PROBLEM:Japan Friendship Hospital’s laboratory and blood bank, located in the Izabal department of Guatemala, has always had to share the same physical space with patients, affecting the quality of care to clients. These facilities lacked privacy; there was no waiting room or restrooms for patients. As a result, biosafety procedures and standards of care could not be met. Even the hospital’s multidisciplinary quality improvement team doubted that this problem could be fixed, given the available resources. In addition to financial constraints, the hospital could not identify any extra physical space nor could they provide the adequate staff or equipment required to overcome gaps in service.



Optimizing Performance and Quality (OPQ) is a process for analyzing the performance of health workers, organizations, and systems and setting up interventions to improve performance and quality. It is a systematic and ongoing process in which stakeholders consider the context of performance, identify performance or quality gaps and strengths, and identify their root causes. Stakeholders then identify corresponding solutions or interventions to address the deficit or build on the accomplishment, with the aim of continually improving the quality of health services and ultimately improving health outcomes.

Through the use of the OPQ methodology, Japan Friendship Hospital’s multidisciplinary team, which included members of hospital leadership and the Board of Directors, was able to effectively discuss different member views and experiences which resulted in service gap-reducing solutions.


Physical Space for the Blood Bank: A team member belonging to the hospital’s pharmacy and warehouse reported that there was indeed an available space with three spacious rooms, bathrooms, and a place that would be an ideal for reception and as a waiting room. After visiting the area in question, the team concluded that it met the facility requirements.

Equipment: Hospital authorities and the OPQ team were able to make ​​arrangements with the Ministry of Health and other local organizations, resulting in the provision of a refrigerator for blood units, centrifuges and other basic equipment to improve the functioning of the blood bank.

Human Resources:To improve the blood bank’s operation and extend to 24-hour services, four additional technicians were hired. A chemical biologist was also hired to provide additional direct support and share the work load with the current blood bank manager, since this manager is also in charge of running the laboratory.

Reducing the Time Needed to Close Gaps: The OPQ team had identified this particular gap in service in March 2010. In October of the same year work began on the new allocated space, including the installation of equipment. The Japan Friendship Hospital OPQ team was able to successfully problem-solve a complicated issue in seven months that would have taken a lot more time and resources if they had decided to build a new facility rather than optimize an existing space.

“Currently,” recounts Ms. Alexandra Arriola, head of the blood bank unit, “my clients have told me they are happy with the service, which is now clean, spacious, and private, and has clean bathroom facilities.”


The unit tends to an average of 150 volunteer blood donors each month through systematic process that meets the criteria for quality care. One client, from Amates, Izabal, reported that she was satisfied with the level of care received, "They treated me promptly and the staff person was attentive and called me by name. This staff person also told me their name; the service was clean and I was always kept informed of everything they were doing [drawing blood] in the blood bank."

Everyone who enters the procedures room can see a posted copy of the golden rules for the treatment of patients, which was drafted and accepted to close certain service gaps for the unit. The personnel working in the blood bank are highly motivated to continue implementing their work  plan, focusing on the client and above all complying with the slogan "no stigma and discrimination of HIV patients", in which the blood bank staff work in coordination with the hospital’s comprehensive care unit.
According to follow up OPQ measurements, the blood bank now achieved 100% compliance of provider performance because, amongst other things, it met all the criteria for proper management of hospital waste; its staff was adequately trained in proper segregation of sharps materials, common waste and contaminated waste.

The total amount of equipment and furniture purchased with hospital funds and with the support of partner organizations such as JICA, WHO and St. Thomas Port Authority, among others, amounted to half a million quetzals



The OPQ methodology adopted by the hospital encourages coordination amongst the multidisciplinary members of the team, helping to identify immediate solutions to reduce identified gaps.

Key elements in the closing of performance gaps included the effort and commitment of the hospital’s multidisciplinary team, including the negotiations and hard work required to manage the purchase of equipment, the hiring of human resources and improvement of facilities.
Advocacy and collaboration with local organizations allowed the hospital to identify sources of external funding and support.


Report Author(s): 
Jaroslava Lemus. Miguel Angel Marroquín.
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