Technical Quality Control in Pathology Laboratories: The Role and Training of Laboratory Technicians

Abstract

This thesis investigates technical quality control in pathology and histology laboratories and the on-going training of technicians who work in them in Saudi Arabia. The role of quality control and associated staff training and skills in a pathology laboratory are indispensable, and support the delivery of high quality services and better patient outcomes. Any misdiagnosis or errors in reports can lead to massive impacts on the quality of service and health consequences to patients. This thesis is devoted to research concerning quality improvement in Saudi histology and pathology laboratories. The thesis includes two research studies: Study one is a systematic review of the training of technicians in pathology laboratories, and the current training of pathology technicians globally. This study followed the PRISMA model for reporting of systematic reviews. The findings of the study indicated that recent developments, such as the increased application of molecular biology in pathology, the increased emphasis upon quality assurance (QA), and the emergence of other important skills are some of the key factors influencing changes in the skills and competencies required for pathology technicians. These skills and competencies are similar in all countries including in Saudi Arabia, the focus of this thesis. The comprehensive literature review established that insufficient attention has been devoted to the development of training programs and that there is a vital need for the development of QA content in professional development programs. Study two study examined quality control in pathology (medical) laboratories and the training needs of medical laboratory personnel. The study adopted the Donabedian model, which is a linear framework of structure, process, and outcome. Secondary sources were used for Study two to create a platform for further research. For primary data, the research variables were the design of QA courses, quality assurance projects (Systems of quality assurance) and pathology laboratory technicians’ roles and experience. The study used descriptive statistics and inferential statistical techniques to analyse the data. The study established that, in the opinions of the respondents in relation to the design of QA course content, the most important priority is the development of a result-oriented, learning-centred approach. Detailed analysis of the survey results are provided in the thesis. The systematic review and the survey informed the formulation of a series of recommended actions for the improvement of services in Saudi Arabia through properly targeted and delivered training to laboratory technicians. The creation of a continuous professional development (CPD) program as well as the development of QA content and a QA project are vital for the improvement of Saudi Arabia’s pathology and histology laboratories. The results of this study indicate that it is highly desirable that Saudi Arabia makes collaborative efforts with existing pathology laboratories in other countries to develop its own pathology laboratories. Saudi Arabia may opt to establish a specialised centre for the development of quality control laboratories. It may also opt to develop new programs accredited by international laboratories and develop the infrastructure for some laboratories. Hence, it must make strong partnerships and collaborations with established pathology laboratories, such as those in Australia and the United States. Furthermore, it must train all its laboratory technicians to ensure that they have sufficient knowledge in the appropriate handling and analysis of samples, equipment operation, and other work, which they perform in the laboratory. The thesis concludes that the most important training need is the development of a result-oriented, learning-centred approach to learning. This is crucial for the education of technicians. The learning-centred approach must then be followed by evidence-based laboratory medicine and safety. The study suggestions for Histology laboratories must provide high-quality services by enforcing a technical quality control system. This can be achieved by providing accurate, relevant, precise and comprehensive data.