Managing for quality in clinical microbiology services.

Abstract

The technical quality of the work performed in clinical microbiology laboratories is regularly monitored, by external and internal schemes. Among the factors which might affect quality, attitudes of the laboratory staff are rarely considered. In this study, three concepts recognised by occupational psychologists as being important in the work place, Job Satisfaction, Commitment and Climate, were measured among microbiology biomedical scientists (BMSs) in the United Kingdom A self-report questionnaire was developed through preliminary interviews and two pilot studies. The perceptions of Job Satisfaction, Commitment (to both Profession and Organisation) and Climate were measured using established models from the occupational psychology literature. Three scales were devised specifically during this study to assess an individual BMS's perceptions of the standard of their own performance, the attitudes of their colleagues towards their work and the quality within their laboratory. A fourth measure was developed which collated all the ways that technical quality in clinical microbiology laboratories is currently measured in the UK into one scale. A total of 2415 questionnaires were posted to BMSs employed in National Health Service, Public Health Laboratory Service, Privately funded and University laboratories between November 1998 and February 1999. By March 1999,931 replies had been received, a response rate of 39%. BMSs reported lower Job Satisfaction than Medical Laboratory Technologists (the equivalent profession) in the United States. The results supported Meyer and Allen's (1991) three-component model of commitment and showed that BMSs experienced Professional Commitment more strongly than Organisational Commitment. An eight dimension model of Climate was developed, for clinical microbiology staff, from Newman's (1977) Perceived Work Environment scale. BMSs' perceptions of Individual Climate were affected by a number of demographic factors, but the most important was the size of the laboratory. The optimal number of people in a clinical microbiology department for positive Individual Climate was found to be less than 30. Affective Commitment to the Profession was the component of Commitment which most strongly influenced technical quality, through its positive relationship with an individual BMS's performance at work. Through aggregation of Climate scores for selected laboratories, it was shown that Laboratory Climate correlated positively with technical quality. From BMSs' perceptions of their laboratory's quality, a scale to assess `A Climate for Laboratory Quality' was developed. There was a strong positive relationship between `A Climate for Laboratory Quality' and a department's score on the measure of technical quality. Interviews with staff in four clinical microbiology laboratories supported the questionnaire findings with respect to Laboratory Climate. Qualitative data collected from a representative group of users of each of the four microbiology services showed that users' main concern was rapid turnaround time for results. Comments also highlighted the need for more effective communication between laboratory staff their colleagues working directly with patients.