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Meeting the Challenges of Global
Laboratory Systems Development:
Human Resources Capacity
Development
Lucy A. Perrone, MSPH, PhD
Assistant Professor
Department of Global Health, University of Washington
Director, Certificate Program in Laboratory Leadership and Management
International Training and Education Center for Health (I-TECH)
• What are the big challenges for medical
laboratories globally?
• How can addressing HR improve lab
quality?
• Will you join us?
Key Questions
International
Training and
Education
Center for
Health
(I-TECH)
International
Clinical
Research
Center
(ICRC)
Health
Alliance
International
(HAI)
Institute for
Health
Metrics and
Evaluation
(IHME)
Center
for AIDS
Research
(CFAR)
Center for
Integrated
Health of
Women,
Adolescents,
and Children
(Global
WACh)
Improve laboratory governance,
quality and capacity towards:
• Evidence-based disease
diagnosis
• Patient care and treatment
• Timely disease detection and
surveillance
• Improved facility level biosafety
and national biosecurity
The Laboratory System
Strengthening Team’s Approach:
I N T E R N A T I O N A L T R A I N I N G & E D U C A T I O N C E N T E R F O R H E A L T H
Certificate Program in Laboratory Leadership and Management pre- service and educational programs
Laboratory QMS training and mentorship
QA of Diagnostic testingGovernment advocacy, policy
development and strategic planning
Program Management, Monitoring and Evaluation
Team Areas of Practice
Collaborators:• UBC POLQM• One World Accuracy (Laboratory External Quality Assurance Program)• I-ETCH SIGHT TEAM- Systems Innovation for Global health Technology (Informatics)
Development & Implementation• BloodWorks Northwest (Blood safety and supply) • Diagnostic Microbiology Development Program (TA in bacterial culture methods)
Delivering Quality through a Systems
Approach:
•Data and Lab
Management
•Safety
•Customer Service
Working on HIV rapid/POC testingprotocols
Training: HIV rapid testingon sample panels
Cote d’Ivoire, July, 2017
Clinicians stop utilizing testing
services
Syndromic clinical diagnosis prevails
Evidence-based clinical
practice suffers
Health policy suffers- no investment made in labs
Quality of
testing poor
The Cycle of Poor Testing
Quality:
Laboratories are an integral
part of the health system
Policy and Strategic Planning complex testing
Clinical Service Support
simple integrated testing
National Reference Laboratory
Regional Reference Laboratories
Referral Hospitals
Primary Hospital
Health Centers
Senior Health Scientists
Specialists
Senior Technologists
Program Officers
Doctors
Nurse Practitioners
Medical Assistants
Health data
•Appropriate National –Local organizational structures
•Laws and regulations
•Ability to lead and manage laboratories to national and international standards
•An Educated workforce
– Pre-service/in-service
•Professional Organizations
•Access to quality equipment/reagents
•Ability to manage and share information
Key Elements to Laboratory Quality and Capacity
Dec 16, 2011
SEARCH:
JUMP:
Students:
Program Directors:
Guide for Accredited Programs
Guide for Approved Programs
National Accrediting
Agency for Clinical
Laboratory Sciences
5600 N. River Rd.
Suite 720
Rosemont, IL 60018-
5119
847.939.3597
773.714.8880
773.714.8886 (FAX)
http://www.naacls.org
The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) is committed to beingthe premier international agency for accreditation and approval of educational programs in the clinicallaboratory sciences and related health professions through the involvement of expert volunteers andits dedication to public service.
The Standards They Are a-Changin' An Overview of the Proposed NAACLS Standards NAACLS is pleased to offer this new workshop on Thursday, February 23, 2012 inSalt Lake City at CLEC. Early registration ends 1/15/12 and final registration ends2/10/12.
view workshops...
ASPA: Specialized & Professional Accreditation: WhatShould I Know?ASPA has created a video to help explain Accreditation.
Change to NAACLS Standard 7 A change to NAACLS Standard 7, adding item N, was adopted at the September23, 2011 Board of Directors meeting. Standard 7-N requires that students must beprovided with a clear, publically available, description of the program and itscontent and current publications, which must include at least one outcomesmeasure. To comply with the Standard, programs must disclose at least oneoutcomes measure in current publications (e.g., program brochures, studenthandbooks, policy manuals, catalogs, websites, etc...) available to students and/orapplicants of the program. (Effective for Self-Studies due September 1, 2012 or later)
Self-Study Template Available!NAACLS Programs undergoing the Accreditation process can now complete theirSelf-Studies using a pdf template. The Self-Study Template can be completedusing the free version of Adobe Reader. Simply download the file and follow theinstructions within. Completed Self-Studies can be submitted to NAACLS via flashdrive. Please note that you must save the file, not work on it online.
Guide to Accreditation for the DCLS The Guide to Accreditation for Doctoral Clinical Laboratory Science programs ison the web. If you have questions or comments, please send them here.
Program Revitalization: Strategies for Survival A task force chaired by Donna Spannaus-Martin has been charged to review andupdate the NAACLS Program Revitalization: Strategies for Survival document.Other task force members include Linda Ross, Debbie Wisenor, RandyVandervander, Fred Rodriguez (board liaison), and Gwen James-Oriaikhi (staffliaison).The Program Revitalization Task force would appreciate any ideas/strategies thatyou might have to include in the updated document. These can be sent directly toDonna Spannaus-Martin.
What are the challenges for
RLC’s?
People are at the Center of the
Health System Building Blocks
Systems thinking for health systems strengthening. WHO. 2009
What does this all mean for
RLC’s?
• Resource-limited countries
start at a disadvantage
towards achieving lab quality.
• Human Resources
development is a sustainable
way to improve lab quality/
• One of strongest influences
on lab quality lies with the
Lab Director and Managers.
Functioning
Laboratory System
Continuing education for current laboratory
staff cadres and management &
Mentorship
Training New
Laboratorians- Pre Service Education
(MLT BS)Graduate
Programs in Laboratory
Science and Public Health
Training and Education to Support
the Laboratory System
• Inadequate financial resources• Inadequate network support- Absent functional linkages
between labs• Difficulties assuring consistent quality of reagents and
equipment function• Procurement challenges• Limited HR capacity and high turnover of staff • Staff competency and work ethic• Infrastructure challenges like Inconsistent electricity and
poor water quality• Inadequate training in management of lab operations
Challenges for Lab Management
• Establish direction
• Align people
• Motivate and inspire
• Lead change
Expectations ofLeaders and Managers
• Planning and budgeting
• Organizing and staffing
• Improve processes
• Problem solve
Leaders Managers
WHO Stakeholders meeting on
Laboratory Leadership and
Management Needs12-13 May 2011, Lyon, France
Key Meetings on Laboratory Leadership
• Laboratory Supervisors
• Private and public sectors
• Global focus
• In-service education
• Blended learning
• Capstone/Laboratory
improvement Project
• Modular, customizable
• LMS with discussion board
• Mentored
I-TECH Certificate Program in
Laboratory Leadership and
Management
Core competency development
Hard Skills
• Understanding of quality
laboratory service
delivery requirements
• Advocating, partnership,
networking
• Visioning and planning
• Strategic thinking
• Policy development and
program planning
Soft Skills
• Understanding
organizational change
• Development of personal
leadership skills
• Developing and leading
teams
• Developing leadership
skills
• Understanding ethics and
leadership
Learning Goals
• Apply leadership traits and management skills
required for optimal laboratory performance and
inter-coordination with key stakeholders in the
public health community.
• Implement Quality Management System (QMS)
practices.
• Improve laboratory compliance and accountability
in line with local, national, and international laws
and regulations.
• Implement appropriate diagnostic methodologies
and technologies.
• Apply critical analyses to laboratory data and
communicate results and interpretations in an
impactful way.
Participants
• Mid-career senior manager or
director of a public health or
clinical laboratory.
• At least a Bachelor degree or
equivalent.
• >5 years of laboratory technical
experience.
• >2 years of laboratory supervisory
experience.
• Currently supervising >3 staff
• Comfortable daily computer user;
experienced using the Internet, e-
mail.
Program Mentors
• Senior level scientist with experience
in laboratory management.
• Graduate level degree (e.g.
Doctorate).
• Comfortable daily computer user;
experienced using the Internet, e-mail.
• >10 years of laboratory technical
experience,
• >5 years of laboratory supervisory
experience.
Key Program Elements
Audit Lab, Assess Gaps,
Develop Work Plan
Implement the Work PlanReassess Lab, Summarize, &
Present
Evaluate & Reflect
THE CAPSTONE PROJECT
An lab-specific, lab management team-based opportunity to:
Identify areas in their laboratory’s operations that need improvement.
Expand their leadership, management, analytical, and communication skills.
Implement principles of continuous quality improvement through ongoing cycles of assessment and interventions to address problems and gaps.
Focus on an area of particular interest to them in laboratory operations.
Completion Requirements
To receive a certificate, participants must pass all 5 courses
and complete the Capstone project.
MoH leadership support and
oversight
Financial support by the MoH and
US CDC
5-9 months of online training by
UW and UBC faculty and mentor
support
2 In-Person Workshop by UQ and UBC faculty
Laboratory Improvement Projects in 16 Referral and Reference
Laboratories
Mentorship by local and regional mentors (online and in-person)
Laboratory Quality
Improvement
towards ISO 15189
Program 2017-18
UW- UBC Collaboration
Functioning
Laboratory System
Continuing education for current laboratory
staff cadres and management &
Mentorship
Training New
Laboratorians- Pre Service Education
(MLT BS)Graduate
Programs in Laboratory
Science and Public Health
Training and Education to Support
the Laboratory System
Improving laboratory testing
quality and capacity using a
mentored laboratory quality
stepwise implementation (LQSI)
approach in Cambodia
Cambodia
• 25 Provinces, 159 districts
• Population (2015)= 15,578,000
• Lower-middle-income status country, GDP = $18 billion,
gross national income per capita = US$1,070, Poverty rate
= 17.7%, 90% of whom live in the countryside
• 32% of children <5 yro are stunted, 79% do not have
access to piped water supply and 58% do not have access
to improved sanitation.
• Literacy= 73.6%
• 70% of the population is under the age of 40 (2013)
• Limited health workforce
2015 data from the World Bank and WHO
IHR Capacity
Average laboratory general indicator
scores (WHO LAT-Facility level tool) ,
Public Health Laboratory Assessment
Report, Cambodia Ministry of Health, 2013
Laboratory Capacity is Insufficient
and Quality is PoorProficiency Testing Scores (2014)
# LaboratoryMicrobiology Biochemistry Hematology Serology
Part 1 Part 2 Part 3 Part 1 Part 2 Part 1 Part 2 Part 3 Part 1 Part 2 Part 3
40 100% 90% 100% N/A N/A N/A N/A N/A 100% 100% 97%
41 89% 88% 100% 46% 42% 81% 54% 83% 87% 86% 93%
42 100% 96% 100% 57% 46% 71% 63% 83% 88% 100% 100%
43 95% 81% 100% 48% 29% 0% 33% 67% 83% 100% 92%
44 100% 96% 92% 43% 53% 52% 52% 72% 86% 100% 90%
45 94% 88% 100% 36% 50% 54% 77% 89% 96% 96% 83%
46 85% 96% 92% N/A N/A N/A N/A N/A 97% 100% 93%
47 94% 96% 100% 36% 41% 40% 56% 72% 97% 92% 92%
48 84% 76% 96% 18% 38% 0% 0% 67% 96% 96% 96%
49 N/A N/A N/A 29% 41% 48% 44% 44% 96% 93% 90%
50 N/A N/A N/A 50% 40% 27% 46% 61% 100% 100% 100%
51 86% 85% 100% 44% 64% 65% 52% 94% 100% 93% 87%
52 N/A N/A N/A 39% 67% 60% 77% 83% 100% 100% 87%
53 N/A N/A N/A 28% 37% 27% 44% 50% 100% 97% 90%
54 N/A N/A N/A 38% 27% 46% 58% 83% 100% 80% 88%
55 N/A N/A N/A 23% 38% 50% 54% 39% 97% 97% 97%
56 N/A N/A N/A 71% 62% 21% 38% 83% 100% 100% 75%
57 N/A N/A N/A 10% 18% 48% 58% 67% 100% 100% 96%
58 N/A N/A N/A N/A N/A N/A N/A N/A 100% 96% 100%
Average for I-TECH labs 93% 45% 52% 94%
Average of Cambodian labs 93% 89% 98% 39% 43% 43% 50% 71% 96% 96% 92%
The Laboratory Quality Stepwise
Implementation (LQSI) Tool
Phase 1
Phase 2
Phase 3
Phase 4 104 178 129 54
Number of activities:
465 total
• Ministry’s of Health
• I-TECH LSS Staff
• Health Resources Services Administration (HRSA)
• Centers for Disease Control and Prevention (CDC)
– Global AIDS Program
– Global Disease Detection
• Department of Defense, Defense Threat Reduction Agency
• Department of State, Cooperative Bio-engagement Program
Acknowledgements
