Tools, Technologies and Training for Healthcare Laboratories

March Madness: Out-of-control in North Dakota

Dr. Westgard returned to his birthplace in March 2009. Reflecting on events there more than half a century ago, as well as those terrible floods of more recent times, Dr. Westgard writes that both past and present call us to quality.

April 2009

James O. Westgard, PhD

My apologies to the people attending the conference in Philadelphia last Month. I truly intended on being there to talk about “Customizing QC”, but succumbed to “March Madness.” For those of you not familiar with this term, it’s not a disease; rather, it refers to the basketball craze that takes over the US in the month of March. March is tournament time all over the country, from high school to college. Fifty years ago my Plaza High School team won the North Dakota State Class C basketball championship. We were invited back to this year’s tournament in Minot to be recognized for that long ago accomplishment.

It was wonderful to see many old friends. Seven of the ten members of the 1959 Plaza Lions attended, along with our Coach and his wife, our team manager and cheerleaders, and several other classmates. This included my brother-in-law Wayne who was a “gunner” on the team and my sister Margie who was a cheerleader. We also visited my home town which is about 50 miles from Minot. Plaza is a lot smaller than I remember, about 5 blocks wide by 7 blocks long. I can remember driving to school even though the school was on the next block kitty-corner across from our home. I had a neat ‘51 Chevrolet coup that I drove everywhere. My father’s garage is still standing and the sign “Westgard Implement Company” is still there.

Best of all, my son Sten and my grandson came along with me to celebrate this occasion. I think Sten gained a better appreciation of his roots and the great state of North Dakota. Having my grandson along just made everyone feel better as he is one of the most enthusiastic sports fans and a joy to be around.

I’m including several pictures here, but the one I like best was taken by my grandson! We were scheduled to fly from Minot to Minneapolis Saturday morning, but got fogged in. The flight was cancelled and we had to drive to Minneapolis, some 9 hours and 525 miles away. Along the way, my grandson took this picture which shows his view from the backseat. Sten is driving and that’s me on the right. The world looks different from the back seat. This picture reminds me that I’ve been fortunate to be in the front seat on a long road to quality.


This may be hard to explain, but basketball actually contributed to my life’s work in Quality Control and that’s why attending this reunion took priority over other activities. I learned a lot about teamwork, learned to work with a group of people to achieve something greater than what we could accomplish individually. Equally important, basketball had to do with gaining confidence to compete in a challenging world. Growing up in North Dakota meant learning to work hard and to take satisfaction in your own accomplishments, even when others didn't understand what you’re doing. Playing a defensive role on a high school basketball team could be a lonely job, but the coach recognized my role and my parents supported my efforts. That was enough for me to develop confidence in what I do and a sense of satisfaction in doing the “right thing right.”

I’ve been lucky to achieve recognition for my professional work. It has been surprising because I liken Quality Control to playing defense, rather than scoring points. Defense is usually noticed only when it breaks down and something bad happens. I think this applies to laboratories and clinical laboratory scientists as well. We're in the background of medical practice, yet our contributions to healthcare are immense and important, whether others understand this or not! Laboratory services are taken for granted until there is an interruption or failure, then, for a few moments, others understand the importance of what we do. We are an important part of the healthcare team, but our contributions are not often recognized. One of our profession’s ironies is that if we didn’t do such a good job of testing, everyone would be more aware of the importance of what we do. I’ve said before that the easiest way to gain recognition for Laboratory Medicine and the CLS profession would be to have one national testing holiday, rather than a week of national recognition.

As Sten, my grandson, and I drove through North Dakota, we could see the danger of the melting snow and the Red River rising. Many Dakotans are pitching in right now to play defense, adding sandbags to the dikes to hold back the rising water. The Red River has a history of flooding, in spite of repeated recovery efforts, which gives stark evidence that things do go out-of-control in the real world. Such an out-of-control event, like the "hundred year flood," is often thought to be a “black swan,” meaning an event is so improbable we believe it will never happen and therefore, we are unprepared when it does. Nassim Taleb, the author of the book The Black Swan: The impact of the highly improbable, notes that “Black Swans being unpredictable, we need to adjust to their existence (rather than naively try to predict them).” That’s a pretty good explanation of the need for Quality Control all the time, not just when there’s a storm warning.

Today’s companion to the Black Swan is risk management, a practice which just demonstrated a remarkable failure on Wall Street, yet is poised to take on a new role in healthcare laboratories. We are moving in the direction of “risk management QC,” which means that we will depend on a manufacturer’s prediction of what events might happen in order to minimize the time, effort, and cost of doing QC. In the context of Black Swan events, we are likely to find ourselves faced with an "unpredictable" event. Like Fargo, we'll probably have to rely on the heroic efforts of our citizens (the staff) to deal with a crisis, rather than reaping the rewards of prudent management decisions (i.e. a levee system like that of Grand Forks). These decisions will seem rational at the time, allow labs and diagnostic companies to cut costs and corners in the short term, and when the "unpredictable" crisis hits, all of us will be quick to assert there was nothing we could have done. This new “risky” management approach for laboratory QC is brought to us courtesy of CMS/CDC/FDA and ISO/CLSI. It’s arrival is imminent with the publication of EP22 and EP23 expected this year.

The lesson for laboratories is that we must continue to play defense because if we let down, bad things will happen and the failure-costs will be high. Hard-nosed defense and old-fashioned QC are still important! (And you were wondering how I could possibly segue from basketball to QC and even to risk management?)


Pictures from North Dakota

Breakfast at the Plaze Blue Star Cafe

Breakfast at the Plaza Blue Star Cafe: (left to right) Margie, Chuck Gates, Dennis Spletstoser, Coach Christensen, Joan Christensen, David Loock, Wes Bilden, me,, and Ardis Loock.

The 1959 State Championship Team with their Trophies

Back at the Plaza High School with the trophies: me, Wes Bilden, Coach Christensen, Wayne, David Loock, and Chuck Gates

Moment of recognition from the State Tournament Crowd

At the North Dakota State Basketball Tournament in Minot, getting recognition and a round of applause from the crowd:(left to right) Coach Christensen, Joan Christensen, me, Wayne, and Margie. Note the Plaza Lions letter jackets.


Another reunion - fans, cheerleaders of the team

At Sammy's Pizza Place, a restaurant where the team and fans would gather after the games: left to right) Ardis Loock, David Loock, Margie Splestoser, Wayne Spletstoser, Connie Patton, me, Beverly Johnson, Chuck Gates, Joan Christensen, Coach Christensen, and Jerry Knutson.



The Westgard Implement Company

Three generations of Westgards at the Westgard Implement Building in Plaza, North Dakota