GLI GLI Quality Tool
GLI Quality Tool — Version 2.0

Build a Monthly TB Laboratory Review Cycle

A monthly TB laboratory review meeting provides a reliable way to examine performance, identify risks and assign accountable follow-up. It should function as a routine quality management activity rather than an isolated investigation or a presentation of figures without decisions. A useful cycle brings together specimen quality, diagnostic accuracy, turnaround time, staff competency, equipment performance, safety and the timely reporting of results.

The GLI Quality Tool supports this work through a four-phase roadmap and twelve Quality Systems Essentials. Adapt the approach to the laboratory’s staffing, workload and referral arrangements, whether it is a specialist reference laboratory or a smaller facility working with a public health service. Start with a manageable set of indicators, establish consistent definitions and improve the meeting gradually as data quality and reporting habits become established.

Establish the review purpose and accountability

Define what the meeting is responsible for before selecting metrics. Its purpose may include reviewing laboratory performance against agreed targets, tracking corrective and preventive actions, checking that critical results have been escalated and identifying support needed from managers. A short terms-of-reference document should state the review frequency, participating roles, required evidence, decision-making authority and escalation pathway. This prevents the meeting from drifting into general discussion or duplicating other quality assurance activities.

Assign clear ownership for each part of the cycle. A laboratory manager or quality lead may chair the meeting, while a technical officer presents diagnostic indicators. Representatives from laboratory, nursing, infection prevention, supply management and public health coordination can contribute where relevant. The action owner should be the person able to implement and verify the agreed change, rather than simply the person who reports the issue. Deputy attendees and remote participants should also be able to provide evidence and comment on proposed actions.

Build the review around the GLI Quality System Essentials covering safety, personnel, equipment, documentation, assessment and continual improvement. The phase-specific quality improvement resources include checklists and practical materials that can support meeting preparation. For accreditation planning, Australian laboratories commonly use NATA accreditation against ISO/IEC 15189, so internal review evidence should support the documentation and improvement processes examined during external assessment.

Prepare trustworthy performance information

Choose indicators that represent the complete patient pathway. Include specimen rejection and transport delays, turnaround time from receipt to authorised report, critical result notification, culture contamination, quality control failures, external quality assessment performance, equipment availability, stock shortages and overdue preventive actions. Separate molecular testing, microscopy, culture and drug susceptibility testing because their turnaround times, workloads and quality risks differ. Consider workforce indicators such as completed competency assessments and training, as well as safety events involving aerosols, sharps, spills or incorrect specimen handling.

Agree on a definition, denominator, data source and target for every indicator. For example, define turnaround time from laboratory receipt to report authorisation, identify excluded requests and state whether the target applies to routine or urgent specimens. Display both the number and denominator, such as 18 rejected specimens from 420 submissions, rather than presenting a percentage alone. Show the previous month, rolling trend and target together, and mark missing data as missing instead of treating it as satisfactory performance.

Validate the figures before they reach participants. The person preparing the dashboard should reconcile results against laboratory information systems, confirm that corrections have been applied and investigate unusual movements. Where a change follows a new platform, revised procedure or reporting workflow, annotate the graph so that staff can distinguish a real improvement from a change in measurement. Keep identifiable patient information outside the meeting pack, applying the Commonwealth Privacy Act 1988 where applicable and relevant state or territory health-records legislation.

Conduct the review as a focused meeting

Send a concise pre-read several working days in advance. It should contain the agenda, previous action register, current dashboard, exceptions requiring attention and supporting documents. Participants should have enough time to check unusual results and prepare for decisions. Late changes can be noted, but substantial data corrections should be resolved before the meeting rather than consuming discussion time or undermining confidence in the dashboard.

A practical 60-minute agenda can allocate ten minutes to previous actions, 20 minutes to performance indicators, 20 minutes to exceptions and risks, and ten minutes to confirm actions and responsibilities. Begin with actions carried over from the previous review, because repeated delays often reveal a wider capacity or management issue. Discuss indicators in the order of patient and laboratory risk rather than following the dashboard mechanically. A rising rejection rate may require discussion of transport conditions, collection practices or laboratory processing, while a delayed report may reflect equipment, staffing or authorisation bottlenecks.

Invite open discussion without allowing the meeting to become a blame session. Ask what changed, how staff identified the change, whether other sites are affected and what evidence would show that the response worked. Australia’s geography adds operational complexity: transport from remote clinics and Aboriginal and Torres Strait Islander health services can be affected by weather, road access, flights and specimen stability requirements. Include transport data and community or service-partner feedback where they explain performance. Where laboratories in Melbourne, Sydney, Brisbane, Adelaide and Perth join the same review, confirm time zones carefully, particularly when Brisbane and Perth standard time differ from daylight-saving time in Melbourne and Sydney.

Convert findings into accountable action items

Use a consistent structure so that every significant finding leads to a recorded decision. The following measures and action fields provide a practical starting point rather than a mandatory performance framework.

Core monthly measures:

Action item records:

Do not create an action for every fluctuation. A small variation that remains within normal variation may need monitoring rather than a formal intervention. Conversely, a single serious event may require immediate action even when the monthly rate looks acceptable. Link the action to the relevant risk assessment, standard operating procedure, competency requirement or external quality assessment finding.

Competency gaps may need a different response from equipment faults or documentation errors. For staff capability, the GLI guide on a competency assessment checklist can help supervisors define observable tasks, acceptable performance and reassessment requirements. Record whether the action involves initial assessment, supervised practice, retraining or authorisation status. Ensure that any restriction on staff duties follows the laboratory’s documented competency and human resources procedures.

Close the loop and sustain improvement

Maintain an action register between meetings. Include the agreed action, owner, due date, evidence required for closure and current status. The chair should check overdue items at the start of each review, and managers should address recurring delays rather than simply moving the due date. An action is not complete merely because a document was drafted or equipment was repaired. Closure should confirm that the deliverable was implemented and that the intended risk or performance gap has reduced.

Review effectiveness after an appropriate period. For a turnaround-time intervention, compare results before and after implementation while checking whether workload has shifted elsewhere. For competency-based action, verify that the technician consistently demonstrates the required tasks. For a safety correction, confirm that the new control has been implemented and understood. If results have not improved, reopen the action or develop a revised corrective action using a structured root cause analysis.

Keep the cycle connected to the laboratory’s wider quality management system and broader public health obligations. Tuberculosis is a notifiable disease in Australia, but notification pathways, timeframes and authorised recipients vary under state and territory public health legislation. The review may identify delays in result communication or referral, and those matters should be routed through the appropriate local process without exposing unnecessary patient information. Australia’s pathology market includes public hospital laboratories, private providers and specialist reference services, so agreements about responsibility and escalation should be clear when work crosses organisations.

Begin the next cycle now: select one indicator with a clear owner, place the first monthly laboratory review in the shared calendar, prepare the dashboard and leave the meeting with a verified action register ready for follow-up.