Meeting the Challenges of Global Laboratory Systems Development: Human Resources Capacity Development

Transcription

1 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)

2 Key Questions What are the big challenges for medical laboratories globally? How can addressing HR improve lab quality? Will you join us?

3 International Training and Education Center for Health (I-TECH) Health Alliance International (HAI) Institute for Health Metrics and Evaluation (IHME) International Clinical Research Center (ICRC) Center for AIDS Research (CFAR) Center for Integrated Health of Women, Adolescents, and Children (Global WACh)

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5 The Laboratory System Strengthening Team s Approach: 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

6 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 Team Areas of Practice Certificate Program in Laboratory Leadership and Management pre- service and educational programs Laboratory QMS training and mentorship Program Management, Monitoring and Evaluation QA of Diagnostic testing Government advocacy, policy development and strategic planning 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)

7 Delivering Quality through a Systems Approach: Data and Lab Management Safety Customer Service

8 Training: HIV rapid testing on sample panels Cote d Ivoire, July, 2017 Working on HIV rapid/poc testing protocols

9 The Cycle of Poor Testing Quality: Quality of testing poor Clinicians stop utilizing testing services Health policy suffers- no investment made in labs Syndromic clinical diagnosis prevails Evidencebased clinical practice suffers

10 Laboratories are an integral part of the health system Policy and Strategic Planning complex testing National Reference Laboratory Regional Reference Laboratories Referral Hospitals Senior Health Scientists Specialists Senior Technologists Program Officers Primary Hospital Health Centers Doctors Nurse Practitioners Medical Assistants Clinical Service Support simple integrated testing Health data

11 Key Elements to Laboratory Quality and Capacity 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

12 What are the challenges for RLC s?

13 People are at the Center of the Health System Building Blocks Systems thinking for health systems strengthening. WHO. 2009

14 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.

15 Training and Education to Support the Laboratory System Continuing education for current laboratory staff cadres and management & Mentorship Training New Laboratorians- Pre Service Education (MLT BS) Functioning Laboratory System Graduate Programs in Laboratory Science and Public Health

16 Challenges for Lab Management 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

17 Expectations of Leaders and Managers Leaders Establish direction Align people Motivate and inspire Lead change Managers Planning and budgeting Organizing and staffing Improve processes Problem solve

18 Key Meetings on Laboratory Leadership WHO Stakeholders meeting on Laboratory Leadership and Management Needs May 2011, Lyon, France

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20 I-TECH Certificate Program in Laboratory Leadership and Management Laboratory Supervisors Private and public sectors Global focus In-service education Blended learning Capstone/Laboratory improvement Project Modular, customizable LMS with discussion board Mentored

21 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

22 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.

23 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.

24 Program Mentors Senior level scientist with experience in laboratory management. Graduate level degree (e.g. Doctorate). Comfortable daily computer user; experienced using the Internet, . >10 years of laboratory technical experience, >5 years of laboratory supervisory experience.

25 Key Program Elements

26 THE CAPSTONE PROJECT Audit Lab, Assess Gaps, Develop Work Plan Implement the Work Plan Reassess Lab, Summarize, & Present Evaluate & Reflect 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.

27 Completion Requirements To receive a certificate, participants must pass all 5 courses and complete the Capstone project.

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29 Program UW- UBC Collaboration Mentorship by local and regional mentors (online and in-person) MoH leadership support and oversight Financial support by the MoH and US CDC Laboratory Quality Improvement towards ISO Laboratory Improvement Projects in 16 Referral and Reference Laboratories 2 In-Person Workshop by UQ and UBC faculty 5-9 months of online training by UW and UBC faculty and mentor support

30 Training and Education to Support the Laboratory System Continuing education for current laboratory staff cadres and management & Mentorship Training New Laboratorians- Pre Service Education (MLT BS) Functioning Laboratory System Graduate Programs in Laboratory Science and Public Health

31 Improving laboratory testing quality and capacity using a mentored laboratory quality stepwise implementation (LQSI) approach in Cambodia

32 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

33 Laboratory Capacity is Insufficient and Quality is Poor IHR Capacity Proficiency Testing Scores (2014) # Laboratory Microbiology Biochemistry Hematology Serology Part 1 Part 2 Part 3 Part 1 Part 2 Part 1 Part 2 Part 3 Part 1 Part 2 Part % 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% % 96% 100% 57% 46% 71% 63% 83% 88% 100% 100% 43 95% 81% 100% 48% 29% 0% 33% 67% 83% 100% 92% % 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 laboratory general indicator scores (WHO LAT-Facility level tool), Public Health Laboratory Assessment Report, Cambodia Ministry of Health, 2013 Average for I-TECH labs 93% 45% 52% 94% Average of Cambodian labs 93% 89% 98% 39% 43% 43% 50% 71% 96% 96% 92%

34 The Laboratory Quality Stepwise Implementation (LQSI) Tool Phase 1 Phase 2 Phase 3 Phase Number of activities: total

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36 Acknowledgements 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