Cultivating the garden
Paul A. Raslavicus, MD
Here it is—summertime. It’s the time of year when we in "northern
climes" fuss in our gardens, even if it’s only a planter outside the
apartment window. The overwintered bulbs have long ago bloomed, and
the annuals show their glory.
The College is akin to a garden that needs occasional cultivating,
pruning, and weeding so that our work brings the most value to you,
our members, and your associates. Sometimes the spadework involves
much investment of time and money. Sometimes we fertilize with a
task force or a customer survey. Sometimes we make significant changes
to nurture healthy growth. Two recent examples of such change involve
the CAP Laboratory Accreditation Program and the College’s annual
meeting plans for 2004 and beyond.
Each year 16,000 LAP inspectors conduct 3,000 laboratory inspections.
The College’s subspecialty laboratory accreditation work is flourishing:
785 laboratories accredited for molecular pathology, 237 for cytogenetics,
580 for flow cytometry, and 2,500 for cytopathology. While the laboratory
universe shrinks, we continue to experience a net growth of more
than 100 laboratories per year and to receive initial applications
for accreditation from nearly three times that many laboratories.
As the LAP grows, it continues to implement new approaches and
technologies. We recently concluded the first two-year cycle of
graded inspections. We now have a relative performance assessment
for every laboratory that we inspect. We have simplified the reapplication
process by using a prepopulated reapplication form. We have eliminated
redundancy by retaining needed information from one inspection to
the next. And we have developed a new post-inspection critique.
The critique has shown that:
Are we taking a rest from our labors? Absolutely not. We continue
to cultivate, to find ways to improve our service.
- More than 97 percent of the laboratories are very satisfied
or satisfied with the overall inspection process, inspection team,
and summation conference.
- More than 97 percent of the team leaders and members are satisfied
or very satisfied with the overall inspection; an average of 97
percent indicate that stated educational objectives are being
- Laboratories are well satisfied with the qualifications of team
members in all disciplines; the average rating for these aspects
is 4.5 on the 5.0 scale.
- We must assure that all of our inspectors, especially in some
of the "new" disciplines, such as biochemical genetics and molecular
pathology, are properly qualified—that is, they practice
that specialty on a regular basis. The CAP resource committees
are also working toward this end.
- We currently inspect as a single unit 475 laboratories in each
of the 65 health care systems. The degree of laboratory integration
is variable and, in many cases, the only link is through common
corporate ownership. Systems inspections have often been problematic.
We need to better define a true system laboratory.
- We must keep inspection team size at a level that is not unduly
disruptive to laboratory routine.
- We must create custom checklists so laboratories are queried
only on what is relevant to them. A pilot mechanism for creating
customized checklists is expected to be available by year-end.
- The College is considering educational programming to better
prepare laboratory directors and supervisors for reinspections.
Formal consultative services may be in the offing as well.
- We know that it is getting harder to free hospital staff for
inspector duties. While we want to preserve the voluntary nature
and educational benefits of LAP inspections, we need to consider
whether on-site CAP staff support would lessen the burden on inspection
teams and assure continuity and consistency.
Such are the duties of the gardener!
In another area of the garden, we did not need a survey to tell
us that the ASCP/CAP joint meeting was not working well for our
members: Dwindling attendance and empty exhibit halls made that
clear. Through the years, the structure, content, and spirit of
the meeting changed, as did the directions of the sponsoring societies.
In financial terms, the costs to run the meeting and the required
subsidy per attendee escalated. When the CAP Board of Governors
examined the relative costs and the benefits to our members, it
reluctantly concluded it is no longer feasible to continue the current
Still, it was a difficult decision to end the CAP’s joint meeting
with the American Society of Clinical Pathologists. Any departure
from tradition is uncomfortable. We do, however, see a tremendous
potential in a College-driven, College-managed, College-focused
annual meeting in which we would not be constrained by others in
terms of when and how we can present critical scientific, reimbursement,
and practice issues that affect pathologists.
We came to you to find out how to make the meeting come alive
again. You told us you want to have ample time to meet with and
learn from one another; to experience cutting-edge, innovative education;
to learn advocacy and practice management skills; and to set an
agenda for the future of the specialty.
We intend to provide you with such an experience. A reformatted
meeting will be created by you and for you with a focus on effective
advocacy, dynamic governance and idea exchange, and more interactive
education. To accomplish this goal, we will investigate collocation
or collaboration with other physician and medical laboratory groups,
including the ASCP. We will make sure the meeting is a homecoming
for our members. In a member-driven organization such as the CAP,
our get-together will be an opportunity for dynamic networking.
In a setting that will also offer cutting edge, practical learning
experiences, our garden will blossom. And in this atmosphere of
collegiality and intellectual stimulation, a new generation of dynamic
leaders in medicine and pathology will arise. Our commitment to
you is ongoing. Not only do we tend to the root system, we weed,
prune, and cultivate for lasting value and vitality.