title: A continuous quality improvement project to improve the quality of cervical Papanicolaou smears.
abstract: OBJECTIVE
  To improve the quality of cervical Papanicolaou smears by continuous quality improvement techniques.
  
  
  METHODS
  The study used a Papanicolaou smear data base of over 200,000 specimens collected between June 1988 and December 1992. A team approach employing techniques such as process flow-charting, cause and effect diagrams, run charts, and a randomized trial of collection methods was used to evaluate potential causes of Papanicolaou smear reports with the notation "inadequate" or "less than optimal" due to too few or absent endocervical cells. Once a key process variable (method of collection) was identified, the proportion of Papanicolaou smears with inadequate or absent endocervical cells was determined before and after employment of a collection technique using a spatula and Cytobrush. We measured the rate of less than optimal Papanicolaou smears due to too few or absent endocervical cells.
  
  
  RESULTS
  Before implementing the new collection technique fully by June 1990, the overall rate of less than optimal cervical Papanicolaou smears ranged from 20-25%; by December 1993, it had stabilized at about 10%.
  
  
  CONCLUSIONS
  Continuous quality improvement can be used successfully to study a clinical process and implement change that will lead to improvement.
authors.affiliation: Department of Obstetrics and Gynecology, Henry Ford Hospital and Health System, Detroit, Michigan.
authors.forename: R T
authors.initials: RT
authors.lastname: Burkman
authors.forename: R
authors.initials: R
authors.lastname: Ward
authors.forename: K
authors.initials: K
authors.lastname: Balchandani
authors.forename: S
authors.initials: S
authors.lastname: Kini
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013048:Specimen Handling / Q000295:instrumentation / Q000592:standards; D017749:Total Quality Management; D014626:Vaginal Smears / Q000295:instrumentation / Q000592:standards*