1. Stepwise hospital accreditation certification: Can we learn from WHO-Afro Stepwise Laboratory Accreditation? 2 ND NATIONAL QUALITY IMPROVEMENT FORUM MLIMANI CITY CONFERENCE CENTRE 21-22 NOVEMBER, 2012 Dr Charles Massambu, Assistant Director, Diagnostic Services

2. Presentation outline Background Objectives Materials & methods Results & lessons learnt Conclusions and recommendations Acknowledgements

3. Background Accreditation is the process by which a facility becomes officially certified as providing services of a reasonably good quality, so that the public can trust in the quality of its services. The term is most often used with reference to schools and hospitals. It is an essential tool in continuous quality improvement of hospital services, It is a process that requires staff and management or leadership commitment with established quality standards in order to achieve the desired goal.

4. Laboratory Accreditation Is a peer review process by which an authoritative body ensures that laboratories meet explicit quality management criteria, in order to give a formal recognition that the laboratory is competent to carry out examination. 4

5. Basing on the fact that only few developing countries have established quality standards that are affordable and easy to implement and monitor, the World Health Organization Regional Office for Africa (WHO AFRO) established a stepwise laboratory accreditation approach, Uses a 0- to 5-star scale, to the recognition of evolving fulfillment of the ISO standard rather than pass-fail grading.

6. Main objective This article looks at lessons’ learnt in laboratory services quality improvement using WHO-AFRO stepwise accreditation approach, and the possibility of applying it as a springboard for hospital services quality improvement through Stepwise hospital services accreditation certification.

7. Objectives 1.To analyze successes and challenges of laboratory services quality improvement process using WHO AFRO stepwise accreditation approach 2.To determine whether lessons learnt can be applied to improve quality of hospital services through stepwise accreditation certification.

8. Materials & methods Literature on WHO AFRO stepwise laboratory accreditation Processes and procedures used to strengthen laboratory management towards accreditation (SLMTA) to twelve regional (6) and district (6) hospital laboratories Progress reports on quality management systems (QMS) implementation in 12 hospital laboratories The criteria for selection of 12 hospital laboratories were: good number of qualified laboratory staff, good laboratory infrastructure, evidence of QMS implementation, e.g. participation in External Quality Assessment (EQA) schemes, accessibility throughout the year and hospital management commitment. The 12 labs were enrolled from Mar 2010 to Aug 2011 using SLMTA method of implementing QMS

9. SLMTA approach & accreditation goal –Strengthening Laboratory Management Towards Accreditation: SLMTA –Strengthening Laboratory Management Towards Accreditation: is an innovative task- and competency- based training and mentoring tool kit that begins with baseline assessments with the WHO-AFRO checklist uses a multiple workshop model with supervised improvement projects conducted between trainings which ends with final assessments. The goal To have all district laboratories accredited with 2 stars and regional laboratories with 3 stars.

10. Lab accreditation through SLMTA approach 10 Improvement Projects Workshop #1 Workshop #2 (3 months) Workshop #3 (3 months) Site Visits Site Visits Site Visits Behavioral Changes & Laboratory Improvement Baseline Assessment Baseline Assessment Final Assessment Accreditation Readiness Final Assessment Accreditation Readiness

11. Results & lessons learnt …1/4 Baseline assessment results Twelve (12) regional (6) and district (6) hospital laboratories were enrolled for SLMTA phase I using WHO Afro stepwise laboratory accreditation approach. The regional and Municipal labs included: Amana, Arusha, Dodoma, Morogoro, Tanga and Temeke, The District laboratories includes: Kahama, Kisarawe, Lushoto, Mafinga, Newala, and Tukuyu. Only one regional lab (Arusha -Mt Meru Hospital Lab) scored 1 star during the Initial assessment, the rest of the regional and district laboratories scored below 1 star

12. Results & lessons learnt …2/4 Final assessment accreditation readness Four (4) out of 6 (67.7%) regional laboratories scored 1-3 stars (Bombo 1, Mt Meru 2, Morogoro 2 and Amana 3) Three (3) out of 6 (50%) district laboratories scored 1-2 stars (Mafinga 1, Lushoto 2 and Newala2). Two regional (Dodoma, Temeke) and three districts (Tukuyu, Kisarawe and Kahama) hospital laboratories did not score any star.

13. Results & lessons learnt …3/4

14. Results & lessons learnt …4/4 The five most common challenges were: lack of management and leadership commitment, reluctance of staff to change their attitudes and behavior, lack of documents and records, frequent out of stock frequent equipment breakdown.

15. Conclusions and recommendations WHO AFRO Stepwise Accreditation Approach is a solution to most of the identified challenges for Health Laboratory Accreditation SLMTA approach is an innovative task- and competency- based training and mentoring tool kit that equips laboratories preparing for laboratory accreditation. It is possible to apply WHO AFRO stepwise accreditation using the 5 star model approach for the Stepwise Hospital Accreditation Certification. Hospital Management and Leaders should support Hospital services to be accredited on International Standards using WHO AFRO Stepwise Accreditation and PDSA/QI Approaches.

16. Recommendations –1/2 Improve training background of hospital staff on: 1.Hospital management and leadership 2.QMS implementation 3.Stepwise Hospital accreditation 4.Hospital Biorisk Management 5.Inventory management 6.Planned preventive maintenance of medical equipment Train and re-train hospital staff on item 1-6 above Mentor hospital staff on lab QMS implementation Monitor, evaluate and perform competence assessment to hospital staff Participate in EQA schemes 16

17. Recommendations ---2/2 Communicate organizational aims Focus on systems and not individual’s problems Support staff as they address issues Avoid blame and punishment (it’s never worked) Set realistic timeframes and focus on incremental improvements Encourage continuous improvement and involve staff at all levels Reward achievements, innovations or positive suggestions 17

18. Acknowledgements MOHSW – Diagnostic Services Section – Inspectorate Unit (Quality Assurance Section) – HLPC – PHLB – MeLSAT CDC WHO CLSI ASCP AIHA AMREF WB GF Abbott Fund

19. Thank you for your attention Ninawashukuru kwa usikivu wenu 19