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Introduction: Healthcare organizations are complex systems where healthcare professionals, patients, biological materials, and equipment constantly interact and provide feedback with highly consequential outcomes. These are the characteristics of a complex adaptive system. Healthcare delivery requires coordination but it necessarily relies on delegation of essential functions. It is thus essential to have an engaged workforce to ensure optimal outcomes for patients. Thus human performance factors play a key role in ensuring both the presence of excellent healthcare provision and the absence of outcomes that must be avoided-"never events." Methods: The commitment of management was a precondition for the implementation of the high-reliability organization (HRO) principles. A team from middle management was engaged and provided with appropriate management tools for identifying, prioritizing, assessing, and applying solutions for the safety concern in their operating systems. Results: This article documents efforts at the National Institute of Health (NIH) to adapt the principles of HROs to diagnostic laboratories and vaccine production facilities at its campus in Islamabad, Pakistan, and seeks to draw some lessons for how this approach can be usefully replicated in such facilities elsewhere. Conclusion: Public health institutes such as NIH deliver vital products and services that are inherently risky to produce, where the consequence of failure can be catastrophic. Adopting the HRO principles is an approach to improving not just safety, but also the overall organizational performance in any setting, including low-resource settings, and can serve as an implementable process for other institutions.
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OBJECTIVE: To document overall performance and improvement, if any, gained through participation in an International External Quality Assessment Scheme (IEQAS). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Haematology Department, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan, from January 1996 to December 2006. METHODOLOGY: Overall performance of blood parameters and parasite identification were analysed. Individual values were assessed against consensus value (mean + or - SD) and deviation index (DI) from the mean, whereas coefficients of variation (CV) were calculated for years 1996 to 2006. The results are expressed as percentage of accurate versus inaccurate results, deviation index (DI) and coefficient of variation (%CV). RESULTS: The laboratory achieved 87.74% of values within acceptable limits for haemoglobin, 72.03% for white blood count, 69.49% for platelet and 77.03% for reticulocyte estimation. Results were satisfactory, having DI values less than 3 for all four parameters. %CV values was found to be dependent on the type of test performed and varied among different parameters. Difficulty has been observed in identifying Plasmodium malariae and ovale. CONCLUSION: Participation in External Quality Assessment Schemes is extremely beneficial for the improvement of laboratory performance and quality of care. Evaluation of the survey results on a regular basis serves as a useful guide to assess overall performance of the laboratory. Standardization of analytical procedures, equipments and reagents, continuous monitoring of personnel competency and thorough investigation of discordant results significantly contributes to the delivery of quality diagnostic services.