CURRICULUM VITAE

Name : Dr. Tjan Sian Hwa MSc, SpPK

DOB
: 7 November 1956

Education background
:
Medical Doctor : Medical Faculty University of Indonesia
Master of Science in Clinical Tropical Disease : Mahidol
University
Clinical Pathologist : Medical Faculty University of Indonesia

Affiliation
:
Indonesian Association of Clinical Pathologist
Indonesian Association of Clinical Chemistry

Current Position
:
Head of Clinical Laboratory Department Koja Hospital
Head of Clinical Laboratory Department Mitra Internasional
Hospital

Quality
Indicators

QUALITY IN LABORATORY
MEDICINE

RIGHT

TEST
PATIENT
RESULT
TIME
DOCTOR

SAFETY
SATISFACTI
ON
COST
EFFECTIVEL
Y

QUALITY INDICATORS
ISO 15189:
measure[s] of the degree to which a set of
inherent characteristics fulfills requirements and
can measure how well an organization meets
the needs and requirements of users and the
quality of all operational processes.

ISO 9000:
The organization shall determine, and
collect and analyze appropriate data to
demonstrate suitability and effectiveness of
the quality management system and
evaluate where continual improvement of
the effectiveness of the quality management

HE BENEFIT OF QUALITY INDICATOR

LABORATORY:
Documentation and quantification of laboratory quality
Indicates the performance of a service or process.
Database for Planning, Judgments, Prioritization, Quality
improvement, Risk management
Accomplish regulation and accreditation requirement
Benchmarking
Healthy competition
CONSUMER
Choosing of laboratory providers
REGULATOR
Monitoring clinical laboratory quality
Harmonization

DEVELOPMENT OF QUALITY
INDICATORS

Select indicators
Develop indicators
Analyze, present, interpret
Act on

result

SELECT INDICATORS
Purpose:

Quality Improvement
Monitoring Quality
Regulation
At

relevant functions and levels within the organization

Preanaytic, Analytic, Postanalytic

Support : Logistic , RnD, finance, HRD , Safety, Customer

Service
Indicator

Type : Process, Outcome, Balancing

Indicator Level : Main, Support and Project Indicators

Baldrige Balance Metrics

Customer satisfaction
Employee satisfaction
Financial performance
Operational performance
Product and Service quality
Supplier performance
Safety and environment and public
responsibility

INDICATORS
PrePreanalytic

Appropriateness of test request/ number of test requested

Preanalytic:
Number of rejected samples/ number of samples received in lab
Number of Wrong Identification/ number of samples
Number of needle stick injury/ number of blood collection

Analytic

Number of parameter with EQAS out of control/ number of parameters

tested per year

Number of parameters above 5 sigma level/ number of parameters tested
Support:
Number of LIS down time
Training Program Achievement
Patient satisfaction
Delay of lab result caused by delay in reagent delivery

LEVELS
Main indicator :
crude measures of an organizations mission or target.
turn around time
Support Indicator :
is any midlevel indicator that directly affects a main
indicator
time within specimen collection and laboratory check in
Main indicator and support indicators sometimes are not
for improvement action level Indicators
Project level indicator:
used within an actual improvement effort and support the
related support indicator
sending specimen to laboratory within 15 minutes of
specimen collection

TYPE
PROCESS
indicators measure some aspect of a step within a process.
Eg: Frequency of Internal QC Outliers

OUTCOME
Eg : Turn Around Time / Time between sample received and result

reported
BALANCING
to guard against suboptimization
by monitoring whether gains in the main project indicators werent

made at the expense of other processes not currently involved in

improvement.
a project to reduce the turn around time, only to find the rate of
laboratory result error increase.

DEVELOP INDICATORS

A. Operational definition
B. Data collection process
C. Setting target or action threshold

INDICATORS NAME
Clear

and easily understood meaning

Being specific and actionable rather than being

broad and vague

Avoid

a statement of negative judgment.

Eg: % of phlebotomy failure

Contain

unit of measure.

Average minutes waiting time for blood collection

Number of good rating for cleanliness/ no

responders in outpatient department

DEVELOP INDICATORS
TARGETS
Set Objectively discriminates
between good or bad quality
Validate by Study
Clinical Relevancy
Customer, stakeholder expectation
Determined by an expert panel of
health professionals
Matched Benchmarks
Regulation

AVOID : only measures easy to count, easy to achieve,

with
arbitrary and static targets.

EVIDENCE BASED
BLOOD CULTURE CONTAMINATION
False-positive culture results are costly because
they are associated with increased hospital
LOS,
diagnostic
testing,
and
antibiotic
prescriptions.
Long-term monitoring and use of competent
phlebotomy teams are interventions associated
with sustained reductions in blood culture
contamination rates. (Am J Clin Pathol 2009;131:418-431 )
Median estimated blood culture contamination
rates were 2.5% -2.9% (Arch Pathol Lab Med.
1998;122:216-221)

OPERATIONAL DEFINITION
Percentage of non-hemolysis samples from pediatric wards
Clear description of what variable to measure :

What is hemolysis

The population :

Inpatient, outpatient , pediatric, geriatric

Contain a unit of measure:

samples

Duration/ time of collection :

every months

Targets, Time frame :

Above 95 % , in 1 years

Develop Indicator:

DATA COLLECTION
What
Data
Unit

data or variable to collect/ measure

type : Qualitative or Quantitative

of measurement

Where

is the data collected from computer, manual

How

do we collect the data

Repeated measurements by different data collectors or instruments,
at different times and places, get similar results

How

often do we collect the data

How

to present : numbers, rate, graph, table

Who

will be responsible to collect , report and analyse the data.

ANALYZE, PRESENTATION , INTERPRETATION

Should be evaluated periodically

How

will the data be reported and

presented
Average, outliers
Rates, nominal
Numbers , Texts, Table, Graphic

How to interprete the data

ACT ON INFORMATION

What

to do if the target is not achieved

Evaluate Root cause analysis

PDCA

What

to do if indicator is achieved

Stop monitoring
Continue with the current target
Increase the target

PITFALLS
To many or too few priority based on risk
assessment and evidence
Owner of indicators:

CRITICAL VALUE REPORTING

1. From instrument result to patient

treated
2. From
result to doctor:
Actionable
forinstrument
quality improvement
notified
LABORATORY TURN AROUND TIME
- Support indicators

Specific:
SPECIMEN REJECTION:
- Percentage of laboratory hemolysis sample
- Percentage of pediatric ward hemolysis sample

PITFALLS

Bias
PATIENT SATISFACTION SURVEY
- Average of Patient Satisfaction
- Percentage of Good and Very Good Rating
Patient Satisfaction

Penalty and rewards:

Motivate
Bias of data, inaccurate data

GOOD INDICATOR
Based

on priority
Actionable for quality improvement
Not too many, not too few
Measurable
Valid and reproducible
Achievable and actionable
Sensitive and specific
Time frame
Dynamic
Feasibility of implementation and cost

HARMONIZING LABORATORY
INDICATORS

Laboratory Medicine Reference

Laboratory Bench Marking
National Quality Indicators
National Laboratory Medicine Quality

IFCC

Working Group on Laboratory Errors and Patient

safety (WG LEPS)
a project that promoted and developed a model
of quality indicators (MQI) , that should be
evidence-based, feasible, and actionable for
most laboratories around the world.
divided into process and outcome measures,
mainly based on measures of the pre-, intraand analytical procedures and processes.

available atwww.ifcc-mqi.com.

QUALITY INDICATORS

QUALITY INDICATORS

QUALITY INDICATORS

SUMMARY
Quality

indicators are markers of laboratory

performance and indicators for quality improvement

Quality

indicators should be measurable,

reproducible, sensitive, specific, dynamic and
actionable

Important

to involve staff in the composing,

evaluating, result and corrective action

Harmonizing

quality indicators are needed for

benchmarking and monitoring laboratory quality

Thank you for

listening