Critical review of the Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA): suggestions for harmonization, implementation and improvement

Abstract

Abstractobjective Clinical laboratories in low-and middle-income countries (LMIC) need fundamental improvement because quality laboratory services are essential for the decision-making capacity of clinicians, health workers and public health authorities. To this end, a tiered accreditation scheme Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) was developed by WHO-AFRO, CDC and others for clinical laboratories in LMIC. One to five stars are accredited to laboratories based on the level of compliance with a checklist. Our aim was to evaluate the quality and applicability of this accreditation scheme compared with international quality standards.methods We performed a critical review of this scheme to formulate recommendations for implementation, harmonization and improvement. Two analyses were performed: one assessing its coverage of the ISO 15189:2007 standard and one to identify and evaluate priorities of the accreditation checklist.results Although the content of the checklist covers all aspects of total quality management, it strongly prioritizes resource management activities. We recommend identifying critical requirements for each tier of accreditation to assure a certain level of quality for each tier or instead using a pass ⁄ fail approach towards accreditation. In addition, the checklist should include more questions for assessing proper management, ethics and continuous improvement to meet ISO 15189.conclusion Launching accreditation schemes for laboratories in LMIC should be encouraged. After further optimization of SLIPTA, clinical laboratories may certainly benefit, leading to more correctly diagnosed patients and less waste of resources.

A comprehensive review of the SLMTA literature part 2: Measuring success

“…5 These QSEs can be grouped by stages of the quality cycle: Resource Management (equipment; facilities and safety; organisation and personnel; purchasing and inventory), Process Management (client management; documents and records; information management; process control and internal/external quality assessment) and Improvement Management (corrective action; internal audit; management reviews; occurrence management). 6 To assess progress, baseline and exit audits are conducted before and after SLMTA implementation, respectively, using the SLIPTA checklist. ‘Surveillance’ audits are also often conducted after the exit audit in order to monitor continued improvement and assess sustainability.…”

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

“…23 The three QSEs with the lowest scores for these laboratories at exit audit (internal audit, corrective action, and occurrence management and process improvement) are all part of the improvement management stage. Datema et al 24 point out that this stage is given the lowest scoring weight of the three quality stages in the SLIPTA system (16% of the total score, compared with 48% for resource management and 36% for process management in the original scoring structure; and 20%, 48% and 33%, respectively, in the current scoring structure). 15 They argue that ‘this stage is of prime importance for sustaining the continuous improvement cycle’ 24 and that by awarding it fewer points, laboratories may be ‘less stimulated to invest effort in improvement management’.…”

“…15 They argue that ‘this stage is of prime importance for sustaining the continuous improvement cycle’ 24 and that by awarding it fewer points, laboratories may be ‘less stimulated to invest effort in improvement management’. 24 …”

A Systematic Approach to Capacity Strengthening of Laboratory Systems for Control of Neglected Tropical Diseases in Ghana, Kenya, Malawi and Sri Lanka

“…Our aim was to develop a capacity strengthening programme which used a common approach to assessment and monitoring, but which could be tailored to take account of the different ways laboratories were financed, managed, and operated and their interactions with national programmes and regional collaborators. There are many capacity strengthening initiatives being carried out with laboratories in LMICs [5]; however, many of these initiatives focus on individuals' skills (e.g., technical skill of using microscope) [6] or institutional systems and processes (e.g., quality control office) [7] ignoring wider national and international structures (e.g., national and regional health systems) integral to establishing sustainable capacity.…”