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Quality is a pervasive term that is perhaps overused. Quality assurance and improvement plans in surgical pathology seek to "assure" and "improve" surgical pathology "products". To accomplish this, basic notions such as quality and product must be defined and understood. In this article, the definition of quality and how it applies to surgical pathology is explored. Quality attributes of a surgical pathology laboratory are defined, with a discussion of how those attributes are measured in the context of a quality assurance and improvement plan. In addition, other factors are presented that are needed to achieve a structure that maintains output of a quality product.
QUALITY
Quality has several definitions. 1 It may be defined as an attribute of an individual or object. More often quality is defined as superiority of kind or as a level of excellence. Quality, however, has taken on more specific definitions that relate to manufacturing or industrial production. 2 Some have defined quality as "conformance to specifications", others have suggested that quality is meeting or exceeding customers' expectations. In this context, the definition of quality is related to the product made or service rendered. Therefore quality measures may need to be customised. In industry, six sigma has emerged as a generic quality standard. 3 This standard aims to have the total number of failures in quality, or customer satisfaction at 3.4 defects or fewer than 4 defects per 1 000 000 products. This is derived from statistical methods at the level of six sigma or six standard deviations of likelihood in a normal distribution of customers. By comparison, various studies have estimated surgical pathology error rates from as low as 0.25% (2500 per million) to as high as 40%. 4 Most investigators, however, agree that a significant error rate in surgical pathology is in the range of 0.5% to 1%.
MEASURING QUALITY IN SURGICAL PATHOLOGY
Then how do we define quality in surgical pathology? Elements of quality that are important in surgical pathology include report accuracy, timeliness, and report completeness. 4 In manufacturing, one typically adds price or cost into the expectation of quality. However, in the current system of third party payers in medicine, price has been diminished in consideration of quality.
If it is agreed that accuracy, timeliness,...