Stanley J. Robboy, MD

September 2012

Stanley J. Robboy, MD

For safety, generations of volunteers

CAP laboratory accreditation is celebrating its 50th anniversary this year. Pathologist volunteers have built this program, one inspection at a time, and have done so in a way that ensures perpetual evolution. We owe a debt of gratitude to the original visionaries, whose stubborn determination set the bar for the rest of us.

Some of the 50-year celebration materials have used numbers to describe our progress. They mention, for example, that more than 11,000 pathologists, medical technologists, and others served on laboratory inspection teams in 2011 alone. They report that 72,000 laboratories, including more than 350 outside the United States, are currently CAP accredited and that our inspection teams spent 230,000 hours (115 person years) auditing 2,700 laboratories in 2011.

Let’s step back and consider one of those statistics. What do 230,000 hours mean? How many days away from home? How many nights spent writing reports? How many afternoon summation conferences, where pathologists sit down together and talk about how deficiencies can be corrected? Driving this 230,000-hour commitment is something everyone understands: patient safety.

Experience teaches—that’s the nut. It was experience that drove CAP accreditation—that, along with something in our cultural DNA. So much in medicine cannot be learned from a book. So much in the laboratory carries stakes that are so high as to make the margin for error virtually nonexistent. Quality patient care in the laboratory means getting it right every time.

Getting it right has involved an iterative cycle of growth and testing and learning and improvement. The various accreditation checklists featured 2,936 items at last count—and that was after the checklists had been combed to eliminate redundancies.

In many ways, laboratory accreditation is where the rubber meets the road. It lays the brickwork and lights our path. It drives home the principles and the vision that translate to our mission. Building a successful program has required attention to detail, commitment to patient safety, technical savvy, iterative learning, and generations of volunteers who were—and are—generous to the bone.

The CAP accreditation staff tells me that when people see a new requirement, they know there’s always a story about it. That’s how we teach and learn—through our stories. The greatest strength of our program is that it’s peer-to-peer education. An inspection is not about a clipboard or checklist; it’s about peers who sit down together, talk about their challenges, and partner to meet the highest standards of patient care in pathology. It’s about inspectors saying they learn something new on every inspection. And it’s about residents, fellows, and those new to practice who will tell you they learned things about the nature of their science as members of inspection teams that could not have been covered in their formal training. And you know they will turn around and teach those who follow.

A successful accreditation program will foster interest in cutting-edge science and technology. Recently, the program has begun to accredit biorepositories—as I write, four have been accredited and 15 others are in the pipeline. Introducing biorepository accreditation, like everything we do in the CAP, requires a high level of collaboration across departments. The CAP Personalized Health Care Committee has developed a webinar (Biospecimens and Biorepositories for the Community Pathologist) that is posted for download from the transformation Web site. I highly recommend the free webinars; they feature some of the most respected educators and researchers in our field. (A great way to stretch your brain!)

The accreditation program has also stepped up with new next-generation sequencing checklist requirements in molecular medicine. All checklists are updated as medicine and technology evolve.

Accelerated activities in international accreditation are providing opportunities for cross-pollination of member leaders in different countries, especially those in academic and larger medical centers abroad. Our international inspector certification program was piloted last October in Beijing. About 25 pathologists, laboratory directors, and key laboratory personnel from accredited labs in China participated; among the 25 were 12 who serve as CAP international quality ambassadors. A second inspector certification training program in Mumbai, India in January drew 23 participants. The CAP is looking into more such training programs, perhaps in Brazil and Singapore. As our overseas partners develop their own inspection teams, the cost of their participation will go down, making accreditation more accessible and raising the level of pathology practice worldwide.

So if someone asks where you’re from, tell them you come from a place where continuous quality improvement and patient safety are in the cultural DNA. Tell them you come from a place where there are no shortcuts to excellence. Tell them you come from a place where a person’s finest legacy is an abiding interest in doing good. Then they’ll know they’ve met a pathologist whose energies and commitments honor a legacy of quality, consistency, and innovation in the interest of medical progress and patient safety.

Our accreditation programs have grown out of the cultural DNA of an organization whose members are bright and visionary and comfortable with intelligent risk-taking. Pathologists who understand the importance of collaboration—with one another, with agencies of government, and with other groups that share our interest in patient safety—have established a stellar reputation for CAP accreditation that reflects well on our tradition and bodes well for our future.