Customer Satisfaction in Anatomic Pathology - CiteSeerX

Customer Satisfaction in Anatomic Pathology A College of American Pathologists Q-Probes Study of 3065 Physician Surveys From 94 Laboratories Richard J. Zarbo, MD, DMD; Raouf E. Nakhleh, MD; Molly Walsh, PhD; for the Quality Practices Committee, College of American Pathologists

● Context.—Measurement of physicians’ and patients’ satisfaction with laboratory services has recently become a requirement of health care accreditation agencies in the United States. To our knowledge, this is the first customer satisfaction survey of anatomic pathology services to provide a standardized tool and benchmarks for subsequent measures of satisfaction. Objective.—This Q-Probes study assessed physician satisfaction with anatomic pathology laboratory services and sought to determine characteristics that correlate with a high level of physician satisfaction. Design.—In January 2001, each laboratory used standardized survey forms to assess physician customer satisfaction with 10 specific elements of service in anatomic pathology and an overall satisfaction rating based on a scale of rankings from a 5 for excellent to a 1 for poor. Data from up to 50 surveys returned per laboratory were compiled and analyzed by the College of American Pathologists. A general questionnaire collected information about types of services offered and each laboratory’s quality assurance initiatives to determine characteristics that correlate with a high level of physician satisfaction. Setting.—Hospital-based laboratories in the United States (95.8%), as well as others from Canada and Australia. Participants.—Ninety-four voluntary subscriber laboratories in the College of American Pathologists Q-Probes quality improvement program participated in this survey. Roughly 70% of respondents were from hospitals with occupied bedsizes of 300 or less, 65% were private nonprofit institutions, just over half were located in cities, one third

were teaching hospitals, and 19% had pathology residency training programs. Main Outcome Measures.—Overall physician satisfaction with anatomic pathology and 10 selected aspects of the laboratory service (professional interaction, diagnostic accuracy, pathologist responsiveness to problems, pathologist accessibility for frozen section, tumor board presentations, courtesy of secretarial and technical staff, communication of relevant information, teaching conferences and courses, notification of significant abnormal results, and timeliness of reporting). Results.—The database of 3065 physician surveys was derived from 94 laboratories. An average of 32.6 surveys (median 30) was returned per institution, with a range of 5 to 50 surveys per institution. The mean response rate was 35.6% (median 32.5%). The median (50th percentile) laboratory had an overall median satisfaction score of 4.4. The lowest satisfaction scores that were obtained all related to poor communication, which included timeliness of reporting, communication of relevant information, and notification of significant abnormal results. Statistically significant associations of customer satisfaction with certain institutional characteristics and laboratory performance improvement activities were identified. Conclusions.—The importance of this satisfaction survey lies not in its requirement as an exercise for accrediting agencies but in understanding the needs of the customer (in this case the physician) to direct performance improvement in the delivery of quality anatomic pathology laboratory services. (Arch Pathol Lab Med. 2003;127:23–29)

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accredit laboratories, the Joint Commission on the Accreditation of Healthcare Organizations and the College of American Pathologists (CAP), both require assessment of customer satisfaction. The former, in the Improving Organization Performance standards of the Accreditation Manual (PI 3.1), requires that data be collected on the needs, expectations, and satisfaction of individuals and organizations served.1 Additionally, the CAP Laboratory Accreditation Program’s general checklist requires in the ‘‘Quality Improvement’’ section that ‘‘referring physicians’ and patients’ satisfaction with the laboratory service have been measured within the past 2 years.’’ 2 This standardized approach to quality measurement is

n the anatomic and clinical pathology laboratory, patients are the ultimate customers. However, physicians enjoy a preferred customer status, and their opinions are an essential component in developing a customer-oriented laboratory. In the United States, the 2 major agencies that

Accepted for publication August 20, 2002. From the Department of Pathology, Henry Ford Hospital, Detroit, Mich (Drs Zarbo and Nakhleh); and the College of American Pathologists, Northfield, Ill (Dr Walsh). Corresponding author: Richard Zarbo, MD, DMD, Department of Pathology, Henry Ford Hospital, 299 West Grand Blvd, Detroit, MI 48202 (e-mail: [email protected]). Arch Pathol Lab Med—Vol 127, January 2003

Customer Satisfaction in Anatomic Pathology—Zarbo et al 23

one of many satisfaction studies conducted during the past 12 years in the CAP Q-Probes laboratory quality improvement program. The Q-Probes program of time-limited monitors was founded in 1989 to establish key benchmarks and standardized approaches to measurements of laboratory quality. To date, the program has resulted in more than 100 peer-reviewed publications defining preanalytic, analytic, and postanalytic benchmarks for quality improvement in all disciplines of pathology and laboratory medicine.3 This Q-Probes study was designed to evaluate the physicians’ level of overall satisfaction and specific satisfaction with 10 different aspects of anatomic pathology laboratory services. MATERIALS AND METHODS Study Design Participants in the voluntary-subscription Q-Probes program of the CAP were sent this study in the first quarter of 2001. The study material was composed of 3 parts: a standardized survey with instructions for its use, input form 1, and input form 2. The survey form had an introductory header customizable for local use. The form enabled physician customers to rate overall satisfaction and satisfaction with 10 specific aspects of anatomic pathology laboratory services on a scale of 1 to 5, for which a poor rating equaled 1, a below average rating equaled 2, an average rating equaled 3, a good rating equaled 4, and an excellent rating equaled 5. Each laboratory developed a distribution and collection scheme that was appropriate for their physician customer base. Physician customer was defined as any physician, excluding physicians in training, who used the anatomic pathology laboratory services. Physicians in training (interns and residents) were specifically excluded from this study. The mode of collection and the deadline date were inserted into the applicable section of the survey form, and the surveys were distributed to all physician customers up to 300. If the number of the laboratory’s physician customers exceeded 300, then the 300 highest-volume physicians were surveyed. Data from all surveys returned within 4 weeks or the first 50 surveys returned, whichever occurred first, were compiled by laboratories onto a summary document, input form 1 (data collection form). Smaller laboratories with fewer physician customers that did not have 50 surveys returned were instructed to return the data that were received. Promotion of the survey was suggested to improve physician participation. A second document, input form 2 (general questionnaire), was completed by the laboratory to collect information about the types of services offered to physician customers served by the anatomic pathology laboratory and the laboratory’s quality improvement initiatives. Data analysis was performed by a CAP statistician on both input forms returned by laboratories within the deadline. Within 6 weeks, each participant laboratory received an individualized performance report, and within 12 weeks a more detailed data analysis and critique. This report provided statistically analyzed results with demographic and practice characteristics of participants related to performance. The summary report of results included all institutions at the 10th, 50th, and 90th percentile ranks of performance for overall satisfaction; the percentage of excellent and good ratings (the proportion of excellent and good ratings in relation to the total number of ratings reported for each service category); and the percentage of below average and poor ratings. Higher percentile ranks indicated better relative performance. Participants also received the authors’ interpretation and recommendations for improvement.4

Statistical Analysis Satisfaction scores were calculated using the following equations. 1. Overall Satisfaction Score: (No. of Excellent Ratings 3 5) 1 24 Arch Pathol Lab Med—Vol 127, January 2003

(No. of Good Ratings 3 4) 1 (No. of Average Ratings 3 3) 1 (No. of Below Average Ratings 3 2) 1 (No. of Poor Ratings 3 1) for Overall Satisfaction Level/Total Number of Ratings (1–5) for Overall Satisfaction Level. 2. Percentage of excellent or good ratings: (No. of Excellent or Good Ratings for Specific Laboratory Service Category 3 100)/ Total No. of Ratings (1–5) for Specific Laboratory Service Category. 3. Percentage of below average or poor ratings: (No. of Below Average or Poor Ratings for Specific Laboratory Service Category 3 100)/Total No. of Ratings (1–5) for Specific Laboratory Service Category. The influence of the institutional demographics and practice characteristics from input form 2 was evaluated for association with overall satisfaction and the percentages of below average/ poor ratings and excellent/good ratings for each anatomic pathology service category. If a participant failed to answer a question for any of the demographics or practice characteristics listed, that participant’s data were excluded from the database for that question only. Differences between groups were tested using nonparametric Kruskal-Wallis and Wilcoxon tests. A P value of .05 or less was considered to be statistically significant.

RESULTS Institutional Characteristics A total of 94 institutions submitted data from 3065 customer physicians who rated their satisfaction with anatomic pathology laboratory services. Most institutions (95.8%) were from the United States; the remaining participants were from Canada and Australia. An average of 32.6 surveys (median 30) were submitted per institution, with a range of 5 to 50 surveys per institution. The mean response rate was 35.6% (median 32.5%), with a range of 2.8% to 100%. Just more than 32% of participating institutions were teaching hospitals, and nearly 19% had a pathology residency program. Approximately 92% of institutions participating in this study were licensed by the Joint Commission on Accreditation of Healthcare Organizations, and almost 86% were accredited by the CAP. Table 1 displays other characteristics of participating institutions. Distributions for anatomic pathology service and staff volumes for 2000 are listed in Table 2. Quality Indicators Overall Satisfaction Scores. The overall satisfaction score ranged from a minimum of 3.7 to a maximum of 5. The median overall score for all participants was 4.4. Aggregate Satisfaction Scores. The aggregate results from the 3065 surveys submitted by all study institutions are tabulated in Table 3. Overall, physician customers were most satisfied with quality of professional interaction, pathologists’ responsiveness to problems, and diagnostic accuracy. Timeliness of reporting, communication of relevant information, and notification of significant abnormal results exhibited the highest percentage of below average/poor ratings. All universally applicable aspects of anatomic laboratory services had aggregate ratings in the combined ‘‘not applicable’’ and ‘‘no response’’ categories that were less than 10.5%. The only exceptions were the 3 satisfaction assessments of pathologists’ accessibility for frozen sections, quality of tumor board presentations, and teaching conferences/courses, which were in the range of 41.6% to 53.3% ‘‘not applicable’’ and ‘‘no response.’’ Despite the higher rate that these latter services were either not available or not evaluated, the frequency of below avCustomer Satisfaction in Anatomic Pathology—Zarbo et al

Table 1. Characteristics of Participating Institutions* No. of Institutions

Percentage of Institutions

Institution type Private, nonprofit Private, profit State, county, or city hospital Government, federal University hospital Independent laboratory Other

58 4 11 4 3 4 5

65.2 4.5 12.4 4.5 3.4 4.5 5.6

Occupied bedsize 0–150 151–300 301–450 451–600 .600

30 23 12 6 6

39.0 30.0 15.6 7.8 7.8

Institution location City Suburban Rural Federal installation laboratory

45 27 16 1

50.6 30.3 18.0 1.1

Governmental affiliation Nongovernmental 71 Nonfederal governmental 14 Federal governmental 4 * Not all laboratories responded to all queries.

79.8 15.7 4.5

erage/poor ratings were low, in the range of 0.6% to 1.4%, similar to the other aspects of service assessed. Percentage of Excellent/Good Ratings. The highest median percentage value of excellent/good ratings was observed for quality of professional interaction (96.3%) and diagnostic accuracy (96.1%). Timeliness of reporting had the lowest median value (79.8%) for percentage of excellent/good ratings. The data distributions are displayed in Table 4. Percentage of Below Average/Poor Ratings. The lowest scores related to poor communication, namely, timeliness of reporting, communication of relevant information, and notification of significant abnormal results. The data distributions are listed in Table 5. Laboratory Practices. Table 6 displays the number and percent of responses to each question regarding laboratory and customer satisfaction practices that might assist in attaining a higher level of physician satisfaction. The majority of laboratories had specific turnaround time goals for surgical pathology biopsies, surgical pathology resection specimens, dermatopathology specimens, autopsy preliminary and final reports, gynecologic and nongynecologic cytology, and fine-needle aspirates. Aspects of Practice Associated With the Overall Satisfaction Score. The statistically significant associations (P , .05) related to institution demographics, performance improvement, and customer satisfaction practices are listed as follows:

Table 2. Distribution of Anatomic Pathology (AP) Service and Staff Volumes All Institutions Percentiles

AP service volume Surgical pathology accessions Autopsies Gynecologic cytology accessions Nongynecologic cytology accessions Fine-needle aspirates

10th

25th

50th (median)

75th

3710 2 8 280 40

6968 7 1500 583 93

11 163 19 8814 1133 285

15 475 44 22 787 2229 639

2 2

3 3

4 6

7 10

14.5 25

13 18 0

20 30 4

29 40 24

50 60 40

68 80 60

AP staff volume Total No. of pathologists Total No. of technical staff AP percent billable tests Inpatients Outpatients Nonpatients

90th

30 425 115 46 505 3399 1177

Table 3. Percentage and Aggregate Number of Ratings

Laboratory Service Category

Quality of professional interaction Pathologist responsiveness to problems Diagnostic accuracy Courtesy of secretarial and technical staff Communication of relevant information Notification of significant abnormal results Pathologists’ accessibility for frozen sections Tumor board presentations Teaching conferences and courses Timeliness of reporting Arch Pathol Lab Med—Vol 127, January 2003

Excellent, % (No.)

Good, % (No.)

Average, % (No.)

Below Average/Poor, % (No.)

Not Applicable and No Response, % (No.)

62.1 (1897) 55.3 (2988) 54.4 (1664) 49.7 (1521) 47.9 (1459) 47.4 (1450)

26.6 (813) 27.3 (835) 36.1 (1104) 34.6 (1059) 35.5 (1082) 33.0 (1010)

4.8 (145) 5.7 (173) 5.7 (174) 6.9 (211) 10.8 (329) 11.4 (347)

1.1 (34) 1.2 (38) 0.7 (21) 1.5 (45) 3.7 (113) 3.8 (115)

5.4 (164) 10.5 (320) 3.2 (98) 7.3 (223) 2.2 (66) 4.5 (136)

34.9 (1066) 26.4 (805) 23.0 (701) 39.3 (1202)

18.0 (551) 19.2 (584) 17.0 (519) 36.3 (1112)

4.0 (123) 4.3 (131) 5.5 (167) 16.8 (515)

1.4 (42) 0.6 (19) 1.2 (36) 5.8 (176)

41.6 (1270) 49.5 (1507) 53.3 (1623) 1.8 (56)


Table 4. Distribution of Percentage of Excellent/Good Ratings for Each Service Category All Institutions Percentiles* 10th

Quality of professional interaction 81.8 Diagnostic accuracy 82.6 Pathologist responsiveness to problems 82.6 Pathologists’ accessibility for frozen sections 75.0 Tumor board presentations 75.0 Courtesy of secretarial and technical staff 81.3 Communication of relevant information 69.6 Teaching conferences and courses 62.5 Notification of significant abnormal results 64.7 Timeliness of reporting 56.3 * Higher percentile rankings indicate better relative performance.

25th

50th (median)

75th

90th

91.5 89.3 89.3 86.0 82.4 87.5 78.9 76.5 79.6 70.0

96.3 96.1 93.6 93.3 93.1 93.0 88.5 88.2 86.3 79.8

100.0 100.0 98.0 100.0 100.0 95.9 94.0 100.0 91.8 88.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 94.0

Table 5. Distribution of Percentage of Below Average/Poor Ratings for Each Service Category All Institutions Percentiles* 10th

25th

50th (median)

75th

Quality of professional interaction 4.0 0.0 0.0 0.0 Diagnostic accuracy 3.4 0.0 0.0 0.0 Pathologist responsiveness to problems 4.8 2.0 0.0 0.0 Pathologists’ accessibility for frozen sections 7.7 3.2 0.0 0.0 Tumor board presentations 5.9 0.0 0.0 0.0 Courtesy of secretarial and technical staff 5.3 2.2 0.0 0.0 Communication of relevant information 10.2 6.9 2.0 0.0 Teaching conferences and courses 13.3 3.6 0.0 0.0 Notification of significant abnormal results 11.5 6.5 2.0 0.0 Timeliness of reporting 16.0 10.0 3.9 0.0 * Higher percentile ranks were assigned to indicate better relative performance (ie, higher percentage of excellent/good ratings percentage of below average/poor ratings).

● Institutions with lower percentages (0%–40% vs 41%– 100%) of anatomic pathology billable tests performed on outpatients had significantly higher overall satisfaction scores (4.5 vs 4.3). ● Institutions with a specific turnaround time goal for surgical pathology resection specimens had significantly higher overall satisfaction scores (4.4 vs 4.1). ● Institutions that placed images in pathology reports had significantly higher overall satisfaction scores (4.6 vs 4.4). Aspects of Practice Associated With the Percentage of Excellent/Good Ratings. The following characteristics were associated with ratings of good to excellent. ● Nonteaching institutions had higher percentages of excellent/good ratings (median 91.3% vs 84.9%) for communication of relevant information and timeliness of reporting. ● Institutions without pathology resident training programs had higher percentages of excellent/good ratings for communication of relevant information (median 90.0% vs 81.6%), timeliness of reporting (median 81.6% vs 71.7%), and notification of significant abnormal results (median 88.4% vs 81.8%). ● Nongovernmental institutions had higher percentages of excellent/good ratings for pathologists’ accessibility for frozen sections. ● Institutions with lower percentages of anatomic pathology–billed tests performed on outpatients had higher percentages of excellent/good ratings for timeliness of reporting. 26 Arch Pathol Lab Med—Vol 127, January 2003

90th

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 and a lower

● Institutions with a specific turnaround time goal for surgical pathology resection specimens had higher percentages of excellent/good ratings for tumor board presentations. ● Institutions with a policy for alerting clinicians of medically critical values in anatomic pathology had higher percentages of excellent/good ratings for notification of significant abnormal results. ● Institutions with lower autopsy volumes in 2000 had higher percentages of excellent/good ratings for communication of relevant information, timeliness of reporting, and notification of significant abnormal results. ● Institutions that placed images in pathology reports had higher percentages of excellent/good ratings for tumor board presentations. Aspects of Practice Associated With the Percentage of Below Average/Poor Ratings. Statistically significant associations (P , .05) were also found between higher percentages of below average/poor ratings and the institutional characteristics, performance improvement activities, and customer satisfaction practices. These associations are as follows: ● Institutions without a specific turnaround time goal for surgical pathology resection specimens had higher percentages of below average/poor ratings for timeliness of reporting and tumor board presentations. ● Institutions with higher surgical pathology accession volumes in 2000 had higher percentages of below average/poor ratings for pathologists’ accessibility for frozen sections. Customer Satisfaction in Anatomic Pathology—Zarbo et al

Table 6. Laboratory Practices and Policies in Participating Institutions* No. of Institutions

Specific turnaround time (TAT) goals TAT goals: surgical pathology biopsies Yes No TAT goals: surgical pathology resections Yes No Not applicable, service not offered TAT goals: dermatology pathology specimens Yes No Not applicable, service not offered TAT goals: autopsy preliminary and final reports Yes No Not applicable, service not offered TAT goals: gynecologic cytology Yes No Not applicable, service not offered TAT goals: nongynecologic cytology Yes No Not applicable, service not offered TAT goals: fine-needle aspirates Yes No Not applicable, service not offered Communicate TAT goals to physician customers† Yes, for surgical pathology services Yes, for cytopathology services Yes, for autopsy services No Routine monitoring of performance Routinely assess TAT in anatomic pathology† Yes, for surgical pathology services Yes, for cytopathology services Yes, for autopsy services No Routinely perform frozen section correlation and trace error rate Yes No Routinely assess error rate as reflected in peer review or amended/revised reports issued Yes No Monitor pathologists’ on-call response rate Yes No Anatomic pathology policies Audit or seek intradepartmental consultation on newly diagnosed cases of malignancy Yes No Policy for alerting clinicians of medically critical values Yes No * Not all laboratories responded to all queries. † Multiple responses were permitted.

COMMENT Surveys of customers and employees have long been used to gauge satisfaction in product and service development and in personnel management. Long-running business-to-customer surveys, such as the A. C. Nielsen ratings of television and movie media and J. D. Powers ratings of new automobile quality, have wide name recArch Pathol Lab Med—Vol 127, January 2003

Percentage of Institutions

87 2

97.8 2.2

79 7 2

89.8 7.9 2.3

69 15 3

79.3 17.2 3.5

83 4 3

92.2 4.4 3.3

62 11 16

69.7 12.3 18.0

77 9 2

87.5 10.2 2.3

73 12 3

83.0 13.6 3.4

57 52 44 27

64.8 59.1 50.0 30.7

70 62 56 13

78.7 69.7 62.9 14.6

81 8

91.0 9.0

75 14

84.3 15.7

12 75

13.8 86.2

71 19

78.9 21.1

56 33

62.9 37.1

ognition in the United States. Business-to-business and government-to-citizen evaluations have become increasingly popular as competition drives customer service to higher levels. Lately, personal interview, paper surveys, and telephone surveys have been succeeded by internet software–based questionnaires, affording flexibility of timely monitoring, analysis, and assessment of end-cusCustomer Satisfaction in Anatomic Pathology—Zarbo et al 27

tomer satisfaction. The health care industry typically employs contractors to evaluate patient/client and employee satisfaction to benchmark services. When the laboratory is included in such surveys, the level of information collected is often lacking in the level of detail necessary for pathologist managers to recognize opportunities and implement meaningful process improvements. This Q-Probes study was designed to specifically identify key aspects in anatomic pathology services that are important to the immediate customer, the clinician, who in turn is directly responsive to the patient. In this sense, this Q-Probes study can be likened to a business-to-customer satisfaction survey. Physician satisfaction with microbiology services was surveyed in the mid-1990s, and a previous Q-Probes study conducted in the year 2000 measured physician satisfaction in specific aspects of general clinical pathology services.5,6 The importance of customer feedback in driving quality improvement in medicine is now recognized. As of 2001, one of the major laboratory-accrediting agencies specifically requires that ‘‘referring physicians’ and patients’ satisfaction with the laboratory service have been measured within the past 2 years.’’ 2 We focused on 10 key aspects of anatomic pathology services in this Q-Probes study of physician customer satisfaction. The pathologist plays an important but often unsung role in providing consultation and tissue diagnosis, which facilitate modern medical treatment planning, so it is not surprising that the highest ratings were accorded quality of pathologist professional interaction, diagnostic accuracy, and pathologists’ responsiveness to problems. These are critical aspects of pathology practice that are essential to delivering quality patient care. This emphasis on diagnostic accuracy is reflected in the 91% of laboratories in this survey that routinely performed frozen section correlation and tracked error rates, as well as the 79% of laboratories that audited or sought intradepartmental consultation on newly diagnosed cases of malignancy. The greatest opportunities for improvement were all shown to relate to communication. These areas include timeliness of reporting, notification of significant abnormal results, and communication of relevant information. The productivity pressures of current clinical practice have placed greater demands on pathologists to not only communicate the correct diagnosis, but also to communicate a complete and perhaps expanded information set at the outset and within a truncated timeframe that anticipates return patient visit schedules. To improve these aspects of pathology service, the voices of clinician customers must be heard to influence the redesign of pathology practice to meet individual clinical practice demands. Despite the importance of communication in current medical practice, in this Q-Probes study, 80% of the participants indicated that they had not conducted a satisfaction survey within the past 2 years. The laboratory-accrediting agencies have recently emphasized the importance of this customer service aspect of pathology practice and now require this survey exercise as part of performance improvement. The majority of laboratories participating in this study had specific turnaround time goals for surgical pathology biopsies (98%), surgical pathology resection specimens (90%), dermatology specimens (79%), autopsy preliminary and final reports (92%), gynecologic cytology (70%), nongynecologic cytology (88%), and fine-needle aspirates (83%). However, these goals were poorly communicated 28 Arch Pathol Lab Med—Vol 127, January 2003

to customers for surgical pathology services (65%), cytopathology services (59%), and autopsy service (50%). Our own experience is that timeliness of reporting is markedly improved when this becomes a divisional goal, and specific turnaround times achieved for specimen types are monitored and shared with staff weekly. The end result of this focus on customer satisfaction was seen in this QProbes study, in which institutions with specific turnaround time goals for surgical pathology resection specimens had significantly higher overall satisfaction scores than did the 10% of institutions without these turnaround time goals. This inattentiveness to a key measure of quality likely translated into the higher percentages of below average/poor ratings for timeliness of reporting and tumor board presentations for these latter laboratories. Given limited and declining resources in pathology, it is reasonable that pathology practices may design approaches that cater to subsets of clinicians whose timely and specific content demands are made known by this type of survey tool. In the previous decade, many advances were made in standardizing and assuring complete report content of numerous malignancies using checklist and synoptic report formats.7–10 However, there is much yet to be standardized, with opportunities remaining in tissue reports of nonneoplastic diseases. It is important to determine what information physician customers prefer in pathology reports. In this Q-Probes study, we observed that pathology practices that placed images in pathology reports had significantly higher overall satisfaction scores, likely reflecting a value-added response to customer preferences. An often-overlooked communication opportunity, in addition to the routine paper or electronic report, is assurance that clinicians are notified of significant or unexpected abnormal results. Closure of this communication loop, either by way of summary report lists of biopsies received from a clinician, Health Insurance Portability and Accountability Act (HIPAA)-compliant e-mail notices of an abnormal finding, or through other avenues, is a valueadded service that may assure timely treatment of serious diseases. Many laboratories have a written policy that addresses the communication and report documentation of medically critical values in anatomic pathology.2 In this study, 37% of participants had no such policy. From previous Q-Probes studies of surgical pathology turnaround times conducted during the mid-1990s, we know that certain fixed institutional parameters, like an educational teaching mission, are associated with reporting delays.11 In this 2001 satisfaction survey, we found that teaching institutions and those with pathology residency training programs satisfied their clinician customers less well than nonteaching institutions. Teaching institutions tended to have higher percentages of below average/poor ratings for communication of relevant information and timeliness of reporting, whereas pathology residency programs tended to have higher percentages of below average/poor ratings for the same aspects of practice, as well as for notification of significant abnormal results. The time is long overdue for departments with pathology residency teaching programs to find ways to integrate resident physician education without compromising the quality and timeliness of services delivered. References 1. Comprehensive Accreditation Manual for Pathology and Clinical Laboratory Services 2000–2001. Standard PI 3.1: PI-10. Oakbrook Terrace, Ill: Joint Commission on Accreditation of Healthcare Organizations; 2000.

Customer Satisfaction in Anatomic Pathology—Zarbo et al

2. Commission on Laboratory Accreditation. Laboratory Accreditation Program: 2001 Inspection Checklist: Laboratory General. QUESTION:GEN:22875, GEN:41320. Northfield, Ill: College of American Pathologists; 2001. 3. Schifman RB, Howanitz PJ, Zarbo RJ. Q-Probes: a College of American Pathologists benchmarking program for quality management in pathology and laboratory medicine. In: Weinstein RS, ed. Advances in Pathology and Laboratory Medicine. Chicago, Ill: Mosby-Yearbook; 1996:83–120. 4. Zarbo RJ, Nakhleh RE. Q-Probes 01–11 Anatomic Pathology Customer Satisfaction: Data Analysis and Critique. Northfield, Ill: College of American Pathologists; 2001. 5. Miller K. Q-Probes Clinical Pathology Customer Satisfaction: Data Analysis and Critique. Northfield, Ill: College of American Pathologists; 2000. 6. Peddecord KM, Baron EJ, Francis D, Drew JA. Quality perceptions of microbiology services: a survey of infectious disease specialists. Am J Clin Pathol. 1996;105:58–64.

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7. Zarbo RJ. Interinstitutional assessment of colorectal carcinoma surgical pathology report adequacy: a College of American Pathologists Q-Probes study of practice patterns from 532 laboratories and 15 940 reports. Arch Pathol Lab Med. 1992;116:1113–1119. 8. Markel SF, Hirsch SD. Synoptic surgical pathology reporting. Hum Pathol. 1991;22:807–810. 9. Association of Directors of Anatomic and Surgical Pathology. Standardization of the surgical pathology report. Am J Surg Pathol. 1992;16:84–86. 10. Rosai J. Standardized reporting of surgical pathology diagnosis for the major tumor types: a proposal. Am J Clin Pathol. 1993;100:240–255. 11. Zarbo RJ, Gephardt GN, Howanitz PJ. Intralaboratory timeliness of surgical pathology reports: results of two College of American Pathologists Q-Probes studies of biopsies and complex specimens. Arch Pathol Lab Med. 1996;120:234– 244.
