Quality systems aren't just about completeness of a quality manual and abundance of system documents.  Accurate and up-to-date documents certainly are a critical part and provide the foundation for the system, but the way in which that system is put into action in the laboratory is what makes a program a success or failure.  Each laboratory is unique, and so each laboratory's functioning quality system is unique.  The "American Association of Veterinary Laboratory Diagnosticians (AAVLD) Requirements for an Accredited Veterinary Medical Diagnostic Laboratory" provide the rules to follow, but do not specify how to implement those rules.  That allows each laboratory the flexibility to develop a system that is useful for them.  This is the challenge of the quality managers and laboratory staff.  How to make their unique system work as efficiently, painlessly, and effectively as possible, while complying with the AAVLD requirements and assuring accurate and timely information is provided to our clients.

It is important to take advantage of what resources are available to help with confusion in interpreting the rules and discovering different tools other laboratories have used that work.  There is no one-size-fits-all program that will work for everyone, but certain aspects of one laboratory's program may provide ideas that can work for another laboratory.  It is essential that we continue to share and exchange ideas and examples, even after our programs are established and matured.  Laboratories are not a stagnant environment.  Things are constantly evolving and changing.  Budget shortfalls, changes in organizational structure, staffing issues, facility replacement or aging, new test methods, new regulations, new equipment, new databases, and much more, present new issues that may require adjustments in the quality system.  If we take advantage of what's already proven to work, we can succeed in improving our systems without too much trial and error that can make staff members frustrated and reluctant to change.  The AAVLD Quality Assurance Committee was created as a resource to provide this opportunity.  In addition, quality training opportunities such as the recent NAHLN Quality Management System Training allow staff to become more familiar with the requirements of a quality system, which may also provide a source of new ideas for improvement.

External and internal audits provide us with indications of where we need to place more effort.  One area where deficiencies are commonly found during an AAVLD audit is document control.  This is a process that has many different aspects to it, and therefore many areas that are subject to nonconformance.  Quality Managers are often disappointed to find that the document control system that has been established is not working as intended.  In these instances, instead of forcing the policies of an existing document control program on the laboratory, it is often useful to examine the issue in more detail.  For example, if a document is being printed and used consistently against policy, it is helpful to find out why.  In discussing the issue with the laboratory staff and finding out what the needs are, it may be possible to come up with a solution that will fit with the current policy and still provide the laboratory staff with what they need.  Or, it is also possible to make adjustments in the laboratory policy to assist the laboratory staff while still complying with the requirement.  This is where examples or methods from other laboratories may be helpful, and can be adapted to your use.  Keeping an open mind to other ways of achieving the same goal can help your program to evolve and provide laboratory staff with a system that works for them.  Laboratory staffs are far more likely to stay in compliance if the system is set up to work with their needs, when possible.  Flexibility and willingness to allow the quality system to evolve are important for continuous improvement. 

Another common area of nonconformance is documentation of training for initial and ongoing competence.  The AAVLD Quality Committee is planning two training sessions during their upcoming meeting in November.  One, regarding training, is intended to provide a forum where examples that are working well from different systems will be shared by a panel of presenters.  Following that is an open discussion when members will be encouraged to share their own examples with the group.  This exchange will provide a great opportunity to access new ideas that could be used to improve or enhance existing quality programs.   I encourage interested AAVLD members to come and share their successes and difficulties with training documentation, as it may provide a great new idea or a solution to an ongoing problem.  Working together we can improve the quality of individual laboratories and the discipline overall.