Article: Evaluating Laboratory Performance With the Six Sigma Scale.

To the Editor.--I read with interest the article by Nevalainen and colleagues[1] on clinical laboratory quality. Several points come to mind.

The economic environment in which most clinical laboratories currently function is not friendly. Laboratories operate under stringent budgets. Personnel are worked to the limit and have little time to think creatively about problems and improving systems. Managers are overloaded with responsibilities. Revenue per unit of work continues to shrink (eg, the 2001 Medicare budget calls for further reductions in payments to laboratories). Meanwhile, overhead attributable to regulatory requirements keeps increasing. Clinical ...

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