Stanley J. Robboy, MD

March 2012

Stanley J. Robboy, MD

Promoting excellence far from home

Broadcast journalist David Gergen spoke last year at the PathPAC luncheon; afterward, I read his best-selling book on leadership. Gergen, who was a speechwriter for four presidents, says that effective leaders respect the core values of those they hope to lead, and identify with their collective aspirations. He characterizes the Declaration of Independence as a document “that is not intended to be a statement of who we are but of what we dream of becoming, realizing that the journey never ends.”

The CAP Board of Governors last September added one word (“worldwide”) to the end of the CAP mission statement, a modest change that highlights the organic nature of our growth and evolution. The decision to underscore the international component of our endeavors reflects three modern realities: 1) the CAP is committed to its fellows and international fellows wherever they may practice; 2) the world has shrunk; and 3) medicine is global.

International activity within the CAP Laboratory Accreditation Program has accelerated in response to increased demand. Accreditation is a core activity of the College; to many outsiders, it is who we are. Our commitment to patient protection and interest in the related science of laboratory quality assurance provided the genesis for CAP accreditation and continue to drive its evolution.

CAP accreditation has a wonderful creation myth that grew out of events at the 1960 annual meeting in Chicago when the CAP was just 14 years old. Two members who would later be presidents (William Reals, MD, and James Barger, MD) were attending a reception on the 20th floor of the Conrad Hilton hotel. They wanted to talk about a program to protect laboratory quality but the room was too noisy. Although Chicago is cold in November, the two stepped outside onto the old-fashioned fire escape to draft the enabling resolution for what would become the CAP accreditation program. When pathologists believe it is time to do something, they find a way to get it done.

Fifty years later, the CAP accredits laboratories in 45 countries, and laboratories in 96 countries subscribe to CAP proficiency testing. In 2011, more than 11,000 CAP inspectors and team members volunteered more than 230,000 hours to audit 2,700 laboratories. CAP members on supervising bodies and scientific resource committees also contribute, writing checklists and verifying test accuracy. CAP accreditation is a thoughtfully conceived, carefully tended grassroots movement that has grown along with its fine reputation.

All of which brings me to the Arab Health Conference held in Dubai in January, where I represented the CAP and learned, one encounter at a time, that many pathologists practicing in the Middle East are eager to pursue CAP accreditation for all the right reasons.

As geographic barriers to worldwide excellence rapidly disappear, we have begun to witness a race for institutions to improve patient care by improving accuracy of test results, quality of interpretation, and commitment to patient safety. According to the Accreditation Council on Graduate Medical Education, one-third of pathology residents in the U.S. are graduates of foreign medical schools, many of which do not sponsor residency programs. Those who come to the West for residency remain our friends after they return home. They know what excellence in laboratory quality assurance looks like and are determined to bring it to their patients. Demand for CAP accreditation has grown organically as pathologists at medical schools, hospitals, and independent laboratories in the Middle East have networked with one another and shared what returning graduates have told them about their training experiences.

While at Arab Health, I was privileged to meet CAP member Laila Abdel-Wareth, MBBCh, FRCPC, chair of the Pathology and Laboratory Medicine Institute at Sheikh Khalifa Medical City (SKMC), a major hospital system that has grown dramatically in the last decade. It was created in 2005 as a result of the merger of all publicly held health care organizations on Abu Dhabi island. At the time, practice guidelines in the component institutions were variable or nonexistent. The leadership at SKMC later partnered with the Cleveland Clinic in Ohio to accelerate modernization. At the SKMC Pathology and Laboratory Medicine Institute, Dr. Abdel-Wareth shepherded the journey toward accreditation. SKMC is now a core laboratory with about 200 personnel.

Dr. Abdel-Wareth’s enthusiasm for quality assurance is contagious; I don’t know anyone who could have resisted her determination to make the SKMC laboratories among the best in the region. It was so delightful to hear her explain how peer-to-peer education in the laboratory accelerated quality improvement, how they worked with CAP mentors to identify next steps, and why the integrated staff teams they created had so effectively encouraged healthy competition.

Dr. Abdel-Wareth told me that as they worked toward accreditation, her management team would “titrate the heat” to reassure and enlist the support of those who were skeptical or anxious about the changes they were making. The unambiguous CAP checklists were key, she said, “like someone talking you through it.” And when her staff enabled their laboratories to achieve accreditation, it all came together.

“It was inspiring to see how the College changed us,” she said. “People became supportive of each other. They are very proud now and have continued to make changes, not because CAP wants us to but because they really breathe it and live it and understand exactly what the culture of quality and excellence is about.”

Now, as at the start, it’s about mission. The excellence that our international partners achieve provides further evidence of the importance of leadership and the value of our shared commitment to foster excellence in the practice of pathology and laboratory medicine worldwide.