Tuesday, March 20, 2012
The Power of Quality Assessment
I had a wonderful experience today. I am in southern Africa working on a consultant basis with a proficiency testing program. So today we did a visit to a rural District hospital laboratory. The term district means that while being in a rural area and small, it acts much as a regional center. While it is a full service clinical laboratory (providing chemistry, microbiology and hematology services) it lacks certain fundamentals meaning that it has internet irregularly, no land-line telephones, and relatively unstable electricity. This makes things tough to develop a modern scale communication approach to sharing information for diagnostic care. With the exception for the universal access to personal cellular phones communication remains as paper and local ground transportation based.
The reason that I was there was to gather some information on the laboratory staff’s knowledge and opinions of Quality systems and proficiency testing. And what I saw assured me that I had made a right career decision when I decided to focus my attention and whatever talent and skills to implementing Quality.
The first thing that was obvious was the cleanliness and organization of the laboratory. A near perfect example of Lean philosophy (neat, sorted, everything in its place). Paper based accessioning logs again neat, organized, and up-to-date, and traceable. Well written SOP’s (again manually generated). Not a lot of books readily available, but clearly the laboratory staff here have things put together very well.
When we talked about proficiency testing and their PT provider, their response was that they see PT as their essential Quality check. They receive samples on a regular quarterly basis with some samples on a monthly basis, and they get their results reported back to them via paper that is transported by local courier.
They don’t have the resources to overwork samples, but they had already decided to treat their samples the same as clinical sample: a standard basic work-up and that is what is reported. They integrate the PT samples into their routine work on the day of receipt and test them the same day. Whoever is “on”, includes the PT samples with the routine samples and just work through the whole group together. There is no second guessing, no tricks, no special testing. “We get what we get and we that’s what we report.
And here is the cherry on top of the sundae. When the PT results come back, the group of technologists get together in the little room at the back, and review the results together. They talk about what they got right and what needs fixing, and then they all sign of the PT report with their signatures.
No tricks, no gaming, no cynicism. A group of laboratorians working in an isolated environment doing very good laboratory work in a simple and straightforward professional way, and grateful for the support that they get for the PT program.
This experience supports my own experience from my own program in Canada. When we do our satisfaction surveys, large academic centers (we call them Category A laboratories) find our program interesting but say we provide little educational material that is new to them. They get most of their new knowledge from journals and conferences and workshops and from their own research. Fair enough. But for the smaller facilities that don’t have their own researchers on staff or don’t have the time or resources to participate in the other elements mentioned, they find our educational materials as essential and describe us as their most useful source of continuing professional information.
It is enriching when you see smaller laboratories in isolated regions doing well on despite the additional challenges they deal with on a daily basis. It means that the patients in these regions have the opportunity to receive care based on quality information. There are many gaps that exist in healthcare between the resource limited regions and resource enriched.
Proficiency Testing provides a way to make the gap a little smaller.