Preoperative Evaluation Clinic Redesign: An Initiative to Improve Access, Efficiency, and Staff Satisfaction.

In 2008, Mayo Clinic in Jacksonville, Florida, developed the preoperative evaluation (POE) clinic under the department of anesthesiology to provide preoperative history and physical examination, and medical optimization. Over time, the POE clinic expanded to accommodate more than 90% of surgical patients, outgrowing the initial practice model. The increased patient volume with shortened turnaround times bottlenecked patient access. A multidisciplinary quality improvement team used Define, Measure, Analyze, Improve, and Control methodology to understand the issues, test potential solutions, and develop sustainable processes. With progressive Plan-Do-Study-Act cycles, it moved from small internal tests of change to implementation throughout the institution. Patient access improved by 14% (P < .001) and triage efficiency by 30% (P < .001). These elements led to a 14% improvement in operating margin and a 24% improvement in staff satisfaction. Sustainability was ensured with an accessible dashboard of performance indicators.

SLIPTA e-Tool improves laboratory audit process in Vietnam and Cambodia.

BACKGROUND: The Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist is used worldwide to drive quality improvement in laboratories in developing countries and to assess the effectiveness of interventions such as the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. However, the paper-based format of the checklist makes administration cumbersome and limits timely analysis and communication of results. DEVELOPMENT OF E-TOOL: In early 2012, the SLMTA team in Vietnam developed an electronic SLIPTA checklist tool. The e-Tool was pilot tested in Vietnam in mid-2012 and revised. It was used during SLMTA implementation in Vietnam and Cambodia in 2012 and 2013 and further revised based on auditors' feedback about usability. OUTCOMES: The SLIPTA e-Tool enabled rapid turn-around of audit results, reduced workload and language barriers and facilitated analysis of national results. Benefits of the e-Tool will be magnified with in-country scale-up of laboratory quality improvement efforts and potential expansion to other countries.

Improving quality management systems of laboratories in developing countries: an innovative training approach to accelerate laboratory accreditation.

The Strengthening Laboratory Management Toward Accreditation (SLMTA) program was developed to promote immediate, measurable improvement in laboratories of developing countries. The laboratory management framework, a tool that prescribes managerial job tasks, forms the basis of the hands-on, activity-based curriculum. SLMTA is implemented through multiple workshops with intervening site visits to support improvement projects. To evaluate the effectiveness of SLMTA, the laboratory accreditation checklist was developed and subsequently adopted by the World Health Organization Regional Office for Africa (WHO AFRO). The SLMTA program and the implementation model were validated through a pilot in Uganda. SLMTA yielded observable, measurable results in the laboratories and improved patient flow and turnaround time in a laboratory simulation. The laboratory staff members were empowered to improve their own laboratories by using existing resources, communicate with clinicians and hospital administrators, and advocate for system strengthening. The SLMTA program supports laboratories by improving management and building preparedness for accreditation.