Seven Deadly Sins of Quality Management Are Found in Many Clinical Laboratories

Unproductive workplace dynamics retard performance improvement efforts

This perspective on management values as the true root cause of defects was articulated in 2003 in a paper titled the “Seven Deadly Sins of Quality Management.” It was published in “Quality Progress” by John Dew, Director of Continuous Quality Improvement at the University of Alabama. 

Now, writing in a guest column for the October 2009 issue of “LabMedicine,” Lucia M. Berte, President of the consulting firm Laboratories Made Better! PC, notes that Dew’s seven sins represented a new taxonomy for looking at management mindsets, each of which can lead to quality programs. She then provided clinical laboratory examples of how these “undesirable beliefs” contribute to ongoing quality problems in the organization. 

      1.   Placing budgetary considerations ahead of quality.
Here Berte suggests that, by viewing the budgeted line items for quality activities as costs, lab managers fail to consider the cost of failure. The cost of failure includes the cost of recollecting specimens, repeating tests, reproducing reports and correcting reporting errors. When quality isn’t measured, managers fail to consider the cost of poor quality even as they reduce spending on activities that improve quality, such as staff training, continuing education, and ongoing implementation of quality management systems.   

2. Placing schedule considerations ahead of quality.
Berte observes that, while there is always time on every shift to look for lost samples, resend lost reports and take complaints, little time is devoted to activities that would correct the systemic issues that produce these defects. Slavish devotion to production schedules-which puts quality improvement activities on the back burner-means ignoring the fixes which would allow the laboratory to more easily accommodate the testing schedule.  

  3. Placing political considerations ahead of quality.
Offering the example of a lab manager telling staff “to never report any problems with nursing because that would simply increase the number of incident reports nursing files on the laboratory”, Berte describes this situation as one where politics within the organization governs quality-thus preventing effective quality improvement actions.   

 4.Being arrogant .
She observes, “I call it ‘professional arrogance’ when one profession looks down at another profession for not knowing what it knows and treats the other professionals as though they were simple-minded children.” Berte says that until professionals respect the other professionals in their clinical lab, “it’s the patient who gets hurt in the scuffle.”  

5.   Lacking fundamental knowledge, research or education.
When lab “leaders” pooh-pooh quality management activities as an added expense and burden on the workload, they fail to recognize how quality increases efficiency, organizational effectiveness and profitabilityne. This is an example of leadership dismissing the value of that knowledge. In labs where this attitude exists, she contends, “improving patient safety will be difficult at best.” 

6.  Pervasively believing in entitlement.
Under this sin, years of service make both managers and staff feel entitled to their jobs, salaries, and benefits. This feeling of entitlement creates resistance to accepting changes in their job responsibilities and the introduction of new technologies and economics. As a consequence, clinical lab management is inhibited from candidly assessing a lab’s performance, then sharing and acting on information that would improve the quality and performance of the lab.   

7.   Practicing autocratic behaviors, resulting in “endullment.”
Berte describes this as the situation where “management makes one-sided decisions and staff begrudgingly endures work process problems and must wait for management to discover them [the problems] and take action.” In such circumstances, top-down management shuts off the creativity, ideas, and willingness of lab staff to identify problems and develop solutions. That allows systemic defects to continue unaddressed.  

One of the interesting insights from the observations of Berte and the original work of Dew is how the art of management is advancing. Each of these seven deadly management sins describes situations and organizational dynamics that are familiar to anyone who has spent a few years in the workplace. The goal of these authors is to call managers’ attention to the seven deadly management sins and encourage them to fix these unproductive situations. In turn, not only would this improve patient safety, but it would make clinical laboratories a more energizing, productive place to work for all of the staff.