President’s Desk Column

Cultivating the garden

July 2002
Paul A. Raslavicus, MD

Here it is—summertime. It’s the time of year when we in "northern climes" fuss in our gardens, even if it’s only a planter outside the apartment window. The overwintered bulbs have long ago bloomed, and the annuals show their glory.

The College is akin to a garden that needs occasional cultivating, pruning, and weeding so that our work brings the most value to you, our members, and your associates. Sometimes the spadework involves much investment of time and money. Sometimes we fertilize with a task force or a customer survey. Sometimes we make significant changes to nurture healthy growth. Two recent examples of such change involve the CAP Laboratory Accreditation Program and the College’s annual meeting plans for 2004 and beyond.

Each year 16,000 LAP inspectors conduct 3,000 laboratory inspections. The College’s subspecialty laboratory accreditation work is flourishing: 785 laboratories accredited for molecular pathology, 237 for cytogenetics, 580 for flow cytometry, and 2,500 for cytopathology. While the laboratory universe shrinks, we continue to experience a net growth of more than 100 laboratories per year and to receive initial applications for accreditation from nearly three times that many laboratories.

As the LAP grows, it continues to implement new approaches and technologies. We recently concluded the first two-year cycle of graded inspections. We now have a relative performance assessment for every laboratory that we inspect. We have simplified the reapplication process by using a prepopulated reapplication form. We have eliminated redundancy by retaining needed information from one inspection to the next. And we have developed a new post-inspection critique. The critique has shown that:

• More than 97 percent of the laboratories are very satisfied or satisfied with the overall inspection process, inspection team, and summation conference.
• More than 97 percent of the team leaders and members are satisfied or very satisfied with the overall inspection; an average of 97 percent indicate that stated educational objectives are being met.
• Laboratories are well satisfied with the qualifications of team members in all disciplines; the average rating for these aspects is 4.5 on the 5.0 scale.

• We must assure that all of our inspectors, especially in some of the "new" disciplines, such as biochemical genetics and molecular pathology, are properly qualified—that is, they practice that specialty on a regular basis. The CAP resource committees are also working toward this end.
• We currently inspect as a single unit 475 laboratories in each of the 65 health care systems. The degree of laboratory integration is variable and, in many cases, the only link is through common corporate ownership. Systems inspections have often been problematic. We need to better define a true system laboratory.
• We must keep inspection team size at a level that is not unduly disruptive to laboratory routine.
• We must create custom checklists so laboratories are queried only on what is relevant to them. A pilot mechanism for creating customized checklists is expected to be available by year-end.
• The College is considering educational programming to better prepare laboratory directors and supervisors for reinspections. Formal consultative services may be in the offing as well.
• We know that it is getting harder to free hospital staff for inspector duties. While we want to preserve the voluntary nature and educational benefits of LAP inspections, we need to consider whether on-site CAP staff support would lessen the burden on inspection teams and assure continuity and consistency.

Such are the duties of the gardener!

In another area of the garden, we did not need a survey to tell us that the ASCP/CAP joint meeting was not working well for our members: Dwindling attendance and empty exhibit halls made that clear. Through the years, the structure, content, and spirit of the meeting changed, as did the directions of the sponsoring societies. In financial terms, the costs to run the meeting and the required subsidy per attendee escalated. When the CAP Board of Governors examined the relative costs and the benefits to our members, it reluctantly concluded it is no longer feasible to continue the current meeting format.

Still, it was a difficult decision to end the CAP’s joint meeting with the American Society of Clinical Pathologists. Any departure from tradition is uncomfortable. We do, however, see a tremendous potential in a College-driven, College-managed, College-focused annual meeting in which we would not be constrained by others in terms of when and how we can present critical scientific, reimbursement, and practice issues that affect pathologists.

We came to you to find out how to make the meeting come alive again. You told us you want to have ample time to meet with and learn from one another; to experience cutting-edge, innovative education; to learn advocacy and practice management skills; and to set an agenda for the future of the specialty.

We intend to provide you with such an experience. A reformatted meeting will be created by you and for you with a focus on effective advocacy, dynamic governance and idea exchange, and more interactive education. To accomplish this goal, we will investigate collocation or collaboration with other physician and medical laboratory groups, including the ASCP. We will make sure the meeting is a homecoming for our members. In a member-driven organization such as the CAP, our get-together will be an opportunity for dynamic networking. In a setting that will also offer cutting edge, practical learning experiences, our garden will blossom. And in this atmosphere of collegiality and intellectual stimulation, a new generation of dynamic leaders in medicine and pathology will arise. Our commitment to you is ongoing. Not only do we tend to the root system, we weed, prune, and cultivate for lasting value and vitality.