[Histonet] a question on ethics

[Gary Gill]

True, but it's helpful to use the same language as that used by the
regulatory folks.  Regardless, make certain everyone understands the
difference between QC and QA and puts various activities in the right bin:

QUALITY CONTROL AND QUALITY ASSESSMENT
	Quality control activities look forward.  They define the product's
quality, imparting to it the credibility needed for its intended purpose.
QC activities are the result of planning and are applied prospectively to
everything that contributes to the final product, thereby impacting the
outcome.  QC activities are deterministic (i.e., lead to expected results
when followed).
	Quality assessment activities look backward.  They measure the
degree to which desired outcomes are successful (i.e., their impact).  QA
activities, therefore, retrospectively sample outcomes.  The findings modify
the processes that contribute to the final product (e.g., did the patient
have cancer as reported; if not, why?).  As a practical matter quality
assessment activities are probabilistic (i.e., have attendant uncertainty
relative to reliability), as it not possible to review all product outcomes.

DIFFERENTIAL FEATURES OF QUALITY CONTROL AND ASSESSMENT
	The following table is intended to help distinguish whether an
activity is one of quality control or quality assessment:

Differential Feature		Quality Control	Quality Assessment
Purpose				Defines Quality	Measures Success
Timing				Prospective		Retrospective
Application				All Processes	Sample Outcomes
Impact				Outcomes		Processes
Nature				Deterministic	Probabilistic

Gary Gill

-----Original Message-----
From: Marsha R Price [mailto:mprice26 <@t> juno.com] 
Sent: Friday, August 13, 2004 10:15 AM
To: garygill <@t> dcla.com
Cc: pathrm35 <@t> adelphia.net; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] a question on ethics


Actually, the hospital where I worked for the last year called it
"Performance Improvement" also. I do not think they care much about what you
call it as long as you have a well defined and documented plan in place.
Marsha

On Fri, 13 Aug 2004 08:36:18 -0500 Gary Gill <garygill <@t> dcla.com> writes:
> Current CLIA has replaced quality assurance with quality assessment
> as the
> preferred term.
> 
> Gary Gill
> 
> -----Original Message-----
> From: Marsha R Price [mailto:mprice26 <@t> juno.com]
> Sent: Friday, August 13, 2004 8:28 AM
> To: pathrm35 <@t> adelphia.net
> Cc: histonet <@t> lists.utsouthwestern.edu
> Subject: Re: [Histonet] a question on ethics
> 
> 
> Ron,
> You need to have an Quality Assurance Plan in place. That is an CAP 
> checklist question. I have a manual with logs etc. that you can have a 
> copy of. It can be customized for your lab. You can turn this lab 
> around with a
> well defined QA Program. QA is not an option it is a 
> must/requirement if you
> are a CLIA or CAP certified  lab.
> 
> Let me know if you would like a copy of the manual. It was done on
> Word. So
> I can send to you electronically and you can make changes to it.
> 
> Marsha Price
> 
> On Fri, 13 Aug 2004 04:27:14 -0500 "Ron Martin"
> <pathrm35 <@t> adelphia.net>
> writes:
> > Fellow techs,
> > I am in a difficult situation and need some serious advice. I 
> > recently (4 months ago) accepted a technical supervisor position
> in
> > a dermatology lab. I went from a bench tech at my old job to this
> 
> > position. I also walked away from a raise at my old position so I
> 
> > could step into a supervision position. I took the new position
> > because I was told by my manager that she would teach me some 
> > supervision, management and financial skills that I currently do 
> not
> > have as well as the growth potential of the company.This position
> is
> > not what I was told it would be. Part of my "duties" include
> > emptying the trash, clean the bathroom  (not happening) and taking 
> 
> > her personal and professional calls. The question on ethics is the
> 
> > high volume of mistakes made by our technician, our offices and
> also
> > by my manager herself.
> > I caught a mistake made by our tech a few weeks ago.She put the
> > wrong tissue on the wrong slides as she inverted the two cases. I 
> > caught her mistake before it went out. One time she assigned the 
> > same number to two different cases. She then sent the correct case 
> 
> > out for a consult (which wasn't needed) and put the wrong patient
> 
> > name on the slide. Every other day there is something different.My
> 
> > manager will not terminate her as she knows I am seeking
> employment
> > elsewhere and she cannot afford to lose a tech.
> > One day my manager gave three cases the same accession number.She
> 
> > caught her mistake on one of the cases but I still ended up with
> two
> > cases with the same number. When I first started there my manager
> 
> > had a case in which there " was no tissue in the container". She
> > said that she notified the office about the situation however up 
> to
> > six weeks later the office was still calling looking for
> results.At
> > that point she wrote up an incident report and dated it six weeks
> 
> > prior to coincide with the surgery date.
> > Our offices are not any better. One case came in with the wrong
> > patient information. It took about 7 weeks for the office to 
> realize
> > that they sent the wrong patient information with the biopsy as
> the
> > names were close in spelling.  The offices continually send
> mistakes
> > with incorrect spelling of patients names and incorrect anatomical
> 
> > locations.
> >  I have tired to document everything but there are too many
> mistakes
> > and I don't have enough time or energy to keep up with them.My
> > manager wants us to do our own "internal quality control". My 
> > interpretation of this is that she doesn't want our physician and 
> 
> > risk manager to know of these mistakes. Are these becoming common
> 
> > problems or is it just my situation?
> > I want to emphasize that I hope I am not being unethical myself
> for
> > revealing this information but I really need some advice and
> > support.I have very high standards and they are not being met in 
> > this current situation. I am currently seeking a new position but 
> I
> > need employment and cannot resign until another position becomes
> > available. I would like to stay in Florida and if anyone knows of 
> 
> > any positions please inform me as I am at my wits end. Thanks in
> > advance.
> > 
> > Ron
> > _______________________________________________
> > Histonet mailing list
> > Histonet <@t> lists.utsouthwestern.edu 
> > http://lists.utsouthwestern.edu/mailman/listinfo/histonet
> > 
> > 
> 
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