Abstract
BackgroundBungoma District Hospital Laboratory (BDHL), which supports a 200-bed referral facility, began its Strengthening Laboratory Management Toward Accreditation (SLMTA) journey in 2011 together with eight other laboratories in the second round of SLMTA rollout in Kenya.ObjectivesTo describe how the SLMTA programme and enhanced quality interventions changed the culture and management style at BDHL and instilled a quality system designed to sustain progress for years to come.MethodsSLMTA implementation followed the standard three-workshop series, mentorship site visits and audits. In order to build sustainability of progress, BDHL integrated quality improvement processes into its daily operations. The lab undertook a process of changing its internal culture to align all hospital stakeholders – including upper management, clinicians, laboratory staff and maintenance staff – to the mission of sustainable quality practices at BDHL.ResultsAfter 16 months in the SLMTA programme, BDHL improved from zero stars (38%) to four stars (89%). Over a period of two to three years, external quality assessment results improved from 47% to 87%; staff punctuality increased from 49% to 82%; clinician complaints decreased from 83% to 16; rejection rates decreased from 12% to 3%; and annual equipment repairs decreased from 40 to 15. Twelve months later the laboratory scored three stars (81%) in an external surveillance audit conducted by Kenya Accreditation Service (KENAS).ConclusionManagement buy-in, staff participation, use of progress-monitoring tools and feedback systems, as well as incorporation of improvement processes into routine daily activities, were vital in developing and sustaining a culture of quality improvement.
Highlights
Laboratory systems are one of the core capacities that countries must develop in order to comply with World Health Organization (WHO) International Health Regulations, since they play a major role in the key processes of detection, assessment, response, notification and monitoring of events.[1]
Poor External Quality Assessment (EQA) data for chemistry and haematology, as well as an increased mortality rate in medical wards from 3% in 2009 to 9% in 2011, were presented to management to demonstrate that laboratory failures could be contributing to deaths, especially amongst HIV patients for whom treatment depends heavily on chemistry results
Erratic temperatures no longer interfered with the quality of results or turnaround time and overall EQA results improved from 47% in 2010 to 87% in 2013 – above the set target of 80% (Table 1)
Summary
Laboratory systems are one of the core capacities that countries must develop in order to comply with World Health Organization (WHO) International Health Regulations, since they play a major role in the key processes of detection, assessment, response, notification and monitoring of events.[1]. The Strengthening Laboratory Management Toward Accreditation (SLMTA) programme promotes rapid, measurable improvement in laboratories of developing countries. Kenya began the SLMTA implementation process with 12 laboratories in April 2010. Bungoma District Hospital Laboratory (BDHL) was enrolled in the second SLMTA round in February 2011, along with eight other laboratories. Radical changes were phased in to encourage all laboratory staff to participate in improvement activities, adopt more disciplined and stringent work duties and schedules, engage in laboratory planning and include hospital management and other stakeholders in the process. Bungoma District Hospital Laboratory (BDHL), which supports a 200-bed referral facility, began its Strengthening Laboratory Management Toward Accreditation (SLMTA) journey in 2011 together with eight other laboratories in the second round of SLMTA rollout in Kenya
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