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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Make it Easy to Do the Right Thing

Published September 19, 2011 11:18 PM by Glen McDaniel

 In medical laboratory science -and in life in general- we tend to over-complicate issues. Making processes more difficult reduces productivity and (rather than ensure near-perfection as intended) might even be a safety risk in itself. As I wrote in a recent blog: keep it simple unless there is a clear, strong argument for doing otherwise.

A related subject is the tendency to make it difficult to do the right things. Let me explain. Most organizations and professions tout the importance of adhering to certain standards, acting ethically, being compliant, avoiding fraud, waste and abuse.  That all sounds good on paper, but why make it difficult to do the right thing-whatever "right" happens to be in your context?

It's human nature to avoid complications and stress. So a laboratorian is less likely to be compliant in areas that require too many steps, multiple documentation of the same process, reporting routine issues to a manager or reporting a variance to a hyper-critical person. The same principle applies if the culture is one of blame. Who wants to self-report if their head is going to be on the chopping block? In that sort of environment, the mantra of "doing the right thing" is likely to be more words than practice.

Recently, I read about two different situations, one indicating how the system made it difficult to do the right thing and the other a resounding success of "making it easy to do the right thing."

The Atlanta Public Schools and some other school systems around the country have been caught up in scandals of teacher-orchestrated cheating on standardized tests.

Student performance on  these high stakes tests are used to rank schools, give raises to teachers and allocate scarce resources for competing schools. So teachers simply "teach to the test" instead of giving students a more well-rounded education.  First mistake. Then teachers routinely erase and change wrong answers on tests to improve their school's overall scores. Second mistake. Speaking out was discouraged and whistleblowers suffered severe consequences-including termination.  The culture was such that instead of doing the right thing, it was so much easier to "go along to get along."

On the other hand a Kaiser Permanente initiative I read about demonstrates how they have made it easy to do the right thing. Realizing that the management of chronic diseases is a complicated, expensive process, Kaiser has several protocols in place to ensure patients actively participate in their care, take their medications consisterntly and see their healthcare provider frequently. Patients have an online portal where they can see lab results in real time, schedule visits and email their doctors- and get a response withing 24 hours.

Each medical office has its own pharmacy where a patient can pick up prescriptions and speak to a pharmacist. There are parking spaces dedicated to patients picking up prescriptions from the pharmacy and patients can opt to have their medications mailed to their homes so they do not have to make a trip to the pharmacy.

 Additionally a patient can go to any medical office to seek medical care, whether that is where their physician is or not. The patient's electronic medical record an be accessed from any service site. Is it any wonder Kaiser has some of the best patient compliance rates and  above average outcomes?

In your own lab it is helpful to look at processes from time to time to see how they can be simplified. Cultivate a no-blame atmosphere where errors can be reported and discussed without fear of recrimination. If something goes awry, look at built-in processes before you target individuals.  You will find if you make it easy to do the right thing you are much more likely to have compliance, good employee morale and the better patient outcome you ultimately desire.


I am sorry in my last post  I meant to address my comment to Ryan from NY (not Nick). Sorry.

Jonas, CLS October 1, 2011 4:13 PM
Los Angeles CA

That is every CLS nightmare. In California we have to over-document everything it seems . This is one of the most law happy states so to meet regs and to cover our license we have to dot every eye and cross every T. Nick are you saying your fellow workers are incompetent? I am sure they dont know that is what you think of them. Are you also saying that every complicated procedure and every crazy rule we have is because someone messed up. Naw I dont think so.

Jonas September 29, 2011 5:40 PM
Los Angeles CA

Unfortunately incompetence breeds errors, which result in corrective actions... which usually end up being added steps.  

Think in your daily workload, how many extra steps you take to result a test as a result of an incompetence-related error's corrective action

Ryan September 24, 2011 7:59 AM

This is so true. Most times we have to follow very detailed policy and no one ever gives you credit for succeeding 99% of the time. They only think about when things dont go right. Also they never consider that someone might foul up because they make things so doggone complicated. We have logs and logs. We have forms to fill out for everything. Documentation is very important in healthcare, but when you do it just to see if soemone is going to mess up, then that's teh wrong reason. i agree more people would do the right thing if it was easy to do.

Pappilon T. MT September 21, 2011 3:32 PM
Douglasville GA

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