An Experiment in Risk, Trust, Confidence and Competence

An Experiment in Risk, Trust, Confidence and Competence

112216_1517_Anexperimen1.pngStarring Rebecca, with thanks to all the good sports at Sheer Vanity in Espanola, Ontario.

Risk – Combination of the probability of occurrence of harm and the severity of that harm (ISO/IEC Guide 51.)

What did I do?

I contemplated the risk of allowing someone I never met to cut my hair to her quality standards without my instructions because I assumed  that anyone working in a hair salon would:

  1. know more than I did about matching hair styles to face shapes,
  2. like to ‘design’ hairstyles,
  3. be confident in their skills,
  4. care about me

– and, of lesser importance to me, that she

  1. had been trained,
  2. had passed an exam

I actually took the risk only after evaluating what Rebecca said.  I wish I had the video running to show you the look on her face.  The conversation went something like this:conversation-1

Why did I do this?

I wanted to create an analogy to the risk you take when you go for a laboratory test. 

You trust the lab to send your doctor a result that is good enough for him/her to make the right decision for you – because you assume that your risk is always managed by someone who:

  1. has been trained – with current best practice
  2. passed an exam – that verifies competence to make sure patient results are always good enough,
  3. knows more than you do about controlling quality,
  4. likes to ‘design’ and manage quality control processes,
  5. is confident in his/her skills,
  6. can prove that your result today is right, and
  7. cares about you.

In my 40+ years experience, the only thing I will guarantee you is #7.  Lab professionals care deeply about patients.

In fact, the medical laboratory technologists, technicians and scientists you trust to ensure your quality receive little QC training; it does not reflect best practice; they have not been competency certified.  Many laboratories do not even define what is good enough for you, let alone ensure it.  Laboratories who do set quality goals allow up to thousands of results to fail before their quality control processes even alert them to a problem. The quality control in most labs cannot verify your acceptable risk – because they are still using decades-old statistical concepts that do not even include place for “acceptable risk criteria.”

If the lab sends a normal result when you have an early stage disease, you get much worse before the doctor knows.


Wrong results –> Wrong Treatment –> Harm

What can you do?

Ask how the laboratory proves your result is good enough before they send it to your doctor.  Don’t accept the vague “we follow the regulations” answer.  It is simply not true in most labs.  Accuracy is agreement with truth.  Labs test quality control samples they assume to mirror patient samples. If the QC sample nearest your result is good, they assume your result is good.

  1. How do they define ‘good enough’?
  2. How many results do they allow to be NOT good enough before they stop and fix a method?
  3. Is my risk acceptable – at the last monthly/regular QC review
  4. Will your QC processes alert you if the method fails today?
  5. Will you be reporting my result before you check that QC was OK at the time my sample was tested?

What should you know?

  1. Laboratory errors put you at serious risk.
  2. It is possible now to quantify risk and maintain medical goals and acceptable risk levels approved by your doctors for you
  3. It is possible now to reduce laboratory errors by 50% – just with better QC design.

The Process of Mathematically-OptimiZed Risk Evaluation(c)


Where can you learn M.O.R.E.?









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