Poor Performance Criteria
Criteria for identifying Poor Performance and Persistent Poor Performance
The central purpose of external quality assurance is to ensure that laboratories are delivering a service of the highest possible quality. The Molecular Genetics Scheme maintains the principle of assessment by professional consensus and attempts to improve standards by education and peer group review rather than by censure or penalty. Performance criteria are necessary to allow an individual laboratory's performance to be measured against national standards and to identify any laboratory, which is failing to meet these criteria. Participants who fall below the standards set out here are deemed to be performing poorly.
Poor performance will be determined at the level of the individual disease, rather than on the basis of the participant's average score across all diseases. Thus it will be possible, for example, to be a poor performer for CF while performing well for all other diseases.
Poor performance is defined as follows:
Genotyping: Scoring less than 1.6 on genotyping for a disease.
Interpretation: Scoring less than 0.7 times the mean score for a disease.
Mean scores will be calculated to two decimal places. Individual participants' scores will be calculated precisely.
Clerical Accuracy: This category of marking will not contribute towards poor performance.
The poor performance and persistent poor peformance criteria was reviewed during 2006 and ratified by NQAAP in November, 2006.
POOR PERFORMANCE AND PERSISTENT POOR PERFORMANCE CRITERIA FOR CYSTIC FIBROSIS TESTING ON BLOOD SPOTS AND MOLECULAR RAPID ANEUPLOIDY TESTING IS AVAILABLE FROM THE SCHEME ORGANISER (info@ukneqas-molgen.org.uk) Last Updated: 10th April, 2007 by Sandi Deans
History: 29/01/2007 SD
Incorrect advice given, correct advice not given
Where a report contains advice which is considered by the Steering Committee to be dangerously erroneous, or when a report does not contain advice considered by the Steering Committee to be essential, this will be sufficient to constitute Poor Performance, irrespective of the scores achieved in the categories above.
Non-participation
Participation in each round of EQA for all diseases offered as a clinical service is a requirement both of the Molecular Genetics EQA Scheme and of CPA Laboratory accreditation. Non-participation for any disease offered as a clinical service by the laboratory in any round of EQA in which that disease is offered will be deemed Poor Performance for that disease in that year. This will apply irrespective of previous performance scores for that disease. Laboratories will not be expected to continue participation for any disease no longer offered as a clinical service but should inform the EQA Scheme organiser in writing when this occurs.
Persistent Poor Performance Criteria
Persistent Poor Performers will be defined as either
- those participants who perform poorly for a disease in three out of any six consecutive EQA rounds.
or
- those participants who perform poorly for a disease in any two consecutive rounds of EQA.
In October 2007, NQAAP for Clinical Cytogeneyics and Molecular Genetics ruled that the identity of persistent poor performing labortories will be disclosed to the NQAAP panel. This will take immediate effect.
Notes:
- When a serious genotyping error is identified the Scheme Organiser will contact the participant as soon as the error comes to light. In this way it is intended that any consequences of the laboratory error will be rectified without delay.
- Performing poorly in any one of the above categories will count towards Persistent Poor Performance.
- Performing poorly on genotyping in one round of EQA and interpretation in the next two rounds will have the same consequences as performing poorly on genotyping for three rounds of EQA. A participant who has performed poorly for more than one disease in more than one QA round may, at the discretion of the Scheme Organiser, be referred for Persistent Poor Performance even if they have not met the criteria for Persistent Poor Performance in any individual disease.
- A participant which falls below the standards described above, thereby incurring a poor performance score for that round of EQA, will be alerted to this fact in writing by the scheme organiser. At this point the participant may feel confident about addressing the problem internally but help and advice will be made available on request. The Scheme Organiser will not reveal the identity of the participant to those providing such assistance unless the participant has specifically given permission to do so.
- When a laboratory is identified as a poor performer in a non-consecutive second round of EQA they will again be approached by the Scheme Organiser who will make inquiries into the possible source of error (poor performance in two consecutive years will constitute Persistent Poor Performance ). In this circumstance the laboratory will be urged to audit their procedures carefully and to accept advice and assistance to rectify any problems which may be revealed.
- Additional rounds of EQA samples may be distributed between the usual times at the discretion of the Steering Committee. These distributions will be designed to address specific problems that have arisen from the usual rounds of EQA with the intention of speeding up the process of identifying Persistent Poor Performance. Such additional rounds of EQA will be governed by all Conditions of Participation, criteria for identifying Persistent Poor Performance and other procedures of the UK NEQAS for Molecular Genetics as detailed in this manual. Participation in these additional rounds of EQA may be limited to laboratories identified as poor performers in a previous round.
- Once a laboratory reaches the criteria for Persistent Poor Performance the Scheme Organiser is obliged to notify the National Quality Assessment Advisory Panel (NQAAP) and the identity of the laboratory will be revealed. The Panel will consider the best approach to improve the situation and will contact the laboratory through the scheme organiser, requesting a response by a specific date. If no response is received by this date or if the response to this is deemed unsatisfactory the Chair of the Advisory Panel will write directly to the Head of Department. If all of these measures fail the Chair of the Panel may request a visit to the laboratory by two Panel members. If no resolution can be achieved by these measures NQAAP will approach the Joint Working Group for advice on how to proceed.
- Experience in the scheme suggests that referral to NQAAP will be very infrequent, since the majority of laboratories will correct any deficiencies before reaching that stage in the procedure. This is as it should be, since the consequences of a referral to NQAAP are serious, with implications for CPA accreditation as well as the obvious doubts that must arise about the quality of service to patients.
Last updated: October 2007, Sandi Deans
Review History: Nov 2006 SD /Feb 2006 SD
