Uncovering the causes of poor quality pathology laboratory services in acute myocardial infarction

A study was undertaken to identify the causes that contributed to poor quality pathology services for hospitalized patients with acute myocardial infarction. Through the use of continuous quality improvement (CQI) strategies, the procedure involved a systematic process analysis which assessed the types and sources of variation, and possible causal factors for changes in performance. Thirteen suspected causes of poor quality were identified and data collected to confirm or reject their involvement. The study demonstrated that even strongly suspected causes of poor quality need to be confirmed by data. We found that 23% of the suspected root causes were not substantiated by the data collected. The CQI approach was process driven and should be adaptable to other clinical situations and not just pathology services.