The impact of SLMTA in improving laboratory quality systems in the Caribbean Region

Abstract

BackgroundPast efforts to improve laboratory quality systems and to achieve accreditation for better patient care in the Caribbean Region have been slow.ObjectiveTo describe the impact of the Strengthening of Laboratory Management Toward Accreditation (SLMTA) training programme and mentorship amongst five clinical laboratories in the Caribbean after 18 months.MethodFive national reference laboratories from four countries participated in the SLMTA programme that incorporated classroom teaching and implementation of improvement projects. Mentors were assigned to the laboratories to guide trainees on their improvement projects and to assist in the development of Quality Management Systems (QMS). Audits were conducted at baseline, six months, exit (at 12 months) and post-SLMTA (at 18 months) using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist to measure changes in implementation of the QMS during the period. At the end of each audit, a comprehensive implementation plan was developed in order to address gaps.ResultsBaseline audit scores ranged from 19% to 52%, corresponding to 0 stars on the SLIPTA five-star scale. After 18 months, one laboratory reached four stars, two reached three stars and two reached two stars. There was a corresponding decrease in nonconformities and development of over 100 management and technical standard operating procedures in each of the five laboratories.ConclusionThe tremendous improvement in these five Caribbean laboratories shows that SLMTA coupled with mentorship is an effective, user-friendly, flexible and customisable approach to the implementation of laboratory QMS. It is recommended that other laboratories in the region consider using the SLMTA training programme as they engage in quality systems improvement and preparation for accreditation.

A comprehensive review of the SLMTA literature part 1: Content analysis and future priorities

“…Six papers presented experiences from a single laboratory 7,10,17,26,28 or a single hospital, 9 14 presented data from two to 45 laboratories within a single African country, 8, 12,–15,18,–22,25,29–31 one discussed activities in two Southeast Asian countries, 23 one covered data from four countries in the Caribbean Region 11 and six had a general or global focus. 1,16,23,24,32,33 In total, these studies included detailed information on SLMTA implementation in 211 laboratories in 18 countries.…”

“…One study of SLMTA implementation in the Caribbean Region reported that ‘past laboratory assessments and training did not provide them with a structured roadmap to assist in implementation; as a result, the majority of these laboratories did not initiate the process of QMS development and implementation’. 11 Another reported that ‘prior to the introduction of SLMTA, several trainings and quality improvement initiatives had been implemented in hospitals and laboratories in Ethiopia, but little improvement was noted’. 12 In Botswana, there had been ‘slow progress in implementing QMS’, and authors noted that ‘previous training of healthcare workers has focused on general management topics rather than identifying tangible tasks to bring about change, making the training difficult to apply in the laboratory’.…”

“…In many cases, these circumstances improved with the advent of the US President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, 7,11,14,15,22,27 which emphasised the importance of quality laboratory tests and infused much-needed capital into the laboratory systems. 36 Other international programmes also played a key role, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria 37 and the Global Health Initiative.…”

“…32 Support and mentorship models have ranged from no site visits or mentorship, 8,20 occasional visits, 14 periodic visits of several days to several weeks, 8,10,16,28,29,30 to embedded mentors working full time in their assigned laboratories for extended periods 11,14,18,22,25,26,29,30 (Table 3). Kenya has piloted a novel mentorship model, ‘twinning’ public laboratories with local state-of-the-art research laboratories.…”

Maximising mentorship: Variations in laboratory mentorship models implemented in Zimbabwe

“…4 Several countries have utilised the embedded mentorship model incorporated with SLMTA training, with good results. 11,12,13,14 Our SLMTA training for Cohort II was conducted in a decentralised model rather than in centralised workshops; one study in Cameroon also found decentralised training to be effective. 12 …”