ISO 17025: practical benefits of implementing a quality system

As a laboratory certified to ISO 9001:2000 and accredited to ISO 17025, rtech laboratories has incorporated an overall system for technical and quality management, which results in benefits observed in daily laboratory practices. Technical requirements were updated to include the addition of formal personnel training plans and detailed records, method development and validation procedures, measurement of method uncertainty, and a defined equipment calibration and maintenance program. In addition, a stronger definition of the sample preparation process was documented to maintain consistency in sampling, and a more rigorous quality control monitoring program was implemented for chemistry and microbiology. Management quality improvements focused on document control to maintain consistent analytical processes, improved monitoring of supplier performance, a contract review process for documenting customer requirements, and a system for handling customer comments and complaints, with continuous improvement through corrective and preventive action procedures and audits. Quarterly management review of corrective actions, nonconforming testing, and proficiency testing aid in determining long-term trending. The practical benefits of these technical and management quality improvements are seen on a daily basis in the laboratory. Faster identification and resolution of issues regarding methods, personnel or equipment, improved customer satisfaction, meeting quality requirements of specialized customers, and overall increased laboratory business are all the result of implementing an effective quality system.     

Experience of accreditation in a surface science laboratory

The analytical laboratory MateC of Fondazione Bruno Kessler has successfully offered material characterization on international research and development market for the last 25 years. Since the beginning, this market has drastically changed becoming more exacting for higher standards, and introducing a quality management system became mandatory for a successful operation. In order to pursue the market and customer needs, the MateC activities have been accredited according to ISO/IEC 17025 quality management standards. This paper summarizes many years’ experience of work under the ISO/IEC 17025 compliant quality system standard in a surface science laboratory for performing material characterizations, considering all significant pros and cons.     

The process of management review

Management review of the quality-management system is an item in many quality standards and a requirement of the ISO 9001:2000 standard and of laboratory standards ISO 15189 and ISO 17125, and others. These reviews are conducted to ensure that the top management is informed and involved in the quality-management system with respect to continuing adequacy and effectiveness, and opportunities for improvement of the system. The management review is a process that should be conducted and audited utilizing the process approach. A process approach is defined as “An activity using resources and managed in order to enable the transformation of inputs into outputs” (ISO 9001:2000). All identified main processes in the quality system should be monitored through data collection by appropriate methods, assuring that data are valid, representative, and adequate. For management review data must be collected and presented in an accessible form so that processes can be evaluated according to objectives, goals, resources, etc. On the basis of this information the laboratory management makes the necessary decisions and ensure that actions are taken that improve the effectiveness of the quality-management system. As output from the management review process, there should be evidence of decisions regarding: change of quality policy and objectives; plans and possible actions for improvements; corrective actions as appropriate; increased customer satisfaction; and planning of resources needs. Identification of the processes involved and using the process approach in the management review ensures the continual improvement of the quality system. Presented at the conference Quality in the Spotlight, March 2006, Antwerp, Belgium.     

Reacting to spontaneous feedback from external customers in a university hospital laboratory

Modern quality standards for laboratories recommend the use of customer feedback in quality improvement. Spontaneous customer feedback is one method to obtain information from customers. In the present study, we analysed the feedback data from external customers (health centres and other hospitals) to our university hospital laboratory during 2001–2006. The most common subject matters of the feedback, covering 87% of a total of 95 reports, were lacking test results, suspicion of the validity of test results, return of samples in transportation boxes to customers and delays in service. On investigation, errors or defects were revealed in 78 cases. The most common errors were lacking (45 cases; 58%), erroneous (20 cases; 26%) or delayed test results (7 cases; 9%). As much as 68% of these errors took place in the pre-analytical phase of the laboratory process, occurring most commonly during specimen transfer, when entering orders into the laboratory information system at the university hospital or during sample processing. The most common underlying causes for errors were unintended errors and non-compliance with operating instructions. Latent errors were identified in 14% of the cases. Corrective actions were performed in 79% of the reported cases. It is important that the feedback reports are investigated to find out possible errors and their underlying causes so that appropriate corrective actions can be taken. When processed properly, spontaneous customer feedback is a method that can be used supplementarily to other methods to detect errors and defects in clinical laboratories and to aid in quality improvement.     

Relevant elements of laboratory competence

 The staff of a laboratory, and its pre-conditions in terms of management principles and work procedures, constitute the basis for customer satisfaction including the quality of the results. It is argued here that there is a rather limited core of principles and procedures, the relevant elements of which are essential for "laboratory competence". These elements are treated as part of the requirements in international quality standards, in particular the draft revision of the ISO/IEC-Guide 25. It is suggested that it should be possible to structure them in a more flexible way and to integrate the elements into the ordinary management system of a laboratory.     

Implementation of ISO 9001 in a medical testing laboratory

 The Department of Clinical Chemistry and Molecular Genetics, within the Institute of Clinical Pathology and Medical Research at Westmead Hospital, is a medical testing laboratory operating within the public sector health system of New South Wales, Australia. It provides acute-care pathology services to Westmead Hospital (a 900-bed tertiary referral university teaching hospital) as well as to three district hospitals and three rural hospitals. In addition to these core clinical chemistry services, it offers approximately 150 specialised biochemistry, pharmacology, toxicology, trace metal and molecular genetics assays as a reference laboratory service. In 1993, the Department became Australia's first medical testing laboratory to be registered to ISO 9001-1987/AS3901-1987. In 1995, this certification was extended to AS/NZS ISO 9001-1994. We are currently preparing for further accreditation to ISO/IEC Guide 25-1990, with additional supplementary requirements for medical testing. This paper describes the Quality System that the Department developed and which has been successfully maintained and extended since original certification. Important features of the Quality System are: 1. Primary design of the Quality System to meet medical and customer needs, with subsequent addition of required ISO elements. 2. Use of national Quality Award criteria to identify key business processes. 3. Development of integrated technical non-conformance, customer complaint, staff suggestion, and quality system corrective action procedures. 4. Implementation without external resources. Our conclusions are that ISO 9000 Quality Systems can be applied to medical testing laboratories, and can be implemented with minimum resource costs. Improvements in technical and service quality and business performance have resulted from this process. However, implementation of ISO 9000 at the level of individual Departments is not ideal. Greater improvements are possible when this process is undertaken at the level of the entire organisation. Received: 9 September 1996 Accepted: 5 October 1996     

Unification of the quality assurance systems of public health laboratories conformed to ISO 17025, ISO 15189, and ISO 9000: a major organizational change

The Department of Public Health Laboratories consists of five major laboratories located across the country of Israel: four environmental laboratories performing microbiological and chemical testing of food and water products [accredited according to International Organization for Standardization (ISO) 17025 since 1999) and a fifth laboratory that is dedicated to virology testing (certified according to ISO 9000 since 2003). Historically, each laboratory operated independently and developed its own quality assurance (QA). On November 2004, an important strategic decision was made: to unify all five laboratories’ QA systems conformed to ISO 17025, ISO 15189, and ISO 9000—a transition from five laboratories operating independently in the field of QA toward establishing a multisite laboratory. This process was considered and visualized as a major organizational change and therefore raised some resistance among both QA managers and the professional laboratories’ management. Thus, it was necessary to overcome the resistance and at the same time induce thoughts of ways of reshaping and formatting the new and uniform quality manual and uniform standard operating procedures (SOPs). In September 2005, the first phase of the process was completed, and all four environmental public health laboratories successfully passed a reaccreditation audit using a uniform QA manual guide and partially uniform SOPs. We shall share our experience and discuss the major contributions of this process to overall laboratory management. Presented at the 3rd International Conference on Metrology, November 2006, Tel Aviv, Israel.     

ISO compliant laboratory quality systems and incident monitoring improve the implementation of laboratory information systems

Quality systems can provide a means of measuring the rate of occurrence of defined incidents and non-conformities. We have studied the application of laboratory quality systems to monitoring the implementation of laboratory information systems (LIS) in two similar size tertiary hospital pathology laboratories in Australia. At one site, one department implemented a quality system accredited to ISO 9001–1987 and ISO 9001–1994 while the rest of the organisation did not have a formal quality system; this site implemented the Cerner PathNet LIS. At the other site, the organisation was in the process of implementing ISO/IEC Guide 25–1990 and ISO/IEC 17025–1999; this site implemented the PJACC AUSLAB LIS. The rate of quality system incidents and non-conformities was used to track the progress of implementation of the LIS. We found that different quality systems appeared equally useful in monitoring the rate of occurrence of incidents. However, the presence of a formal quality system greatly improved the proportion of incidents that could be investigated and resolved at root cause level. Incident monitoring, as part of a formal quality system, proved to be a useful tool in monitoring and managing the implementation of these LIS. Received: 4 August 2001 Accepted: 21 March 2002     

Practical experience of simultaneous accreditation and certification acquired in RIVM's official medicines control laboratories

 This article presents an overview of the practical experience acquired in two governmental medicines control laboratories in the Netherlands which combine the application of EN 45001 and ISO 9002 standards in the regulatory field of quality and risk assessment, and quality control of medicines and medical devices. This practical experience also includes simultaneous accreditation and certification. The EN 45001 standard was applied to laboratory testing activities and the ISO 9002 standard to non-laboratory file assessment activities as these activities are not covered by the scope of EN 45001. It appears that a combined application of these standards is practicable because they complement each other well. EN 45001 strongly emphasises technical competence. ISO 9002, on the contrary, emphasises more strongly the efficiency of the management processes and customer requirements. Received: 1 October 1998 · Accepted: 21 December 1998     

Internal audits in private medical laboratory practice – a Finnish experience in 1996–2000

Internal audits inherently effect quality improvement, and concrete results can be expected by careful planning. As audits should improve the quality system in situ, the development of audits should not be neglected. ISO/IEC 17025 describes the objectives of internal audits and management reviews in more detail compared to the former standards EN 45001 and ISO/IEC Guide 25, although the main features are unchanged. This addresses continuous surveillance of the current practice. A brief questionnaire on vertical audits was distributed to 74 of 120 employees at a Finnish private medical laboratory, Medix Laboratories Ltd. A positive feed-back was received from the current management of audits. However, the study revealed that continuous supervision of audits is needed. Many employees were not willing to perform audits if they had no previous experience. Additionally, audits performed at the workbench were not considered as the best possible for fruitful discussions. Received: 20 February 2001 Accepted: 30 November 2001     

Utilisation of customer feedback in a university hospital laboratory

The article describes the customer feedback system at a university hospital laboratory and the analysis of the feedback data from clinical customers in 2001–2006. The most common subject matters of the feedback were suspicion of the validity of laboratory results, delay in service and lacking test results, covering 82% of the 115 reports. The investigations of the cases revealed errors or defects in laboratory services in 81 cases. The most common errors or defects were erroneous test results (35 cases; 43%), delayed test results (24 cases; 30%) and lacking test results (15 cases; 18%). The most common underlying causes for a laboratory error or defect were unintended errors and non-compliance with operating instructions. Seventy-six percent of the feedback reports led to corrective actions. It is important to react to every instance of customer feedback and to find out possible errors or defects in the laboratory process. Uncovering the underlying causes makes adequate corrective and preventive actions possible.     

The contribution of the accreditation process to public administration: promotion of vital organizational changes

Accumulative evidence suggests that the implementation of international standard operating procedures, induce, by their virtues, major organizational changes. These changes are both cultural and behavioral including changes in decision-making processes, organizational norms, and values. The decision of any organization to adopt quality assurance, specifically via accreditation, should be regarded as a strategic one. As such, it prerequisites top management commitment, budgeting the process and promoting active inter-collaboration of all organizational members. The accreditation process according to ISO/IEC 17025:1999 of the Haifa Public Health Laboratory, will be used as a case study. A number of practical benefits of such organizational changes will be demonstrated and discussed, among them improved quality customer service and handling customer's complaints, establishing multichannel communication, enhanced interlaboratory collaboration and coordination. It is important to note that the accreditation process was accompaniment by extensive training of both management and employees on-site and off-site.     

The current status and future of medical laboratory quality regulation and accreditation in Ghana

High-quality and reliable laboratory services are important components of effective and well-functioning health systems. Accurate, reliable and timely medical laboratory testing is crucial to patient care and disease surveillance. Unfortunately, in many sub-Saharan African countries, medical laboratory systems are adversely affected by the unavailability of medical laboratories, poor laboratory infrastructure and lack of well-trained personnel [1]. Quality in the laboratory is only achieved in a systematic way through the implementation of a quality management system. The results of the study showed that approximately 60?% of the 78 respondents were unaware of the requirements of ISO 15189:2007. A trial of proficiency testing, termed ??blind proficiency testing??, was carried out in which 19 laboratories determined the concentrations of urea and cholesterol in a proficiency testing material. Of the 19 laboratories that determined the concentration of urea, 63?% produced satisfactory results with scores between ?2 and +2. Similarly, 63?% of the participating laboratories obtained satisfactory z scores for cholesterol determination. Some of the laboratories that obtained satisfactory scores for urea determination had unsatisfactory scores for cholesterol determination and vice versa. It is recommended that the Ghanaian government pass a law and establish a standard to regulate medical laboratories in Ghana in order to improve quality in a significant way.     

Implementation of ISO/IEC 17025 standard in a nuclear analytical laboratory: The KAERI experience

The practical experience on the implementation of ISO/IEC 17025 compliant quality system in a nuclear analytical laboratory of the Korea Atomic Energy Research Institute (KAERI) is described. This paper summarizes the need for a quality system and accreditation, the process of a quality system implementation, the quality system structures, and the formal accreditation of our laboratory by the Korean Laboratory Accreditation Scheme (KOLAS). Also, the improvements in the management, technical and service quality which resulted from implementation of this system are briefly reported.     

Blood banking quality: minimum requirements for TQM

In 1995, the Council of Europe published a guide with recommendations providing transfusion services with a set of guidelines and principles relating to the preparation, use and quality assurance of blood components. As a blood transfusion service is at the same time a supplier of blood products and a test laboratory the quality management system must include good medical practice, good manufacturing practice and good laboratory service, all of which are closely linked. We made a critical evaluation of the content of the guide and analysed requirements and recommendations in comparison with quality management systems applied by the concerned partners. As a major critic we observed that the guide does not take into account any quality system of the in vitro diagnostic (IVD) supplier and/or distributor. With the addition of some items outlined in ISO 25 and ISO 9000, the Council of Europe document can be improved so that it complies with internationally accepted quality management standard recommendations.     

The German perspective of using the EFQM model in medical laboratories

The financial resources of health care services are only nominally growing in Germany. Therefore, the politicians have been forced to act. Up to now, a fixed limit of remuneration should not affect the quality of patient management. However, these primary economic issues have initiated positive and negative reactions from the laboratory medicine community. In hospital laboratories the challenge is to realise continuous improvement of service quality but at the same time reduce costs. This can only be achieved by introducing total quality management (TQM) and measuring the quality obtained by the European Foundation for Quality Management (EFQM) model. Predominantly formal attempts to improve quality at the level of ”enablers” such as certification (ISO 9000) or accreditation (EN 45000, ISO 15189) will not solve these problems. Two groups in Germany work on TQM and EFQM: the Working Group ”Laboratory Management” of the German, Austrian and Swiss Societies for Laboratory Medicine and for Clinical Chemistry, and the Institute for Quality Management in Medical Laboratories (INQUAM). Their work has resulted in several books on the subject, successful propagation of application of the EFQM model and a proposal for a formalized ”certification” procedure according to the model.     

Using a learning curve approach to reduce laboratory errors

Hospital laboratories have error rates that are too high and in some cases may be responsible for adverse patient treatment. This paper introduces reliability growth management (RGM), which is based on learning curve theory, as a method to improve laboratory error rates. RGM is widely used in the defense and automotive industry to solve problems when resources are limited and knowledge about the product and/or process is incomplete. An example of RGM, which was used to improve the reliability of instrument assay systems in the medical diagnostics industry is presented. RGM is a closed-loop process that entails creating a goal and event model, classifying events with failure review and corrective action system (FRACAS), tracking progress and predicting completion with Duane analysis. Results achieved by RGM were far better than those obtained by previously used methods. RGM techniques can be transferred to hospital laboratories to reduce laboratory error rates. The advantages of RGM compared to other quality initiatives such as ISO 9000 and Six Sigma are discussed. Received: 3 February 2002 Accepted: 17 July 2002 Acknowledgements The majority of the work of transferring reliability growth management from the defense industry to the medical device industry was performed by Keith K. McLain, while he was at Ciba Corning Diagnostics. Keith is now at Ortho-Clinical Diagnostics (email: KMcLain@ocdus.jnj.com). Presented at the European Conference on Quality in the Spotlight in Medical Laboratories, 7–9 October 2001, Antwerp, Belgium Abbreviations  RGM Reliability growth management · FRACAS failure review and corrective action system · CAP College of American Pathologists · LIS laboratory information system · HIS hospital information system Correspondence to Jan Krouwer     

MiC in Chemistry Curriculum at the University of Tartu: the current status

The introduction of MiC (Metrology in Chemistry) into the Chemistry Curriculum at the University of Tartu using a two-stage approach is described. As the first stage the topics of MiC are first touched at the beginning of the first analytical chemistry lecture course in the 3rd semester. The emphasis there is on the measurement uncertainty (MU) and its practical estimation (based on the ISO GUM approach). The main purpose of this is to make it clear from the beginning that MU is an integral part of any measurement and to enable the students to estimate MU in the laboratory courses of analytical chemistry (3rd and 4th semesters). As the second stage, MiC is treated in more detail in a dedicated course where also topics, such as reference materials, interlaboratory comparisons, standardization, quality management, accreditation, etc are covered. Received: 6 November 2001 Accepted: 6 December 2001     

Quality assurance in research: incorporating ISO9001:2000 into a GMP quality management system in a pharmaceutical R+D+I center

There is currently no universal or standardized quality system for the recognition of excellence of a research center. Knowledge and competence may not be enough in the current rapidly changing world in which high productivity and continuous improvement are essential. The purpose of this study was to assess the impacts of implementing the ISO9001:2000:2000 standard in an academic research center dedicated to R+D+I (research, development and innovation) in the pharmaceutical industry. The article describes the stages we followed to implement the ISO9001:2000 system, which was achieved by integrating it into the previous regulatory system of GMP (Good Manufacturing Practices). As a result of implementing ISO9001:2000, the center has seen distinct improvements, such as fewer errors in project documentation, improved assessment of customer satisfaction, and the effective implementation of periodic plans, e.g., in calibration, preventive maintenance, and investments. Overall, ISO9001:2000 implementation has been beneficial for the organization and could be applied to other research centers.