TABLE 1.

National Tuberculosis Reference Laboratory improvement projects during first round of Strengthening Laboratory Management Toward Accreditation, 2011–2013, Mozambique.

Improvement project	Objective	Actions taken	Outcome
Improve the quality of samples received	Reduce the number of samples rejected to less than 5%	Develop and distribute instructions for sample collection, packing and transportation Train NTRL staff, sample carriers and drivers Indicator monitored monthly	Rejection rate decreased from 27% to 4%
Improve temperature records for equipment	Monitor the temperature of all applicable equipment in the laboratory	Develop temperature monitoring forms Procure thermometers Train NTRL staff Monitor temperature deviations and apply corrective actions, if deviation is detected Indicator monitored monthly	Reagents and samples stored at adequate temperature
Improve turn-around times	Reduce the TAT of smear microscopy to 48 hours, solid culture to 62 days, and DST to 28 days	Develop a worksheet for each laboratory test to monitor TAT Validate results on the same day they are ready Train NTRL staff Indicator monitored monthly	TAT for smear microscopy reduced from 72 to 48 hours TAT for solid culture reduced from 66 to 62 days TAT for DST reduced from 32 to 29 days
Customer satisfaction	Measure customer satisfaction across the laboratory network	Survey implementation Train NTRL staff to apply the survey in several Health Units and for outpatients. Create a complaints book Analyse customer satisfaction survey and define improvement actions Survey performed twice a year	85% of customers were very satisfied with NTRL performance in the following survey
Personnel files	All staff must have their personnel files completed	Develop a list containing all documentation and information needed for each staff member Inform NTRL staff to provide all necessary documentation Files are updated frequently and reviewed on a yearly basis	90% of the staff personal files were completed
Equipment life books	Create life books for all laboratory equipment	Prepare registration forms, SOPs and folders for each piece of equipment Create a maintenance and calibration plan for each piece of equipment	All equipment calibrated and under a maintenance plan

Abbreviations: DST, drug susceptibility testing; NTRL, National Tuberculosis Reference Laboratory; SOP, standard operating procedures; TAT, turn-around time.