Ong Siew Kim, Donovan Grant T, Ndefru Nayah, Song Sophanna, Leang Chhayheng, Sek Sophat, Noble Michael, Perrone Lucy A
International Training and Education Center for Health (I-TECH) Cambodia, Phnom Penh, Cambodia.
Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA.
Hum Resour Health. 2020 Nov 4;18(1):84. doi: 10.1186/s12960-020-00521-8.
Laboratory diagnostic testing service delivery and compliance with international standards for laboratory quality are directly influenced by laboratory workforce competency. Many hospital laboratories in constrained resource settings such as Cambodia struggle to cope with the training needs of laboratory professionals in an environment of competing healthcare development priorities. Resource-limited countries need an adaptable and effective approach to provide laboratory professionals with job-specific quality oversight training to ensure the accuracy, timeliness, and reliability of diagnostic services.
Here, we describe the results of an in-service training and mentoring program conducted with the Cambodia Ministry of Health at 12 tertiary-level hospital laboratories to drive improvements in laboratory quality management systems toward ISO 15189 accreditation, which demonstrated significant progress between baseline and outcome audits in a concurrent study. This case study describes the program, and evaluates how the four primary activities, including actionable gap assessments and planning, centralized and in situ training curriculum, in-person mentoring, and remote tele-mentoring via video communication technologies, contributed towards quality improvement in the participating laboratories. We evaluated participant responses to Likert scale and free response questions from program and training evaluation surveys, and we used thematic analysis to develop a model of best practices within the program's four primary activities to inform future training approaches. Of these activities, participants agreed most highly that in-person visits and planning based on gap assessments contributed to their learning and ability to improve laboratory operations. Tele-mentoring was rated lowest by participants, who were critical of excessive group dialogue and distraction during web-conferencing; however, feedback suggests both in-person and remote mentoring contribute to continuing education, accountability to action, and peer collaboration and problem solving to improve workforce efforts toward improved quality management systems.
We recommend here a package of in-service training activities for laboratory quality management system improvement initiatives in resource constrained settings that includes needs-based curricula and personalized action plans for participants; interactive and on-site training workshops; and in-person mentoring, complemented with well managed and regular tele-mentoring that focuses on knowledge retention, accountability to goals, and collaborative problem solving. Our model presents an adaptable approach to human resource development for quality improvement in medical laboratories.
实验室诊断检测服务的提供以及对实验室质量国际标准的遵循，直接受到实验室工作人员能力的影响。在诸如柬埔寨等资源有限的环境中，许多医院实验室在医疗保健发展优先事项相互竞争的环境下，难以满足实验室专业人员的培训需求。资源有限的国家需要一种适应性强且有效的方法，为实验室专业人员提供针对具体工作的质量监督培训，以确保诊断服务的准确性、及时性和可靠性。
在此，我们描述了与柬埔寨卫生部在12家三级医院实验室开展的一项在职培训和指导计划的结果，该计划旨在推动实验室质量管理体系朝着ISO 15189认可方向改进，在一项同期研究中，该计划在基线审核和结果审核之间显示出显著进展。本案例研究描述了该计划，并评估了四项主要活动，包括可操作的差距评估和规划、集中式和现场培训课程、面对面指导以及通过视频通信技术进行的远程电子指导，如何对参与实验室的质量改进做出贡献。我们评估了参与者对计划和培训评估调查中李克特量表及自由回答问题的回应，并使用主题分析来制定该计划四项主要活动中的最佳实践模式，以为未来的培训方法提供参考。在这些活动中，参与者高度认同基于差距评估的面对面访问和规划有助于他们学习以及提高实验室运营能力。参与者对远程电子指导的评价最低，他们批评网络会议期间小组对话过多且容易分散注意力；然而，反馈表明面对面指导和远程指导都有助于继续教育、对行动负责以及同行协作和解决问题，从而提高工作人员在改进质量管理体系方面的努力。
我们在此推荐一套针对资源受限环境中实验室质量管理体系改进举措的在职培训活动，其中包括基于需求的课程和为参与者制定的个性化行动计划；互动式现场培训工作坊；以及面对面指导，并辅以管理良好且定期的远程电子指导，后者侧重于知识保留、对目标负责以及协作解决问题。我们的模式为医学实验室质量改进的人力资源开发提供了一种适应性方法。
