SCHOOL OF MEDICAL

LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3

OUTLINE ● Generates costs.

I. HMIS Data Quality ● Affects:
A. Data Quality E. Data Quality Tools → Customer satisfaction
B. Lot Quality Assurance F. Root Cause Analysis → Company reputation
C. Routine Data Quality G. Sustaining a Culture of → Strategic decisions of management
Assessment ● You can gauge data based on:
Information Use
D. Development
→ Accuracy
Implementation Plan
→ Completeness
LEARNING OBJECTIVES → Relevance
● Discuss data quality, quality assessment, and ▪ To the context that you are using it
development implementation plan; → Consistency
● Explain the importance of data quality tools; and ▪ ex. Data with a lot of units
● Differentiate the different techniques used in root cause → Reliability
analysis ▪ Also known as the source of information or data.
→ Presentability
I. HMIS DATA QUALITY → Accessibility

Topic Outline
B. LOT QUALITY ASSURANCE SAMPLING (LQAS)
● Data Quality
→ LQAS, RDQA, Dev’t Implementation Plan ● A tool that allows the use of small random samples to
● Data Quality Tools distinguish between different groups of data elements (lots) with
● Root Cause Analysis high and low data quality.
● Sustaining a Culture of Information Use → For health managers and supervisors, LQAS are actually very
useful because it will only use small samples and makes the
Overview conduct of surveys more efficient and of course easier.
Roadmap of the discussion:
→ No need to study or include a lot of samples or participants.
A. Data Quality ● Widely applied in the healthcare industry for decades and has
B. Lot Quality Assurance been used for quality assurance of product.
C. Routine Data Quality Assessment ● Designating health facilities, monthly reports, sections of
D. Development Implementation Plan monthly reports and group of data elements as “lots” to
E. Data Quality Tools provide representative samples for data quality assurance of
F. Root Cause Analysis District Health Information System (DHIS).
G. Sustaining a Culture of Information Use ● LQAS was originally developed in 1920s primarily to control the
quality of output in industrial production processes.
A. DATA QUALITY → So that's why they have the “lot” number
→ it involves taking a small random sample of a manufactured
● Overall utility of dataset(s) or data set as a function of its ability batch (lot) and test those sampled items for its quality or if the
to be processed easily and analyzed for a database data number of defective items in the sample exceeds the
warehouse or data analytics system. predetermined criteria (based on the company’s standards).
→ considered high quality if it is used appropriately and is ● LQAS determines if the samples will be released in the market or
available based on the context it is given
● Signifies the data's appropriateness to serve its purpose in a not.
given context.
→ is useful and consistent Steps in Applying LQUAS
→ In case you don't consider your data as high quality, there is
what we call data cleansing which can be done to raise the 1. Define the service to be assessed. (e.g. DQA of DHIS)
quality of available data according to rules in 2005. 2. Identify the unit of interest. (e.g a supervisory area, facility,
● Used in the areas of: hospital, district)
→ Customer relationship management (CRM) 3. Define the higher and lower thresholds of performance
▪ it has been a major concern for large companies based on prior information about the expected performance of
→ Data integration the region of interest.
→ Regulation requirements ● ex. How many sections of the SPH laboratory are providing
the reports on time?
Aspects of Data Quality ● Formula for Report timeliness rate:
● Number of on-time reports/ Total number of Reports x 100
Poor Data Quality

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 SCHOOL OF MEDICAL
LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3

● You want to have more than 70 percent on-time reports ● Assume a program that a certain program covers the whole
versus your lower threshold which is 40 on time so your district.
range would be 40- 70% ● Each county is then called a supervision area (e.g. Omoro, etc)
4. Determine the level of acceptance error.
and district a “supervision unit.”
● at least 5 out of 8 sections have to be on time for it to be
acceptable ● LQAS would choose a minimum of 19 items (ex. household
5. Determine the sample size and decision rule for acceptable schools, health units) from each supervision area in order to
errors to declare an area as performing “below expectations”. assess an indicator.
6. Identify the number of errors observed (mismatched data
elements will be reliably determined if the facility is performing
above or below expectations).

6 Important Terms

Figure 3. Example: Republic of Uganda

● Once the indicator has been assessed and calculated, there are
now those that we consider good and those we consider below
the desired coverage.This is then when we are going to start
categorizing.
Figure 1. Terms ● Pass or fail will be predetermined depending on the quality of the
administration or the company's standards.
Production standard
● % of items that must “pass” (pass the predetermined value based
on the company’s policy and standards) before a lot is accepted.
Coverage
● % of clients who received a service in a defined period of time.
Production unit
● The machine or team that produced or assembled the lot.
● Specifically applicable for manufacturing production, and not for
services.
Supervision unit
● The district where these services are delivered.
Lot
● A batch of items produced in a given time by the production unit.
Figure 4. Coverage
Supervision area
Good
● A county or sub-counties in a given district where services are
● Maintain the program at the current level.
being delivered.
● Identify the “best practices” that can help other programs improve
their performance.
Below average or Desired Coverage
● Identify the reasons for the program problems.
→ Develop target solutions.

Why Use a Sample Size of 19?

● A sample size of 19 provides an acceptable level of error for

making management decisions.
● At least 92% of the time, it identifies whether a coverage
benchmark has been reached or whether an SA is substantially
Figure 2. Example: Republic of Uganda
below the average coverage of a program area.

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 SCHOOL OF MEDICAL
LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3

● Samples larger than 19 have practically the same statistical D. DEVELOPMENT IMPLEMENTATION PLAN
precision as 19.
● They do not result in better information, and they cost more. ● A project management tool that illustrates how a project is
expected to progress at a high level.
Advantages of LQAS for Local Program Management ● Important in ensuring the efficient flow of communication
between those involved in the project.
● Can be used at a local level as it requires only modest ● Minimize issues that would delay the delivery of the project.
supervision.
● Identifies where the successes and challenges are located using 5 discussion in development Implementation Plan
a rigorous sampling theory.
● Produces information that can be rapidly interpreted by local
managers. ● Define goals/objectives
● Paper/pencil analyses rather than requiring computer analyses. ○ Address the question, “WHAT DO YOU WANT TO
● Data can be used for local management as well as for national ACCOMPLISH?”
reporting. ○ “Start with an end in mind”
● Only needs a minimal requirement. ○ In any plan. you need to identify or you need to find out ” why
are you starting this?” or “why did you start this in the first
C. ROUTINE DATA QUALITY ASSESSMENT (RDQA) place?”.
● Schedule milestones
● A simplified version of the Data Quality Audit (DQA) tool
○ Outline the deadline and timelines in the implementation
which allows programs and projects to verify and assess the
phase.
quality of their reported data.
○ You need to make sure that what tasks should be finished
● aims to strengthen Data management and Reporting systems
by week one
● Allocate resources
Objectives of RDQA
○ Determine whether you have sufficient resources (funds,
materials needed), and decide how you will procure those
● Verify Rapidly
missing.
1. The quality of reported data for key indicators at selected
○ Making sure of not losing any resources in the middle of your
sites;
implementation, and making sure that everything you need
2. The ability of data management systems to collect, manage,
has been purchased/ no financial problems or lack of
and report data quality.
resources.
● Implement
● Designate team member responsibilities
1. Corrective measures with action plans for strengthening the
○ Create a general team plan with overall roles that each team
data management and reporting system and improving data
member will play.
quality.
■ so that everyone will know what they should bring to the
● Monitor
table
1. Capacity improvements and performance of the data
● Define metrics for success
management and reporting system to produce quality data.
○ How will you determine if you have achieved your goal?
○ You need to make sure what your measurement /
USES OF RDQA TOOLS measurable outcomes or outputs will be so that you can say
that the project or plan is a success.
● RDQA is an excel based tool and multi-purpose tool that is
most effective when routinely used.
E. DATA QUALITY TOOLS
● Uses of RDQA tools:
○ Determine the purpose.
● Analyses information and identifies incomplete or incorrect data.
○ Selecting levels and sites to be included.
● Data Cleansing- removing abnormalities of data or repeated
○ Identify indicators, data sources, and reporting periods.
information.
○ Conduct site visits.
○ if your data is not that good or it has poor quality, you can do
○ Review outputs and findings.
data cleansing.
○ Develop a system strengthening plan, including follow
○ By maintaining data integrity, the process enhances the
up actions.
reliability of the information used by an organization.
● One of the examples includes: RDQA utilized during dengue
prevention and control programs here in Mindanao. When they
were trying to conceive – the protocol for this program they were
actually using RDQA.

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 SCHOOL OF MEDICAL
LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3

○ refers to the analysis of data to capture statistics or

metadata to determine the quality of the data and identify
data quality issues.
○ ex: how much of the data are erroneous
● Monitoring
○ refers to the deployment of controls to ensure conformity
of data to business rules set by the organization.
● Enrichment
○ enhancement of the value of the data by using related
attributes from external sources such as consumer
demographic attributes or geographic descriptors.

Application/ Scope of Data Quality Tools

Figure 5. How do we do data cleansing ● The first generation of data quality tools was characterized by
dedicated data cleansing tools designed to address
1. Matching of file with our master database normalization and reduplication.
● If there are files, you need to make sure that it should have ● In the last 10 years, a generalization of extract, transform, load
multiple copies. Multiple copies will ensure that you can (ETL) tools are used which focus on data quality management
counter-check if the data match. (DQM).
2. Removal of unwanted and invalid information
● If it doesn't match the master list or semester database, you
need to make sure to counter-check the copy. So you need
to make sure that all the data you will have will be consistent.
3. Addition of genuine, fresh, and responsive contacts
● For the recipients or for the possible sources of the data and
then the number for sending out in messages so that they
can be added.
4. Sending out opt-in messages
5. Final check by data experts
Figure 6. Extract, Transform, Load (ETL) tools; The flow of important data
● Something similar to this is when you need to have your data
verified first by your expert (statisticians)
6. Cleansed data are given back to client F. ROOT CAUSE ANALYSIS
7. Receiving incomplete and rotten data file
● approach for identifying the underlying cause or cause of an
incident so that the most effective solutions can be identified and
Addressing Problems in Data Quality
of course implemented.
- Gartner (2017) explains how quality tools address problems in
● a problem-solving method that identifies the root cause of
data quality.
problems or events instead of simply addressing the obvious
● Parsing and Standardization.
symptoms.
○ Decomposition of fields into component parts and
● Ex: In healthcare – the patient may be having a fever (only a
formatting the values into consistent layouts based on
symptom, has an underlying cause, and is only a reaction to
industry standards and patterns and user-defined business
something else that is causing it ).
rules.
● GOAL: To improve the quality of products and services (if you
○ Example: consistency of SI units
are in manufacturing, production, or services) by using
● Generalized Cleansing
systematic ways to address problems in order to be effective
○ Is the modification of data values to meet domain
(Bowen, 2011).
restrictions, constraints on integrity, or other rules that
define data quality as sufficient for the organization.
● Matching Techniques in RCA
○ Identification and merging of related entries within or
● To address the root cause of a problem, one must identify the
across data sets.
problem and ask “why” five times to determine the proper
● Profiling
strategies to address its root cause (Bowen, 2011)

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 SCHOOL OF MEDICAL
LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3
○ RCA is among the core building blocks in continuous
improvement efforts of any organization in terms of its
operation dynamics.
○ However, these techniques when used alone will not
produce any valuable results
○ Thus, the organization should seek to improve at every
level and in every department for the root cause
analysis to work.
● The analysis helps develop protocols and strategies to address
underlying issues and reduce future and possible errors, just
like a preventive measure.
● FMEA: Failure Mode and Effects Analysis
● Pareto Analysis
● FTA: Fault Tree Analysis
● CRT: Current Reality Tree
● Fishbone Diagram
● Kepner- Tregoe Technique
● Rapid Problem Resolution (RPR Problem Diagnosis)
FMEA: Failure Mode and Effects Analysis
● aims to find various modes of failure within a system and
addresses the following questions:
○ What is the mode in which an observed failure occurs?
○ How many times does a cause of failure occur?
○ What actions are implemented to prevent this cause
from occurring again?
○ Are these actions effective and efficient?
● FMEA is a step-by-step approach for identifying all possible
failures in a design, it could be in a manufacturing or assembly
process or a product or a service.
● Failure Mode
○ ways (or modes) in which something might fail.
○ Failures - errors or defects; can be potential or actual
● Effect Analysis
○ The purpose is to take actions not to eliminate or reduce
failures starting with the highest priorities.
○ studying the consequence of those failures
FMEA is used when:
● there is a new product or process
● there are changes or updates in a product.
● when problem is reported through customer feedback.
Figure 7. FMEA example
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It could be because of the process, which is waking up. So, in
potential failure mode it could be nakatulog through the alarm.
Potential failure effect is late to work. So severity could be five and
so on. Risk Preference Number (RPN) is 100 (severity x occurrence
x detection)
Pareto Analysis
● Pareto Principle (80/20 Rule), also called the Law of the Vital
Few, or Principle of Factor Sparsity
● Roughly 80% of the effects (or results) come from 20% of the
causes (or work).
● Law of the vital few (20%)
○ Vital because they could make the biggest difference
● Named after the economist Vilfredo Pareto.
○ he said that 80% of Italy's wealth belongs only to 20% of the
population
Pareto Analysis is used when:
● There are multiple potential causes to a problem.
Example statements of pareto analysis:
- They said that 20% of criminals commit 80% of the crime. This
means that in a given population if there are a certain group of
criminals, 20% of those criminals are actually the cause of 80% of
the crime in the whole city. 80-20 rule.
- 20% of drivers cost 80% of traffic accidents. This means that for all
the traffic accidents in a certain area, 80% is caused actually by 20%
of drivers.
- Or, we could also say 80% of the pollution originates from 20% of
the factory.
-20% of a company's products represent 80% of its overall sales or
it could be 20% of employees are responsible for 80% of the results
Figure 8. Example of a pareto chart.
The Pareto chart is created using Excel software. It will lay down the
potential causes in a bar and then you need to track down the
collective percentage in a line graph on the top. The reflect causes
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 SCHOOL OF MEDICAL
LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3

in the table should account for at least 80% of those involved in the
analysis.

FTA: Fault tree Analysis

Boolegan Logic
● Centered around three simple words (Boolean Operators): or,
and, and not*.
○ Utilizing Boolean logic to determine the root cause of an
undesirable event.
○ Centered around three simple or the Boolean operators
● At the heart of the Boolean logic is the idea that all values are
either true or false.
Used in:
● Risk and safety analysis

Figure 8. Example of a Fault Tree Analysis

In the chart, car hits object. You can choose and. car hits object and
Driver does not see object. Car hits object and car fails to brake. So
which one of the two. And then you will need to identify is it car hits
Figure 9. Symbols in a Fault Tree Analysis
object and the Driver does not see object or object just around
corner or is it driver is drunk or driver is asleep or it could be car hits
CRT: Current Reality Tree
object and driver does not see objects so car fails to break, or car
is going too fast or the brake is weak.
● used when the root causes of multiple problems need to be
Meaning of the symbols:
analyzed all at once.
● one of the thinking processes logical tools
● depicts the current reality in a series of dependent logical cause
and effect relationships starting from undesirable effects down
to one or few critical root causes of a problem three analysis.
● can be utilized in problem tree analysis

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 SCHOOL OF MEDICAL
LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3

Fishbone Diagram

● aka Ishikawa or Cause-and-Effect Diagram

● uses categories to explore root causes for an undesirable effect
● shows the categorized causes and sub-causes of a problem
○ categories could be the 4M’s of manufacturing, 4S of service
or 8P’s depending on the industry
● useful in grouping causes into categories (e.g. people,
measurements, methods, materials, environment, machines)

Figure 10. Current Reality Tree Chart

So we have here the different stages.The undesirable effects. You

want to analyze all of them and then intermediate effects and then
of course the root causes.
Problems are listed first so what are the symptoms? it's the obvious
symptoms that are listed here first and then followed by the potential
causes of the problem or of the symptoms. By doing so, you will see
a common problem that will be appearing in them, and then you will
be able to find that there are commonalities and you'll be able to
conclude that this is one of the root causes.

Figure 12. Fishbone Diagram

Figure 13. Fishbone Diagram Example 1

Figure 11. Current Reality Tree Example
● main problem/obvious symptom: blurry photo
- UDE1 or Undesirable Effect one passengers are not able to ● ex category: hardware
alight fast or magline. ○ causes: dirty lens, wrong lens
- UDE2 undesirable effect air conditioner seems not running ● good because you are narrowing down the different causes of
properly. the problem

At first, these two undesirable effects or problems don't seem

related. Then, we analyze. Why do passengers not alight fast? So
there are a lot of passengers in the aisle and it could also be
because the bus takes more time to leave the bus stop. So what
could be the cause of this? There are a lot of passengers in the aisle
because the bus exceeded the capacity.

On the other hand, the air conditioner doesn't seem to be working

properly because the air is not circulating well. This is because
people are blocking the ventilation. Now, we can see a relationship.
People are blocking the ventilation because the bus exceeded the
Figure 14. Fishbone Diagram Example 2
capacity limit. Therefore, all in all, these two problems are actually
caused by one root cause which is the bus being overcrowded.
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 SCHOOL OF MEDICAL
LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3

Kepner-Tregoe Technique

● provides a systematic and efficient framework for

organizing, gathering, and evaluating information for
successful decision making
● high success rate
● Breaks a problem down to its root cause by assessing a
situation using priorities and orders of concern for specific
issues
● Various decisions to address the problem are outlined to
ensure that actions recommended are sustainable

Figure 15. Key Trouble Shooting Process Steps

Figure 16. Key Trouble Shooting Process Steps, Situational Analysis in-
depth

SITUATIONAL APPRAISAL
● Identify Concerns
● Set Priority
● Plan Next Steps
● Plan Involvement
● PROBLEM ANALYSIS - To avoid jumping to cause
○ DESCRIBE PROBLEM
■ State the Problem
■ Specify the Problem
○ IDENTIFY POSSIBLE CAUSES
■ Use Knowledge and

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 SCHOOL OF MEDICAL
LABORATORY SCIENCE
HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE (LEC.)
SAN PEDRO COLLEGE – MAIN
CAMPUS
Instructor’s Name: Channey Salas, RMT
AY 2022 – 2023 - 1ST SEMESTER LESSON NO.3

■ Experience, or Distinctions and Changes

○
EVALUATE POSSIBLE CAUSES
■ Test Possible Causes
■ Determine Most Probable Cause
○ CONFIRM TRUE CAUSE
■ Verify Assumptions, Observe, or Try a Fix and Monitor
○ THINK BEYOND THE FIX
■ Extend the Cause
■ Extend the Fix
● POTENTIAL PROBLEM ANALYSIS - To avoid reactive actions
○ IDENTIFY POTENTIAL PROBLEMS Figure 17. PDCA Problem Solving Method
■ State the Action
■ List Potential Problems G. SUSTAINING A CULTURE OF INFORMATION USE
○ IDENTIFY LIKELY CAUSES
■ Consider Causes for the Potential Problems ● Information culture affects outcomes of information
○ TAKE PREVENTIVE ACTION (decision-making) use (Choo, Bergeron, Deltor, & Heaton,
■ Take Action to Address Likely Causes 2008)
○ PLAN CONTINGENT ACTION ● Information culture is determined by the following variables:
■ Prepare Actions to Reduce Likely Effects ○ mission
○ SET TRIGGERS ○ history
■ Set Triggers for Contingent Actions ○ leadership
● DECISION ANALYSIS - To balance benefits and risks ○ employee traits
○ STATE DECISION ○ industry
■ What do we need to decide? ○ national culture
■ What are we trying to do? ○ cognitive and epistemic expectations
○ CLARIFY PURPOSE ● Management (leaders or heads of the companies) should be
■ Develop Objectives the pulse in sustaining a culture of information and should
■ Classify into MUSTs and Weight the WANTs continuously work on maintaining and improving the quality
○ EVALUATE ALTERNATIVES of data and information use
■ Generate Alternatives ● How to sustain your desired culture:
■ Screen through MUSTs ○ define it, lead it, encourage it, measure it, recruit for it
■ Compare against WANTs ○ make sure that there is good leadership so that the culture
○ ASSESS RISKS will be sustained
■ Identify Adverse Concequences ○ sustainability - it will be there for a long period of time to
○ MAKE DECISION make sure that even if the leaders will change, it will remain
■ Make the Best Balanced Choice

RPR Problem Diagnosis

● Diagnoses the causes of recurrent problems by following the

3 phases:
○ Discover – data gathering and analysis of findings
○ Investigate – creation of diagnostic plan and identification
of the root cause through careful analysis of the diagnostic
data
○ Fix – fixing the problem and monitoring to confirm and
validate if the root cause was correctly identified Figure 17. How to sustain your desired culture
● Done through the PDCA Problem Solving Method
● Acting is faster in Slow, thorough planning
● When identifying the root cause of issues and planning for this
correction, the crucial information needing to be gathered is the
nature of the issue itself. During planning, all the data gathered
should be complete and accurate. Know who will carry out or
complete the action and create a complete timeline.

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