Personal

An updated version of this essay appears on the Nothing but the Truth about Quality book.

Dr. Westgard was given the 2003 Professor Alvin Dubin award for Distinguished Contributions to the Discipline and Practice of Clinical Biochemistry. The National Academy of Clinical Biochemistry presented the award to Dr. Westgard during the AACC meeting in Philadelphia. This occasion gave Dr. Westgard the opportunity to thank those who helped shape his career.

• It's an honor
• A career influenced by teachers
• Guided by mentors and colleagues
• Stimulated by sabbaticals
• Prodded by students
• Supported by family and friends
• Tusen Tak!

This essay is necessary for me to write, but not necessary for you to read. It is my way of saying thank you to the many teachers and professional colleagues who have been influential in my life and my work.

Those who frequent this website have probably figured out that I have a personal commitment to education and training that extends beyond the responsibilities of my job as a University professor and the interests of a small business such as Westgard QC. You may have even wondered "why does he do this," particularly making all these educational materials available on this website for free. Yes, we do sell some books, enough to support the website, but this is certainly not a way to get rich.

It's an honor!

Teachers generally do what they do because they love doing it! Most of you know that there isn't a lot of reward and recognition for teachers, in public schools or at a major research university. That's why it is such an honor to be recognized by the National Academy for Clinical Biochemistry 2003 Alvin Dubin Award for "presentations and teaching activities that continually contribute to excellence in the practice of clinical biochemistry." Education in clinical laboratory science doesn't have a very high priority in a Medical School, so it's rewarding to see that it still counts in the world outside where all these medical students will someday practice!

A career influenced by teachers

The reason for my dedication to teaching and training comes from many teachers who have influenced my career. They all helped me develop my abilities so I could help others in return. Starting with my mother and father, both of whom began as teachers, I was under a strong influence to learn and advance through education. My two sisters felt the same influence and became life-long teachers (as were their husbands). Only my brother strayed from this path to become a doctor. And we've had many heated discussions about his deviant behavior! The PhD vs MD argument always consumes the first part of any get together, but it's only takes an hour now.

In many ways, I've lived the life my father had hoped for. He graduated from college with a degree in Chemistry in 1929 - not a good time economically and even worse for families living in North Dakota where a long drought period was beginning. He turned down an opportunity to go to graduate school at the University of Chicago in order to stay close to his family and help them through the difficult times. He taught high school for a few years before returning to the family farm and implement and car dealership in a little town of 300 people. While teaching he met my mother and they "courted" through the thirties until the economics improved and they could afford to get married. By that time, he was fully committed to the family farm and implement/car dealership and any idea of following his own interests was gone. I always thought his personality was better suited to being a professor than a farmer and a business man and I'm sure he would have enjoyed the life I have been able to live.

So I grew up working on the farm or in the garage. Regardless of the weather, we always had work that needed to be done and I learned to work hard, which has been one of the redeeming characteristics for a small town Dakota boy. What I lack in smarts I can usually make up for with hard work and common sense. I learned that lesson on the farm, in the garage, and at home. My father taught me by giving me responsibility and direction. My mother taught me by providing counsel and inspiration and being an example of a person with commitment.

I graduated first in my high school class, which was a dubious honor since there were only 12 students in the class. The biggest honor was playing on the 1959 North Dakota Class C State Championship basketball team. That was a much more important achievement and actually a learning experience that has served me well through the years. Getting the defensive assignment on the other team's best player didn't provide any recognition in the box scores, but the coach (who I count as one of my teachers) was very aware of my contributions to the team and that was enough to keep me going and striving to do better.

I think my high school experience prepared me to find satisfaction in what I do, regardless whether it is recognized by others. That's why I'm not influenced too strongly by outside goals if they don't fit together with my own assessment of needs and priorities. Who would devote his academic career to issues related to quality when there is so little research money available to support studies in this area? Who would continue to invest time in clinical laboratory science education after a decade of closings and reductions of training programs in this area? Who would develop an Internet training program in Laboratory Quality Management when all that is required by CLIA is to run 2 controls per day? Obviously, it must be someone of Norwegian heritage who has a stubborn streak that is way outside the 3SD limit of normal variation.

In college, I met the professor who had guided my father through his chemistry studies. He was just retiring, but there were two other chemistry professors who became the guiding forces in my college career. One was an analytical chemist whose enthusiasm knew no bounds and demands for excellence were the first serious challenge that I faced. The other was an organic chemist who provided me with an opportunity to do research and also a link to the University of Wisconsin. In graduate school, I had the privilege of being a teaching assistant for a renowned teacher of freshman chemistry courses. I had used his books as an undergraduate and couldn't believe my luck in getting to assist with his classes. His example and dedication to teaching was perhaps the most influential of all because he was here at Wisconsin. In addition, my major professor was the author of one of the standard texts in analytical chemistry, and I learned that education was an avenue to influencing practices, as well as helping people.

Guided by mentors and colleagues

The influence of teachers was extended by having mentors and professional colleagues who provided guidance and advice and served as professional role models. I will include some names here because many of you will recognize these clinical and medical scientists. Dr. Royden Rand and Dr. Roy Barnett were two of my earliest mentors. I learned from them mainly by studying their papers, along with occasional contacts in some national committees and at national meetings. Dr. Rand emphasized the importance of sound analytical principles, methodologies, and standardization for making measurements in clinical chemistry. Dr. Barnett advanced quality from a qualitative idea to quantitative requirements for laboratory tests.

On the job, it was the medical technologists in the clinical laboratories at the University of Wisconsin who first helped me understand the need for quality and the efforts required to evaluate and control analytical processes. Several technologists provided strong influence, among them Marion Hunt, Patricia Barry, and Elsa Quam, as well as clinical chemists such as Dr. Neill Carey, Dr. Carl Garber, and Dr. David Koch, and clinical pathologists such as Dr. George Cembrowski and Dr. Frank Larson. Dr. Larson was actually an Internist (and will cringe at being called a clinical pathologist) and the Director of Laboratories who originally hired me at the University of Wisconsin and opened the door to a career in Clinical Chemistry. Other influential Wisconsin colleagues are Drs. Merle Evenson, Ian Carlson, Russ Tomar, Don Wiebe, and Ron Laessig, all of whom have been very helpful throughout my career. My only reservation about these Wisconsin colleagues is that you can't believe any of the stories they tell - particularly Don and Ron.

One thing that we developed at Wisconsin was a method validation approach that provided a more standardized process with objective data analysis and a clear decision on acceptability. That work included the development of the total error concept and the definition of quality requirements in the form of an allowable total error. Total error is so well accepted today that few people remember there was a long fight to get it introduced into clinical laboratory practice. That fight was won by teaching the ideas to the analysts in the laboratory who could see the practical value of the approach, even though the reigning clinical pathologists of the time opposed the ideas. Drs. Carey, Garber, and Koch have continued to present method validation workshops to this day, setting the record for the longest continuously offered workshop at the national AACC meeting.

Today I work closely with Dr. Sharon Ehrmeyer and Dr. Teresa Darcy, both of whom make a commitment to education that is inspiring. Medical Schools can be very narrow minded in their interest and support of medical education, meaning they only recognize medical student education as being important, so one needs some supportive colleagues who have similar ideals and values. Sharon and Teri provide that support for me and make it fun and enjoyable to be a teacher.

Stimulated by sabbaticals

During a trip to a European conference very early in my career, I visited Dr. Bernie Statland while he was studying in Denmark. He introduced me to good Danish beer and also showed me the value of spending some time studying at another institution. That convinced me of the value of a sabbatical leave and I have taken two that provided tremendous learning experiences. The first was in 1976-77 at Uppsala University in Sweden, where I was able to work with Professor Carl-Henric deVerdier, Dr. Torgny Groth, and Dr. Torsten Aronsson. That association was critical to the development of the quality control ideas and the "Westgard Rules", which are now so well known. The Uppsala-Wisconsin collaboration prospered for many years and led to other collaborations with Scandinavian clinical chemists.

My second sabbatical was in 1989-90, when I spent part of the year at Hartford Hospital working with Drs. Robert Burnett, Robert Moore, and George Bowers. Some of the initial inklings about the need for Six Sigma performance came out of this work, particularly in a paper on "Precision requirements for cost-effective operation of analytical processes". We recognized that "more demanding selection criteria (5s-6s < TEa) may be necessary for testing sites where the personnel have little training in analytical techniques, limited understanding of the testing processes, and limited skills for evaluating performance and trouble-shooting procedures." A decade later this idea is starting to ring true across many industries.

The other part of my second sabbatical was spent at Odense University in Denmark, working with Dr. Per Hyltoft Petersen and Dr. Mogens Horder. The QC design tool - the chart of operating specifications or OPSpecs chart - came out of that work and led to a QC planning process to select control rules and the number of control measurements on the basis of the quality required for a test and the precision and accuracy observed for the method. That work, in turn, led to the invention of an automatic QC selection process and the formation of Westgard QC as the mechanism to transfer that invention into a practical form through development of computer software.

These sabbaticals have opened many doors and internationalized my group of friends and colleagues, which in turn has broadened my interests and applications. This special group includes Drs. Henk Goldschmidt from Holland, Jean-Claude Libeer from Belgium, Callum Fraser from Scotland, Carmen Ricos from Spain, Nuala McCarroll from Ireland, Ellen Olafsdotter from Iceland, Else-Maj Suolinna from Finland, and Elizabeth MacNamara from Montreal Canada by way of Ireland.

If I could give young laboratory scientists some advice, I would tell them to take advantage of any sabbatical opportunities that come along. It's a way to step away from the constant demands of a service laboratory and have some time to think about how things ought to be done, rather than just how to get things done right now. A sabbatical is an investment that often carries with it some financial risk, as well as the practical difficulties of relocating your family. It takes a commitment from your whole family to do this, but there will be many benefits from the experience and they will last for several years. Professionally, I can plot my publication record and see the impact of each sabbatical. It clearly shows that I need another sabbatical right now!

Prodded by students

"I wish he could be more exciting." I get this comment every year from student course evaluations, but usually from only one out of twenty students. It's not really a false alarm from 2SD limits because it correctly reflects that my teaching style is rather dull. As I said, I'm Norwegian and we're pretty reserved people! Most students get past this limitation and recognize that I actually am excited and enthused about what I teach and what I do. One delight at this stage of my career is hearing from people who were once a student in my classes at the University, a participant in a workshop at a professional meeting, or an avid reader of my books and papers. Many now appreciate what I taught them, even if they weren't so happy with the style of teaching.

I most enjoy teaching workshops where the participants have a few years of experience in the laboratory. Style is not so much a concern because they quickly recognize the value of the contents. They get enthused because they can see that the ideas, tools, and techniques are practical and useful in their own work. The Westgard workshops that we have presented in Madison in the late spring over the last three years have been the most satisfying teaching experience because the participants are ready and willing to learn, eager to hear new ideas, and looking for approaches that are practical and useful in their own work. A comfortable setting away from work and other distractions is also helpful, and Madison at this time of the year is a beautiful place to be. We've had some truly enjoyable experiences with people from all over the world - Portugal, Denmark, Scotland, Germany, Belgium, Columbia, Montreal, Toronto, Vancouver, and all over the USA.

Because of the ongoing contact with students - yes, even their negative comments, I continue to change the materials and courses that I teach. That constant prodding from students is an important part of continuous improvement in teaching and is truly valuable to the teacher. And the positive feedback that continues to roll in later on soothes any short-term irritations.

Supported by family and friends

We have a granddaughter Linnea, who is named after Carl Linneaus, the Swedish botanist who established the system of classification and nomenclature for plants. She's a constant reminder of the good times our family had in Uppsala, visiting the Linneaus gardens and eating the special Linneaus cookies that honored his birthday. She's also a reminder of the importance of balancing one's career with one's family responsibilities.

I have always said that the brains in our family belong to my wife Joan and that if we were part of the current generation, her career would overshadow mine. Joan began as a teacher, but after having our children, returned to the workplace at a time when there were no jobs for teachers. She pursued a program in public administration and eventually became the Director of Budget Planning for the University of Wisconsin System. Fortunately for me, she has always been supportive of my work and interests and has tolerated my many travels and working vacations for some 38 years now. Now that she has retired, she helps even more, especially with Westgard QC business.

Westgard QC was made possible by the help and support of Bernie Stein and Robert Kennedy. Bernie is a long-time friend from industry who fortuitously retired at the time I needed help to develop the patent for the automatic QC design process. Robert Kennedy is a friend from the University of Wisconsin and a former neighbor from Stoughton who provided the guidance and skill to go forward with the software development.

The other major contributor to Westgard QC in our son Sten, who has made it possible to develop the teaching materials available here and in hardcopy form. Westgard Web was his idea and he developed it from scratch. Being a History and English major, Sten is self-taught on computers, much like I am self-taught on statistics. He has pursued formal studies to legitimize his activities and in May of this year received a master's degree in computer science. It has been a wonderful experience to have the opportunity of working with Sten. Anyone who has grown up on a farm has experienced a different relationship with their parents because they have worked together. Westgard Web has provided that opportunity for us and it has been very rewarding.

Both of our children, Sten and Kristin, have wonderful families, with a total of three grandchildren, each of whom is very special. Kristin's contribution to my professional achievements is less obvious, but she's the real reason for the Westgard Rules. During her teenage year, when I tried to control her late-night partying, I told her "if you're out once after three, twice after two, or four times after one, you're in big trouble." I learned later that these rules work better in the laboratory than at home!

Tusen tak!

So this is my way of saying "a thousand thanks" to the many people who have influenced my work and contributed to my career. You can see the importance influence of teachers throughout my life and, with that perspective, you can understand why teaching has been so important to me. My career has been a good balance of research, teaching, and service, but I don't necessarily do all three all the time. There are times when research predominates, and other times when service or teaching takes the highest priority. Research results must be tested for practicality and applicability through a service laboratory. Research must be translated into widespread practice through teaching. In effect, teaching is the marketing that is necessary to make research available to the laboratory scientists in the field.

It's an honor and a privilege to be a teacher, especially if you consider me one of your teachers!

James O. Westgard, PhD, is a professor of pathology and laboratory medicine at the University of Wisconsin Medical School, Madison. He also is president of Westgard QC, Inc., (Madison, Wis.) which provides tools, technology, and training for laboratory quality management.