Laboratory quality: good works get better
Paul A. Raslavicus, MD
Our College is a unique organization. Other medical associations
tend to have a professional staff run them while the members exist
as passive bystanders. The CAP, on the other hand, involves its
members fully, and, at the same time, depends on its members to
make things tick. Your officers and governors, elected by you often
in a truly contested fashion, bring to their job of running this
organization the wisdom and knowledge of the diverse environments
in which we all practice. And hundreds of you and your coworkers
in the medical laboratory are engaged in and run our Laboratory
Accreditation and Surveys programs. It is because you are involved
and concerned about doing the right things that our specialty maintains
Others may try to provide accreditation services, but our program
is the only one that is not a patchwork of the diverse offerings
of different providers. Other accreditation programs will never
match the seamless integrated product you have developed for the
College. And while costs of participation vary with the complexity
of the laboratory, our programs are competitively priced and have
features (such as the presence of a pathologist on the inspection
team) for which other providers charge a substantial fee.
In any given year, 10,000 people will serve on CAP inspection teams.
Our inspectors—be they medical technologists, cytotechnologists,
supervisors, quality assurance managers, laboratory and administrative
directors, or pathologists—have the opportunity to both teach
and learn from others. This knowledge exchange, unique to our program,
invigorates all participants.
Our inspectors have expertise in all anatomic and clinical pathology
disciplines and direct knowledge of the day-to-day challenges laboratory
personnel face. They are provided with additional learning opportunities
that provide CME and CEU credits. They can earn credits by attending
inspector training workshops and audioconferences and by enrolling
in Web-based learning programs. And this year, medical technologists
who work in transfusion medicine, microbiology, and hematology will
be able to earn CEUs by taking self-tests incorporated (at no additional
charge) into their proficiency testing modules.
Unlike some, we believe all testing is important to patient care
and should be monitored. We reject the notion that waived tests
cannot endanger patient welfare and do not require proficiency testing.
Just ask risk managers whether excluding such testing from the accreditation
process makes fiscal sense. We are committed to providing proficiency
testing for all tests (waived, basic, and leading edge), and we
have the resources to do it. More than 60 medical technologists
on the CAP staff have access to hundreds of highly qualified pathologists
and full panels of subspecialists on CAP resource committees to
answer the inevitable questions that arise.
We ensure that you can evaluate your laboratory’s performance
well by offering large peer groups for nearly every analyte-method
combination. Our menu of more than 400 unique products is much larger
than that offered by any other proficiency testing provider and
meets the needs of laboratories of every size. In 2004 alone, thanks
to the efforts of our pathologist-run resource committees, we will
provide 29 new Surveys and EXCEL modules, at least 15 of which are
not available from any other source.
Some of you, I’m sure, are overwhelmed by the inspection
process. Because of our training in scientific medicine, physicians
tend to be thorough in examining the patient. Similarly, when it
comes to evaluating the medical laboratory, we tend to examine that
elephant from all sides rather than get just an overall view. We
aim for the best diagnosis of quality in the laboratory. In achieving
this, we have permitted the number of laboratory checklist questions
to grow significantly. With the help of federal regulations and
the bureaucracy of HIPAA, CLIA, compliance, and more, we have seen
a marked increase in the required documentation. It could consume
the paper output of an entire Maine lumber mill.
Your colleagues on the Commission on Laboratory Accreditation have
recognized these burdens and are committed to smashing the bureaucracy.
Many of you have worked, in focus groups, on inventing customer-friendly
solutions. We all agree that in examining the elephant, we do not
need to ask if the elephant has stripes. A few examples of changes
that have been made:
- Customized checklists tailored to each laboratory’s test menu are
now in the field. If you don’t do mycobacteriology, you will not find
those questions in your packet. If you don’t do electrophoresis, you
will not be asked about it. No more “not-applicables.”
- The chemistry, special chemistry, and toxicology checklists have been combined
to eliminate redundant questions. One hundred ninety such questions have bit
- New or modified questions have been highlighted to make it easier to spot
- The College now provides immediate online acknowledgment as soon as Surveys
results and other lab improvement program documents are received.
- We have redesigned our account statements to reduce ambiguity about the
status of the account.
But those changes are just the beginning. As I wrote in my May
column, educating professionals is best achieved with programs that
provide timely feedback and opportunity for interaction. Hence,
our Board has approved the immediate development of an information
technology Internet-based initiative that will provide interconnectivity
between our laboratories and the CAP. Whether you are a laboratory
administrator or a charge medical technologist, real-time inquiry
and visualization of proficiency testing status will be a reality.
No, we will not introduce nonmanipulative files (such as PDF files)
for print out. That does nothing more than transfer paper printing
costs from the provider to you. Rather, we will feature dynamic,
two-way electronic communication in a secure environment. In a robust
way, we will provide tremendous flexibility for you to manipulate
and use the knowledge advantage you gain by being a CAP-inspected
If you are being inspected this year, by the next inspection cycle
you will be able to authorize online access to specific lab improvement
program documents for which your staff is responsible, provide online
inter-institutional data to those responsible for hospital or laboratory
systems, and manipulate data for varied applications. By 2005, Laboratory
Accreditation and Surveys participants will have access to optional
forms to submit much of their data electronically. Individual performance
evaluations and participant summary reports will be available via
secure online communication.
We have made important changes in our laboratory improvement programs
in the past two years, and more milestones will be achieved in the
future. The technology is wonderful, and it will make life easier
for all of us. But the foundation of these programs will always
be the willingness of all of you in the laboratory to invest time
and energy on inspection teams, on resource committees, and in a
host of related good works. You are the backbone of our success.