Quality assurance, an administrative means to a managerial end: Part II. The JCAHO ten-step process--selecting indicators of quality.

This is the second of a series of articles on medical laboratory quality assurance (QA). It provides a synopsis of the federal regulations and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards that are driving health-care QA at the laboratory level. The article also reviews the role of the College of American Pathologists (CAP) in laboratory accreditation and QA. This article explains the JCAHO ten-step process in detail. The Joint Commission model can be extremely helpful in designing a QA program and is a very practical template for a QA plan. Understanding the ten-step model, as well as the path of work flow, is essential to selecting meaningful laboratory indicators. Current concepts of quality, quality control (QC), and QA in the health-care industry are still in the developmental stage. Consequently, semantic differences of opinion exist among many laboratorians in regard to QA nomenclature and methods. These ambiguities have been generated, partly, by an extremely rapid evolution of federal and JCAHO guidelines. A major "gray" area exists in defining quality, QC and QA, and methods of quality management. The author has adhered closely to the definitions and nomenclature of the JCAHO to resolve some of the ambiguity. The reader also can review definitions that are presented in detail in the first part of this series (1). The source of most of the following information is federal, JCAHO, and CAP documentation. Some of the information in this article reflects personal managerial experience offered in the hope that it will be of some practical assistance to the reader.