Quality in pathology: how good is good? An introduction

In any profession, medical or not, assurance of professional standards and of the quality of the end-product or the service rendered has become an essential requirement. This holds true also for the practice of pathology. It is the intention to cover in this issue of Virchows Archiv a variety of relevant aspects of quality assurance, directly pertaining to the practice of pathology, and also subjects indirectly related to pathology practice. This includes not only quality assurance in the laboratories (including issues in basic histology, immunohistochemistry, and molecular pathology) but also the question on how the quality of diagnostic practice at the microscope can be monitored, quality assurance in underand postgraduate education and continuous professional development in pathology, sense and non-sense in laboratory accreditation, communication in pathology including the role of structured standard reporting, the role of the autopsy in quality of care assurance, quality assurance in postgraduate education, and last but not least quality assurance in pathology research. Aims and scope of this journal pretend to emphasize “evidence based” approaches. The subjects discussed in this issue, however, to a large extent express “what we think” or “what we are convinced of” as factual supporting evidence is often lacking, for want of studies or because of the nature of the subject. The papers therefore are mostly position papers, intended to stimulate reflection and discussion rather than providing practical solutions. In the first paper in the series (DOI 10.1007/s00428-0151838-0) Clark describes how Lean management, an approach developed by the Toyota automobile company which creates value for the end-user by continuously improving operational effectiveness and removing waste, can be adopted in histopathology. It has been applied in departments throughout the world to simultaneously improve quality (reducing errors and shortening turnaround times) and lower costs (by increasing efficiency). The paper describes the key concepts and how these were adapted to histopathology, using a case study of Lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing Lean management systems. The paper notably emphasizes the need for a change of mindset in the process of Lean implementation. The process goes way beyond introduction of a particular management system; it requires sustained specific people management skills in a working environment emphasizing continuous improvement. It requires significant efforts and means but its potential benefits are far reaching. One of the established core techniques in diagnostic pathology is immunohistochemistry. In spite of the more than 30 years of its steady growth into automated immunostaining aswe know it today, it remains a method beset with pitfalls, in terms of the quality of the reagents and of the analyte, of the protocols used and of the final interpretation of the obtained staining result. This has become even more important in the era of targeted therapy. Vyberg and Nielsen. (DOI 10.1007/s00428-015-1829-1) report on the experience gained with Nordic Immunohistochemical Quality Control (NordiQC), an international academic proficiency testing primarily aimed at assessing quality of the analytical phases of immunohistochemistry. A substantial proportion of the analyses performed (between 20 and 30 %) * Fred T. Bosman fred.bosman@citycable.ch