Primer Part 1 − Preparing a laboratory quality improvement project

• Published in: Clinical biochemistry 2024-05, Vol.127-128, p.110764, Article 110764
• Main Authors: Kathryn Bohn, Mary, Augustin, Roy, Chartier, Lucas, Devine, Luke, Doshi, Samik, Ginty, Leanne, Lass, Elliot, Leung, Felix, Mundle, William, Nimmo, Graeme, Sandy, Alyson, Shillington, Kelly, Simon, Amanda, Steiman, Amanda, Taher, Ahmed, Tang Friesner, Cindy, Zanchetta, Cristina, Taher, Jennifer
• Format: Article
• Language: English
• Subjects: Continuous quality improvement; Model for improvement; Root cause analysis; Test utilization
• ISSN: 0009-9120; 1873-2933; 1873-2933
• DOI: 10.1016/j.clinbiochem.2024.110764

•Quality improvement (QI) is a fundamental component of quality management systems.•Limited guidance exists on implementing/sustaining QI initiatives in lab medicine.•This primer reviews fundamentals of QI methodology and application to our field.•A real example of a serum protein electrophoresis utilization project is described. Quality in laboratory medicine encompasses multiple components related to total quality management, including quality control (QC), quality assurance (QA), quality indicators, and quality improvement (QI). Together, they contribute to minimizing errors (pre-analytical, analytical, or post-analytical) in clinical service delivery and improving process appropriateness and efficiency. In contrast to static quality benchmarks (QC, QA, quality indicators), the QI paradigm is a continuous approach to systemic process improvement for optimizing patient safety, timeliness, effectiveness, and efficiency. Healthcare institutions have placed emphasis on applying the QI framework to identify and improve healthcare delivery. Despite QI’s increasing importance, there is a lack of guidance on preparing, executing, and sustaining QI initiatives in the field of laboratory medicine. This has presented a significant barrier for clinical laboratorians to participate in and lead QI initiatives. This three-part primer series will bridge this knowledge gap by providing a guide for clinical laboratories to implement a QI project that issuccessful and sustainable. In the first article, we introduce the steps needed to prepare a QI project with focus on relevant methodology and tools related to problem identification, stakeholder engagement, root cause analysis (e.g., fishbone diagrams, Pareto charts and process mapping), and SMART aim establishment. Throughout, we describe a clinical vignette of a real QI project completed at our institution focused on serum protein electrophoresis (SPEP) utilization. This primer series is the first of its kind in laboratory medicine and will serve as a useful resource for future engagement of clinical laboratory leaders in QI initiatives.