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Monday, May 2, 2011

A dismaying visit to yesteryear

I understand the challenges in Quality research, in every definition of the phrase.  In the context of MMLQR I mean that it is difficult to create new knowledge that is relevant to the study of implementation of Quality measures to the medical laboratory.  
Medical laboratories are at a new junction.  To move forward we need knowledge about what is working and what is not.  Are national or international standards creating an environment of reduced laboratory error?   Are Quality initiatives making medical care safer?  Can we draw new insights from past experiences to learn new and better approaches to communicate our message in a more constructive manner.  
We need novel ideas to answer basic questions that affect our laboratories and our role in care.

I commend all those those that try and I congratulate those that create useful contributory information.   I would like to say that I congratulate the authors of an article in the March 2011 edition of ASCP LabMedicine.  But that would not be very accurate.

I was interested in reading the article entitled “Measuring the Application of Quality System Essentials in Vermont Clinical Laboratories” especially in a journal by ASCP.  It was published under the section called “Science”.  And then I saw that it was an evaluation of a survey that was sent out in 2005, near six years ago.  Basically, a survey was sent out to approximately 500 laboratories asking (A) if the respondent was aware if their laboratory had some aspects of Quality in place and (B) if they believed that the measure being assessed was effective and (C ) if they believed the measure contributed to Quality.  Their finding was that supervisors with more than 10 years of experience were more likely say they were aware that there were some Quality Measures in place, and that supervisors were more likely than the non-supervisors to say they believed that having an orientation program was effective and contributed to Quality.  
About half of the supervisors didn’t know if their laboratories developed specifications for selecting purchase or vendors.  

In the academic environment we talk about research being the process of developing “new knowledge” as the path to new concepts, methodologies and understandings.  I know this sounds harsh, but I find it hard to characterize the publication of 6 year old “I think” or “I believe” information that is not verified, or linked to a tangible fact as meeting any of those criteria.  Even if the study was published now so that it could be used as the basis of a repeat study done now to see if there were changes in knowledge and believe, it would be highly suspect, at best.  

The Quality movement in medical laboratories is a rapidly evolving picture.  In the US laboratories are choosing to voluntarily adopt international standards (ISO15189:2008) and are looking at Baldridge as the measure of excellence.  

Information about soft perceptions from 6 years ago does not meet any of the criteria for new knowledge.  For Quality in the medical laboratory to progress we do need new information that contributes to new concepts and better understanding.

Some folks might think that I am being unfair or unduly critical.  But they would be wrong.  To paraphrase a comment that I heard on television a few weeks back, if I agreed with those folks then I would wrong too.  

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