Originally posted on August 8th, 2006
One last report on the AACC/ASCLS conference.
What
do you get when you combine techno music, pulsing neon light, flashing
LED badges, Lance Armstrong-style rubber wristbands, a free buffet, and
five open bars?
Labs Are Vital. The Abbott launch of a truly important initiative.
Jeffrey R. Binder, President of Abbott Diagnostics and Senior Vice
President of Operations for Abbott, announced a new program to address
the biggest problem facing the healthcare laboratory: the coming
shortage of qualified laboratory workers.
In the last 25 years, more than 600 schools and university programs for
medical technology have closed. In 2012 we will need 138,000 laboratory
scientists, but at best there will be 42,000 available. (source)
Why? Low salaries for workers mean less interest in the profession.
Worse still, the schools and programs face high expenses. Providing
instruments and other devices necessary to properly train technologists
is not cheap.
Here's where Labs are Vital comes in. At this event, Abbott announced a
new $1 million dollar donation program - schools and programs can apply
for free instruments, reagents, and service. AACC past president,
Stephen Kahn, PhD and Bernie Bekken, President of ASCLS, were present
to welcome this new effort.
It's good to see that Abbott recognizes a critical reality: While
Abbott may be comfortably profitable, their future profits are in
jeopardy if there aren't enough workers to run their instruments. Not
only do the schools need to be supported, but the profession itself
needs to be supported. Labs and lab workers need some better public
relations - and they need to get out of the basement. In the
increasingly cost-stressed healthcare system, the anonymous role of the
laboratory worker means out of sight, out of compensation. Labs Are
Vital hopes to raise the profile of the laboratory worker and make more
of them.
Abbott noted that the Labs are Vital program would be non-branded and
invited participation by other diagnostic companies. This part is key.
For any real initiative to succeed, it can't simply be a marketing
effort by a single company. It's an easy PR move for a company to make
a donation. But if the initiative is strongly identified with just one
company, there is less incentive for other companies to participate.
How will the other companies react? Will they join the effort? Will they create their own? We'll see.
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Originally posted August 7th, 2006
One of the more significant milestones passed at the AACC/ASCLS
conference was the 30th year of the "Concepts and Practices in the
Evaluation of Laboratory Methods" workshop. This workshop, taught by
Carl Garber, PhD, R. Neill Carey, PhD, and David Koch, PhD, is now the
longest continuously taught workshop at the conference.
An article celebrating this anniversary was in the Monday "Convention Daily" of Clinical Laboratory News
(Title: Workshops Offer Participants New Lab Tools and Skills:
Instructors of 'Evaluation of Laboratory Methods' Mark 30th Year').
Unfortunately, the article is not available online (yet), so I will
quote a short passage where Neill Carey and Carl Garber talk about the
'early years' of the workshop:
"'At the time, what we were suggesting was a fairly new concept,' Carey
recalled. 'Before that point, people hadn't talked much about making
decisions on the acceptability of methods based on measuring errors.'
Garber explains that their workshop has always been intended to provide
practical advice for laboratorians on the use - and the misuse - of
statistics. 'Our focus has consistently been on clinical significance -
where the rubber meets the road,' he said 'Through the years we've
tried to help our colleagues better understand what the clinician
requires in terms of allowable error and variation on a test result.'"
I worked with Carl and Neill and David when they worked at the
University of Wisconsin Hospital and Clinics in Madison. They are
a part of that "Wisconsin mafia" that has helped keep quality and
statistics at the center of laboratory testing. I must also admit I had
a hand in developing this workshop, too. We published a series of
papers in the early 1970s on the "proper use of statistics in
evaluating methods" and presented them in a workshop in 1976 at the
American Society of Medical Technology. The next year, 1977, I was
heading over to Uppsala, Sweden, for a sabbatical (where my interest in
QC would begin and where the "Westgard Rules" would be developed). I
recommended that Carl and Neill take the workshop to the AACC
conference (David Koch would join them in 1982.). And they have taught
that workshop ever since.
Over the years, they have applied continuous improvement to their
Method Evaluation workshop, modifying, updating, and adding material.
The workshop, now part of the new AACC University, is a tightly packed
four hours that includes not only the basic statistical studies for
method validation, but also Six Sigma, CLIA regulations and CLSI
guidelines. There's probably no other workshop that is so stuffed with
information. If you ever get a chance to come to the AACC conference, I
highly recommend attending the workshop. You'll learn a lot - either
something new or something you've forgotten.
What they've accomplished is the long distance marathon of conference
programming. Few people would have the stamina, diligence, and
determination to make a fresh presentation every year on this important
topic. But Carl, Neill, and David have done it and I hope they continue
to do it for decades to come.
So congratulations again.
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Originally posted August 1st, 2006
We
want to thank the hundreds of people who came to visit the Westgard QC
booth at the AACC/ASCLS convention in Chicago last week (July 25-27).
This convention is always a rewarding experience for us. It helps us
put faces to the people who visit, read, and embrace the website. For
our visitors, it's a chance to look at our books in hardcopy (instead
of reading free excerpts online), watch a live demonstration of the
software, or just ask questions.
You would be amazed at the questions we get, some very simple and
others quite complex. One visitor asked about rule interpretations of
the 10:x rule for certain specific situations in their laboratory.
Another person asked, "Is Dr. Westgard still alive?" - that's a
question we get every year, actually. And we're always happy to dispel
the rumors.
What encourages us is the fact that the energy and interest in quality
is never lacking. In other fields, people turn their backs on quality,
from the highest CEO to the lowest entry worker. But in the laboratory
industry, people know they have to get their job done right the first
time.
If you weren't at the conference, but have wanted to contact us about
quality, now is the time. Email us at "westgard at westgard.com", call
us at 608-833-0640, or just add a comment.
We want to hear from you.
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Originally posted July 12, 2006
The GAO developed thirteen recommendations based on their investigation
of CMS, CAP, JCAHO, COLA and the other state agencies. The
recommendations are aimed at CMS and what it should do and how it
should change. Here's a quick list in plain English:
Standardize survey findings
Ensure consistent advance notice by state survey agencies
Ensure identifying deficiences comes before education
Impose sanctions on labs with consecutive failures
Require all survey organizations to require whistle-blower posters
Require quarterly proficiency testing
Ensure timely evaluation of survey organizations
Ensure that new survey rules are reviewed in a timely manner
Hire more staff
Perform more validation inspections of state survey organizations
Require more independent validation of survey organizations
Collect and review more survey data
Establish an enforcement database
Some of these recommendations are common sense. Some of them are
bizarre. Most of them will do nothing to address the real problem with
the quality of laboratory testing.
To read in detail - and see the recommendations in the original bureaucratese - read the essay we've posted.
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Originally posted June 30, 2008
Remember the Maryland General laboratory scandal
of two years ago? Part of the outcome of the media circus and the
Congressional Hearings on Maryland General was a request by Congress
for an investigation of CMS by the GAO (Government Accountability
Office). The GAO was asked to examine (1) the quality of lab testing;
(2) the effectiveness of surveys, complaint investigations, and
enforcement actions in detecting and addressing lab problems; and (3)
the adequacy of CMS's CLIA oversight.
Well, that report is finally out - and it's not kind to CMS.
The titles say it all:
Testimony to Congress: CMS and Survey Organization Oversight Is Not Sufficient to Ensure Lab Quality
Full Report: CMS and Survey Organization Oversight Should Be Strengthened
Westgard Web will provide some detailed analysis of the reports (both
what is in the reports and what got left out) in the coming days, but
the first thing we want to do is encourage you to read the reports directly.
Go straight to the source and see what they found, and see if their
conclusions match your own. In July, we'll tell you what we think of
the reports - and you can judge us as well.
Let me pull a few highlights just from the one page summary:
Originally posted June 16, 2008
You've probably noticed that new JCAHO National Patient Safety
Goals
are out. Some new goals have been added this year. These goals are some
of the most prominent new measures, metrics, and indcators that are
being introduced to healthcare. At the Westgard Workshops, Teresa
Darcy, MD, MMM, gave a
presentation on this recent proliferation of Quality Indicators.
Do you know how many Indicators are out there? Here's just a short list
of what Dr. Darcy discussed: