A high growth market, the government in Vietnam launched the 2020 vision to modernise health infrastructure in the country. However, Vietnamese laboratories face challenges in establishing laboratory practice and high-quality standards which means that the lab practices, quality standards and patient safety can be further improved to bring it on par with other countries in Asia Pacific.
To enhance clinical laboratory practice in Vietnam, Roche Diagnostics together with leading industry associations, government-linked bodies developed an educational LEAN programme designed to improve and ensure laboratory quality standards through a lab quality improvement workshop to specifically address the needs and challenges of these labs in Vietnam. An interview with Jozica Habijanic and Associate Professor Hoàng Thi Bích Ngoc finds out more about the LEAN programme.
For our readers who are unfamiliar with the LEAN programme, can you tell us what it is about?
Jozica Habijanic: Good laboratory practices are essential to maintaining high quality standards within the healthcare system – ensuring tests are performed in a consistent way, complex processes and workflows are improved to optimise turnaround times (TAT), and laboratory staff skills are utilised efficiently in order to ensure productivity.
However, our analysis showed that laboratories in Vietnam face several challenges in establishing good laboratory practices. We realised that raising the overall laboratory quality standards and creating lasting impact would require a multi-stakeholder and multi-pronged approach. This led to the formation of the Vietnam LEAN Clinical Laboratory Practice Program, the result of a collaboration between like-minded partners.
As part of a first of its kind public-private partnership, the Asian-Pacific Federation of Clinical Biochemistry (APFCB), the Vietnam Association of Chemical Biochemists (VACB), the University Medical Center (UMC), the Hanoi Medical University (QCC), Roche Vietnam, and Roche Diagnostics Asia Pacific have come together to develop a program that aims to drive laboratory excellence in Vietnam. Dr Tony Badrick from the APFCB played a pivotal role in the launch of this initiative.
Through lab quality improvement workshops, the program helps to guide participants on good laboratory practices, and the improvement measures that can be adopted. It is divided into two core areas taking into consideration the skill sets and level of experience of the participants:
1] LEAN Facilitator Workshops
- This train-the-trainer workshop has been created specifically for senior laboratory staff. Unlike conventional training models, this workshop uses real-life scenarios to bring out certain methodology and principles of LEAN thinking. It also helps participants to better understand the concepts and apply it to daily operational practices within the laboratory.
- It allows participants to build their skills as trainers and gives them the confidence to conduct a two-day LEAN Workshop independently. Participants are also given a step-by-step guide and the necessary materials to conduct such workshops.
- Since the launch, 31 trainers from 13 institutions in Vietnam have successfully completed the train-the-trainer workshops.
2] Education and knowledge building workshops
- These workshops are targeted at a wider group of participants ranging from laboratory managers, section heads to junior staff.
- During the workshop, participants are given practical cases and examples pertaining to different sections within the laboratory which they analyse together with the trainers. Using a structured approach to analyse the problem and reviewing the different processes from start to end, participants are then encouraged to come up with a solution within a set framework.
So far, 210 laboratory staffs have been trained under the program.
By focusing on the specific challenges and unique needs of laboratories in Vietnam, the program creates greater impetus for participants to implement quality improvement within their respective laboratories.
Furthermore, the train-the-trainer model enables the program learnings to be cascaded across the country rather than being restricted to a few laboratories in the big cities.
Why was Vietnam chosen for the LEAN programme?
Jozica Habijanic: There were several factors that led to the launch of this pilot program in Vietnam. The strong in-country expertise, robust educational network and keen interest from local stakeholders were major factors. Our partners – the Vietnam Association of Chemical Biochemists (VACB), the University Medical Center (UMC) and the Hanoi Medical University (QCC) – supported this initiative tremendously, right from program development to execution.
With a growing economy and population, Vietnam is facing the task of upscaling its healthcare infrastructure to meet the growing needs of its people.
The Vietnamese government, which has developed a comprehensive roadmap to 2020, aims to address this by upgrading and modernising the healthcare system. As a result, laboratories will play an even more important role.
In support of Vietnam’s 2020 vision, Roche, as a world leader in in-vitro diagnostics, is spearheading the LEAN Clinical Laboratory Practice program together with our partners to improve the quality standards of laboratory practices across the country. Through this public-private partnership, we are tapping the collective experience, expertise and network of a diverse group to improve operational efficiency and ultimately, deliver good quality healthcare to patients in Vietnam.
What are some challenges labs in Vietnam face in establishing laboratory practice and high-quality standards?
A/Prof Ngoc: The Vietnam government has set a strategic direction to improve healthcare standards. Most laboratories across the country have registered to participate in External Quality Assessment programs. There were about 80 laboratories with ISO 15189 Quality Management Certification at the end of 2017. While the number of laboratories participating in the assessment program is increasing every year, it highlights one crucial fact – the lack of homogeneity among laboratories.
The laboratory staff, equipment and capacity for quality management between labs can greatly differ. As a result, standardising laboratory practice and creating high quality standards across the country can be challenging. Furthermore, the laboratory’s leadership may have different priorities and focus.
With the implementation of the programme, what can the labs aim to achieve?
Jozica Habijanic: The LEAN philosophy aims to streamline processes to eliminate wastage, reduce variations, and consequently, improve operational efficiency and increase revenue. In short, it allows an organisation to do more with less.
This approach, therefore, works in the context of laboratory management where high quality results and quick turnaround are necessary to allow doctors to make decisions with confidence and support patient well-being.
I believe the key differentiator of the LEAN Clinical Laboratory Practice program is the breadth of topics and cases that it covers. The trainers share case studies and real-life examples to highlight how physical, process, technological and organisational changes contribute to a large scale LEAN effort. In addition, the training provides a comprehensive understanding of the steps involved in the implementation of LEAN and creates a structured approach to problem solving.
Such an approach encourages laboratories to view this as a continuous process improvement initiative and not a one-off programme. Laboratories can determine for themselves what steps they can take to improve the process, thereby uplifting the overall quality of healthcare delivery. The end result is quick and accurate to accelerate clinical decision-making so that patients can get the right treatment, faster.
What are some hurdles in implementing the LEAN Clinical Laboratory Practice programme in a clinical laboratory setting in Vietnam?
A/Prof Ngoc: Among the laboratories that have participated in the LEAN Clinical Laboratory Practice program, there are some that have applied the principles of LEAN to change processes within their laboratory. In most cases, this has been done in the pre-analytic phase, for instance, to re-arrange the receiving of patient samples, or in the post-analytic phase to validate patient’s results.
Currently, LEAN principles have been applied at different stages in laboratories across the country. This is largely because most hospital laboratories tend to be overloaded. While these situations can be remedied by taking corrective actions such as improving the work processes and allocating the right resources, the implementation of a new process can be overwhelming for laboratory staff. Often times, it is because of the preconceived notion that it will add to their workload.
Challenges can also stem from the laboratory management’s limited awareness of LEAN principles and perceptions about its limited impact on workflow. Other challenges include resistance to changing what are long-established processes or streamlining diverse processes.
In order to successfully implement LEAN processes, a well-established laboratory requires considerable time and persistence. Steps need to be taken to educate and train the staff on what processes need to be improved and how changes will be implemented.
For new laboratories, on the other hand, it is easier if the management applies LEAN principles when designing the lab workflow. This way, they can build a strong foundation for the continuous improvement of laboratory quality standards. But in both cases, I would say, support from experts, especially those familiar with LEAN thinking, is critical.
The learning curve to adopting the LEAN Clinical Laboratory Practice programme is steep. What advice can you give laboratories who are thinking of adopting it?
Jozica Habijanic: It is important to build LEAN thinking into everyday operations rather than thinking of this as an isolated case. The benefits are manifold when you implement this approach strategically rather than for the sake of it.
Bring changes slowly so that you have higher rates of adoption rather than all at once, as it can otherwise be overwhelming for employees. Instead, pick one aspect of a process or operation that you would like to address first. There will be learnings along the way and best practices that you can apply to other areas as you progress. Having constant communication to see what works and what doesn’t, making changes when needed to further refine the process, are all essential elements.
Where do you foresee Vietnam’s diagnostics industry heading in the next five years?
A/Prof Ngoc: It is an exciting time for the diagnostics industry in Vietnam. We will see strong growth in the next five years, with major emphasis on good laboratory practice and high-quality standards.
This is aligned with the Government’s plan to strengthen the quality management system in the country and enhance laboratory standards. One of their key priorities is to standardise lab quality so that a patient’s test results from one laboratory are accepted by all other laboratories in Vietnam.
There are also plans underway to build the capacity of existing Quality Control Centres by adding more centres. These centres will support External Quality Assessment not only for Clinical Biochemistry but also for other subjects such as Microbiology, Haematology, Molecular Biology and Histology. New reference laboratories will also be established in Vietnam. In addition, the government has prioritised Continuous Medical Education (CME) for laboratory personnel.
All of these are positive developments and are the building blocks for improvements that we will see in the laboratory now but also in the future.
Jozica Habijanic supported the LEAN Clinical Laboratory Practice Programme in Vietnam in her former role as Head of Strategic Development at Roche Diagnostics Asia Pacific. She is currently the Country Manager of Roche Diagnostics in the Philippines.
Associate Professor Hoàng Thi Bích Ngoc is the President of the Vietnam Association of Clinical Biochemists (VACB).
This interview was conducted by Lim Guan Yu.