The Sociedade Beneficente Israelita Brasileira Albert Einstein was founded in 1955 in Sao Paulo, Brazil, the third largest metropolitan area in the world. Hospital Israelita Albert Einstein (Einstein) opened in 1971.
Now, 50 years later, Einstein is an integrated, non-profit health system that serves a variety of needs for patients, businesses, and their community:
Serves the public through its 70,000 square meter hospital and 16 clinics
Fosters the future through its nursing and medical school and research institute
Supports other organizations through its commercial laboratories including a nucleus technical operations (NTO) reference laboratory and contract research organization (CRO)
Einstein has been able to grow and diversify in alignment with their mission to provide “excellence in quality” because of a disciplined strategic planning process. It includes researching best-practices, providing world-class tools and training and developing relationships with partners who share their commitment to quality.
A Compass for Scalable Quality
Dr. Cristóvão Mangueira, Medical Director of Einstein medical laboratories, participated in the strategic growth planning process that began in 2006. One of their first steps was to benchmark what they considered to be some of the premier institutions in the United States.
“We visited Mayo Clinic, M.D. Anderson, and the Baylor College of Medicine,” remembers Dr. Mangueira, noting that all were accredited by the College of American Pathologists (CAP). “And that was included in the decision-making process.”
They found that CAP accreditation offered many benefits: most importantly, a proven process to standardize quality assurance.
“With the type of growth that Einstein has had over the last 10 to 15 years, we could have been really challenged to maintain quality,” says Dr. Carlos Ferreira, Einstein’s Medical Manager of Clinical Pathology and the recent president (2018-20) and current Chairman of the Council of Past Presidents of the Sociedade Brasileira de Patologia Clínica – Medicina Laboratorial (SBCL/ML). “To grow, it’s easy. But if you don’t have these kinds of standards, you can lose quality. Our partnership with the CAP made sure we didn’t lose our way. It gave us our direction.”
CAP Accreditation: A Demonstrable Investment
Einstein also uses CAP standards to measure and communicate the value of laboratory services for management, physicians and patients, and business-to-business customers.
According to Dr. Mangueira, “The CAP is very good for the economic health of our laboratory. Why? Because the process is more quantitative which makes our quality visible and easily demonstrable. We can use these kinds of indicators internally to continually improve and grow the laboratory and externally to capture more business, more easily.”
Dr. Ferreira agrees about the value of CAP accreditation, “It’s not a cost; it’s an investment.” And as such, the growing partnership between the CAP and Einstein laboratories is further cost-justified by how it supports ongoing educational, financial, and marketing objectives, including:
Preserving quality controls as Einstein laboratories scale-up
Educating laboratory managers and staff about new methodologies
Differentiating Einstein laboratories from the competition
Integration of CAP accreditation supports growth, and by all measures, allowed Einstein to extend its benefits to thousands of more patients. While long recognized as the best hospital in Latin America, Forbes recently cited Einstein in their twenty “The Best Hospitals in the World” list and Newsweek ranked it 36th in its 2021“World Best Hospitals” survey.
The CAP is very good for the economic health of our laboratory. Why? Because the process is more quantitative which makes our quality visible and easily demonstrable. We can use these kinds of indicators internally to continually improve and grow the laboratory and externally to capture more business, more easily.
Cristovao Luis Pitangueira Mangueira MD, PhD, MBA Diretor Médico Departamento de Patologia Clínica e Anatomia Patológica
A Distinctive Aspect of Einstein’s Quality Culture
Einstein laboratories also maintain other accreditations, including ISO 14001 and PALC, the Clinical Laboratories Accreditation Program of the SBCL/ML. Dr. Mangueira and Dr. Ferreira agree that while CAP accreditation is complementary to other accreditations, the CAP provides unique value.
“CAP was a choice to get more quality in the laboratory,” Dr. Mangueira states.
“CAP is a more technical accreditation,” adds Dr. Ferreira. “The checklists are very specific, very technical, and cover the process from a clinical application.”
And while the CAP accreditation process is more rigorous, it is not disruptive. As part of the Einstein quality culture, Einstein laboratories had a twenty-year history of using CAP proficiency testing/external quality assessment (PT/EQA) programs. That familiarity, as well as a legacy of internal quality controls, meant the CAP quickly became part of Einstein’s quality culture.
“The first time everything is new,” says Dr. Ferreira, “But now we are mature... it’s a normal part of our process. It’s not difficult because CAP standards are in our blood – part of Einstein’s quality DNA”
CAP Accreditation Facilitates Growth
Since Einstein’s main hospital laboratory achieved CAP accreditation in 2009, the CAP checklists and processes have become fully integrated into Einstein’s daily operations. Building on the CAP’s contributions to their hospital laboratory’s success, Einstein’s NTO reference laboratory became CAP accredited in 2019.
What has become clear in both cases is how much the CAP has helped Einstein succeed in both their quality and growth objectives: laboratory tests have grown from 50,000 to 1.2 million per month over the last twenty years, with the majority of growth in outpatient testing for clinics and other healthcare providers. And over the same period, metrics for accuracy and safety have also improved.
In Einstein’s experience, CAP accreditation does not fundamentally change the way their laboratories operate, but refines their best practices, standardizes their quality controls, and provides a foundational assurance that as Einstein continues to grow, quantity will not dilute quality.
As we’ve developed public and B2B partnerships, it’s been very important to have CAP accreditation because it helps us control the processes to develop these techniques and guarantee the quality and safety of the tests.
Carlos Eduardo dos Santos Ferreira, MD, MBA, PhD Gerente Médico – Medicina Laboratorial Diretoria M.D.A.
The Confidence to Meet New Challenges
Einstein’s partnership with the CAP helps prepare them for both predictable and unpredictable challenges in their growth plan, including training new employees, developing new testing capabilities, and attracting new business-to-business (B2B) partnerships. All were put to the ultimate test in February 2020.
“Most of the first cases in the country were carried out in our laboratories,“ remembers Dr. Ferreira. “In fact, Einstein was the first private laboratory in Brazil to be allowed to report positive tests for COVID.”
By March of 2020, Einstein laboratories would also develop the world’s first next generation sequencing (NGS)-based genetic test for COVID.
“We’ve grown a lot in the two years since the pandemic started.” says Dr. Ferreira. “As we’ve developed public and B2B partnerships, it’s been very important to have CAP accreditation because it helps us control the processes to develop these techniques and guarantee the quality and safety of the tests.”
“If you control your process, if you make the right decisions, you minimize problems,” Dr. Ferreira reflects. “The CAP provides that for us. This is our future.”
