Quality Design in Anatomical Pathology
IMed Publications, May 2011, Pages: 72
Quality is a pervasive term which is often overused and seldom achieved. Dr Walter Shewhart invented the statistical control chart in 1930s which was utilized by the United States during world war-II the United States along with basic quality control methods to produce military supplies in large quantities cheaply, but with good quality.
In manufacturing, quality is a measure of excellence or a state of being free of defects, deficiencies, and significant variation, brought about by the strict and consistent adherence to measurable and verifiable standards to achieve uniformity of output that satisfies specific customer or user requirement. According to American National Standards Institute, the definition of quality, accepted by the CAP (College of American Pathologists), is “The totality of features and characteristics of a product or service that bear on its ability to satisfy given needs.” Some have defined quality as “Conformance to specification”, others have suggested that quality is meeting or exceeding customer expectations.
The Institute of Medicine (IOM) quality metric defined 6 domains of quality: safety, effectiveness, efficiency, timeliness, equity, and patient centeredness. To accomplish this, basic notions such as quality and product must be defined and understood. Elements of quality that are important in generation of the end product i.e. surgical pathology report include accuracy, timeliness, reproducibility, and completeness. The aim of quality should focus on measuring the complete process from the clinician's perspective.
The majority of studies on the quality of oncologic pathology diagnoses have focused on patient safety and have documented a variety of causes of errors that occur in the clinical and anatomic pathology department testing phases. Clinical practitioners play an essential role in error reduction through several avenues such as effective test ordering, providing accurate and pertinent clinical information, procuring high-quality specimens, providing timely follow-up on test results, effectively communicating on potentially discrepant diagnoses, and advocating second opinions on the pathology diagnosis in specific situations.
This is indeed the right time to consider a re-look into the functioning of our anatomic pathology departments, especially in light of litigation threats looming large over today's medical practice. Although designing comprehensive quality system policies and procedures at the department level would appear to be the logical approach in the right direction, precision & accuracy may not be easy to achieve due to various factors. An interdisciplinary approach would be mandatory to formulate effective treatment plans to resolve the pressing problems in medical science, particularly cancer management.
Butterfy efect and quality.
Quality by design concept.
Pre-analytic phase.
Analytical phase.
Standardization of immunohistochemistry.
Classifcation in surgical pathology.
Postanalytic phase.
Error taxonomy and validation.
Structural component of a quality.
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