The Role of Laboratory Leadership and Governance in Quality Management System Sustainability
By Jully Okonji , senior laboratory specialist , APHL Kenya , Edwin Ochieng , country director , APHL Kenya and Reshma Kakkar , informatics manager , Global Health
Leadership and governance are emerging concepts in healthcare ; however , there is limited consensus on the definition , measure and implementation approaches within laboratories . The World Health Organization ( WHO ) defines leadership and governance in healthcare as setting priorities for the maintenance and improvement of the population ’ s health , assessing progress toward the attainment of those priorities , and ensuring that all relevant actors are held properly to account for their actions . These priorities are necessary to ensure sustainable development in healthcare . Applying this definition to laboratories is key for ensuring quality systems and building sustainable laboratory capacity . Laboratory leaders must clearly understand their roles , responsibilities and the expectations of the people they serve .
APHL Kenya partnered with two public health laboratories in Kenya to demonstrate these concepts of leadership and governance . The two laboratories had exhibited no improvement in their quality management systems ( QMS ) for several years . Donors were wary of investing resources due to lack of progress , poor commitment from laboratory leadership , and absence of cooperation between the laboratory and the hospital with which it was associated .
APHL Kenya adopted a detailed and carefully considered approach , which targeted county ( equivalent to a state ) laboratory leadership , hospital management and facility-level management that emphasized :
• Laboratory managers understanding the expectations of their roles .
• Building a strong laboratory team through effective communication .
• Developing solid communication strategies .
• Identifying strengths , weaknesses , opportunities and threats .
The strategy involved recognizing challenges and successes at the outset and determining solutions collectively . The county laboratory leaders , with APHL ’ s assistance , reached a consensus on a standard approach to operations , which included : 1 ) a situational analysis to identify strengths and weaknesses of the laboratories , opportunities and external threats ; 2 ) provision of a work environment conducive to effective laboratory operations ; and 3 ) establishment of a strong foundation guided by situational analysis to better understand the hurdles to sustainable development ( Figure 1 ).
Figure 1 . Situational analysis using participatory approaches .
Figure 2 . Sustainability opportunities were identified during the work sessions .
County laboratory leaders were guided by APHL to identify opportunities for sustainable development under three themes : human resources , financial resources and environmental / infrastructural resources ( Figure 2 ). An overriding requirement was the allocation and commitment of resources to enable the laboratories to function optimally without cessation of essential services . County laboratory leaders also identified the possibility of collaboration between hospital and laboratory leaders to leverage existing capacity and improve the quality of laboratory services .
APHL worked with facility-level laboratory managers to outline priority needs that leveraged available laboratory capacity . These included :
• The role of a robust workforce .
• Timely reagent inventory management .
• Appropriate equipment management through selection and procurement of equipment based on needs and capacities needed .
• Employing control measures and checks using internal quality controls and enrollment in quality assurance programs .
• Ensuring both input and outcome processes were governed by accountability , audits , and determination of outcomes in management forums .
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26 LAB MATTERS Fall 2023
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