Implementing a Laboratory Quality Management System: A call for revaluation of professional practice from a Total Qualit

1. Essentials of survival “Every morning in Africa a gazelle wakes up it knows it has to run faster than the fastest or it will be killed. Every morning a lion wakes up it knows it must outrun the slowest gazelle or it will starve to death .It doesn’t matter who you are a lion or gazelle when the sun comes up you’d better be running” Implementing a Laboratory Quality Management System: A call for revaluation of professional practice from a Total Quality Management perspective Newton Tawanda Runyowa CDC/BOTUSA/HPRL runyowan@bw.cdc.gov

2. Presentation layout • Objectives • Background • Elements of Total Quality Management • Recommendations

3. Objectives • Translate statements about Medical Laboratory Quality into measurable elements • Outline the law of cause and effect with regard to the current status of Medical Laboratory Services • Recommend the Total Quality Management perspective as the appropriate building block for Medical Laboratory Quality in Zimbabwe

4. Background • Provincial heads of laboratories recommendation for a position of provincial chief based at the PMD 1993 • MOH&CW Health Sector Reform proposals 1997 • Medical laboratory sector restructuring as reported by the Permanent Secretary in the annual report statement of 2003 • Practical Guidance for Quality Systems in Medical Laboratories 1999 published by LabQuality of Finland. • Guidance for the development of National Laboratory Strategic Plans WHO Africa Regional Office/CDC • Consensus meeting on clinical laboratory testing harmonization and standardization, Maputo Declaration of 2008 • Southern Africa regional programme on Standardisation,Quality Assurance, Accreditation and Metrology(SQAM) • Global forum on human resources for Health Uganda 2008

5. Law of cause and effect Background cont… Organization Structure Management Human and Financial Resources Supply Chain Management Progressive Standardized Professional Laboratory Practice Laboratory Quality Management Systems Technology & Communication Professional Practice & Service Delivery

6. Elements of Total Quality Management

7. Structure “Men first of all exists ,encounters himself, surges up in the world and defines himself afterwards…he will be what he makes of himself. Thus there is no human nature…man simply is. He is what he wills…man is free man is freedom” Richard Dawkins • Organization, management and policy administration • Laboratory administrative structure • Reporting and referral structure • Professional education and training structure • Stakeholder relationship structure • National Public Health Laboratory Network (NPHLN) • Professional Association structure

8. Technology “ …where people are dying of HIV/AIDS,TB,MALARIA despite the availability of technologies to control then it is partly because the procedures for using those technologies have not been worked out and learnt locally” Christopher Bailey • Inherent low technology status • Rapid innovation and development in medical laboratory technology(diagnostic and research) • Harmonization and standardization of medical laboratory technology(Maputo Declaration 2008) • Bridge technology gap using current multiple technical, development, implementing and monitoring partners through technology “transfers” technology “diffusions” & technology “jumps”

9. People • Hundreds of Zimbabwean trained Medical Laboratory personnel currently registered and working in not less than 15 developed and developing countries • Draw insight from Diaspora challenges and experiences with different health systems and facilitate tailor made investments into the sector • Current people challenges not only to do with numbers but orientation and competency • Need to network our human resource systems to benefit from innovation, flexibility and creative inputs available in networked systems • 2008 Global forum on human resources for health strategies include scaling up health worker education and training, retaining an effective, responsive and equitably distributed health workforce

10. Recommendations • Develop and or implement national laboratory strategic plans • Make mandatory adoption of Laboratory Quality Management systems(ISO17025/ISO15189) by all operating medical laboratories in any sector • The administrative structure and management polices should have defined career progression pathways and staff retention strategies, sub specialization, cross over opportunities to reduce professional isolation, bottom to top education and access to extended and consultant roles for staff, strengthen professional associations

11. Recommendations cont… • Identify gaps in policy formulation, interpretations and implementation, service delivery, accessibility and quality to derive maximum benefits from what is available • Set up professional practice advisory board composed of all stakeholders mandated with the review and advice on structure and content of training, identify continuing training needs of professionals, provide liaison between training department and practicing professionals, identifying and assisting in the establishment of relevant research programmes

12. Recommendations cont… • “Make broad investments in human resources and health infrastructures including procurement systems, supply chains and laboratory services” WHO Director General 2008 • As SADC our health systems in general and laboratory sectors in particular have a lot in common in terms of economic challenges, neglect, service delivery problems, policies, manpower shortages hence we should use these similarities and the available regional framework SQAM to address our challenges, enhance benchmarking and cooperation

13. THANK YOU FOR YOUR TIME • “The scientific man is the only person who has anything new to say and who does not know how to say it” M Barrie • Coming together is a beginning, keeping together is progress, and working together is success