Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?

Abstract

BackgroundKenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation.MethodsAudits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist.ResultsAll laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5–45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs.ConclusionWhilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories.

A comprehensive review of the SLMTA literature part 1: Content analysis and future priorities

“…In many cases, these circumstances improved with the advent of the US President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, 7,11,14,15,22,27 which emphasised the importance of quality laboratory tests and infused much-needed capital into the laboratory systems. 36 Other international programmes also played a key role, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria 37 and the Global Health Initiative.…”

“…Authors noted that also during this timeframe, countries began to develop five-year laboratory strategic plans – Kenya 14,15 and Ethiopia 12,13 in 2005; Botswana 20,28 and Lesotho 21 in 2008; Zimbabwe 30 in 2010; and Ghana 25 and Namibia 19 in 2012. These plans called for laboratory strengthening and development of QMS, some specifying accreditation goals.…”

“…For example, the laboratory strategic plan in Botswana called for implementation of QMS in all laboratories by 2014 and accreditation of four district-level laboratories by 2013 and two national-level laboratories by 2014. 20 In Kenya, the Ministry of Health set a goal to accredit all national and regional level public laboratories 10,14 and established a National Accreditation Steering Committee to coordinate accreditation activities. The Rwanda Ministry of Health aimed to enroll all 48 central and district hospital laboratories in the accreditation preparation process, 29 and the Ministry of Health in Mozambique established a National Laboratory Policy, which outlined their commitment to implement QMS and to pursue accreditation for reference and provincial hospital laboratories.…”

“…13,22,29 Several countries have established departments or workgroups dedicated to the implementation of quality management. For example, Zimbabwe’s National Quality Assurance Program established a Training and Mentorship Department; 30 Kenya’s Ministry of Health created a National Accreditation Steering Committee to coordinate laboratory accreditation activities; 14 and Mozambique established a National Laboratory Technical Working Group to build a framework for a national laboratory quality improvement programme, to lead and coordinate its implementation and to monitor and maintain results. 18 …”

Improving quality in national reference laboratories: The role of SLMTA and mentorship

“…A report by Maina et al suggests that internal audits (which were implemented by the TB laboratory after the first workshop) may be a catalyst for improvements in other areas, as conducting self-review can identify areas that need improvement. 14 Whilst the virology laboratory was already conducting internal audits before SLMTA, the TB laboratory started with a 50% score in this area and increased to 100%, potentially helping to explain their improvement in other areas. The second limitation is that the checklists used for the baseline and exit audits were not exactly the same, potentially introducing bias in the results.…”