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Choose From a Selection Of Recruiter-Approved Layout Designs For Different Job Types. To implement a mentored laboratory quality stepwise implementation (LQSI) programme to strengthen the quality and capacity of Cambodian hospital laboratories. Why a Pre-Disaster Toolkit? 3. What’s in the Toolkit. 5. Federal Government Resources &. Tools. Federal Emergency Management Agency (FEMA).
 
 

 

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Maintains safety rules throughout shift. All other duties as needed. Brand experiences to all customers. In , CDC began assisting the Cambodian health ministry by implementing the strengthening laboratory management towards accreditation SLMTA programme in 12 hospital laboratories in the country. While some participating laboratories demonstrated improvements in testing accuracy, timeliness and reliability, there remained a need to scale up laboratory quality improvement efforts across Cambodia and to dedicate more resources to training and staff mentoring in quality management.

The programme aimed to expand national coverage of quality management system training and implementation. This non-randomized, quasi-experimental quantitative study was done in Cambodia, which has over 15 million people living in 25 provinces.

The national health system has a tiered structure, ordered from national to peripheral levels, which addresses curative and preventive health services.

The 18 public tertiary level referral hospitals serve as a central hub for health care; however, testing services and capacity at many of these laboratories are limited to less than 10 tests Table 1. Together with the bureau of medical laboratory services, the health ministry, WHO and CDC, we selected four national and eight provincial tertiary level referral laboratories with varying patient volumes and diagnostic testing capacities for the mentored LQSI programme Table 1.

None of the staff in the selected laboratories had quality management training before. While there are resources available for laboratory managers to assist them in implementing a quality monitoring system, many of these tools have been proprietary and thus difficult to access in resource-constrained settings.

The activities in the four phases relate to assurance of technical competency of testing phase 1, activities , implementation of quality control measures phase 2, activities , establishing a policy cycle with management, leadership and planning phase 3, activities and creating a quality control improvement document phase 4, 54 activities; Fig.

Phases of the mentored laboratory quality stepwise implementation process, Cambodia, — Each phase is divided further into smaller subsets of activities that laboratories address in 3-week increments.

QI mentors assist laboratories to implement this subset of activities during a single rotation. QI mentors spend one week in each of their three laboratories working on these activities and any remaining activities from previous weeks. The checklist includes an explanation of the activities, how they are aligned with ISO , how to accomplish the activities, listing of the required resources for implementation, listing of staff responsible for different activities, indicators to measure completeness, estimation for required person-hours for each activity and a space to document a completeness score for each activity within each phase.

Completeness scores are percentages based on the number of indicators for each activity. In addition, we developed an internal quality control monitoring tool for mentors to use during on-site visits Box 1 , which assist the laboratory staff in monitoring Levy-Jennings charts and in conducting internal control performance for quantitative tests, including the tracking of total error. We translated all instructional documents and templates produced for the laboratories into Khmer.

Did the laboratory report any results that were out of iQC range? In which section? C Westgard rules e. The implementation of the mentored LQSI programme involved three stages: mentor training, laboratory staff training, and mentoring on LQSI in the laboratories. In the first stage, four trained laboratory technicians were recruited as quality improvement mentors through local human resources firms and by advertising in local newspapers.

These mentors were trained in communication and mentoring skills, the ISO standard and on how to use the LQSI tool for laboratory quality improvement. In the second stage, the mentors accompanied laboratory staff from each of the 12 hospitals three to five from each laboratory in a weeklong training, on the principles of quality management systems, LQSI, and ISO requirements, which took place in a conference facility. Training materials were adapted from the WHO laboratory quality management system toolkit, 25 and the workshops were conducted in Khmer and English with consecutive translation.

Hospital directors as well as provincial health department directors attended the opening sessions and health ministry officials convened all workshops. The third stage involved frequent on-site mentoring to reinforce quality management principles and practices to laboratory managers and staff in all participating laboratories. Each mentor was assigned three laboratories and rotated between them, spending one week in the laboratory during each visit Fig. Mentors continued repeating this in three-week rotation cycles, averaging 17 weeks within each laboratory, over a period of one year.

Mentoring involved building close relationships with hospital leadership and staff, including directors from other departments responsible for procurement of supplies and reagents for the laboratory, and working as a quality improvement team to address challenges collectively.

The mentors regularly met with laboratory managers and staff to reinforce concepts of quality and the importance of testing quality for patient outcomes.

At each laboratory, the mentors assisted the laboratory managers to develop a quality improvement team consisting of a laboratory manager, a quality manager and a biosafety officer. Mentors assisted laboratory managers and staff to complete activities in each phase of the LQSI checklist, as well as to provide access to resources, templates and tools, and teach quality improvement in the laboratory.

The mentors encouraged laboratory staff to use quantitative quality indicator data to monitor quality improvement, such as metrics on test turnaround time and sample rejection, and tracked qualitative data such as customer feedback to motivate staff and improve communication among the hospital administrative and clinical staff. The mentors also taught and monitored laboratory staff on how to run internal quality control, plotting and analysing Levy-Jennings charts, and performing corrective actions when test runs were out of range.

In each laboratory, a stock officer position was assigned and implemented an inventory management system, assessing equipment needs and updating annual operational budgets to equip laboratories appropriately.

Mentors helped the laboratories coordinate with the hospital purchasing department to ensure appropriate provisioning of the laboratory, assisted laboratory staff to document the receipt of consumable supplies and monitor failures in logistics that could affect reagent quality, such as loss of cold chain.

Mentors assisted laboratory managers to develop annual operational plans and budgets to equip laboratories appropriately. Equipment officers were designated at each laboratory and they completed equipment registers and implemented equipment management procedures.

Hospital and laboratory leadership was kept informed of progress and challenges. The mentors met with hospital directors at each visit. The project team also met with the facility leadership and health ministry focal points on a quarterly basis to discuss progress and challenges.

The team worked closely with other laboratory partners in the country that were involved in laboratory system strengthening. To foster inter-laboratory collaboration and collective problem solving, review meetings were convened quarterly, jointly with the 12 laboratories in the SLMTA programme. The project coordinator reviewed the mentors progress reports daily, provided corrective action support and reviewed key documents for accuracy.

The implementation timeline is presented in Fig. All 12 laboratories have improved their operations in the areas of facilities and safety, organization, personnel, equipment maintenance, purchasing and inventory, testing process management, documentation and communication Box 2. In the first 10 months of the programme, laboratories established the foundational practices of a quality management system, including establishing a documentation system to track quality indicators such as specimen rejection rate, turnaround time and client satisfaction.

The programme has also improved the visibility of the laboratory within the hospitals. Clinicians and support staff have become more aware of the quality implementation efforts. Regular meetings and exchanges with leadership and management teams improved the communication between the laboratory and clinical staff. As a result, questions over test results and challenges in laboratory service provision were addressed in a timelier fashion.

In addition to assisting laboratories to implement a quality management system, the mentors have helped establish quality assurance protocols and used new quality improvement tools, such as the monitoring of internal quality control procedures Box 1 and tracking universal laboratory quality indicators. Implementation timeline of the mentored laboratory quality stepwise implementation process in Cambodia — Notes: Each cohort contains six laboratories and each cohort began the LQSI process at different time.

The phases represent quality improvement activities for implementation with increasing complexity. The activities in the four phases relate to assurance of technical competency of testing phase 1 , implementation of quality control measures phase 2 , establishing a policy cycle with management, leadership and planning phase 3 and creating a quality control improvement document phase 4.

Each laboratory created a QMT headed by the laboratory manager, and appointed key positions of quality assurance, biosafety, equipment and stock officers. Personnel folders were assembled. Organizational charts for each laboratory were updated.

 
 

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Claim This Company. Overview Salary Revenue History Demographics. American Hospitality Group has been around for a long time. It was founded back in This established company loves to hire graduates from University of Massachusetts Amherst, with 9. See All Best Workplace Rankings. In addition to assisting laboratories to implement a quality management system, the mentors have helped establish quality assurance protocols and used new quality improvement tools, such as the monitoring of internal quality control procedures Box 1 and tracking universal laboratory quality indicators.

Implementation timeline of the mentored laboratory quality stepwise implementation process in Cambodia — Notes: Each cohort contains six laboratories and each cohort began the LQSI process at different time.

The phases represent quality improvement activities for implementation with increasing complexity. The activities in the four phases relate to assurance of technical competency of testing phase 1 , implementation of quality control measures phase 2 , establishing a policy cycle with management, leadership and planning phase 3 and creating a quality control improvement document phase 4.

Each laboratory created a QMT headed by the laboratory manager, and appointed key positions of quality assurance, biosafety, equipment and stock officers. Personnel folders were assembled. Organizational charts for each laboratory were updated.

Authorization matrices and duty rosters were developed and implemented. The LQSI action plan was reviewed and implemented weekly. A communication plan between the laboratory and clinical staff was used to review quality implementation progress and to discuss challenges.

Biosafety officers were appointed. Biosafety manuals were developed and biosafety practices were initiated at health facilities and at the process level, bio hazardous waste management and laboratory cleanliness was improved at all laboratories.

Several SOPs were developed and implemented including for incident reporting. Laboratories initiated an employee health programme including vaccinations for staff and installed first aid kits in laboratories.

Laboratories initiated biosecurity measures including facility access controls through structural improvements and personnel access restrictions. Laboratory managers initiated improvements to laboratory work flow by separating office space and sample collection areas from the general laboratory area. Equipment officers were appointed, laboratories completed equipment registers, established policies and SOPs for maintenance and cleaning of critical equipment.

Essential equipment was placed on UPS and generator support and equipment operational needs documented. Laboratory airflow is currently being monitored. A hazardous waste material register has been completed and MSDS sheets maintained.

Stock officers appointed, developed stock inventory control register and SOPs for appropriate stock management. Laboratories have initiated procedures to verify reagent quality on newly delivered products before they are taken into service. Quality assurance officers were appointed. Laboratories developed a master SOP and other analytical, equipment and process SOPs and initiated a document review and maintenance system.

The SOPs are stored in the laboratories. Laboratories improved data management processes and developed a standard format for test result reporting. SOPs were developed to ensure correct entry and verification of results on reports and improved notification processes for clinicians.

Laboratories initiated internal quality control procedures for each test performed, including generating Levy-Jennings charts for quantitative tests. Corrective action SOPs were used to initiate specimen acceptance or rejection processes. Laboratories developed standardized laboratory test request forms, sample acceptance or rejection criteria and SOPs for reception and processing.

Internal quality control registers including tracking on Levy-Jennings charts for quantitative tests were managed. Nonconformity forms were also managed and subsequent correction actions were initiated. Laboratories developed laboratory service manuals and conducted stakeholder meetings to review population reference and critical values.

Notes: Achievements as of 1 March , categorized by international quality standards. The implementation of a quality management system in hospital laboratories is an effective method to improve laboratory-testing quality and ultimately patient care.

In November , a follow-up assessment in 15 laboratories across Cambodia, which also participated in a baseline assessment in , was conducted by an independent consultant, who used the WHO laboratory facility assessment tool. The new LQSI approach provides the global laboratory community with another method to advance laboratory quality. Sustainable laboratory capacity strengthening is a long-term commitment that requires leadership, careful planning, effective policies and regulations and dedicated resources.

In the past 25 years, many international donors have committed such resources to improve laboratory capacity, but have done so with a focus on disease specific emergencies, such as human immunodeficiency virus epidemic. However, as the — Ebola virus disease epidemic and other outbreaks of emerging infectious diseases have highlighted, there remains a need to improve laboratory preparedness and practice on a global scale with a focus on laboratory capacity in a non-disease specific manner.

To meet this goal of sustainability, mentored human resource capacity building programmes will need to be implemented to train laboratory managers and staff on processes for quality laboratory services.

Typical costs include full time mentor and expatriate advisor salaries, per diem and travel support for mentor site visits, financial support for quality management system workshops and LQSI review meetings for stakeholders, quarterly reviews and mentor training and office and training supplies such as laptops, cameras, and portable digital projectors.

While the LQSI programme has been conducted with a small sample size, our intensive mentoring approach in Cambodia using the modified LQSI plan has led to faster rates of quality management system implementation than other quality management system implementation methods. We think this can be attributed to our intensive mentoring approach and the utility of the LQSI checklist, which gives partial credit for completeness towards meeting ISO requirements.

This new checklist also contains a detailed action plan for laboratory managers and staff to follow to implement and maintain the quality management system. We think the LQSI action plan in the spreadsheet format is a useful tool for all health laboratories seeking ISO accreditation and we plan to make it available online free of charge.

Our LQSI approach using a full-time staff of embedded quality improvement mentors has proven highly effective in implementing a quality management system in a large number of hospital laboratories in a relatively short period. Others have demonstrated that mentorship assists laboratories to implement quality improvement activities. Our successes to date can also be attributed to strong team coordination, rapid communication and collaborations including frequent in-country meetings to address challenges collectively.

The LQSI review meetings also brought together key staff and leadership and provided opportunities for participants to share experiences and discuss challenges to the laboratory system. Overall, stronger enforcement of national policies and the establishment of a legal authority over laboratory practice are needed in Cambodia. While achievements have been made, several management challenges still exist around enforcing habits of quality assurance such as rejecting inappropriate or poor quality specimens, regularly performing internal quality control, documenting tests and processes, performing corrective action, tracking quality indicators and maintenance of equipment.

Only through strong leadership from hospital and laboratory directors will staff address these challenges. However, many laboratory managers and directors have assumed their positions through promotion due to their technical skills or seniority, and thus have not had formal laboratory management training.

There remains a global need to improve health laboratory leadership and management for these investments in laboratory systems to be sustainable. In summary, classroom-based training followed by regular on-site mentoring using a detailed action plan in the local language allows staff greater opportunity to learn new concepts, ask questions and access resources leading to rapid achievements in quality management system.

The mentored LQSI approach facilitates progress towards improving the accuracy, timeliness and reliability of test results in hospital laboratories and can synergize with other quality management system implementation programmes. While it may not be financially feasible for all health laboratories in Cambodia to seek full ISO accreditation, the LQSI process is a valuable undertaking for quality patient care.

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