UKAS, ISO15189 and laboratory accreditation

So we come to the end of a hard week of full laboratory assessment to ISO15189 standards. As readers of the blog will be aware, I have never been a fan of the philosophy of inspection as it tends to pull us away from purpose and towards an inside-out view of the world, where we do things to keep inspectors happy, rather than because they are the right thing for our customers / citizens / patients. But what a pleasure it is to say that I have almost completely been proved wrong.

The UKAS team have been an interesting mix of peers, who, by and large, have asked fair and challenging questions. What they really liked about our lab are things like ;

- we have an approach to 'measurement of uncertainty' that reflects the genuine importance of this in managing patients.

- the palpable sense of teamwork and 'ownership'. The staff here are connected to the relevance of why they are doing what they are doing.

- the way we work collaboratively with users towards an optimised service, as defined by what matters to the patient, rather than what matters to us.

I think the assessment could be better. There is still too much focus from some assessors on things that are not important, not recognising that there is opportunity and financial cost to their recommendations. There is, on the other hand, not enough focus on things that we know really make a difference to patient care. For instance, are the clinical decisions before and after specimens hit the lab as good as they can be, and what are labs doing to address these?

But I get the impression that there are green shoots in the assessment process that could embrace these concepts. I have loved working with assessors who bring a degree of external challenge and support that is invaluable, They have identified areas that are weak and we need to sort. They have identified many more areas that are strong, and they have said this. To get this external validation is so important to hear. There has been a real sense of excitement in the lab today, as we hear yet more glowing reports about the quality of the work. We don't get this from anybody else. And we can be blind to it ourselves, focussing as we tend to do mainly on things that could be better. To hear that assessors would like to work here, would be happy to have their child's specimens tested here, and that that is most definitely not the case for many laboratories in the UK has just capped a great week.

A final observation about purpose. This lab is beginning to see quality as something that falls out of 'doing the right thing'. I know many labs would say that they do this, but I think many are missing the real opportunities that are out there. It is very hard to see how consolidated labs, that have lost their direct clinical connections, can do this. I wonder if the horror stories that abound about others' experiences of UKAS inspections is a direct result of this loss of purpose - it is translated into low quality work. I think our experience over the last week shows that quality flows from purpose, not the other way round. So thank you UKAS, I eat most of my previous words, and I look forward to working with you more in the future.