An Innovative Integrated Capacity Building Project for Stem Cell Transplantation in the Southern Lazio Region
Authors: Saltarelli Francesca , Andriani Alessandro , Martini Vincenza , Sala Roberta , De Padua Laura , Iaconianni Vincenzo , Majolino Ignazio 
Published: October 2019

Abstract
Autologous stem cell transplantation (ASCT) is a standard treatment for many hematological disorders. Since ASCT needs technical and professional skills, a start-up process should imply the application of a specific methodology to reduce time and costs, and to optimize the results. We describe here an innovative and integrated process leading to the start-up of a transplant activity in the Hematology Unit of the general hospital of Frosinone, southern Lazio, Italy. The method had previously been employed successfully by one of us in a critical context (Mediterr J Hematol Infect Dis. 2017 Apr 15;9). Since 1996, the Hematology Unit in Frosinone gained experience in treating malignant and non malignant disorders, but HSCT could not be performed so patients were referred to other institutions in the country with remarkable costs and discomfort. The innovative aspect of our project is the application of a capacity building methodology aimed at establishing a quality system prior to the initiation of the clinical transplant activity. Capacity building is a continuous process addressed to individuals, organizations and institutions aiming at developing abilities and achieve objectives. A preliminary step was to check sustainability,ie whether the institution was suitable to support an ASCT activity, and to assess the level of expertise of the medical and nurse staff involved in the process. In fact, our Hospital was lacking some of the facilities required to perform ASCT, such as apheresis and stem cell manipulation. To overcome the obstacle, an agreement with the close Latina Hospital that has consolidated experience in ASCT was established, gaining access to their facilities and expertise. In June 2018 we held a first training course addressed to physicians and nurses that covered different aspects of ASCT. A scientific advisor led the process of editing clinical protocols and procedures. Simultaneously a quality system was built based on clinical guidelines that follow the international FACT-JACIE standards. In this phase, the document management system, the outcome indicators and the main rules of the transplant program were created. In order to improve the educational program we planned a second training phase based on on-site coaching. To better accomplish the task, physicians and nurses are now asked to highlight the practical aspects of the process that require further development trough a simple questionnaire. During this second training phase, selected physicians and nurses with experience in transplantation will undertake an open discussion about the aspects requiring further evaluation. The goal is to perform our first autologous transplant within four months since the start of the project. We believe that the capacity building process through on-site training and coaching represents an innovative effective method for developing autonomous skills needed to conduct a sustainable HSCT program.

Disclosures
No relevant conflicts of interest to declare.