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Sunday, October 2, 2011
The Ins and Outs of Canadian Laboratory Quality
Ross Sutherland wrote a comment to a MMLQR blog post. This was an introduction for me to a book that he has written False Postive: Provide Profit in Canada’s Medical Laboratories (Fernwood Publishing 2011). I guess his personal word-of-mouth awareness campaign was successful, to the extent that I bought a copy of the book and had a chance to read it.
It is not a bad read. Well researched and referenced and well written. The thesis of the book is focussed largely on the commercial laboratories that provide service primarily within the community setting in nearly all provinces. Since in my career I have worked in both public and private sectors, and have been a patient in both as well I feel entitled to my opinion which differs somewhat from Ross’s. That is not particularly uncommon in Canada where there tends to be political overtones when it comes to points-of-view of the Canadian healthcare system. I suspect that this contagion is about to spread to the United States as well.
But this is not about that politic. It is about some comments that are made about Canadian laboratory quality, a topic about which I know a great deal.
Sutherland talks about the difficulty that we have in Canada finding out how well or unwell Canadian laboratories perform in Quality assessments. I absolutely agree.
If you want to know about roofers, or car dealers, you can go to the Canadian Better Business Bureau and follow a company’s track record. If you want to know how well schools perform on certain provincial examinations, that information is published annually. If you want to find out about a restaurant you can get all sorts of reviews. But to find out how a laboratory performs is very difficult.
What most Canadians may not be aware is that in most provinces (not all) laboratories are expected to be accredited every 3-4 years following in on-site inspection that is fairly encompassing. And most provinces (not all) expect laboratories to participate in proficiency testing (EQA – external quality assessment). What is very difficult, maybe impossible, to find out how well they performed on the assessments. Part of the reason is that governments choose to not make this information available, which is strange, when one thinks about Canada’s long and recent history of questionable performance and provincial inquiries.
One can think of a number of reasons why provincial governments don’t post the information. First is that they likely don’t want to get into that because they might have to do something about the poor performers. Second it would probably set them into a political minefield with provincial medical associations and healthcare sector unions. And third, why make waves when clearly the general public doesn’t seem to care enough to ask or demand.
CMPT does not share the information because we have a contractual relationship with the medical laboratories that respects confidentiality. We share their results with the accreditation bodies, only if the laboratories agree. If the laboratories choose to not, then the accreditation bodies receive that information directly from the laboratory.
On two occasions (September 2011 and October 2010) I have presented information about aggregate performance, and I have made our Annual Report available on our website (www.CMPT.ca). But we can not and do not release any individual laboratory.
But I do take umbrage about one comment that Sutherland makes about laboratory quality assessment. Reading from a government report written in 2003, he quotes the author who said that medical laboratory quality is only assessed on a technical level and does not address pre-examination or post-examination performance. Not only was she wrong in 2003 when she wrote it, Sutherland was wrong in 2011 when he quoted it. The word irresponsible comes to mind to describe both the writer and quoter. It reinforces two points: just because you are paid as a consultant, it doesn’t mean you know what you are writing about, and just because you read it in a book doesn’t make it true.
Canadian accreditation looks thoroughly at all three phases of laboratory performance. Canadian proficiency testing, in particular CMPT focuses at least as much attention what information is written in the report as how the information was derived. And for the last 10 years we have monitored pre-examination decision making through paper challenges. The information is again in our Annual Report.
So I expect a “mea culpa” from Ross.