Quality Management Systems in Medical Laboratory Practice: A Review of Implementation Challenges in Selected Tertiary Hospitals in Lagos State, South West Nigeria

Quality management systems provide the structural framework through which medical laboratories achieve accuracy, reliability, and consistency in diagnostic output. This study reviewed the implementation challenges of quality management systems in medical laboratories at selected tertiary hospitals in Lagos State, South West Nigeria. A qualitative cross-sectional survey was conducted among 60 senior laboratory personnel, including chief medical laboratory scientists and laboratory managers, across five teaching hospitals. Data were collected through structured in-depth interviews and observational checklists aligned with ISO 15189 quality requirements. Thematic analysis identified recurrent barriers and facilitating factors for QMS implementation. Findings revealed that while all institutions had written standard operating procedures, fewer than half conducted internal audits at the recommended frequency. Equipment calibration records were incomplete in 60.0% of laboratories. Staff training on quality indicators was inadequate, with 53.3% of respondents reporting no formal QMS training in the preceding two years. Procurement delays and inadequate funding were cited as major systemic obstacles. Laboratories accredited by the Nigerian Laboratory Accreditation System showed significantly better compliance with ISO 15189 elements. The study recommends sustained government investment in laboratory infrastructure, mandatory QMS training for all laboratory staff, and accelerated pursuit of accreditation as a national quality improvement strategy. Strengthening regulatory oversight of laboratory quality standards across South West Nigeria's tertiary health facilities is essential for improving diagnostic accuracy and patient safety. Keywords: quality management systems, ISO 15189, medical laboratory, accreditation, Lagos State