CEO SUMMARY: To achieve the goals of continuous improvement and standardization across all facilities within its organization, TriCore Reference Laboratories opted to implement the CAP 15189 quality management system (QMS). Last month, the lab announced its accreditation to CAP 15189 and became the nation’s first laboratory organization to earn a multi-site CAP 15189 accreditation. TriCore’s administration says that its client physicians have noticed the improved testing services.
IN ALBUQUERQUE, NEW MEXICO, last month, TriCore Reference Laboratories became the latest laboratory to implement the quality management system (QMS) of CAP 15189 and earn accreditation to that standard. TriCore says it is the first multi-site laboratory organization in the United States to be accredited to this CAP 15189 standard.
The College of American Pathologists (CAP) now has 18 laboratory organizations which have achieved accreditation under its CAP 15189 program. The American Association for Laboratory Accreditation (A2LA) has one laboratory accredited to the standards of ISO 15189:2007.
TriCore made a major commitment to the 15189 QMS. In New Mexico, it employs 1,100 people who work in 54 sites. The lab contracts with 35 pathologists and scientific directors from two pathology groups. Among its 54 sites are 26 patient care centers. “All sites operate under the ISO 15189 quality management system,” stated Jessie Salk, who is President and CEO of TriCore, “but only three of the sites are accredited to CAP 15189.
“Those three sites are the core laboratory and the two rapid response labs,” continued Salk. “One of these labs is located at the University of New Mexico Hospital (UH) and the other is located at Presbyterian Hospital. All three of these lab facilities are in Albuquerque.
“We decided to implement the 15189 QMS at the core lab and the two rapid response labs first, because we can add other hospitals and sites later,” Salk said. “Currently, the entire TriCore organization operates under the same QMS system because the cross-functional teams involved in this effort represented the various sites.
“One strategy at TriCore is to introduce continuous quality improvement across the entire organization,” she noted. “In October 2009, we applied for CAP 15189 accreditation and had a gap assessment in April 2010. It took just over two years to fully implement the QMS, successfully complete our assessment, and earn accreditation for these three lab testing facilities.
“Implementation of the 15189 QMS has delivered significant benefits to us,” stated Salk. “Like many laboratory organizations, we perform the same testing at multiple sites under the same management and technical requirements.
Separate but Equal
“Our hospital-based labs run very differently from the way we run the core lab,” Salk explained. “That creates a dichotomy in how things work. So our ultimate goal was to standardize these three organizations.
“As a first step, in 2010 we standardized all the lab equipment in these different labs,” she recalled. “The next step was to standardize the processes, the quality management system, and the focus on continuous improvement in each of our facilities. Now we can look at everything the same way across the system, regardless of the location.
“The laboratory staff at the UH lab and in the Presbyterian Hospital lab are our employees, but they are still part of those hospitals,” Salk added. “We wanted to encourage more interaction and break down those silos. This would make it easier to share best practices, to standardize processes, to measure nonconformities, and to conduct root cause analyses.
“Once we got people from each facility into one room and had them talk about the process, the silos disappeared rather quickly,” she said. “The teams identified the best processes for our clients and for our patients. Then we set standards for those processes and developed support systems to consistently meet those higher standards. Since we now measure processes across the system, we are faster and more accurate at spotting problems as they occur.”
TriCore’s Quality and Process Improvement Manager, Pat Strong, agreed. “Every member of the staff now has the training and the knowledge to recognize errors, then find the cause of these errors so they can be prevented and eliminated.
“With this training in place, we can now put more emphasis on the cost of poor quality,” explained Strong. “Our staff understands that errors are costly. This is a very powerful tool to use.”
“Now, if a specimen is misplaced, the entire staff recognizes that the processes or systems we had in place may have been the cause of that lost specimen,” observed Salk. “The QMS helps us do more than simply find or replace that lost specimen. Our lab staff has the knowledge and the tools to identify and eliminate the constraints or systemic problems that caused us to lose the specimen in the first place.
“Our accreditation to CAP 15189 means we all have to dig deeper to find the root cause of problems,” she added. “Then, once we identify that root cause, we can fix or eliminate it.”
Even more powerful is the fact that TriCore’s lab team has implemented processes to prevent errors before they occur. “Much of our continuous improvement activity centers around corrective and preventive action,” noted Salk. “Corrective action helps us to prevent problems from recurring, while preventive action prevents problems from occurring not just in the core laboratory, but in all locations across our organization.
Increased Client Satisfaction
“Another benefit of TriCore’s CAP 15189 accreditation is the improved ability to move staff from one location to another if needed, since they know the systems at all locations,” Salk said. “Improving client satisfaction is our next big objective in the coming months.
“As our lab improves processes and performance measures, it’s definitely improving service to clients,” she added. “That makes us more competitive in our service market. Each time we improve our work processes and service levels, our customers recognize and comment on those improvements. This is not the end or our efforts,” she added. “We have just begun this journey.”