The other day I received an email from a friend with whom
I have worked in past on implementing quality practices. He wrote in part:
A lot has changed at “the laboratory” and the
staff in the lab need more than just documentation. All through the mentorships, they seem to have
been playing for time and now that I am here with them daily, they have
realized that they have to try hard to change their behaviours and work more
towards living quality and not just trying to write, read and sign SOPs. It is amazing, some of the things I have
found within one month of stay here. You will not believe that they have been
participating in EQAs for the past five years but have never ever reviewed any
of their returns for UNACCEPTABLE RESULTS.
In many countries including North America and Europe and
Australia and New Zealand laboratories are required to participate in an
accreditation program which provides some oversight to ensure that laboratories
are doing what they are supposed to do to maintain some level of quality and
competence. In other countries, national accreditation is available, but not
required. Laboratories that see a
quality or business advantage participate on a voluntary basis. In other countries there is no national
accreditation, but laboratories can seek an international accreditation, from
my experience mainly from United States or Australia or South Africa. Generally the experience seems to be that
laboratories with resources or connections seek accreditation, while the others
do not.
The accreditation process is not perfect. It can generate many unintended consequences,
most notably the tendency to brief moments of activity surrounding an impending
visit followed by long sleep. The other
is the tendency to game (cheat) at quality control and quality assessment.
But as the letter above so clearly demonstrates the
absence of accreditation and the assumption of voluntary commitment does not work
either. The letter indicates some pretty
concerning messages. The laboratory has
demonstrated to itself and to the PT provider that it can perform incompetent testing. The laboratory has demonstrated the same fact
over and over for (according to my colleague) for 5 years. And it appears that the laboratory does
nothing about it. It seems that putting out incorrect results is not a problem. It seems that failure to support patient care is acceptable practice.
Somewhere in the education and training and knowledge of
the laboratorians at the laboratory there has been a key breakdown. The point of the exercise is not to look for
errors or opportunities to improve. The
point is to do something about it.
To be fair this is not the only laboratory that misses
the point and continues with a pattern of failure. It happens every where. And you can see how it happens. The whole chain from top to bottom is
broken. The reality is that in many
places NOBODY cares… not the Ministry of Health, not the Hospital Superintendent and not the Clinical staff and not the Laboratory administration.
Personally I put the greatest blame on the laboratory
directors. It is probable or at least
possible that no one in the ministry or the hospital or the clinicians have any
idea about right results and wrong results or about proficiency testing as a
quality indicator. They have other
things on their respective plates. But
the directors should at least be sufficiently knowledgeable about laboratory
work to know when their laboratory is giving out wrong results.
Actually in my experience the one group that does do something to address the problem is the group of clinicians. They simply stop sending specimens. What is the point. They know from their own experience to not trust the results anyways.
Finding solutions can be a challenge. The PT provider most likely is aware of who
is failing and who is not. Start off
with an email or a phone call and find out what is happening or perhaps if
anything is happening. And see if some
assistance can be provided within the finances and scopes of the organization
and the laboratory.
If there is no interest to work toward solutions, then
the only reason that the PT provider can justify continuing to provide the
service is strictly for the money.
And that is immoral.
At least that is my opinion.