Accelerating the spread of laboratory quality improvement efforts in Botswana.

Kelebeletse O Mokobela,Mosetsanagape Modukanele,Mpho T Moatshe

doi:10.4102/ajlm.v3i2.207

Abstract

BackgroundIn 2002, the Ministry of Health (MoH) of Botswana began its journey toward laboratory accreditation in an effort to enhance the quality of laboratory services. After a difficult start, the MoH recognised the need for a more practical and sustainable method for change that could be implemented nationally; they therefore adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme.ObjectiveThis study describes the process and lessons learned in implementing SLMTA and the role of supplemental training and mentoring so as to achieve Botswana’s national laboratory quality improvement goal.MethodsEight laboratories were enrolled into the SLMTA programme in 2010, which included a series of workshops and improvement projects conducted over nine months. Four of these laboratories received supplementary training and focused mentorship from the Botswana Bureau of Standards (BOBS). Laboratory performance was measured at baseline and exit using the World Health Organization Regional Office for Africa’s Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. One laboratory did not receive an exit audit and was thus excluded from the analysis.ResultsAn 18 percentage-point improvement was observed when comparing the median baseline score (53%) to the median exit score (71%) for the seven laboratories. Laboratories that received additional training and mentorship from BOBS improved 21 percentage points, whilst non-BOBS-mentored laboratories improved eight percentage points. Hospital management buy-in and strong laboratory staff camaraderie were found to be essential for the positive changes observed.ConclusionSLMTA facilitated improvements in laboratory quality management systems, yielding immediate and measurable results. This study suggests that pairing the SLMTA programme with additional training and mentorship activities may lead to further increases in laboratory performance; and that SLMTA is a practical approach to extending quality improvement to MOH laboratories.

Highlights

Laboratory quality management systems (QMS) provide a strong foundation for promoting excellence in laboratory services that support fundamental components of effective healthcare systems.[1]
In 2002, the Botswana Ministry of Health’s (MoH’s) Laboratory Services developed a five-year work plan with the goal of accrediting 16 laboratories, which resulted in the initial introduction of QMS in select laboratories
By 2011, after nine years of implementation and extensive partner and consultant support, four laboratories had attained international accreditation. Whilst this accomplishment was commendable, it had been clear for some time that this approach was too costly and too slow to be a sustainable option for long-term quality improvement on a national level; Botswana needed a more viable strategy

Summary

Introduction

Laboratory quality management systems (QMS) provide a strong foundation for promoting excellence in laboratory services that support fundamental components of effective healthcare systems.[1] In many resource-limited countries, laboratories lack robust quality systems, as they have historically been afforded low priority and few resources. This situation has led to poorquality patient care and health outcomes, as well as loss of revenue resulting from inefficient and redundant processes. The MoH recognised the need for a more practical and sustainable method for change that could be implemented nationally; they adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme

Methods

Results

Conclusion