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Sunday, January 9, 2011
Quality and Laboratory Medicine - Who is in charge?
As I continue with the Resident and Graduate Student seminar series, I have a dilemma. I did a pre-course survey, in part to develop an objective measure of the course effectiveness in transferring knowledge.
One of the questions asked in the survey was “When implementing a Quality System in a medical laboratory the single most critical procedure is “.
The responses provided included:
Regular and Frequent Management Review
Regular Internal Audits
Developing and Maintaining a Procedure Manual
Regular Accreditation Assessments
Robust and Regular Quality Control
Only one answer (Regular and frequent management review) was deemed as the correct answer. Of interest of 26 responses to the question, the number selecting that answer was zero. The most common response was “all included” which was probably a poor inclusion on my part, but that does not take away from the absence of recognition of management as arguably the most critical part of implementing a quality system.
I don’t have to reiterate Deming’s stories about the importance of management to quality, because everyone interested in Quality knows and understands that to Deming, the absence of interest by top management results in failure to establish quality. It is relevant that in the book “Out of Crisis” he makes the point that Management is responsible for 94% of error.
Feigenbaum also made the point in Total Quality Management when he said that by using the slogan “quality is everybody’s responsibility” we ensure that quality is “nobody’s” responsibility. Quality is somebody’s responsibility and that somebody is Top Management
I should not be too surprised that a group of residents in pathology and laboratory medicine would fail to recognize the importance of management in quality, because most training programs do not have a tradition of recognizing how much of the work they will be doing will be management. This is an excellent example of systemic failure.
Not to overstate the case (well maybe to overstate a lot!) laboratory chairs who feel it is acceptable and appropriate to “game” or ignore accreditation and proficiency testing are unlikely to see a value and purpose in establishing quality management as a key component of their own laboratory or as a component of resident training. To them quality is solely an operational responsibility, somebody else’s job. In those laboratories that may well be the case.
Pathology and Laboratory Medicine may well be at a cross-roads. I wonder which path we will take.