Application of Management Functions to improve the quality of Laboratory Diagnostic Healthcare Services in Kenya

The study targeting management-level employees working in county referral hospitals tries to establish the methods laboratory managers use to gain leadership and managerial skills. It also investigates the challenges laboratory managers face in gaining management skills.

Through an e-mail survey, structured questionnaires that targeted senior medical laboratory personnel working in Kenyan medical laboratories were used to gather the data. Results indicated that in medical laboratories, scenario-based situational learning and coaching by senior laboratory managers were the most applied methods of gaining leadership and management skills for laboratory managers. 

Besides, the study concludes that formal laboratory leadership and management training courses for laboratory managers could improve the quality of laboratory diagnostic services in Kenya.

 

Introduction 

The clinical laboratory plays a vital role in today’s evidence-based medicine. Its principal role is to release clinical results with maximum accuracy, within the shortest turnaround time, and with minimum costs. The ability to offer quality results depends on the availability of reliable diagnostic equipment in the laboratory. Further, apart from having a good installation of diagnostic types of equipment, a laboratory manager should have adequate clinical laboratory background, with financial flair, and be able to set tasks and monitor their implementation to achieve high efficiency in the laboratory process. 

Wurcel et al. (2019) acknowledge that the laboratory manager should strive to provide modern services in the clinical laboratory aimed at satisfying the health needs and helping the physician optimize the patient desired outcomes. (Harmening, 2021) asserts that for laboratory managers to be effective on the job, they must be technically competent in their specific area of laboratory medicine and familiar with the non-technical side of management. As a result, leadership and management skills are no longer reserved for hospital administrators.

Over the years, most laboratory managers started their work as laboratory scientists. Their intensive training and includes almost everything they require to be good researchers and medical laboratory officers. However, nearly all medical training programs have little management-related content to empower this personnel to run medical laboratories efficiently.

Currently, training for medical laboratory managers in Kenya has received very little attention, and there is no formal training curriculum available to be provided to those in or aspiring to be good laboratory managers. Instead, they gain leadership and management knowledge through on-the-job experience or mentorship by senior scientists within the workplace. 

These two methods, though cost-effective, are ineffective, and their outcomes cannot be clearly measured. Furthermore, unplanned and monitored mentoring in laboratory management, unethical behaviors, and strategies can also be adopted. 

The lack of structured laboratory management training may limit the clinical laboratories' ability to offer quality diagnostic healthcare services.

Purpose and Goals

This study aimed to assess the application of management functions to improve the quality of laboratory diagnostic healthcare services in Kenya. Specifically, the purpose of the study was threefold. First, the study aimed to establish the methods laboratory managers use to gain their leadership and managerial skills. Secondly, the study investigated the challenges laboratory managers face in gaining management skills. Lastly, the study conducted an examination on whether laboratory leadership influences the provision of quality laboratory diagnostic services.

Literature Review

The Role of Laboratory Medicine

Laboratory diagnostic healthcare services provide vital information that may assist health professionals in selecting suitable preventative measures and giving crucial prognostic data to improve patients’ healthcare management. Patients get better medical treatment when health care professionals have access to complete and accurate diagnostic data and information. Wurcel et al. (2019) acknowledge that patients may live healthier and longer lives if illness development is avoided or postponed or if patients recover due to prompt and effective diagnosis. Moreover, Grode et al. (2019) observe that laboratory diagnostics provide information that may aid patients by allowing them to pick the best therapy.

According to WHO (2018), 60 to 70 percent of most essential decisions on patient admission, discharge, and medication are based on laboratory tests. Inaccurate laboratory test results lead to underdiagnosis and misdiagnosis, which may impact the clinical quality and cost-effectiveness of care and patient safety (Horvath, 2013). Quality laboratory services are therefore an important component of the whole healthcare system.

Most laboratory tests are managed in the form of a cascade process. The output of one process leads to an input of the preceding process. Harmening, (2021) argues that the laboratory’s flow path transforms a test order into a test result report. Further, he states that this path is a sequence of processes initiated by a healthcare practitioner authorized to order laboratory testing. The workflow processes proceed through sample collection, transport, receiving, testing, and reporting. Each process step is controlled to assure that the finished product (patient result) meets all the established quality attributes. The clinical laboratory leadership is responsible for identifying the specific steps in every process, guiding the quality indicators, and monitoring against defined performance thresholds. 

The rise in medical laboratory test mistakes reflects the reduction in quality in the healthcare system (Goswami et al., 2010). Any flaw in the diagnostic process, from sample order, sample processing, and reporting, is considered a defect and potentially affects the overall quality of diagnostic services. 
 

Methodology

The study applied an explorative study approach. It targeted management-level employees working in medical laboratories in Kenya through an e-mail survey. Respondents were selected using purposive sampling to get respondents who would offer vital information to the study. The administration of the questionnaires was done during the period between 1st to 30th September 2021.

The study collected data using structured questionnaires.The data collection phase started with the questionnaire design, which was checked for validity by experts in the medical laboratory field. After the design of the final questionnaire, it was emailed to purposely selected samples of 36 laboratories in Level IIIhospitals (n=12), Level IV hospitals (n=12), and Level Vhospitals (n=12) hospitals in Kenya. Thirty-two (32) senior laboratory employees responded to the questionnaire survey.

Results

The study aimed to determine the methods used by laboratory managers to gain leadership and managerial skills. Various methods were listed, and the study participants were required to indicate the extent (from least to great). Analysis was done through frequencies and percentages, and the findings are provided in Table 1. 
 

Table 1

Methods Used by Laboratory Managers to Gain Leadership and Managerial Skills

 

 

 

 

Note: Extracted by the Researcher from SPSS-Statistics data analysis output

The results (Table 1) indicate that all the respondents (100%) indicated that scenario-based situations were applied to a great extent. In comparison 62% indicated that coaching or mentoring by senior laboratory managers was used to a moderate extent. Besides, only 19% indicated that laboratory management-units training in the college/university helped manage laboratories. In comparison, 94% indicated that attending special instructor-led laboratory management courses/lectures was applied to the least extent. Moreover, 81% indicated that regularly attending trade shows and management seminars were used to the least extent. These findings suggest that scenario-based learning the most applied method of gaining laboratory management and leadership skills. 

 

Challenges Laboratory Managers Face in The Process of Gaining Management Skills

The study had the objective of determining the challenges encountered by the study participants in the process of gaining management skills. Several challenges were listed, and the respondents were required to indicate the seriousness of the challenges (from not a challenge to a serious challenge). The findings noted in table 2 show that the lack of availability of training programs was a serious challenge for 94% of the respondents. In contrast, financial resources were a serious challenge for 56% of the study respondents. However, lack of recognition from employers was a minor challenge to 81% of the study participants, while time was not a challenge to 50% of the study participants.

Table 2

Challenges Laboratory Managers Face in Gaining Management Skills

 

 

 

Note: Extracted by the Researcher from SPSS-Statistics data analysis output

 

Figure 1

Most Serious Challenge Faced in Pursuit of Laboratory Management Knowledge

Note: Extracted by the Researcher fromSPSS-Statistics data analysis output

Laboratory Leadership and the Provision of Quality of Diagnostic Services

The study aimed to determine how laboratory leadership and management contribute to improving the quality of laboratory diagnostic services. Several laboratory leadership and management parameters were listed, and the study respondents were required to indicate the extent that they agreed (from disagreeing to strongly agreeing) 

Table 5

Parameters That Contribute to The Quality of Laboratory Diagnostic Services

 

 

 

 

Note: Extracted by the Researcher from SPSS-Statistics data analysis output

The study findings show that all the study participants (100%) strongly agreed that laboratory training in quality management systems contributed to the quality of laboratory diagnostic services. In comparison while 94% strongly agreed that good personnel management and laboratory involvement in purchasing and stock control contributed to the quality of laboratory diagnostic services. Besides, 81% of the study participants strongly agreed that laboratory leadership and management training contributed to the quality of laboratory diagnostic services.

Conclusions and Recommendations

The study concludes that in medical laboratories in Kenya, scenario-based situational learning and coaching/mentoring by senior laboratory managers were the most applied methods for gaining leadership and management skills. Besides, the study concludes that formal laboratory leadership and management training courses for laboratory managers could improve the quality of laboratory diagnostic services. 

Regarding the challenges laboratory managers encountered in gaining management skills, the study concludes that the lack of availability of training programs and financial resources was the most severe hindrance. 

Lastly, the study concludes that personnel management, laboratory leadership, management training, laboratory training on quality management systems, and laboratory involvement in purchasing and stock control were the most notable contributions to the quality of laboratory diagnostic services.

The study recommends that senior decision-makers responsible for training medical laboratory scientists develop effective training programs for laboratory managers that will address the essential components of management functions like personnel management, laboratory quality management, and purchasing and stock control.

 

Author: Josephat Sua

 

References 

Aggarwal, A., Aeran, H., & Rathee, M. (2019). Quality management in healthcare: The pivotal desideratum. Journal of Oral Biology and Craniofacial Research, 9(2), 180. https://doi.org/10.1016/J.JOBCR.2018.06.006

Alelign, A., & Belay, Y. A. (2019). Patient satisfaction with clinical laboratory services and associated factors among adult patients attending outpatient departments at Debre Markos referral hospital, Northwest Ethiopia. BMC Research Notes, 12(1). https://doi.org/10.1186/S13104-019-4558-8

Bengtson, M., Bharadwaj, M., Bosch, A. ten, Nyakundi, H., Matoke-Muhia, D., Dekker, C., & Diehl, J.-C. (2020). Matching Development of Point-of-Care Diagnostic Tests to the Local Context: A Case Study of Visceral Leishmaniasis in Kenya and Uganda. Global Health: Science and Practice, 8(3), 549. https://doi.org/10.9745/GHSP-D-20-00028

Brown, A. (2019). Understanding corporate governance of healthcare quality: A comparative case study of eight Australian public hospitals. BMC Health Services Research, 19(1). https://doi.org/10.1186/S12913-019-4593-0

Cakirca, G. (2018). The evaluation of error types and turnaround time of preanalytical phase in biochemistry and hematology laboratories. Iranian Journal of Pathology, 13(2), 173–178. https://doi.org/10.30699/IJP.13.2.173

Friedberg, R. C., & Rauch, C. A. (2017). The Role of the Medical Laboratory Director. Clinics in Laboratory Medicine, 27(4), 719–731. https://doi.org/10.1016/J.CLL.2007.08.001

Goeschel, C., Wachter, R., & Pronovost, P. (2010). Responsibility for Quality Improvement and Patient Safety: Hospital Board and Medical Staff Leadership Challenges. Chest, 138(1), 171–178. https://doi.org/10.1378/chest.09-2051

Goswami, B., Singh, B., Chawla, R., & Mallika, V. (2010). Evaluation of errors in a clinical laboratory: A one-year experience. Clinical Chemistry and Laboratory Medicine, 48(1), 63–66. https://doi.org/10.1515/CCLM.2010.006

Grode, L., Møller Jensen, T., Parkner, T., Agerholm, I. E., Humaidan, P., Hammer Bech, B., & Ramlau-Hansen, C. (2019). Diagnostic Accuracy of a Point-of-Care Test for Celiac Disease Antibody Screening among Infertile Patients. Inflammatory Intestinal Diseases, 4(3), 123–130. https://doi.org/10.1159/000501520)

Harmening, D. (2021). Laboratory Management, Principles & Processes. Florida: D.H.Publishing &Consulting.

Kamau, A. M., Oluoch, M., & Osuga, B. O. (2018). FACTORS AFFECTING THE AVAILABILITY OF DIAGNOSTIC IMAGING EQUIPMENT: A CASE OF MURANGA COUNTY. Journal of Health, Medicine and Nursing, 3(1), 41–53.

Laposata, M. (2019). Teaching Laboratory Management to Pathology Residents. AJCP , 16-18.

McNerney, R. (2015). Diagnostics for developing countries. Diagnostics, 5(2), 200–209. https://doi.org/10.3390/DIAGNOSTICS5020200

Marcic, R. L. (2009). Understanding Management, 6th Edition. 5191 Natorp Boulevard: South-Western Cengage Leaning.

Mesfin, E. A., Taye, B., Belay, G., Ashenafi, A., & Girma, V. (2017). Factors Affecting Quality of Laboratory Services in Public and Private Health Facilities in Addis Ababa, Ethiopia. The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine, 28(3), 205.

Nevalainen, L. B. (2018). The Laboratory's Role in Assessing Patient Outcomes. Management, 114-119.

Nunes, F. G., Robert, G., Weggelaar-Jansen, A. M., Wiig, S., Aase, K., Karltun, A., & Fulop, N. J. (2020). Enacting quality improvement in ten European hospitals: a dualities approach. BMC Health Services Research, 20(1). https://doi.org/10.1186/S12913-020-05488-9

Wurcel, V., Cicchetti, A., Garrison, L., Kip, M. M. A., Koffijberg, H., Kolbe, A., Leeflang, M. M. G., Merlin, T., Mestre-Ferrandiz, J., Oortwijn, W., Oosterwijk, C., Tunis, S., &Zamora, B. (2019). The Value of Diagnostic Information in Personalised Healthcare: A Comprehensive Concept to Facilitate Bringing This Technology into Healthcare Systems. Public Health Genomics, 22(1–2), 8–15. https://doi.org/10.1159/000501832

WHO. (2018). Laboratory Quality Management System. Lyon: WHO.