Cory Porteus, DO, and Marilyn M. Bui, MD, PhD
February 2017—“Quality management” is the practice of continually evaluating, identifying, and improving the diagnostic process. It refers not only to retrospective action taken after mistakes have been made but also to evaluating near misses and opportunities for improvement in every facet of practice. Quality management is the purest expression of the desire to offer safe patient care across all specialties and practices. A prompt and accurate diagnosis is only the first step in ensuring patient safety.
The past decade has seen explosive growth in areas of medicine chiefly practiced by pathologists such as molecular testing, all of which need to be validated and continually assessed for safety in practice. As pathology can be viewed as the nexus where the art of medicine meets the science of medicine, quality management has become increasingly important and come to demand greater attention.
The CAP has published quality management guides since 1988, when it published its Surgical Pathology/Cytopathology Quality Assurance Manual. There have since been five iterations that highlight the importance of and need for quality management programs in a variety of pathology settings, and pathologists have considered them valuable resources.
The new version from CAP Press, Quality Management in Anatomic Pathology—Strategies for Assessment, Improvement, and Assurance (edited by Qihui “Jim” Zhai, MD, and Gene P. Siegal, MD, PhD), is organized into four informative sections, each of which is divided into chapters on specific areas. The general approaches to quality management are covered in an introduction and six chapters in the first section. This section encompasses designing a quality management plan, a plan’s components and quality indicators, responding to and preventing errors, and regulatory compliance.
Section two is on the systematic approaches, and it is here that each section of the laboratory has its own forum in which to stress the differences inherent in its setting.
Section three comprises chapters on the implementation of informatics and its importance to the quality management process, ISO 15189, and specimen tracking systems. In an era in which information technology is transforming how we practice medicine, this section is timely and offers practical information on laboratory information systems, digital pathology, synoptic reporting, and more. It introduces the nongovernmental organization, ISO, which sets standards for quality assurance, improvement, and management, and it highlights the various ways in which ISO influences daily practice.
The fourth and final section introduces the legal and regulatory issues that quality management programs face as well as the legal and ethical outcomes after errors occur. This section contains some of the most critical and immediately applicable points of interest and consists of standout chapters.
All of the chapters are easy to read and will appeal to a wide range of expertise on the subject matter. The section introductions are brief and set the stage for the chapters to supply the detail. The format is quickly searchable, with the chapters structured such that it is easy to find a section pertaining to a specific area of a laboratory or step of the process. Tables and figures are well laid out and clearly illustrate the desired point.
Designed for pathologists who have limited time to decipher texts, this is a well-organized resource with easy-to-digest points. For those new to the practice of quality management and looking to apply it to their own practice, this text provides a useful and comprehensive step-by-step outline that can enable implementation in minimal time. It is a strategy guide that can bring a reader of any skill level up to speed.
This text also serves as a primary resource for any resident studying for board examinations. The percentage of questions involving quality assurance/improvement has been increasing steadily in recent years. This text is an excellent resource that covers all necessary review material in one easy-to-absorb format. Recently graduated residents and fellows complain of feeling unprepared for the task of being in charge of a lab, which is increasingly expected of recent graduates, and quality management is a key component of successfully managing a laboratory.
In summary, this is a superb resource for quality management that every practicing pathologist should use. It surpassed expectations as to what a general resource guide should provide. It is thoroughly researched, is well written, and will appeal to those with casual interest and to those well schooled in the material. Furthermore, it should be regarded as a primary study text for residents who want to boost board scores and cement their understanding of this complex topic. As of now, it should be the resource book of choice for quality management.
Dr. Porteus is chief resident, Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa. Dr. Bui, a member of the CAP Publications Committee, is a senior member, Departments of Anatomic Pathology and Sarcoma, scientific director of analytic microscopy core, and section head of bone and soft tissue pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa. She is a professor in the Departments of Oncological Sciences and Cell Biology and Pathology, USF Morsani College of Medicine.