Strengthening Laboratory Management Towards Accreditation: The Lesotho experience

Abstract

IntroductionThe Lesotho Ministry of Health and Social Welfare’s (MOHSW) 5-year strategic plan, as well as their national laboratory policy and yearly operational plans, directly addresses issues of accreditation, indicating their commitment to fulfilling their mandate. As such, the MOHSW adopted the World Health Organization Regional Headquarters for Africa’s Stepwise Laboratory Quality Improvement Toward Accreditation (WHO–AFRO–SLIPTA) process and subsequently rolled out the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme across the whole country, becoming the first African country to do so.MethodsSLMTA in Lesotho was implemented in two cohorts. Twelve and nineteen laboratory supervisors and quality officers were enrolled in Cohort 1 and Cohort 2, respectively. These 31 participants represented 18 of the 19 laboratories nationwide. For the purposes of this programme, the Queen Elizabeth II (QE II) Central Laboratory had its seven sections of haematology, blood bank, cytology, blood transfusion, microbiology, tuberculosis laboratory and chemistry assessed as separate sections. Performance was tracked using the WHO–AFRO-SLIPTA checklist, with assessments carried out at baseline and at the end of SLMTA. Two methods were used to implement SLMTA: the traditional ‘three workshops’ approach and twinning SLMTA with mentorship. The latter, with intensive follow-up visits, was concluded in 9 months and the former in 11 months. A standard data collection tool was used for site visits.ResultsOf the 31 participants across both cohorts, 25 (81%) graduated (9 from Cohort 1 and 16 from Cohort 2). At baseline, all but one laboratory attained a rating of zero stars, with the exception attaining one star. At the final assessment, 7 of the 25 laboratories examined at baseline were still at a rating of zero stars, whilst 8 attained one star, 5 attained two stars and 4 attained three stars. None scored above three stars. The highest percentage improvement for any laboratory was 51%, whereas the least improved dropped by 6% when compared to its baseline assessment. The most improved areas were corrective actions (34%) and documents and records (32%). Process improvement demonstrated the least improvement (10%).ConclusionThe SLMTA programme had an immediate, measurable and positive impact on laboratories in Lesotho. This success was possible because of the leadership and ownership of the programme by the MOHSW, as well as the coordination of partner support.

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

“…We identified 28 published manuscripts focusing on the SLMTA programme, 1,7–33 including 26 published concurrently with this article, 1,7-20,22-31,33 one previously-published article summarising the development and methodology of the SLMTA programme 32 and one previously-published study regarding SLMTA implementation in Lesotho 21 (Table 1). Six papers presented experiences from a single laboratory 7,10,17,26,28 or a single hospital, 9 14 presented data from two to 45 laboratories within a single African country, 8, 12,–15,18,–22,25,29–31 one discussed activities in two Southeast Asian countries, 23 one covered data from four countries in the Caribbean Region 11 and six had a general or global focus.…”

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

“…In addition, discussion of internal audit results within the laboratory may have helped to develop an overall quality culture, not only amongst laboratory staff but also amongst hospital management, as has been identified elsewhere as a key factor in SLMTA success. 19 Whilst this hypothesis is generated using a very small number of laboratories and various findings have been reported in other small studies, 20,21,22 our results suggest that further evaluation of the benefits of conducting regular internal audits followed by corrective action is warranted.…”

Setting up a structured laboratory mentoring programme

“…7 In some settings, SLMTA and mentoring have been shown to have better impact than each implemented independently. 8 Whether using mentoring as a means to deliver SLMTA at the laboratory level or as second-level support for laboratories that have completed SLMTA, these two efforts complement one another and can strengthen the drive to realise national accreditation goals.…”