy to follow presentation illustrates the key concepts surrounding processes using process maps, workflow flowcharts and turtle diagrams.
