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Name : Dr. Tjan Sian Hwa MSc, SpPK
: 7 November 1956
Education background
Medical Doctor : Medical Faculty University of Indonesia
Master of Science in Clinical Tropical Disease : Mahidol
Clinical Pathologist : Medical Faculty University of Indonesia
Indonesian Association of Clinical Pathologist
Indonesian Association of Clinical Chemistry
Current Position
Head of Clinical Laboratory Department Koja Hospital
Head of Clinical Laboratory Department Mitra Internasional



and collect and analyze appropriate data to demonstrate suitability and effectiveness of the quality management system and evaluate where continual improvement of the effectiveness of the quality management .QUALITY INDICATORS ISO 15189: “measure[s] of the degree to which a set of inherent characteristics fulfills requirements” and “can measure how well an organization meets the needs and requirements of users and the quality of all operational processes”. ISO 9000: The organization shall determine.

Prioritization. Judgments.  Database for Planning.HE BENEFIT OF QUALITY INDICATOR LABORATORY:  Documentation and quantification of laboratory quality  Indicates the performance of a service or process. Risk management  Accomplish regulation and accreditation requirement  Benchmarking  Healthy competition  CONSUMER  Choosing of laboratory providers  REGULATOR  Monitoring clinical laboratory quality  Harmonization  . Quality improvement.

present.DEVELOPMENT OF QUALITY INDICATORS  Select indicators  Develop indicators  Analyze. interpret  Act on result .

Balancing  Indicator Level : Main. RnD. Outcome. Analytic. HRD . Customer Service  Indicator Type : Process.SELECT INDICATORS  Purpose:  Quality Improvement  Monitoring Quality  Regulation  At relevant functions and levels within the organization  Preanaytic. Support and Project Indicators . Safety. finance. Postanalytic  Support : Logistic .

Baldrige Balance Metrics        Customer satisfaction Employee satisfaction Financial performance Operational performance Product and Service quality Supplier performance Safety and environment and public responsibility .

INDICATORS  PrePreanalytic :  Appropriateness of test request/ number of test requested  Preanalytic:  Number of rejected samples/ number of samples received in lab  Number of Wrong Identification/ number of samples  Number of needle stick injury/ number of blood collection  Analytic :  Number of parameter with EQAS out of control/ number of parameters tested per year  Number of parameters above 5 sigma level/ number of parameters tested  Support:  Number of LIS down time  Training Program Achievement  Patient satisfaction  Delay of lab result caused by delay in reagent delivery .

LEVELS  Main indicator : ▪ crude measures of an organization’s mission or target. ▪ “turn around time”  Support Indicator : ▪ is any midlevel indicator that directly affects a main indicator ▪ “ time within specimen collection and laboratory check in” ▪ Main indicator and support indicators sometimes are not for “ improvement action level” Indicators  Project level indicator: ▪ used within an actual improvement effort and support the related support indicator ▪ “ sending specimen to laboratory within 15 minutes of specimen collection” .

only to find the rate of laboratory result error increase. .  a project to reduce the turn around time.TYPE  PROCESS  indicators measure some aspect of a step within a process.  Eg: Frequency of Internal QC Outliers  OUTCOME  Eg : “Turn Around Time “/ “Time between sample received and result reported”  BALANCING  to guard against suboptimization  by monitoring whether gains in the main project indicators weren’t made at the expense of other processes not currently involved in improvement.

Setting target or action threshold .DEVELOP INDICATORS A. Data collection process C. Operational definition B.

 Eg: % of phlebotomy failure  Contain unit of measure.INDICATORS NAME  Clear and easily understood meaning  Being specific and actionable rather than being broad and vague  Avoid a statement of negative judgment.  “Average minutes waiting time for blood collection”  “Number of good rating for cleanliness/ no responders in outpatient department” .

with arbitrary and static targets. stakeholder expectation  Determined by an expert panel of health professionals  Matched Benchmarks  Regulation  AVOID : only measures easy to count.DEVELOP INDICATORS TARGETS Set Objectively discriminates between good or bad quality  Validate by Study  Clinical Relevancy  Customer. easy to achieve. .

122:216-221) . ▪ Long-term monitoring and use of competent phlebotomy teams are interventions associated with sustained reductions in blood culture contamination rates. and antibiotic prescriptions. diagnostic testing. 1998.131:418-431 ) ▪ Median estimated blood culture contamination rates were 2.9% (Arch Pathol Lab Med.EVIDENCE BASED BLOOD CULTURE CONTAMINATION ▪ False-positive culture results are costly because they are associated with increased hospital LOS. (Am J Clin Pathol 2009.5% -2.

OPERATIONAL DEFINITION Percentage of non-hemolysis samples from pediatric wards Clear description of what variable to measure :   What is hemolysis The population :   Inpatient. geriatric Contain a unit of measure:   samples Duration/ time of collection :   every months Targets. pediatric. Time frame :   Above 95 % . outpatient . in 1 years .

get similar results How often do we collect the data How to present : numbers. table Who will be responsible to collect . manual How do we collect the data  Repeated measurements by different data collectors or instruments. at different times and places. . graph. report and analyse the data. rate.Develop Indicator: DATA COLLECTION What Data Unit data or variable to collect/ measure type : Qualitative or Quantitative of measurement Where is the data collected from  computer.

outliers  Rates. PRESENTATION .ANALYZE. Graphic  How to interprete the data . Table. nominal  Numbers . Texts. INTERPRETATION  Should be evaluated periodically  How will the data be reported and presented  Average.

ACT ON INFORMATION  What to do if the target is not achieved  Evaluate – Root cause analysis  PDCA  What to do if indicator is achieved  Stop monitoring  Continue with the current target  Increase the target .

Percentage of laboratory hemolysis sample . From instrument result to patient treated 2.Percentage of pediatric ward hemolysis sample . From result to doctor:  Actionable forinstrument quality improvement notified LABORATORY TURN AROUND TIME .Support indicators  Specific: SPECIMEN REJECTION: .PITFALLS To many or too few  priority based on risk assessment and evidence  Owner of indicators:  CRITICAL VALUE REPORTING 1.

Percentage of Good and Very Good Rating Patient Satisfaction  Penalty and rewards:  Motivate  Bias of data.PITFALLS  Bias PATIENT SATISFACTION SURVEY . inaccurate data .Average of Patient Satisfaction .

not too few  Measurable  Valid and reproducible  Achievable and actionable  Sensitive and specific  Time frame  Dynamic  Feasibility of implementation and cost .GOOD INDICATOR  Based on priority  Actionable for quality improvement  Not too many.

HARMONIZING LABORATORY INDICATORS  Laboratory Medicine Reference  Laboratory Bench Marking  National Quality Indicators  National Laboratory Medicine Quality .

IFCC  Working Group on Laboratory Errors and Patient safety (WG LEPS)  a project that promoted and developed a model of quality indicators (MQI) .   available at www.  . mainly based on measures of the pre-. feasible. that should be evidence-based. intraand analytical procedures and and actionable for most laboratories around the world.  divided into process and outcome measures.ifcc-mqi.




dynamic and actionable  Important to involve staff in the composing. specific. reproducible. evaluating.SUMMARY  Quality indicators are markers of laboratory performance and indicators for quality improvement  Quality indicators should be measurable. sensitive. result and corrective action  Harmonizing quality indicators are needed for benchmarking and monitoring laboratory quality .

Thank you for listening .