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KliniskBiokemi i Norden · 2 2014
versus latent and cognitive versus non-cognitive
errors (19,20). Latent (systematic) errors were found
e.g. in operating instructions and computer pro-
grams. It is important to find out possible latent
errors, because the occurrence of such errors canbe
preventedwhen theyare foundandcorrected. Inour
analysis,nearlyall errorsclassifiedasactivecognitive
errorswerecaseswhere instructionshadnotbeen fol-
lowed (18).When this kind of error is detected, the
following questions could be asked:Why didn’t the
employee follow the instruction? Did the employee
understand the content of the instruction? Is the
instructiondifficult tounderstandand thus, should it
beamended?Errorsclassifiedasactivenon-cognitive
(unintended) errors were common. These kinds of
errorsaredifficult toprevent.However, even in these
instancesconditionsexposingor factorscontributing
to these errors couldbe found.
The errors were also classified according to the
various sites in the laboratory process inwhich they
occurred (20). This kind of classification makes it
possible to seewhether errors accumulate to certain
sites, thus revealingproblematic steps that areprone
to errors. Table 1 shows a classification of errors or
defectscategorizedaccording to the stepsof the labo-
ratoryprocessduringwhich theyoccurredandaccor-
ding to the underlying causes found based on the
spontaneous feedbackdata fromexternal customers.
New laboratory standard
In the standard ISO 15189:2012 for medical labo-
ratories the requirements of the use of customer
perspective are increased compared to the former
standard ISO15189:2007,meaning that they set new
requirements especially for laboratorymanagement.
For example, laboratory management shall ensure
that laboratory servicesmeet theneeds of the custo-
mers. The management shall also establish quality
objectivesneeded tomeet theneedsand requirements
of customers, and to seek information as towhether
the services havemet theneeds of customers (11,21).
In addition, themanagement has to encourage labo-
ratorypersonnel tomake suggestions for the impro-
vement of services (11,21,22).
Conclusions
1. Customer satisfaction surveycanbeusedasa scre-
ening tool to identify topicsofdissatisfaction.After
the survey, further investigationsmaybeneeded to
find out customer-specific causes for dissatisfac-
tion and toperform targeted corrective actions.
2.Most of the spontaneous feedback receivedby the
universityhospital laboratoryconcerned important
subjects that may have had an impact on patient
care and safety.
3. Every reported case shouldbe investigated to find
out possible errors and their underlying causes so
that targeted corrective actions canbe taken.
4. In comparison to satisfaction surveys, an advan-
tageof the spontaneous customer feedback system
is that it gives a possibility to investigate concrete
cases as soon as possible.
5. Errorsanddefectsrevealedbycustomersatisfaction
surveys and spontaneous feedback should lead to
correctiveactions, sincecustomer feedbackcannot
result inquality improvement ifproperactionsare
not carriedout.
6. Thenew standard forclinical laboratoriesemphasi-
zes,more that the former one, theuseof customer
perspective.
Skogspipa (Angelica sylvestris). Foto: HenrikAlfthan.
