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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Keep it Simple Stupid

Published May 14, 2011 3:51 PM by Glen McDaniel

We often complicate things. Needlessly.  A seasoned laboratorian had to resign her job and move to a new city suddenly due to a family emergency. She could not find a job at her former level of responsibility or in her preferred specialty. So like most resourceful survivors she took a job in a small medical office building (MOB).

The MOB is part of a large system with multiple buildings in the metropolitan area and the general orientation reflected this complexity. The laboratorian (let's call her Jane) had to travel to various offices to be oriented to different instruments and protocols to accomplish the expectation that she could be assigned to any office based on workload and personnel needs.

She first noticed that the directions were confusing and very often no one at the host facility was expecting her-and made it known in no uncertain terms that she was an interruption. Their policies and procedures were housed on only one computer terminal which was often in use, making it difficult for retrieval. Many procedures from patient registration to specimen collection and storage were confusing.  Jane has substantial experience in supervision, clinical practice and performance improvement and felt she might be able to bring order to a chaotic system. But her requests for a rationale, or suggestions for simplification, were met with stony stares or a swift rebuff.

Some staff members would complain to colleagues in Jane's hearing that they were stressed because they were "training a new person." Next she noticed the LIS was very cumbersome and policy required documenting results in several different ways in several places. There was no rhyme or reason to the process.

Jane is looking for a new job. Even though many tests are point of care or moderately complex, she feels more stressed and confused than when she worked at her previous job performing and interpreting complex tests.

The management philosophy of Keep It Simple, Stupid (KISS)  is often encouraged for good reason. First advocated by aerospace engineer Kelly Johnson, KISS and its companion principle of Occam's Razor suggest that in most situations the simplest (safe) method saves time, money, and aggravation; and can even be safer than needlessly complicated alternatives.

New employees form lasting first impressions through the prism of the level of frustration or lack of support they receive early on in their employment. Making an effort to follow policy and please a new employer can result in repetitive acts or an emphasis on the wrong things, resulting in unsafe practice.

Occam's  Razor does not suggest taking short cuts or simplifying naturally complex processes. Rather it advocates that we should tend towards simpler alternative until we can trade some simplicity for increased value or necessary safety.  As laboratorians and leaders, that's a lesson we would do well to learn and a principle we need to  adopt.



In medical laboratory science -and in life in general- we tend to over-complicate issues. Making processes

September 19, 2011 11:35 PM

I think because we do such technical work some folks believe that everything must be complicated. But even a brain surgeon, or rocket scientist do some simple, basic things. I have a brother in law who is a pilot and he does simple things to make sure his aircraft is safe before he flies. There is no busy work and no redoing the same thing over and over. He also has a simple summary of even the most technical stuff. Yea, making things complicate only make techs tired and frustrated. It does not help anyone including the patient.

Jonas MLT May 20, 2011 6:40 PM
Brooklyn NY

I was actually fired from a a job in another state because I dared to question all the double-work and useless paperwork at the place I worked at. We had a computer system but yet there was a paper log for everything. Then someone had to review the paper logs for variances. Even in documenting, there were so many pathways for the same thing, critical values would not flag, but you got into trouble for missing calling a critical. I know criticals are important, but how hard is it to write  rule for the computer to flag criticals? As techs we spent so much time rewriting and rechecking ourselves at the end of the shift that I swear we made more mistakes, we were always stressed and we even ran into overtime double checking our work and filling out forms. As I said, I questioned some practices once too many and was called disruptive. Go figure.

Rob S. May 16, 2011 6:58 PM
Las Vegas

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