Global Scientific Solutions

for Health

MOLECULAR SURVEILLANCE OF DRUG RESISTANT MALARIA IN THE GREATER MEKONG SUBREGION

WORKSHOP 2011
BANGKOK, THAILAND 4 8 JULY 2011

QUALITY ENHANCEMENT STEP-DOWN TRAINING (QUEST)

INSTRUCTOR / PARTICIPANT GUIDE

Quality Enhancement Step-Down Training (QuEST)

INTRODUCTION
Quality Enhancement Step-Down Training (QuEST) is a series of practical exercises designed to help identify and enhance (improve) practices and procedures in the laboratory.

PART 1 | QUALITY ENHANCEMENT

Continuous improvement in the safety of our laboratories and quality of laboratory test results is the responsibility of ALL staff members, including technicians, post-doctoral researchers, principle investigators and laboratory managers. Scientists and researchers are increasingly aware of the benefits of continuous quality improvement in their laboratories as a means to increase productivity, decrease costs and attract more funding. Quality enhancement (also called quality improvement) will involve the following activities:
Laboratory audit; Identification of needs and recommendations for enhancement/improvement; Plan for improvement; Implementation of improvement activities Follow-up; Feedback.

Why continuously improve quality?

Accurate, reproducible results lead to faster, higher quality research and better publications. We want to ensure our published data is correct. We want our labs to have a reputation for high quality research. The higher the quality, the more likely we are to attract funding.

PART 2 | STEP-DOWN TRAINING

This workshop is intended to be used by participants to train and encourage other laboratory staff to implement quality and safety improvements in their laboratories. The final part of the workshop will involve development of a work plan to be implemented in the participants laboratories. Participants will also develop a presentation on the workshop to share with one another as well as the staff back in their laboratories.

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Quality Enhancement Step-Down Training (QuEST)

THE QUEST WORKSHOP

During the course of the week, we will work through a series of exercises designed to improve quality and safety in the laboratory. These exercises will be carried out in a working research laboratory that has been set up to demonstrate a number of quality and safety issues.

EXERCISES
There are 5 separate exercises, some of which combine multiple activities:
Exercise 1: Laboratory Audit Exercise 2: Laboratory Improvement Planning Exercise 3: Quality Improvement Implementation Exercise 4: Laboratory Follow-up Audit Exercise 5: Step-down Planning Exercise 6: Presentation

Why continuously improve safety?

We want to protect ourselves and our staff from injury and sickness. We want our staff to protect their families from injury and sickness. Ideally, we want identify a hazard before someone gets hurt. We want to learn from safety issues so we can prevent them from happening again. We want to help others by teaching them about our safety improvement programs. We can maximize productivity with healthy staff. We want to ensure that we follow

PARTICIPANTS
This workshop is aimed at principle investigators, laboratory managers, supervisors, technicians and researchers with an interest in improving laboratory quality and safety.

EXPECTED OUTCOMES
At the end of QuEST, participants are expected to:
1. 2. 3. 4. 5. 6. 7. 8.

Understand the importance of periodic laboratory audit; national safety regulations. Develop their own laboratory self-assessment tool; Use a tool to identify quality and safety issues in the laboratory; Recommend quality improvement measures; Develop measurable activities of improvement; Implement key quality and safety improvements; Assess the impact of quality and safety improvements; Develop a work plan for quality and safety improvements in their own laboratories.

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Quality Enhancement Step-Down Training (QuEST)

EXERCISE 1: LABORATORY AUDIT

OVERVIEW
Before we can begin to improve quality (quality improvement) and safety, we need to determine which documents and procedures are already in place. We can do this by performing an audit in the laboratory and using the information we collect to identify and plan specific quality and safety improvement activities.

EXERCISE OBJECTIVES
Recognize the importance of developing a laboratory audit tool; Design a laboratory audit Perform a laboratory audit Gather information on the procedures and practices in place withinthe laboratory; Write an audit report. Identify procedures and practices that could be established or enhanced to improve quality and safety in the laboratory;

ACTIVITY A | DESIGN AN AUDIT TOOL

INTRODUCTION

Quality Improvementthe practice of continuously assessing and adjusting performance using statistically and scientifically accepted procedures. College of American Pathologists (CAP), USA. Audit a methodical examination and review.
90 min.

An audit tool is a list of questions that guide us to establish which procedures and practices are already in place in the laboratory. An audit tool may be made up of any combination of questions and should provide good information about the facility, Benefits of using an audit tool:
We can audit many procedures and practices in a standardized manner; We can repeatedly audit the same / similar procedures and practices to measure improvement; We can file audit reports that show improvement over the long term.

The purpose of this activity is to design an audit tool for use in the demonstration laboratory. One part of the tool relates to quality and the other to safety. The tools will assist us in identifying the procedures and practices that could be established or enhanced to improve quality and safety.

INSTRUCTIONS
1. 2. 3. 4. 5. 6.

In your package, you will find an envelope containing printed questions concerning laboratory quality and safety. Choose 20 questions from safety that you think are most important to ask in your audit. Choose 20 questions from quality that you think are most important to ask in your audit. Discussion which questions and why? Modify or add to the questions as you see fit. Attach the questions to the safety and quality audit tool template.

DELIVERABLES:

Safety and quality audit tool

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Quality Enhancement Step-Down Training (QuEST)

ACTIVITY B | AUDIT THE LABORATORY

INTRODUCTION
90 min.

The purpose of the audit is to collect objective evidence to determine the status of safety and quality in the laboratory. We are going to use this evidence to help us to improve laboratory procedures and practices. Each of you will act as an auditor; using the tools you developed for Activity A to collect evidence from the laboratory.

INSTRUCTIONS

1. Work your way around the laboratory answering each question based on facts that can be proved in turn (you may have to walk in and out of rooms repeatedly). through analysis, measurement 2. Each question applies to the entire laboratory facility therefore, if the answer is no in one room, the tool must be filled in as and observation. such. You will add a comment stating in which room the issue was found. Audit Report 3. As you complete the audit tool, make sure you add comments where applicable Written record of the findings (i.e. where the answer to the question is no). and recommendations of an 4. In addition, takes notes in your separate notebook comments and suggestions for audit. improvement (you will need these for the feedback session).

Objective Evidence - Information

The laboratory has been set up so that your audits will reveal some common safety / quality issues. Your audit should be very thorough. You will need at least 90 min to answer every question in relation to the entire laboratory facility. You should feel free to engage in discussion and exchange ideas with the group.

DELIVERABLES:

Completed safety and quality audit questions.

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Quality Enhancement Step-Down Training (QuEST)

ACTIVITY C | LABORATORY VISIT

INTRODUCTION
45 min.

The focus of this training is on the identification and implementation of improvements in laboratory quality and safety. Although, we do not discuss accreditation, some laboratory managers may be considering a nationally or internationally recognized certification of quality and safety. In addition, it is very useful to visit a laboratory where ongoing quality and safety improvement is systematic. Building the quality management system required for certification can take many years and requires significant resources and long term commitment.

INSTRUCTIONS
1. 2. 3. 4.

You will be provided with a short tour of a laboratory that is currently preparing for accreditation. You should take note of the quality and safety procedures and practices in place. Take note of any obvious differences between the laboratory you are visiting and your own laboratory. Each participant should prepare 2 questions on quality and 2 questions on safety to ask the laboratory manager.

DELIVERABLES:

Written answers to quality and safety questions

ACTIVITY D | WRITE AN AUDIT REPORT

INTRODUCTION
30 min.

Documentation is extremely important for quality improvement. After all, how can we measure improvement if there is no record of what things were like before? Documenting our audit by writing an audit report provides an historic record of the continual quality improvement process. It is important to store these records so that we can review the improvements we make and inform others of our progress and commitment to quality improvement.

INSTRUCTIONS

1. Complete the audit report template in your folder. 2. Fill both the findings and recommendations sections.

DELIVERABLES:

Completed findings and recommendations sections of audit report.

Quality Management System Controlled policies and procedures that define and direct the management and operation of an organization or entity. Accreditation A formal procedure to determine the compliance of an entity to implementing required policies and procedures.

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Quality Enhancement Step-Down Training (QuEST)

EXERCISE 2: QUALITY IMPROVEMENT PLANNING

OVERVIEW
120 min.

Many people wonder why it is important to write a plan of laboratory quality and safety improvements. A written plan:
Ensures we capture all the necessary actions required for improvement; Provides a document we can share with others for their input; Provides a list of actions that everyone can ensure is implemented; Provides a record of our intended actions that we can review in the future.

Corrective Action - Steps taken to improve the quality of a process or procedure.

EXERCISE OBJECTIVES
INSTRUCTIONS

Use the audit report tool to translate findings and recommendations into a list of implementable activities. Identify corrective actions.

1. Complete the corrective actions section of the audit report template used in Activity D.

DELIVERABLES:

Completed corrective actions section of audit report.

EXERCISE 3:QUALITY IMPROVEMENT IMPLEMENTATION

INTRODUCTION
60 min.

We have spent the last few hours assessing laboratory processes and procedures, and identifying areas that can be improved. Now it is time to start making some changes that can improve quality and safety.

EXERCISE OBJECTIVES
INSTRUCTIONS
1. 2. 3. 4.

Change It can be very difficult to accept and embrace the need for change, especially when we have been doing something one way for many years. It is important to understand that change is a significant requirement for laboratory quality improvement. Remember that such changes are often for the better.

1. Implement corrective actions using laboratory tools provided.

Identify the areas / activities you will implement (group discussion). In your folder, you will find a number of signs and templates that may be useful for safety and quality improvement. Proceed to the laboratory and begin implementing the changes. For each change, complete the box in the corrective actions section of the report.

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Quality Enhancement Step-Down Training (QuEST)

5. Write any comments on the corrective actions e.g. outstanding actions to be taken.

DELIVERABLES:

Quality and safety activities implemented. Corrective actions section completed.

EXERCISE 4: LABORATORY AUDIT (FOLLOW-UP)

90 min.

EXERCISE OBJECTIVES
1. Perform a follow-up audit. 2. Conduct a group feedback meeting.

ACTIVITY A | AUDIT THE LABORATORY

INTRODUCTION
45 min.

After auditing, planning and implementing, our next exercise is to perform a follow-up audit to measure how much we improved from the first audit.

INSTRUCTIONS

1. Re-audit the laboratory using the audit tool template you developed in Exercise 1 (you will be given a fresh copy of the audit you designed). 2. Work your way around the laboratory answering each question in turn (you may have to walk in and out of rooms repeatedly). 3. Each question applies to the entire laboratory facility therefore, if the answer is no in one room, the tool must be filled in as such. You will add a comment stating in which room the issue was found. 4. As you complete the audit tool, make sure you add comments where applicable (i.e. where the answer to the question is no). 5. In addition, takes notes in your separate notebook comments and suggestions for improvement (you will need these for the feedback meeting).

DELIVERABLES:

Quality and safety audit questions completed.

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Quality Enhancement Step-Down Training (QuEST)

ACTIVITY B | AUDIT REVIEW AND FEEDBACK MEETING

INTRODUCTION
In this workshop, we will run through the audit process twice. Why? Because in reality (back in our laboratories), we would be auditing on a regular basis, identifying areas for improvement, implementing improvement activities and then re-auditing to measure how much we improved from the previous audit. In this exercise, we are going to:
Review and follow up on corrective actions from the previous audit. Make recommendations for corrective actions on the new audit. Answer the question did we improve?

INSTRUCTIONS

1. Set the feedback meeting agenda. 2. Hold the meeting. 3. Document and store meeting minutes.

DELIVERABLES:

Meeting minutes.

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Quality Enhancement Step-Down Training (QuEST)

EXERCISE 5: STEP-DOWN PLANS

INTRODUCTION
We want to ensure that we:

30 min.

The purpose of this exercise is to create a plan for implementing workshop activities back in our laboratories.
Begin / enhance laboratory quality and safety improvement; Train our colleagues and staff to implement quality and safety improvement.

EXERCISE OBJECTIVES
1. Complete a work plan of quality and safety improvement activities.

INSTRUCTIONS

1. Discuss with the group your plans for implementing quality and safety improvement in your laboratory. 2. Write next steps on the large stick-it notes.

DELIVERABLES:

Draft plan / flow diagram.

EXERCISE 6: PRESENTATIONS
ACTIVITY A | POWERPOINT SLIDE PREPARATION AND PRESENTATION
INTRODUCTION

165 min.

As part of the step-down training, we would like you to develop a presentation on the activities you performed during the week. The presentation will be shared with the other (analytical/quality) group so that they may learn from your experiences. The presentation is also intended to be used in the stepdown training when you return to your laboratory. It is important to share information with other staff in the laboratory.

EXERCISE OBJECTIVES
1. Design and deliver a presentation on the activities and outcomes of the workshop.

INSTRUCTIONS

1. Complete the PowerPoint Slide Presentation template in your folder. 2. If you do not have a computer, please give the completed template to your facilitator who will put them into the computer. 3. Each group has 10 minutes to present. Each presentation will be followed by a discussion.

DELIVERABLES:
GSSHealth

Completed PowerPoint Slide Presentation template.

www.gsshealth.com

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