[ed. We get a lot of email at Westgard Web. Most of them are questions, some are comments, and rarer still, some are well thought out essays. Here's one of the latter, worth an entire post of its own...]
By Jared Waterman, MT(ASCP), PA-CTruth or Fairy Tale? I ask this important question, because over the past 9 years of being a medical technologist, I’ve noticed a trend in several clinical laboratories. (Keep in mind that I am armed with training from the University of Wisconsin CLS program that included an education in method development and statistical analysis from Dr. Westgard himself.) The trend is that many lab technologists FALSELY believe they are producing quality test results, when in fact, they have no idea what that quality actually is....
Another trend is many supervisors responsible for monitoring quality control results and systems, do not know how to analyze data, make conclusions on testing performance, or guarantee quality testing is performed. While I do believe analytical quality certainly exists in all laboratories, quantifying the amount of quality present in most laboratories would be hard to perform for most technologists today. I have noticed that some labs run tests without ever defining the quality needed for testing. I attribute this to lack of education on how to define, monitor, and run programs to ensure quality testing.
I feel that understanding and performing quality measures in laboratories has become a lost art if you will. Part of the reason is because many labs find it easier for a vendor to “guarantee” quality by offering to perform validation and performance testing on new instrument purchases. This saves valuable time and ensures that medical technologists can focus on their task at hand… performing the testing. It is also easy for directors and lead techs to use quality and statistical vocabulary terms, without understanding the meaning behind such words. They speak of implementing total quality management (TQM) practices, yet the quality is never defined in these labs, and statistics are misapplied. Put another way, how can a lab say they have a Quality Management program, with Quality Control practices set in place, when they’ve never defined the quality requirement needed for each test being performed, let alone understand the data from instrument performance characteristics that helps assess quality of the test?
This ongoing practice is like paying money for a home inspection and appraisal before being approved for a loan by the bank. Simply put, the cart got ahead of the horse when it comes to understanding the quality of laboratory testing.
Even in the modern day of internet, rapid and easy information gathering, and free content on quality analytical testing posted at Westgard.com, laboratories are still not getting the message. Is it because they are too busy focusing on the actual testing, or being asked to perform more and more testing with less personnel, that quality goes by the way-side? Or is it because many technologists don’t understand the basics of quality measures, hate statistics, and are scared to venture outside their comfort zone and actually learn something different than what they already know? The current practice of operating an instrument, unaware of the quality of a result and what it means, has to end. Likewise, relying on untrained personnel to monitor quality parameters for testing must end.
I do not know the answers to these questions, but see the topic of quality laboratory testing misrepresented daily. It can be seen in many forms: misapplying multi-QC rules, incorrectly assuming that a 2SD violation can be taken care of by rerunning the QC and landing within 2SD meaning a method problem has gone away, or never existed. Other examples include: not using the correct QC rules because test performance characteristics were not identified along with not defining the Quality Requirement of the test. Yet another is falsely believing that an instrument vendor performs method validation correctly and thus guarantees you quality testing. The examples are endless, and frustrating, yet continue to be a huge problem that continually occurs and remains unnoticed. When and where do we draw the line for the misrepresentation that quality testing is being performed in today’s labs?
I do not have a specific answer to this question; however, I can offer some solutions to the problem. After all, every squeaky wheel deserves some grease. One solution would be for lab directors to budget for and include a lead quality tech position in the lab. This tech would be responsible for developing continuing education exercises and staff development in the area of quality. They could also direct and monitor the lab quality program underneath the pathologist who is ultimately responsible for the testing quality. Using seasoned techs and pairing them with newer techs in a symbiotic relationship would help both generations improve the quality of testing. I do believe that today’s younger techs are exposed and better trained in the area of quality testing and statistical analysis, but are not allowed to participate in quality planning because of their “inexperience” as an actual technologist. By having mentors, new techs can influence and help educate seasoned techs on the proper uses of statistical QC programs, rather than continue to run at the widely accepted 2SD standard across all tests in the lab. After all, isn’t quality testing the responsibility of every tech in the lab at all times? I think a team approach would dramatically improve the quality of testing in labs today, but we must break the chain of, “it has always been done this way, so we will continue to do it this way.” By addressing the lack of knowledge in identifying quality, sharing the responsibility of quality testing between new and seasoned techs, quality will be improved in all labs that perform clinical testing.
This bright young man has a future outside Medical Technology. Based on many years in the field, you, like myself, ask "Why Not?" and the stale, reiterated answer is, "Becase we've always done it that way." Medical Technologists by their nature are creatures of habit and comfort. They don't want to see, do or try anything new that will take them out of their comfort zone. Although instrumentation, LIS, state of the art equipment comes and goes, they apply the same old rules we had in the dark ages when most things were done manually and in duplicate. Get out while you can, it's not going to change.
Posted by: John Topper | February 17, 2010 at 02:22 PM