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Saturday, September 28, 2013

The Better Way to Move Quality Forward



There are two ways that we can introduce Quality to medical laboratories in resource limited countries; one is to sell them accreditation and proficiency testing services from large international organizations, and the other is to help them develop their own programs.  

Canada is a good model to look at.  In the 1960s many Canadian laboratories recognized the value of accreditation and proficiency testing, but had no programs, so they did what made sense; they purchased the services from the United States and the United Kingdom.  After barely 10 years the province of Ontario began to realize that in the long run they were far better developing their own programs.  Ontario was joined by Quebec and then Manitoba and Saskatchewan and Alberta and British Columbia, each developing a local authority with the capability of taking care of their own Quality needs.  If they shared another provinces program they did so knowing they had a seat at the discussion and decision table.   Over time a community of accreditation bodies and a community of proficiency testing programs developed that served the needs of Canadian laboratories in a typical Canadian style, progressive and innovative and with participant involvement.  Today the Canadian programs are arguably among the best in the world, no longer needing outside programs.  In 50 years we moved from nothing to being world leaders.  

Countries that buy programs from other countries make a big mistake and here is why.
1:       Countries that sell their program do it primarily to generate revenue.  Let me be clear, I may be a Canadian but I am not a socialist.  I have no problems with the concept of generating revenue.  What I do have a problem with is a country making samples that are designed for wealthy country sophisticated laboratories and then multiplying them multi-fold and selling them to laboratories that are working with (by our standards) archaic equipment and in basic beyond basic environments.  The samples are designed to address very sophisticated issues which are not remotely close to the issues in these new laboratories.  They are samples that have no clinical relevancy to those laboratories.  If proficiency testing is not clinically relevant then it is a total waste of time.

2:       In order to make samples made by the thousands to survive in extended travel they have to be freeze dried (lyophilized) turning them all into basically white crystal powder that requires reconstitution when they get to the destination.  Freeze drying may be OK for instant coffee, but it certainly is not appropriate for simulated medical laboratory samples.  They don’t look right and they don’t act right.  If they don’t look right or act right then they don’t meet any international standard for proficiency testing, and more to the point they don’t serve as any form of competent measure of laboratory Quality.  They are a waste of time effort and money.

So we are part of a process to do it better.  Rather than sell countries our samples, we train them how to make their own.  When they join us for the training program (and yes we do charge for the training program) we point out the tools on how to sort out what kinds of clinically relevant samples they need for the laboratories in their own country, and then provide the tools to make samples that are as simple or as basic as they need.    We train them to make samples that will survive transport in their own country without freeze drying.  We train them on making their samples value added to ensure they meet the continuing education and continual improvement needs the laboratories have in order to meet Quality and accreditation goals.  We provide them with the opportunity for follow up, to get back to us with questions and challenges.  We provide them with the opportunity to take their expertise and share it with their neighbours.  

With luck and perseverance, they will be able to create a network of Quality Partners that took us 50 years by trial and error, perhaps in 25 years.  

This is a win-win-win-win.  We win because we generate revenue and help countries.  The countries win because they learn to tools to develop new and better programs that meet the needs of their country.  The laboratories win because they have access to systems that can have a positive impact on their testing processes.  And the patients win because their sample results are better Quality assured.  

To date we have helped 8 countries.  We have 3 more countries booked for later this year.

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