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

Robert N Maina,Abdikher D Mohamud,Connie J Sexton,Elizabeth T Luman,Sikhulile Moyo,Sammy K Milgo,Susan M Ochieng,Doris M Mengo

doi:10.4102/ajlm.v3i2.222

Abstract

BackgroundKenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation.MethodsAudits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist.ResultsAll laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5–45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs.ConclusionWhilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories.

Highlights

Accurate, timely and affordable medical diagnosis to support patient care and management remains a challenge in developing countries
All of the laboratories increased their scores from exit to surveillance audit; two achieved one star, two achieved three stars and the laboratory that began at three stars achieved four stars (Figure 1)
Whilst laboratory B outperformed the other laboratories both at its exit and surveillance audits, this may in part reflect the smaller size, lower workload and less complicated management system of this small private research laboratory compared with the four hospital laboratories

Summary

Introduction

Timely and affordable medical diagnosis to support patient care and management remains a challenge in developing countries. In addition to the cost of developing these systems, barriers are raised by the lack of awareness amongst healthcare workers regarding the benefits of accreditation on health services. Several publications have highlighted the advantages of a comprehensive QMS in a laboratory setting along with recognition of areas of QMS that were at risk of failing.[2,3,4,5] Accreditation is widely recognised as being an essential element of strengthening the QMS in public health laboratories and may have a positive effect on other sectors of the healthcare system.[6,7]. Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation

Methods

Results

Discussion

Conclusion