Role of internal quality audits in surgical pathology: Outcome in an Indian tertiary care hospital

In developing countries like India, accreditation is still a voluntary, rather a mandatory process. External Quality Assurance Schemes in Surgical pathology are still at nascent stage. Most pathologists (and few other clinicians) probably subconsciously accept intra/inter observer bias in practicing this subjective specialty. However, they usually overlook it; partly because they have no secure alternate quality assurance methods to cost effectively substitute locally standardized customer satisfaction benchmarks. In this, art of practicing science, it is important to highlight that, if morphological features cannot be reliably, reproducible and quantified by group of fellow pathologists, any conclusion that is clinically important is almost meaningless and, at worst misleading. Presently there is more frequent case consultation and discussion through electronic media, than ever before. But, still uniformity in diagnostic terminology, grading systems, and criteria across all the pathologist community is yet to be achieved. Greatest fear of such audit is the manipulation. Finding deficiency and correcting that deficiency do not necessarily go together. However, if a solution is found, outcome in the experience gained by fellow pathologist are many fold and invaluable for visible practice of evidence based medicine. Here in we discuss role of internal audit in creating good working environment by collective decision making, team work mentality, formulating local policies and procedures with common goal of quality patient care.