"Quality is a choice. Choose to make it better.” – Ron Kaufman
You make a million choices every day. The choice to hit the snooze button just one…more…time. The choice to eat a healthy meal or succumb to that all too accessible fast food option that is so heavily flaunted in front of you. Your work in the lab is no different. You make choices to blithely accept the status quo through statements like, “it’s good enough” or, “I don’t have time to troubleshoot that issue.” This laissez faire mentality has got to stop. In a world of planned obsolescence, where things are intentionally made to not last, we have become far too complacent in accepting less than optimal quality.
In your laboratory, you are no doubt faced with staffing challenges, supply chain issues, antiquated equipment, and a myriad of other difficulties on a daily basis. Each and every one of you has been forced to do more with less. Many of these issues are unfortunately outside of your control. Despite these constraints, you must rise above these hurdles and make the choice to prioritize quality.
Do you believe you are a good judge of your own quality? Some of you may be saying, “of course I am!” I challenge you to ponder that thought for a minute. What criteria are you using to judge your lab’s quality? Most likely, it's a criterion that has been derived from your own experiences or the experiences of those you work with. The level of quality that you have grown accustomed to is a byproduct of those experiences. But what if there was a metric by which you could judge the quality of your lab’s work that was agreed upon by subject matter experts across the entire globe? Luckily for you, there is!
The Histology Quality Improvement Program (HistoQIP)
In 2003, NSH partnered with the College of American Pathologists (CAP) to create a program called Histology Quality Improvement Program (HistoQIP) that will assess the quality of your slides in your laboratory. The following criteria are assessed: fixation, tissue processing, embedding, microtomy, and staining. HistoQIP started with a single program that garnered 457 labs to subscribe. HistoQIP now has an impressive 15 programs and over 2,000 labs from more than 80 countries around the world subscribing to these resources.
How do you know that the criteria that the CAP and NSH utilize is any better than how your own lab assesses quality?
This is a great question! The HistoQIP program utilizes almost identical criteria as the following entities:
● UKNEQAS CPT - UK National External Quality Assessment Scheme
● RCPA QAP - Royal College of Pathologists of Australasia - Quality Assurance Program - Australia
● IQMH - Institute of Quality Management Program - Toronto, Ontario, Canada (formerly QMP-LS) ● afAQap - Association Française de Association Qualité en Anatomie et Cytologie Pathologiques - Strasbourg, France
● SEAP-IAP - Sociedad Española de Anatomía Patológica - Madrid, Spain
Obviously, the standards by which your slides are graded are globally accepted, but what about the quality of the people that are using these standards?
Who grades HQIP Slides?
The HistoQIP committee is made up of subject matter experts consisting of both pathologists and histotechnologists. The HistoQIP committee selects individual graders on an annual basis based on their experience in their field of expertise and their involvement in NSH. The committee then has competency trainers, whose role it is to develop a training curriculum to educate each grader, including those that have graded for many years. Each person has explicit and implicit biases, again based on their own experiences, and the intent of the training curriculum is to standardize the grading criteria for each program. Each new grader is paired up with committee members who help ensure a standard grading process is achieved. In addition, the concordance of each grader, including established graders, is monitored on an annual basis to mitigate deviations from the process.
A Digital Tool That Extends Results Into Education
The HistoQIP committee desired to ensure that labs could actually see and understand the grading criteria on which their slides are assessed. The committee created the Digital Reference Tool for H&E staining so that the subscribing labs could have a 40x digital image that they could zoom in/out on and assess any artifacts identified.. The Digital Reference Tool is an invaluable resource for troubleshooting, continuing education, competency assessment, or as an educational tool for laboratory staff.
If you haven’t yet joined HistoQIP, the question is why?
There is no better way to improve your lab’s quality. Make the choice today to join over 2,000 labs that have committed to improving quality.
I’ll leave you with one last thought and a quote. Some techs may feel “bound” by expressed demands and preferences of their pathologists, who are also prone to those same biases of what they have grown accustomed to seeing. Some pathologists may feel that there is no need for an external quality assessment. Conversely, some techs may say things like: “my pathologists haven’t had any complaints so therefore we don’t have a need for this program” but as Jim Collins once said, “Good is the enemy of great.” Don’t settle for good enough! Each patient deserves better.
To find out more visit the website.
Written By: Jeremy Johnston, BS, HT(ASCP), QIHC(ASCP)