Translating a National Laboratory Strategic Plan into action through SLMTA in a district hospital laboratory in Botswana

Abstract

BackgroundThe Ministry of Health (MOH) of Botswana adopted Strengthening Laboratory Management Toward Accreditation (SLMTA), a structured quality improvement programme, as a key tool for the implementation of quality management systems in its public health laboratories. Coupled with focused mentorship, this programme aimed to help MOH achieve the goals of the National Laboratory Strategic Plan to provide quality and timely clinical diagnoses.ObjectivesThis article describes the impact of implementing SLMTA in Sekgoma Memorial Hospital Laboratory (SMHL) in Serowe, Botswana.MethodsSLMTA implementation in SMHL included trainings, improvement projects, site visits and focused mentorship. To measure progress, audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist were conducted at baseline and exit of the programme, with scores corresponding to a zero- to five-star scale. Turnaround times, customer satisfaction, and several other health service indicators were tracked.ResultsThe laboratory scored 53% (zero stars) at the baseline audit and 80% (three stars) at exit. Nearly three years later, the laboratory scored 85% (four stars) in an official audit conducted by the African Society for Laboratory Medicine. Turnaround times became shorter after SLMTA implementation, with reductions ranging 19% to 52%; overall patient satisfaction increased from 56% to 73%; and clinician satisfaction increased from 41% to 72%. Improvements in inventory management led to decreases in discarded reagents, reducing losses from US $18 000 in 2011 to $40 in 2013.ConclusionThe SLMTA programme contributed to enhanced performance of the laboratory, which in turn yielded potential positive impacts for patient care at the hospital.

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

“…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. 1,16,23,24,32,33 In total, these studies included detailed information on SLMTA implementation in 211 laboratories in 18 countries.…”

“…12 In Botswana, there had been ‘slow progress in implementing QMS’, and authors noted that ‘previous training of healthcare workers has focused on general management topics rather than identifying tangible tasks to bring about change, making the training difficult to apply in the laboratory’. 28 …”

“…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.…”

“…32 Support and mentorship models have ranged from no site visits or mentorship, 8,20 occasional visits, 14 periodic visits of several days to several weeks, 8,10,16,28,29,30 to embedded mentors working full time in their assigned laboratories for extended periods 11,14,18,22,25,26,29,30 (Table 3). Kenya has piloted a novel mentorship model, ‘twinning’ public laboratories with local state-of-the-art research laboratories.…”

National Laboratory Planning: Developing Sustainable Biocontainment Laboratories in Limited Resource Areas

“…This same document can later be used by quality and biosafety officers to monitor processes and progress in the laboratory, based on scores during the baseline and exit assessments. 28 SLIPTA examines the systems and documentation in use but does not evaluate the results of laboratory work. To this end, proficiency testing of laboratory assays-for example, processing of mock samples either through intralaboratory result comparisons or internationally accredited proficiency testing programs-can identify areas for process modification or additional training.…”