JHSPH Capstone Presentation_McKinney_050107_Final_c
-
Upload
barbara-mckinney -
Category
Documents
-
view
178 -
download
1
Transcript of JHSPH Capstone Presentation_McKinney_050107_Final_c
![Page 1: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/1.jpg)
Laboratory Services in Lesotho: A Journey to Quality
Capstone Project Presentation
Barbara Chase McKinney,M.D.
May 1, 2007
![Page 2: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/2.jpg)
Acknowledgements American Society for Clinical Pathology (ASCP) Ministry of Health and Social Work / Laboratory
Services, Lesotho World Health Organization (WHO) The Centers for Disease Control (CDC) The Clinton Foundation Johns Hopkins Bloomberg School of Public
Health Gilbert Burnham, MD, PhD
![Page 3: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/3.jpg)
Today’s Journey Context
The Country and the Healthcare System MOHSW / Laboratory Services
My Assignment Assessment Findings Quality Assurance Program Plan Training Progress
![Page 4: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/4.jpg)
![Page 5: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/5.jpg)
Lesotho at a glance Independent Kingdom Completely surrounded by South Africa Area – 30,355 sq km (slightly smaller than Maryland) Population: 2,022,331 HIV/AIDS Prevalence Rate: 28.9% PLWHA: 500,000 including 16,000 children
![Page 6: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/6.jpg)
Lesotho Healthcare SystemHealth Service Areas
![Page 7: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/7.jpg)
Laboratory Services in Lesotho GoL Initiates Large Scale
ART (2004) Laboratories essential to
diagnosing HIV and monitoring ART
Increased testing volume (>200%)
Expanded range of services offered
New high technology equipment Added demands for highly
accurate and reliable results
“Know your Status” Campaign (2005)
![Page 8: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/8.jpg)
ART Scale Up
![Page 9: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/9.jpg)
My AssignmentTechnical Assistance to the MOHSW / Laboratory
Services of Lesotho
Quality Assurance Program
![Page 10: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/10.jpg)
Letter from MOHSWLaboratory Director
“We are in the process of setting up our quality assurance programme and basically we will be starting from scratch…” Kekeletso Mosisili
![Page 11: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/11.jpg)
My Trips to LesothoJune 20 to July 7, 2006
September 18 to October 6, 2006
![Page 12: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/12.jpg)
Today’s Journey Context My Assignment Assessment
Assessment tools Laboratories Assessed
Findings Quality Assurance Program Plan Training Progress
![Page 13: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/13.jpg)
Assessment Tools Direct Observation Questionnaire Interviews - Stakeholder Analysis
Laboratory Personnel Laboratory Clients – Patients, Physicians, Nurses, Hospital Administrators Laboratory Stakeholders
Donors/Funding Agencies Governmental Non-governmental
Documents Job Descriptions Laboratory Statistics Lesotho National HIV/AIDS Strategic Plan, 2006-2011 MOHSW Summary Operational Plan 2005/2006 MOHSW Memorandum of Understanding with Health Partners
![Page 14: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/14.jpg)
Laboratories Assessed June / July 2006 Butha-Buthe Leribe Mafeteng Mahale’s Hoek Queen Elizabeth II Scott Hospital *
September / October 2006 Maluti Adventist Hospital* Berea Mantsonyane – St. James * Roma – St. Joseph’s * Qacha’s Nek – Maatebeng
Hospital Tebellong Hospital *
* CHAL Hospitals
![Page 15: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/15.jpg)
Facilities
![Page 16: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/16.jpg)
Findings Infrastructure
Facilities Space Safety
Equipment Consumables -
Reagents Purchasing & Inventory
Human Capacity Culture of Quality
![Page 17: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/17.jpg)
Today’s Journey Context My Assignment Assessment Findings Quality Assurance Program Plan Training Progress
![Page 18: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/18.jpg)
What is to be done? Quick Fixes Must Be Done For the Long Term
![Page 19: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/19.jpg)
Quick FixesCulture of Quality Quality Champion from
each lab to form a national Quality Team
Principles of quality to all laboratorians – QA Seminar
QA newsletter Equipment monitoring
initiated Hand washing
![Page 20: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/20.jpg)
Quick FixesEnvironment
Inventory all equipment and remove all non-functioning equipment from the laboratory premises
“House Cleaning” Remove old
paperwork, manuals, and receipts
![Page 21: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/21.jpg)
Quick FixesRecognition
Make it rewarding! Develop a laboratory
recognition program Criteria for excellence Plaque Recognition ceremony Presented by
prominent official Publish it in the
newspaper
![Page 22: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/22.jpg)
Must Be DoneCulture of Quality Daily QC
Internal & External Controls Standard Operating Procedures (SOPs) for all
procedures performed Documentation & Record keeping
Statistics tallied, recorded, and reported monthly Equipment
Maintenance logs Temperature monitoring for all refrigerators and blood bank
transport
![Page 23: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/23.jpg)
Must Be DoneCulture of Quality Improvement must be
measured Balanced scorecard for
each lab or section Compare divisions
graphically Post graphs in each
laboratory Publish the results in the
QA newsletter0
102030405060708090
Jul Aug Sep Oct
HemeChemMicro
![Page 24: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/24.jpg)
For the Long TermEquipment Basic equipment in
every lab Equipment logs
Maintenance & routine service (Service contracts purchased with equipment)
Repair - communication with service personnel
Safety policies & protocols
![Page 25: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/25.jpg)
For the Long TermConsumables Assure reliable
reagent supply Budgeting Inventory Control Consider strategies to
make the laboratory sustainable
Consider cost recovery
![Page 26: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/26.jpg)
For the Long TermHuman Capacity People are an investment in
the future Establish a culture of quality Training for all laboratorians
Test-specific Management
Organizational structure of responsibility and authority
Career advancement Competency assessment Hire clerks
![Page 27: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/27.jpg)
![Page 28: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/28.jpg)
Today’s Journey Context My Assignment Assessment Findings Quality Assurance Program Plan Training Progress
![Page 29: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/29.jpg)
Quality Assurance Seminar October 1, 2006 - Lancer’s Inn Maseru
Seminar Topics1. Principles of Quality
Assurance2. Specimen
Management3. Internal & External
Quality Control4. Standard Operating
Procedures5. Documentation and
Record Keeping
![Page 30: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/30.jpg)
Seminar Statistics 39 Attendees of 40 Invitees Educational Evaluation
38 total pretests, 24 matched pre and post tests statistically evaluated Matched Pre-test Score Mean – 17.5
(Confidence Interval 16.53-18.47) Matched Post-test Score Mean – 19.1
(Confidence Interval 18.31-19.94) Paired t-test t = .003, p >0.2 Change in Individual Scores – All individuals showed improvement
Satisfaction Evaluation Overall meeting rated 3.87 out of 4.0 by participants Based on 21 point assessment
Planned 3 month follow-up Internal Assessment with Checklist
![Page 31: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/31.jpg)
Training MOHSW Laboratory Training Plan (CHAI)
Pre-service ASCP Evaluation of NHTC
Lesotho, November 2006 Test-specific technical training
ASCP Chemistry, Hematology & CD4 Lesotho, July 2007
Clinic-laboratory relations Laboratory Management Training
ASCP Module Development Chicago, March 2007
Mentoring Program
![Page 32: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/32.jpg)
Progress Infrastructure Reagents & Consumables Human Capacity Culture of Quality
![Page 33: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/33.jpg)
Culture of Quality QA Representatives forming a National QA Team QA Newsletter Quality Manual
Mission, Vision & Values Quality Standards National Quality Management System Standard Operating Procedures Laboratory Handbook for Users
National Accreditation EQA / Proficiency testing for the laboratories EQA for Rapid HIV Testing
New position for managing EQA for rapid testing
![Page 34: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/34.jpg)
The Journey Continues…June 4-20, 2007
![Page 35: JHSPH Capstone Presentation_McKinney_050107_Final_c](https://reader035.fdocuments.in/reader035/viewer/2022070520/58f0c88e1a28abc3068b4641/html5/thumbnails/35.jpg)
Discussion