Labquality Days: A Quality Adventure

Labquality Days: A Quality Adventure

Over the last while I have had the opportunity to attend a number of laboratory quality oriented conferences; Laboratory Quality Confab in San Antonio (held this year in New Orleans), Seeding Knowledge conference in Jeddah, our own POLQM Laboratory Quality Conference in Vancouver, and most recently LabQuality Days in Helsinki Finland.  Each has been a unique experience and each equally excellent with its own features. 

Of the group, LabQuality Days has had the longest run; this year was the 43^rd holding, going back to 1973, apparently without a break.  I could be wrong, but that must be the longest run for a medical laboratory quality oriented conference anywhere in the world.  

Apparently over the years there have been both lean and abundant attendances.  This year there were about 500 people split into two simultaneous sub-conferences, one held in Finnish, and the other in English.  The Helsinki Conference held the session without any difficulty.  

I can’t speak about the Finnish conference in large part because my facility in Finnish is non-existent.  (Apparently I am not alone.  I am told that the only place where Finnish is spoken is in Finland.)  But I can say that as I walked by their sessions in the main auditorium it was always full.  The international conference was held in a smaller room for about 200 people and it was always well attended as well.

The international conference had a dual theme: Pre-analytics and Point of Care; two topics with a lot of current interest, obviously with widespread appeal.  The speakers were widely distributed from Canada (me), Australia, and an array from across Europe including Norway, Denmark, Germany, Portugal, Lithuania, UK, the Netherlands, and Switzerland.  Apparently that was only a small subset of the total group distribution; in total there were folks from 26 different countries.   

I probably shouldn’t speak for others, but I leaned tons, and was really happy that I had attended.  

The meeting was started by the keynote speaker Bruce Oreck (a former American Ambassador to Finland) who talked about the state of highly disruptive change that is impacting business in general and by inference the medical laboratory.  Bruce is not the first speaker to raise the topic, but certainly was very effective.

To my mind, the person from who I learned the most was Anne Stavelin, from the EQA/PT program in Norway (NOKLUS) who was very much in the disruptive mode herself.  Norway was recognized that the primary user of Point of Care tests is NOT the hospital laboratory or emergency department, but is the family docs in the community, and also recognizes that they also have an obligation to be competent and deserve the opportunity to learn through quality assessment.  Astoundingly in a country of 5 million people, NOKLUS has almost 5 thousand clients participating in EQA associated with POCT.  For the arithmetically challenged, that means that close to one out of every 1000 people (0.1percent) living in Norway is involved in quality assessment.  The mind boggles.   

For the anatomic pathology folks Pedro Soares de Oliveira from Portugal was pretty disruptive as well as he talked about how much the preparation of glass slide samples for pathology analysis continues to be an “art “ rather than a “science” still dependent on touch and feeling rather than precision and standardization.  I wonder how one would calculate the measurement uncertainty of the impact of sample reading and interpretation and diagnosis.  Clearly the times, they are a-changing very soon

I am really happy that I have had the opportunity to be introduced to this meeting.  Better late than never.  This will not be a one-off attendance.

A warning to folks not living in northern climes; the weather is not nice, but the hospitality  and meeting  and greeting and learning opportunities abound and far out way the inconveniences of some rain, or snow and cold.

PS:  We will be continuing to host our POLQM Medical Laboratory Quality Conferences  in October in Vancouver.  I am not sure that we will hold 43 conferences under my management, but maybe with my successor?

CMPT at the crossroads.

In many ways health care is only recently awakening to the notion of Quality Management.  For reasons interesting, despite many false starts, the publication of the Institute of Medicine’s To Err is Human, finally struck an accord that sparked the whole of the Patient Safety movement, and with it, increasingly active awareness in Quality as a backbone structure of health organizations.  

That is not to say that Quality was absent from all aspects of health; indeed there were some early pockets of success.  Medical laboratory Quality Control and Quality Assurance has a long but hushed history going back through the 1930s and forties with the creation of Levey-Jennings Quality Control charting (llearned from Shewhart), and the development of proficiency testing, having grown from the ground breaking studies published by Belk and Sunderman in 1947, and followed by the introduction of accreditation by the College of American Pathologists a few years later.

Over the past 60 years we have seen a lot of changes in structure and process in the Quality instruments.  Take proficiency testing (PT/EQA) as an example.  In his early studies, Sunderman demonstrated a sad and embarrassing lack of laboratory testing consistency, although to be fair, the materials that they were using for challenges was pretty iffy.  The group of colleagues created samples for interlaboratory testing using serum or water and whole blood but with no regard for production or transport or standardization.  

That is not said as fault.  What we know now was spawned from studies that followed these early days.  Had the group in Philadelphia not started, we would not know what we know today.  

Since those days, the breadth and depth and science and technology of PT/EQA has grown by leaps and bounds.  As laboratory recognition, mainly by accreditation, became the norm, the number of laboratories requiring PT/EQA samples grew dramatically, as did the number of programs.  From my perspective this was generally not a competitive program versus program exercise.  In Canada all the programs worked pretty much together, sharing technology and ideas.  

For about 20 years we saw more surveys with more sophisticated challenge materials.  As one of my colleagues has said, you may not ever get rich from EQA, but you will always be interested in what you are doing.

Change started in the mid-1990s as laboratory closure and consolidation started to appear.  At first as a trickle, and then as a flood, the number of laboratories shrunk dramatically, in some areas by as much as 75 percent.

To give a positive spin, the last 15 years or so created a huge opportunity for creative and innovative thought.  How do you continue to meet the needs of the consolidated larger laboratories, knowing that the point of consolidation was to reduce budgets, and continue to keep the programs viable.  

Some groups have successfully expanded their outreach internationally, others have changed their own funding model.  And others, decided that it was time to find other activities to get involved in, and the PT/EQA component stopped.

For CMPT we went through a complete transformation exercise.  First and foremost we adopted a better organizational model through Quality Management and certification to ISO9001.  With that in place it became easier for us to set annual goals and objective for planned revision.   We worked a lot at communicating with our participants to get their input (Call that Customer Satisfaction).  We worked with new challenge targets to expand the breadth of our service and we focused a lot of energy on becoming more adept at making highly stable multi-purpose clinically simulating challenge materials, not only for our own program, but also for others.  We focused a lot of attention at building up a library of materials, and a reputation for solid educational materials.  We got into developing training programs for PT/EQA programs in other countries so that we could have a network for collaboration.  

Now it seems that the authorities’ need to consolidate has reduced, at least for the moment, and some of the pressure may be off.  

But now 30 years CMPT is a stronger and more effective and confident member of the PT/EQA community.   Our Quality Management infrastructure will remain in place, with increasing focus on Quality and Service and Excellence.  We will continue to focus on innovation (and perhaps some dimension of invention).  We will be making some bold moves toward more and stronger laboratory participant participation. 

What will the laboratory Quality field look like as we go forward; less conventional testing, more Point-of-Care, more outside-of-mainstream testing, more home-brew rapid change assays?  Will PT/EQA be a part of this, or will we devolve into a runt program serving a diminishing infrastructure.  Only time will tell. 

For the best answer, put in your calendar to check my blog in 2042.

But in the meantime, to look at where we are now and what we are doing now, please visit us at:

www.CMPT.ca