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October 2005 - EXCELLENCE

I would hazard a guess that most of us have the word "Excellence" in front of us most of the time. Perhaps it is included in our organisational vision, perhaps in our laboratory mission statement. Even our Society Mission statement includes the phrase "striving for Excellence". What is this Excellence we are all striving for? Can you, in fact, ever achieve excellence?

I have been pondering this question as I write chapters for our laboratory manual and pour yet another cup of stimulant to keep me awake. Turning to my trusty dictionary Excellence features the concepts of 'surpassing merit or quality', of 'being superior to', of 'being most outstanding' or being 'pre-eminent' which in turn means excelling others. All these terms include the concept of relative qualities, of comparison. They also imply that excellence is a transient thing due to constantly moving goal posts.

I have always believed we should be raising the bar in everything we do. I have also believed that if you believe in something strongly enough it can be achieved - the impossible just takes a little longer to achieve. This sort of philosophy, of course, has a down side to it and that is the toll it takes on your energy supply and hence my questioning of late. The reality is that we may raise the bar but does it make a difference at the end of the day. Introduction of better quality testing is admirable but is the clinical decision making going to be any better as a result? We may have greater pride in our work but is the patient benefiting?

Recently I was asked to advise on the purchase of spirometers for a community based project and this lead to my wrestling with this question. My experience tells me that a key to quality spirometry in the community, or anywhere in fact, is Quality Assurance. There are spirometers out there that are very robust, are reliable, do not require calibration and produce excellent results. The software that goes with them, however, does not allow for good quality audit. The other type of instrument requires calibration, is equally robust but feeds into software that allows full functionality with respect to Quality audit. The trade off is that regular calibration will be required. Studies in the USA have clearly shown that preservation of testing standards over time is dependent on ongoing audit and quality assurance. The instrument is no longer the limiting factor in achieving quality, it is the operator. I believe that the quality of the spirometry would be better using one of the instruments that utilises the more flexible database but it will require the establishing of a QA programme to monitor test performance. Furthermore, if the data accumulated from this project is to be useful for research down the track, quality must be guaranteed.

Which is the better solution? Choose an easy to use instrument that attempts to look after quality itself and trust the technology to alert us to operator limitations? Or should I raise the bar in community testing and set up an audit programme to support the community workers. The easier option is very tempting and it would leave me free to write more Trains of Thought, but will it foster the striving for excellence we profess as Respiratory Scientists?

Excellence is, by definition, always out of reach. Each time the bar is raised people will start clearing it and it needs to be raised again. As with anything, the incremental return for extra investment in quality assurance diminishes, the higher the background quality. That, however, is not sufficient reason to justify standing still.

The search for excellence is important. I just have to be careful that my search for professional excellence doesn't compromise my search for WA lifestyle excellence.


October, 2005




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