Friday, April 18, 2014

Fishing and Proficiency Testing

Fishing and Proficiency Testing

In our UBC Certificate Course in Laboratory Quality Management we introduced a concept which we call Quality Partners.  These are agencies and organizations whose primary purpose is to enhance the quality of medical laboratories.  Without these partners, the likelihood of a medical laboratory developing any semblance of quality enhancement and error reduction for all intents and purposes, negligible.  The primary Quality Partners are Accreditation, Proficiency Testing providers, Standards Development organizations, Education providers, Professional Organizations, and Suppliers.  While I am biased, of this group, the only  partner that has ever demonstrated the ability to actually reduce errors is the Proficiency Testing provider group.

When PT exists with good and competent programs, laboratories receive samples that closely resemble actual samples, with the singular but essential difference being that the sample has been pre-tested and stabilized so that the correct result is known by the provider.  The challenge to the laboratory is to test the sample and come to the same value.  If the laboratory can do that they are told they are proficient; if they cannot they are told they have opportunities for improvement to learn how and why they made mistakes, and to determine how they can avoid such errors going forward.  

PT providers are a committed group of people, dedicated to the premise that helping laboratories overcome errors directly contributes to patient care and patient safety. 
While my own personal focus in on water testing and patient care microbiology sample testing, most developed countries have PT providers not only for medical laboratory testing and water, they also test for food and engineering, and many many other types of laboratory tests. 

Unfortunately, developing countries see the value of developed medical laboratory testing, and see the value of quality partners, but they do not have local access to PT.  And that is a problem.

For many, the solution is to purchase PT samples from a larger country, who is always more than happy to provide them.  That the samples were never designed to address the issues of developing countries and that to get the samples to the laboratories at considerable distance they have to compromise their quality by freeze-drying the samples is of little concern.  When they write the informative sheets, they are written from the perspective of the large parent country and without any perspective for the developing region.  

So the product they receive is costly, not designed for their purpose, not optimised for their purpose, and not assessed or graded for their purpose.   That does not seem to be much of a deal, and from what I have seen, the success rates on the samples is rarely barely close to acceptable. 
We have taken a different approach.

Rather than just shipping samples, we bring one (or preferably two) able persons to our centre and give them intensive training in producing samples and setting up a basic program that will allow them to start a program, select, produce, transport samples relevant to their setting, and show them how to grade them and produce a critique.   As mentioned it is an intensive program.  Some get the information they want in one session, others come back for a second session.  

Over the duration of our program we have usually had one country participate each year.  This year we will have had representatives from 3 countries.  And we are getting contacts and expressions of interest for next year.  So by an awareness scale we seem to be having success.  

This summer we will be doing a survey to see if the countries that have visited us  have implemented programs and if those programs are still in operation.  (Satisfaction and Loyalty).

Without getting too sophomoric, the whole experience reminds me the proverb “Give a man a fish, and you feed him for a day; show him how to catch fish, and you feed him for a lifetime.”  Contrary to popular myth, this is not biblical nor Greek or by Confucius in origin, although I can understand the foundation for the various myths. 

The original version was “…give a man a fish he is hungry again in an hour; if you teach him to catch a fish you do him a good turn."  This was written originally by a British author, Anne Isabella Ritchie and published within a story entitled Mrs. Dymond, in an American magazine Littell's Living Age printed in September 1885.

Personally I prefer the original version.

PS:  If you want to know more contact us through


  1. Hi Dr. Noble,

    This is very good idea & a dedicated effort in promoting quality in developing countries. It is a good step in increasing the awareness about the importance of profiecincy testing & how it can contribute in raising the bar of quality in medical laboratories.

    I was thinking of doing the same thing but in the field of cytology. We have a semiautomated machine for doing Liquid based cytology. Months after starting this machine, we found that we have a considerable number of cases that we can share with other labs & getting consensus on the result. That was the beginning of the idea of developing something like a PT program. Some questions has been raised when we were discussing the cases, what organizations or bodies can give me the authority to distribute such cases and build a program around it, My laboratory is accredited by the College of American Pathologists but is that enough?

    It would be great if we can discuss the possibility or the preliminary steps for starting such an idea & what is the feasibility of its implementation.

  2. There are lots of different ways to develop a constructive program. Contact me and we can chat.


Comments, thoughts...