Integration of Quality Management Systems in a Rural, Low-Resource Environment: The Experience at Phebe Hospital in Bong County, Liberia

Laboratory strengthening programs have been limited to clinical testing for prioritized diseases such as Ebola Virus Disease (EVD), Lassa Fever, COVID-19, Multidrug Resistant Tuberculosis, Malaria, and Human Immunodeficiency Virus (HIV). While patient outcomes are key concerns, limited efforts have been directed at improving Quality Management Systems (QMS). The benefits of QMS are correlated to improved patient care in resource-limited settings. This article examines the ability of a laboratory in a low-resource setting to integrate QMS into clinical care, describes its challenges, and measures its benefits on improved treatment outcomes. Gap analysis was conducted to implement QMS at Phebe Hospital, Bongo county, Liberia. We prioritized the framework of workflow processes and reorganization, equipment and inventory management, and documentation as challenges hampering the effective implementation of QMS. As a stepwise intervention strategy, laboratory workflow and infrastructure were remodeled, staff retrained, partners managed, and system changes were communicated to strengthen the laboratory systems. Improvement in communicating goals to clinicians, following work plans, managing staff time, delegating responsibilities, allocating resources, and strategically managing the presence of multiple partners as effective strategies to improve QMS were observed. We demonstrated that improving QMS strengthens the laboratory systems at Phebe Hospital. To sustain such initiative, Phebe Hospital must focus efforts on building sustainable laboratory systems and structures. We propose future studies to evaluate the short- and long-term benefits of such interventions.