From benchmarking to best practices: Lessons from the laboratory quality improvement programme at the military teaching hospital in Cotonou, Benin

Abstract

Background: In 2015, the Army Teaching Hospital–University Teaching Hospital (HIA-CHU [Hôpital D’instruction des Armées de Cotonou Centre Hospitalier et Universitaire]) laboratory in Benin launched a quality improvement programme in alignment with the World Health Organization Regional Office for Africa’s Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA). Among the sub-Saharan African laboratories that have used SLIPTA, few have been francophone countries, and fewer have belonged to a military health system. The purpose of this article was to outline the strategy, implementation, outcomes and military-specific challenges of the HIA-CHU laboratory quality improvement programme from 2015 to 2018.Intervention: The strategy for the quality improvement programme included: external baseline SLIPTA evaluation, creation of work plan based on SLIPTA results, execution of improvement projects guided by work plan, assurance of accountability via regular meetings, training of personnel to improve personnel competencies, development of external stakeholder relationships for sustainability and external follow-up post-SLIPTA evaluation.Lessons learnt: Over a period of 3 years, the HIA-CHU laboratory improved its SLIPTA score by 29% through a quality improvement process guided by work plan implementation, quality management system documentation, introduction of new proficiency testing and internal quality control programmes, and enhancement of personnel competencies in technical and quality management through training.Recommendations: The programme has yielded achievements, but consistent improvement efforts are necessary to address programme challenges and ensure continual increases in SLIPTA scores. Despite successes, military-specific challenges such as the high mobility of personnel have hindered programme progress. The authors recommend that further implementation research data be shared from programmes using SLIPTA in under-represented settings such as military health systems.

Key success factors for the implementation of quality management systems in developing countries

“…Forty-one percent of the analysed studies revealed personnel motivation as key to successful QMS implementation. 26 , 28 , 30 , 31 , 37 , 41 , 42 , 44 , 45 , 47 , 48 , 49 , 53 Our results correspond to the findings of other studies that have recognised the psychological aspect of organisational changes and individual change acceptance as key components of success in healthcare innovation. 57 , 58 …”

“…Most of the studies included in this review were conducted in Africa: Ethiopia ( n = 6), Kenya ( n = 4), Tanzania ( n = 3), Lesotho ( n = 3), Botswana ( n = 2), Nigeria ( n = 2), Cameroon ( n = 2), Mozambique ( n = 2), Rwanda ( n = 1), Zambia ( n = 1), Ghana ( n = 1), Zimbabwe ( n = 1), and Benin ( n = 1). 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 Studies reporting data from the Southeastern Asian countries (Cambodia [ n = 2], Vietnam [ n = 2]), 50 , 51 , 52 , 53 the Caribbean Region ( n = 1), 54 and Armenia ( n = 1) 55 were also included in the analysis (Supplementary Table 1). We found no relevant studies conducted in Eastern Europe (Ukraine, Belarus, Moldova, Romania, etc.)…”

“…Involving personnel in the decision-making process and teaching them the basics of QMS could help overcome the reluctance to change and develop personnel commitment. 29 , 30 , 37 , 38 , 40 , 49 …”

“…Managerial and technical laboratory personnel must be conversant with the standard’s requirements and practical applications. 24 , 27 , 28 , 29 , 30 , 31 , 34 , 37 , 39 , 40 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 55 Technical personnel should also be aware of the standard’s requirements for technical procedures, 22 , 24 and laboratory management personnel must be familiar with organisational management, leadership, and improvement activities. 26 , 32 , 50 , 51 …”

“…Adequate staffing is the second valuable resource that greatly affects the QMS implementation process. The lack of human resources 25 , 28 , 29 , 37 , 42 , 55 and employee turnover 30 , 31 , 32 , 40 , 41 , 49 , 54 can hinder the progress of QMS implementation. Laboratory management should keep this in mind and make appropriate management decisions in hiring the laboratory staff needed to efficiently handle the workload and prevent staff turnover.…”