Tools, Technologies and Training for Healthcare Laboratories

Understanding Quality

What does the word "Quality" mean, anyway? Is it an absolute or relative term? Jerry Ehrmeyer, a frequent speaker at AACC conventions, discusses what "quality" really means, using everyday examples from the quality of wine to the quality of maps.

The origin of the essay as a literary form is generally attributed to Michel Esquem de Montaigne, a 16th century French philosopher. By definition, the “essay is a written interpretation of experience.” 1 The object of an essay is to present an interpretation of, or personal response to, a particular condition or event. To that end, I submit the following as one person’s interpretation (understanding, if you will) of Quality.

Defining Quality!

Quality is one of those words that evokes an array of mental images, depending upon one’s background and experience. Quality is, etymologically speaking, a concept (an image, idea or theory). It is what we say it is, or determine it to be through general consensus! When used as a noun it can describe an essential characteristic, property or attribute--as in the slogan used by the Ford Motor Company that proclaimed, “Quality is Job #1.” When used as an adjective it can describe a distinguishing characteristic or feature--as evidenced by the worldly acclaim for the quality wines of Clos de Vougeot.

The true meaning of the word quality is diminished by its redundant and, seemingly, ubiquitous use. We are inundated on a daily basis by those who wish to provide us with a product or service of exceptional quality--a lesser claim would be counterproductive! Consequently, we have come not only to expect quality, but demand it--even when unsure as to how it is defined. Thus, quality--like truth, freedom, love and beauty--invites personal interpretation, which only bifurcates our efforts to establish a truly workable definition.

Quality: Relative or Absolute?

Thirty-two years ago when being interviewed for a teaching position, I was asked if “freedom” was relative (comparative, in reference to something else) or absolute (not conditioned by, or dependent upon, anything else).2 Of all the interview questions I have fielded throughout my career as an educator, it was the one question I have never forgotten. My response at that time was rooted in the belief that the exercise of one’s freedom was relative--limited to those behaviors that did not restrict or inhibit the rights of others in the exercise of their freedom. As one will conclude by the end of this essay, my interpretation of quality is similarly shaded!

Quality Wine

For hundreds of years, quality wine was synonymous with that vinted from the grapes grown in select vineyards found within the geographic boundaries of France. Thomas Jefferson, President of the United States from 1801 to 1809 and one of the great wine connoisseurs of his time, counted among his favorites the wines of Haut-Brion, Lafite, Latour, Margaux and Yquem.3 It was these wines, with their special traits and characteristics, that first established the standards for quality.

The widely acknowledged superiority of French wines was challenged for the first time in 1976, when two American wines were rated “best in class” at a widely publicized tasting held in Paris. Were these award-winning California wines truly unique? Did they establish a new standard by which to judge quality? Is there an absolute standard by which to judge the overall quality of a wine? Should the Pinot Noirs of Oregon be considered of lesser quality because they do not look, smell and taste exactly like the more highly acclaimed wines produced, periodically, in the Burgundy region of France? To what extent should the quality of a wine reflect “consumer satisfaction,” regardless of their knowledge and experience?

In all likelihood, the standard(s) of quality used by the consumer and the wine industry will continue to evolve. The quality in quality wine is, and probably always will be, relative! Quality will continue to be an illusive term in describing wine until there are generally accepted criteria for its assessment. Perhaps of greater significance is our acknowledgment that on the “continuum of life and living,” defining and quantifying the quality of wine is of relatively little importance. There will always be a wine we enjoy at a price we can afford!

Quality Education

As a career educator, I have engaged literally thousands of students, from middle school through graduate school, in discussions centering on the quantitative and qualitative aspects of formal education. Perhaps most cogent to the topic of “understanding quality” were the discussions that centered on "quality education.” Quality is generally inferred from some dissimulative combination of faculty credentials, per-student-cost, test scores (ACT, SAT, GRE, etc.), graduation rates, admits to college or graduate school, and the periodic rankings of a select(ed) group of administrators and educational consultants, rather than from an “authentic assessment” of the knowledge, skills and abilities of the students.

Given the paucity of objective measures at the individual level, society has come to rely on GPA, rank-in-class, and a variety of standardized test scores to judge the quality of one’s educational experience. Ironic, given the acknowledged “grade inflation” (one large high school recently recognized and honored 27 co-validictorians with overall GPA’s exceeding 4.00) and “dumbing down” of text books that has taken place over the last 20 years.

With the advent of global competition, we in the United States are being forced to seriously look at the quality of the “product” leaving our schools, especially primary and secondary schools. The consensus seems to be that the majority of students are falling behind those of other industrialized nations--our competitors in the global marketplace. This was recently brought to our attention when the U.S. Department of Education released the results of the Third International Mathematics and Science Study. A sample of eight-graders ranked 17th in science and 28th in mathematics when competing with a half-million other students in 41 countries.4

The absence of agreed upon standards by which to assess quality in education has serious implications. The ability of a nation to compete and prosper is dependent, in large part, upon the knowledge and productivity of all its people! On our “continuum of life and living,” defining and quantifying quality education is much more important than defining and quantifying quality wine!

Quality Engineering

Dava Sobel’s recent bestseller, Longitude, relates the story of John Harrison, an 18th century watchmaker who developed a chronometer of such quality--although containing 753 separate parts, it lost only five seconds in 81 days at sea--that it quickly came to replace the traditional methods (astronomical observations, etc.) for determining longitude, that had resulted in the tragic loss of an untold number of ships at sea.5 In this example, quality is still relative, even though there was a rigorous, agreed upon standard of performance that the clock had to meet.

Today, you can purchase a Junghans MEGA Watch for $995 that each night receives longwave time signals from the U.S. Atomic Clock. Its onboard computer automatically resets the time to within ten billionths of a second per day. While certainly a mind-boggling degree of accuracy, it does not represent absolute (totally free of error or defect) quality. A hand-held electronic device can be purchased from K-Mart for $199 that will bounce a signal off a global positioning satellite to give your location, accurate to within a few feet. Again, this reflects a high degree of accuracy when compared to previous methods used to determine longitude, but still not absolute quality.

On our “continuum of life and living,” the quality of the chronometer developed by Harrison to measure longitude takes on far greater importance than either of our other two examples. The difference being that the consequence of poor quality was not a poor meal or underemployment, but a significant loss of life and capital equipment.

Conclusion!

One can be sustained for a long time drinking wine generally thought to be of poor quality, especially if one happens to enjoy it! A nation can sustain itself for decades before the problems inherent in an inadequate educational system begin to show! Regardless of the wine we drink, the status of our educational system, or how we insure accuracy in the engineering process, quality will be an illusive concept until we are willing and able to establish standards for its assessment. If absolute quality is unattainable, then we must strive for the highest level of relative quality possible, given our technology and resources.

Understanding Quality: Condensed Version!

1. Quality is relative! It “is” what we say it is, or determine it to be through general consensus.

2. Quality is constantly evolving! Consequently, we must continue to explore and develop new ways by which to define and measure it. We must learn and quickly adopt proven QC, QA, and TQM practices. As an anonymous writer once put it, “Insanity is doing the same thing over and over again, yet expecting different results.” In dealing with quality, we are inclined to “talk the talk” and “do the did.”

3. Quality is less of a competitive tool than an absolute necessity to compete! Arguments made through the years by Shewhart, Deming, Juran, Taguchi, and Crosby support this position!

4. Quality is attained through a planned, concerted effort! It involves paying attention to the process, involving staff, and responding to customer needs.

Ciao!

Footnotes

1Robert B. Donald, Betty Richmond, Lillian Grifith Wargetz, Kathleen Werner. Writing Clear Essays (Third Edition) Prentice Hall, 1996; p.2.

2The New Lexicon Webster's Dictionary of the English Language, 1990 Edition. New York: Lexicon Publications, Inc.

3Gabler, James M. Passions: The Wines and Travels of Thomas Jefferson. Baltimore: Bacchus Press, 1995.

4"The Learning Lag: You Can't Blame TV." US News and World Report, December 2, 1996, 16.

5Sobel, Dava, Longitude. New York: Penguin Books, 1995.


Jerry Ehrmeyer retired, with emeritus status, from the University of Wisconsin-Eau Claire. During his twenty-five year tenure there, he taught in the Departments of Psychology and Secondary and Continuing Education; served as the Coordinator of the Cooperative Education and Internship Programs, Assistant Director of the Office of Career Planning and Placement, and as a Program Manager in the Career Services Office.

Jerry used to give presentations and facilitated workshops on a variety of topics at the state, regional, national, and international level. He was a three-time recipient of an Outstanding Speaker Award from AACC.