Implementation research: a mentoring programme to improve laboratory quality in Cambodia.

Medical laboratories in low-resource settings often struggle to meet international quality standards, which can compromise diagnostic accuracy and patient outcomes. Prior research has shown that structured quality management systems can improve laboratory performance, but few studies have focused on how to implement these systems in resource-limited environments. Implementation science offers a framework for adapting global standards to local contexts, but gaps remain in understanding how to sustain these efforts. No prior work had resolved how to train local mentors to support continuous quality improvement. This gap motivated the development of a stepwise programme that integrates training, mentoring, and monitoring. The study addresses the challenge of translating international standards into practical, locally relevant tools. It builds on prior knowledge of quality management systems but introduces a new approach to mentorship and adaptation. The research responds to the need for scalable, context-specific solutions in laboratory quality improvement.

The study aimed to strengthen laboratory quality and capacity in Cambodia through a structured mentoring programme. It sought to address the challenge of implementing international standards in a local context. The programme focused on training mentors and hospital staff in quality management systems aligned with ISO 15189. The goal was to improve laboratory performance without disrupting service delivery. The approach included stepwise implementation through a structured tool adapted to local needs. The study also aimed to evaluate progress in quality management system adoption across multiple laboratories. It tested whether a combination of training, mentoring, and monitoring could lead to measurable improvements. The findings contribute to the field of implementation science in clinical diagnostics.

The study involved recruiting and training four laboratory technicians as mentors in quality management and ISO 15189 standards. Twelve hospital laboratories were selected for the programme, and their staff received training in quality management systems. Mentors provided tri-weekly in-person support using a software-based checklist adapted from a web-based resource. The checklist was translated into Khmer and structured into four implementation phases. Each phase included a set of quality improvement activities with increasing complexity. Project staff monitored progress through weekly conference calls and bi-monthly meetings with stakeholders. The tool allowed on-site mentoring and real-time tracking of laboratory activities. The study evaluated implementation progress from September 2014 to March 2016.

By March 2016, the 12 laboratories had completed 74-90% of phase 1 activities, 53-78% of phase 2 activities, and 18-26% of phase 3 activities. The structured mentoring approach enabled staff to learn quality management concepts while continuing their regular duties. The Khmer-translated checklist facilitated on-the-job learning and progress tracking. Regular in-person mentoring sessions supported continuous improvement without service disruption. The programme demonstrated that stepwise implementation can be effective in low-resource settings. The use of a local language checklist improved engagement and understanding. Weekly monitoring and bi-monthly stakeholder meetings ensured consistent progress. These results suggest that a combination of training, mentoring, and monitoring can enhance laboratory quality.

The study demonstrates that a mentored stepwise implementation programme can improve laboratory quality in Cambodia. The authors propose that structured mentoring and locally adapted tools are effective in supporting quality management systems. The findings suggest that tri-weekly mentoring and regular monitoring are key to successful implementation. The use of a software-based checklist in the local language enhanced programme effectiveness. The authors note that progress varied across phases, with higher completion rates in earlier stages. They emphasize the importance of ongoing mentorship and stakeholder engagement. The study supports the idea that quality management systems can be adapted to local contexts. These conclusions are based on the observed progress and feedback from participating laboratories.