Quality management principles lacking in health-care planning

As Canadians, we should be proud of the fact that, under the umbrella of the Canadian Standards Association, we developed and prepared the world’s first standard for quality management in 1975.

Somehow, however, we have forgotten our history and management practices that have become the gold standard worldwide.

Canada’s auditor general recently reported that the Public Health Authority “was not adequately prepared to respond to a pandemic.” In a written reply, the authority said that “COVID-19 has provided a lived experience of a global pandemic the nature of which Canada has not seen in over 100 years.”

But while it’s true that nobody plans ahead for 100 years, how about planning for one, two or 10 years? Or even one week or month in advance?

It shouldn’t be a problem but it is one and there is no excuse for it. The problem is the bungled supply chain to obtain vaccines and its poor service quality resulting in the haphazard administration of vaccines into peoples’ arms. More pointedly, the question is: Are we trying our best to solve the crisis?

As historian John M. Barry wrote of lessons learned in his classic 2004 book The Great Influenza, a chronicle of the 1918 flu epidemic that killed an estimated 50 million people worldwide: “Those in authority must retain the public trust” and “the way to do that is to distort nothing, to put the best face on nothing, and to try manipulate no one.”

The biggest problem has been a complete lack of attention to – and investment by the proper authorities in – the implementation of the modern science and methodologies of quality control planning, assurance and quality management, from A to Z. These proven management methodologies are used by manufacturing companies to continually improve their production systems and train their workforces and supply chains, top to bottom.

The same management methodologies should be used to handle health-care crises so that errors and inconsistencies are eliminated in the entire system, from vaccine purchase to administration, to minimize wasted time, effort and money.

Unfortunately, the lack of a federal plan in sync with the provincial and territorial sub-plans for a nation-wide vaccination project has been the biggest omission. Fragmented thinking, uncoordinated and ineffective communication plans between the centre and the provinces, failed technological promises and a lack of unified leadership have been strikingly obvious.

A plan, however, is not a plan until it is published and distributed to all stakeholders.  

The federal government and provinces can’t live on isolated islands, not in times of crisis. To fix this misalignment, a master plan envisioned, designed and written in a manner similar to a quality assurance manual for a multinational corporation is essential. Even though our health-care system is decentralized, the overall national health-management strategy need not be that way in times of national crises.

The logical place to start is the release of a federal “strategy document” under the leadership of the Public Health Authority of Canada outlining the vision and mission statements. It would list policy directions; specific federal roles and rules; desired outcomes; organizational objectives and structure; procedural needs to align health-care standards; regulations; equity requirements; procurement quality control; help of military personnel and emergency services as needed; border crossing; travel restrictions; and guidelines. An audit program would assess the overall project success and accountability.

Joint federal-provincial teams selected from health care, quality control, planning and emergency management fields would handle the separate federal and provincial tasks and responsibilities, list priority tasks based on risks and data and formulate communication plans.

Provincial and territorial plans must work in tandem with the federal plan so that chances of errors, inconsistencies and delays in vaccination administration are minimized to zero defect occurrence, or to quality management’s high-performance Six Sigma level, the most stringent quality control specification required for public health and safety that allows for only three mistakes in one million operations.

The provincial and territorial plans will require much deeper and finer details than the federal plan since they will be responsible for the vaccination rollout. They will need to outline program design, documentation and implementation and plan for vaccine distribution logistics and administration of vaccination rollout.

The design phase consists of appointing a CEO; formalizing policy statements; researching health-care standards; public awareness campaigns; writing statements on the vaccination program scope with answers to questions of 5W1H (who, what, where, when, why and how); developing a system for online vaccination appointments; finalizing the draft of the plan; and finally, publishing the plan in the form of a manual.

The documentation phase outlines procedures for vaccination and transportation; storage and handling; just-in-time delivery to selected locations; training of personnel; tracing and record keeping to follow-up on side effects; deficiencies; and maintaining data records on files.

The implementation phase critically requires a dry run along with employee training, dissemination of documents and forms, preparation of to-do lists, communication tools and a publicly visible time-scheduling chart for vaccination.

Everyone doing his or her best is not the answer. It is first necessary for all those on the team to know exactly what to do and be sufficiently trained on how to do the job right the first time. 

If there is a silver lining to the pandemic, it is the opportunity to question our status-quo in everything that we do. What has become clear is that pandemic or no-pandemic, Canada needs a national as well as provincial and territorial quality improvement strategy. To administer this strategy, it is high time that we have federal and provincial Ministries of Quality Improvement.

The magic word is “improvement.” Assurance of quality of life is a non-controversial, non-partisan issue. Engineering and management principles must be embedded into policy and decision-making at every level of government. Quality management will improve efficiency and effectiveness in providing public services. And save the taxpayers a bundle at the same time.

What is a bundle? Considering an estimated $380 billion in COVID-19-related federal spending, and taking the Fraser Institute study on about 30 per cent waste hidden in government services on a project of this magnitude, the suggested plan could mean a saving of $126 billion.

If there ever was a time to get dead serious, this is it.

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Madhav Sinha


Madhav Sinha (PhD, P.Eng), is the president of the Canadian Society for Quality.

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