Seven Deadly Sins of Quality Management Are
Found in Many Clinical Laboratories
Unproductive workplace dynamics retard performance improvement
Some quality experts are recognizing that the true root causes
of non-conforming events in clinical laboratories and pathology
groups are not flaws in individual work processes. Rather, they
argue the true root causes of defects are actually embedded
organizational values and beliefs which management uses to
justify and reinforce the way it organizes and operates the
This perspective on management values as the true root cause of
defects was articulated in 2003 in a paper titled the
Sins of Quality Management.” It was published in
Progress” by John Dew, Director of Continuous
Quality Improvement at the University of
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
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.
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
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
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.”
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.
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