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The purpose of this paper is to illustrate a service quality framework that enhances service delivery in clinical laboratories by gauging medical practitioner satisfaction and by providing avenues for continuous improvement.

The case study method has been used for conducting the exploratory study, with focus on the Mauritian public clinical laboratory. A structured questionnaire based on the SERVQUAL service quality model was used for data collection, analysis and for the development of the service quality framework.

The study confirms the pertinence of the following service quality dimensions within the context of clinical laboratories: tangibility, reliability, responsiveness, turnaround time, technology, test reports, communication and laboratory staff attitude and behaviour.

The service quality framework developed, termed LabSERV, is vital for clinical laboratories in the search for improving service delivery to medical practitioners.

This is a pioneering work carried out in the clinical laboratory sector in Mauritius. Medical practitioner expectations and perceptions have been simultaneously considered to generate a novel service quality framework for clinical laboratories.

The purpose of this study was to evaluate the status of US hospital Laboratory Information Systems. Laboratory Information Systems are critical to high quality healthcare service provision. Data show that the need for these systems is growing to meet accompanying technological and workload demands. Additionally, laboratory tests provide the majority of information for clinical decision‐making. Laboratory processes automation, including patient result verification, has greatly improved laboratory test throughput while decreasing turn‐around‐times, enabling critical results to reach physicians rapidly for improved clinical outcomes.

Data were drawn from the 2007 Healthcare Information and Management Systems Society (HIMSS) Analytics Database, which includes over 5,000 US healthcare organizations and provides extensive data on the hardware, software, and information technology infrastructure within healthcare organizations.

US hospitals are actively involved in laboratory systems planning to improve health service quality. Specifically, data show 76 new laboratory information systems are currently being installed in 2007 with another 399 under contract for future installation. As a result, increasing investment in laboratory information systems is providing state‐of‐the‐art clinical laboratory support, which enhances clinical care processes and improves quality. These state‐of‐the‐art Laboratory Information Systems, when linked with other clinical information systems such as Computerized Physician Order Entry and Electronic Medical Record, will support further healthcare quality improvement.

This article includes the most current information available on the US hospital laboratory information system applications.

To review the application of the principles of benchmarking to the field of laboratory medicine.

Review of the literature on performance management techniques employed in healthcare provision, and specifically in laboratory medicine, including benchmarking.

The review identifies the main performance indicators employed in quality assurance and benchmarking programmes that have been developed in laboratory medicine. Some of these have a clear benefit in improving laboratory performance, whilst others are used for more general management purposes. The emphasis of these programmes is on improving analytical performance, together with pre‐ and post‐analytical performance. The review highlights the fact that benchmarking in laboratory medicine is undertaken largely in isolation from the clinical setting in which it is applied. The benchmarking activities are, therefore, concerned with the process (dealing predominantly with efficiency and productivity) of producing laboratory results and do not probe into the way in which the laboratory services are employed in the care of patients (dealing with outcomes and value). Some examples of health outcomes studies are discussed, which demonstrate the value of the laboratory medicine service. They highlight the complexity of developing a more outcomes orientated approach to benchmarking of laboratory medicine services. These studies would show how the laboratory was used; they give a more holistic view of the role of laboratory medicine in healthcare provision.

The review shows how a more comprehensive and integrated approach to benchmarking of laboratory medicine service would provide valuable information on the effectiveness of the laboratory services.

The motivation for this paper is to better understand the strengths and limitations of quantitative performance measures in a changing environment. The context is one of organisational change and innovative management. Using a case study approach, the paper presents a history of organisational change and focuses on attempts to drive and assess efficiency through performance measures in a public hospital‐based pathology laboratory. The various financial and non‐financial performance measures used in the laboratory are presented. A discrepancy between accounting reports and laboratory management analyses of costs is reported. The notorious difficulties of costing health services are examined through the dispute that arose about whether the mean cost‐per‐test was increasing or decreasing over a three‐year period. Competing representations of performance are analysed. Whilst the case study looks at a New Zealand example, many of the pressures facing pathology services are typical of medical laboratories worldwide. General issues of performance measurement are discussed.

The Uganda Makerere University provides clinical laboratory support to over 70 clients in Uganda. With increased volume, manual data entry errors have steadily increased, prompting laboratory managers to employ the Six Sigma method to evaluate and reduce their problems. The purpose of this paper is to describe how laboratory data entry quality was improved by using Six Sigma.

The Six Sigma Quality Improvement (QI) project team followed a sequence of steps, starting with defining project goals, measuring data entry errors to assess current performance, analyzing data and determining data‐entry error root causes. Finally the team implemented changes and control measures to address the root causes and to maintain improvements. Establishing the Six Sigma project required considerable resources and maintaining the gains requires additional personnel time and dedicated resources.

After initiating the Six Sigma project, there was a 60.5 percent reduction in data entry errors from 423 errors a month (i.e. 4.34 Six Sigma) in the first month, down to an average 166 errors/month (i.e. 4.65 Six Sigma) over 12 months. The team estimated the average cost of identifying and fixing a data entry error to be $16.25 per error. Thus, reducing errors by an average of 257 errors per month over one year has saved the laboratory an estimated $50,115 a year.

The Six Sigma QI project provides a replicable framework for Ugandan laboratory staff and other resource‐limited organizations to promote quality environment. Laboratory staff can deliver excellent care at a lower cost, by applying QI principles.

This innovative QI method of reducing data entry errors in medical laboratories may improve the clinical workflow processes and make cost savings across the health care continuum.

Internal quality control (IQC) represents an essential risk management tool within the total testing pathway (TTP) that contributes to the overall objective of assuring the quality of results produced in medical laboratories. Controlling analytical phase quality alone requires significant expertise and input by scientifically trained staff. This effort has escalated exponentially following the publication of the International Organisation for Standardisation (ISO)15189:2012 requirements for quality and competence in medical laboratories. The reported inconsistency and diversity to IQC approaches in diagnostic laboratories is definitive evidence that international guidance in IQC programme design and implementation is long overdue. The paper aims to discuss these issues.

Herein, the authors define, describe and critically examine the essential elements four stages of an IQC programme and suggest a template to inform both design and ease of implementation. For practical application, the authors have stratified the proposed methodology into four stages: staff education and training; IQC material; IQC targets; and IQC procedure, and provide recommendations that meet ISO15189:2012 requirements.

These recommendations are informed by the published literature together with the collective experience working in clinical biochemistry and diagnostic endocrinology laboratories. The authors note that the laboratory staff’s effort on IQC is a continuous process, driven by changes within each IQC stage, in response to risk analysis, maximising economic value or through professional leadership and central to IQC programme implementation and delivery.

The authors offer a template that laboratories can use to inform the design and implementation of their IQC programme.

The proposed IQC programme is user friendly, flexible and pragmatic with the potential to harmonise practice. The authors have provided a template to potentially harmonise IQC practice nationally. Given the central and critical role that IQC practice plays in ensuring the quality of patient results’ importance, the authors contend that the time has come for international consensus and statutory regulation regarding the minimally acceptable criteria for its implementation, monitoring and review.

After implementing an internal quality control (IQC) programme, the purpose of this paper is to maintain the requisite analytical performance for clinical laboratory staff, thereby safeguarding patient test results for their intended medical purpose.

The authors address how quality can be maintained and if lost, how it can be regained. The methodology is based on the experience working in clinical laboratory diagnostics and is in accord with both international accreditation requirements and laboratory best practice guidelines.

Monitoring test performance usually involves both prospective and retrospective IQC data analysis. The authors present a number of different approaches together with software tools currently available and emerging, that permit performance monitoring at the level of the individual analyser, across analysers and laboratories (networks). The authors make recommendations on the appropriate response to IQC rule warnings, failures and metrics that indicate analytical control loss, that either precludes further analysis, or signifies deteriorating performance and eventual unsuitability. The authors provide guidance on systematic troubleshooting, to identify undesirable performance and consider risk assessment preventive measures and continuous quality improvement initiatives; e.g., material acceptance procedures, as tools to help regain and maintain analytical control and minimise potential for patient harm.

The authors provide a template for use by laboratory scientific personnel that ensures the optimal monitoring of analytical test performance and response when it changes undesirably.

The proposed template has been designed to meet the International Organisation for Standardisation for medical laboratories ISO15189:2012 requirements and therefore includes the use of External Quality Assessment and patient results data, as an adjunct to IQC data.

Two-thirds of medical decisions are based on laboratory test results. Therefore, laboratories should practice strict quality control (QC) measures. Traditional QC processes may not accurately reflect the magnitude of errors in clinical laboratories. Six Sigma is a statistical tool which provides opportunity to assess performance at the highest level of excellence. The purpose of this paper is to evaluate performance of the coagulation laboratory utilizing Sigma metrics as the highest level of quality.

Quality indicators of the coagulation laboratory from January 1, 2009, to December 31, 2015, were evaluated. These QIs were categorized into pre-analytical, analytical and post-analytical. Relative frequencies of errors were calculated and converted to Sigma scale to determine the extent of control over each process. The Sigma level of 4 was considered optimal performance.

During the study period, a total of 474,655 specimens were received and 890,535 analyses were performed. These include 831,760 (93.4 percent) routine and 58,775 (6.6 percent) special tests. Stat reporting was requested for 166,921 (18.7 percent). Of 7,535,146 total opportunities (sum of the total opportunities for all indicators), a total of 4,005 errors were detected. There were 2,350 (58.7 percent) pre-analytical, 11 (0.3 percent) analytical and 1,644 (41 percent) post-analytical errors. Average Sigma value obtained was 4.8 with 12 (80 percent) indicators achieving a Sigma value of 4. Three (20 percent) low-performance indicators were: unacceptable proficiency testing (3.8), failure to inform critical results (3.6) and delays in stat reporting (3.9).

This study shows that a small number of errors can decrease Sigma value to below acceptability limits. If clinical laboratories start using Sigma metrics for monitoring their performance, they can identify gaps in their performance more readily and hence can improve their performance and patient safety.

This study provides an opportunity for the laboratorians to choose and set world-class goals while assessing their performance.

To the best of the authors’ knowledge and belief, this study is the first of its kind that has utilized Sigma metrics as a QC tool for monitoring performance of a coagulation laboratory.

Personnel costs comprise the largest clinical laboratory expense. Yet standards to judge the productivity of personnel have not been established. A survey of the authors’ own personnel was conducted to derive productivity standards in the Clinical Hematology Laboratory at the Massachusetts General Hospital, Boston, Massachusetts, USA. Technologists were asked how many white blood cell differentials they could perform in an eight‐hour shift. Differential productivity was tracked before and after the survey. Of the respondents, 100 per cent failed to meet their own expectations of productivity. Nine technologists were tracked both before and after the survey was mailed and manifested a significant increase in productivity. These results suggest that technologists are objective in their assessment of their own productivity, that their opinions might be a resource for establishing productivity standards within the laboratory, and that such surveys may serve as motivational tools to augment productivity.

This paper sets out to evaluate the potential of financial performance benchmarking as an expenditure control tool for a national pathology service comprising both public and private service providers.

Primary data were provided by direct consultation with a wide range of stakeholders, whose experience and perspectives were sought primarily through informal face‐to‐face interviews. The authors analyse these informant contributions alongside official reports and the published literature on dual public‐private health service provision.

Informants identified potential advantages and pitfalls in comparative pathology benchmarking for expenditure control. They also identified some significant negative implications for health service quality and suggested related compromises. Often misunderstood cost benchmarking issues are clarified in the paper.

Several areas of importance for further investigation are suggested.

The paper concludes that appropriate performance benchmarking can be applied to New Zealand pathology services as a useful service rationalisation tool and a realistic price‐signalling device, provided that certain safeguards on health service quality are in place.

General issues complicating financial performance benchmarking across sectors in a mixed economy for health service provision are identified for the guidance of researchers, decision‐makers and planners.