GLI GLI Quality Tool
GLI Quality Tool — Version 2.0

Designing a user satisfaction questionnaire for TB laboratory services

A well-designed feedback tool can become the heartbeat of a tuberculosis laboratory's quality management system, signalling where workflows run smoothly and where they need attention. For laboratories working through the four phases of the GLI roadmap, a structured satisfaction questionnaire captures the lived experience of clinicians, nurses, couriers and laboratory scientists who rely on the service every day. When designed thoughtfully and analysed consistently, the instrument shifts from a one-off survey into a continual improvement mechanism that supports the twelve Quality Systems Essentials.

Australia presents an interesting case for designing such a tool. Although national TB incidence is low compared with high-burden regions, notifications cluster in specific populations, including Aboriginal and Torres Strait Islander communities in the Northern Territory and Far North Queensland, and in migrants arriving from high-prevalence countries. Reference laboratories such as the Queensland Mycobacterium Reference Laboratory in Brisbane, the Victorian Mycobacterium Reference Laboratory at the Royal Melbourne Hospital, and the New South Wales facility at Westmead each serve vast catchments that include remote clinics reachable only by light aircraft or long-haul road travel. A questionnaire that works well in a metropolitan teaching hospital must still make sense in places like Alice Springs or Thursday Island, where turnaround times can stretch and courier logistics feel more like a postal run across the outback.

The challenge for quality managers is balancing standardisation with sensitivity to local context. Survey questions must align with the QSE framework while remaining short enough to fit into a busy shift. Free-text fields should encourage honest reflection, and the analysis process should respect the time pressures of staff who might otherwise see yet another form as a chore. The remaining sections walk through how to design the questionnaire, test it, interpret the results and use the findings to drive genuine change.

A common mistake is treating the questionnaire as a static document that lives in a folder and gets reviewed once a year. In laboratories where staff turnover is high and where outreach services depend on smooth coordination between hubs, the tool should evolve alongside the service. Whether the laboratory sits within a public pathology network such as NSW Health Pathology or operates as part of a private provider like Sonic Healthcare or Healius, the feedback instrument becomes the connective tissue between management decisions and the bench-level reality of those receiving and producing results.

Mapping questionnaire content to the Quality Systems Essentials

Before drafting any items, quality managers should walk through the twelve QSEs and identify the touchpoints where a typical user interacts with the laboratory. Specimen reception, result reporting, safety culture, equipment performance, internal audits, supplier relationships and corrective actions all create moments of friction or satisfaction. Each of these can become a thematic cluster within the questionnaire, helping respondents recall specific recent experiences rather than offering vague impressions.

When the survey is tied directly to the QSE framework, analysis becomes more actionable. A drop in satisfaction around turnaround times points toward process control or sample transport, while comments about unclear result formats may flag documentation or information management weaknesses. This mapping exercise also helps laboratories preparing for external assessments under accreditation schemes such as NATA or the Royal College of Pathologists of Australasia, where evidence of user input strengthens the continual improvement file.

Question Format Strengths Limitations Best Used For
Likert scale items Easy to compare across sites and time periods Can feel impersonal and miss nuance Tracking satisfaction with turnaround, communication, professionalism
Multiple choice with predefined options Quick to complete, simple to analyse Limits depth of insight Confirming awareness of services or recall of recent interactions
Open-text responses Captures stories, ideas and unexpected issues Harder to quantify, requires careful coding Identifying new risks or improvement opportunities
Ranked priority lists Forces trade-offs and reveals what matters most Cognitively demanding Setting priorities when several issues compete for attention

Choosing question formats for different laboratory roles

A clinician submitting specimens from a remote outreach clinic in the Kimberley has different concerns from a laboratory scientist reviewing quality controls at a metropolitan reference centre. Designing separate but linked question banks for each role keeps the tool short and relevant. Clinicians might be asked about result clarity, courier reliability and notification phone calls after hours, while bench scientists could focus on equipment availability, training access and the usefulness of internal audits.

Australian laboratory culture tends to be informal and direct, and this influences how questions are phrased. A dry, corporate tone can produce polite but uninformative answers, while a conversational style that includes everyday language such as "how did we go?" or "tell us what worked and what didn't" can encourage more honest responses. Local expressions are useful for opening prompts, even if the rest of the questionnaire remains in plain English.

Length matters too. Most respondents will give a survey between three and seven minutes of attention before fatigue sets in. Keeping the questionnaire under twenty items, splitting it by role and offering an "exit early" option after the core questions preserves data quality. Where multilingual responses are needed, such as in services serving Mandarin, Vietnamese or Tagalog speaking communities, a translated version with back-translation checks prevents ambiguity and respects the diversity of patients and clinicians using the service.

Pilot testing and validation across multiple sites

Once the first draft is ready, pilot testing in at least three different sites catches problems that might be invisible at the drafting table. A reasonable approach is to trial the instrument in a metropolitan laboratory, a regional centre and a remote outreach post. Each setting will reveal different issues, from internet connectivity for online surveys to the wording of questions about safety, where staff in lower-resource settings may interpret a single item very differently from those in well-resourced tertiary hospitals. Laboratories working across several jurisdictions can draw on guidance for standardising TB lab forms to ensure the survey sits within a consistent documentation family while still allowing local flexibility.

Pilot participants should be debriefed informally after completing the form, asking whether any question felt unclear, repetitive or intrusive. Cognitive interviewing, where respondents think aloud while answering, is particularly useful for the open-text items. Comments gathered at this stage often flag questions that look fine on paper but feel awkward in practice, such as asking frontline nurses to rate safety culture before they have had a chance to settle into the service.

Practical lessons from Australian pilots:

Analysing responses and closing the loop

Analysis should begin while the survey is still live, not after it closes. A rolling review of incoming responses lets the quality manager spot patterns early and follow up on urgent comments before the data set is finalised. Quantitative items can be tracked in a simple spreadsheet or, where available, in the laboratory information system, while open-text responses benefit from thematic coding using a framework aligned to the QSEs.

Closing the loop is where many feedback processes quietly fail. Staff who took the time to respond expect to see what happened next, even if the answer is that a particular issue cannot be fixed immediately. A short summary report, presented at a staff meeting or shared through the laboratory intranet, demonstrates that participation was worthwhile. Where responses come from external users such as hospital clinicians or Aboriginal Health Practitioners in remote communities, a tailored response channel, perhaps through a quarterly newsletter or a face-to-face visit by a liaison officer, shows that the laboratory values the relationship.

Linking feedback findings to existing documents strengthens the system. Comments about unclear result formats, for instance, can prompt updates to the laboratory safety and quality manual, while recurring issues with specimen transport can become input to a risk register. For laboratories building such documents from scratch, the GLI guide on tailoring a TB safety manual provides a useful starting structure that can absorb feedback-driven updates over time.

Sustaining the feedback cycle over time

A single survey is a snapshot; a feedback programme is a movie. Sustained impact comes from repeating the instrument at planned intervals, perhaps annually or after every major service change, and tracking trends rather than single data points. Trend analysis reveals whether interventions from previous cycles have actually moved the dial, and where satisfaction may be quietly drifting downward despite no obvious complaints reaching management.

Engagement strategies keep the cycle alive. Rotating the topics covered each year prevents survey fatigue, while spotlighting one QSE per cycle keeps the depth manageable. Celebrating improvements that came directly from user feedback, through staff newsletters, internal social channels or even a simple morning tea, reinforces the value of participation. In Australian laboratories, where teams often span large geographic areas and meet only through virtual platforms, these small recognitions help maintain a shared sense of ownership over the quality system.

Common pitfalls to avoid when sustaining the process:

Putting a feedback instrument to work in your own service becomes easier with the right support. The GLI platform hosts a dedicated feedback channel where laboratories can compare experiences with peers, ask questions of quality advisors and share templates that have worked in real settings. Sharing what your questionnaire reveals, alongside the actions that follow, helps the wider community of TB laboratories across Australia and beyond raise the standard of care for every patient whose sample passes through the system.