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Press Start: Lead an Empowered Life as a Clinical Laboratorian

What’s Your Style?
June 28, 2015 4:44 PM by Glen McDaniel

Have you ever found someone very difficult to work with no matter how you try? On the other hand you find others who consistently seem to adjust, cooperate and understand even if things don’t go as planned.

 

We all have different personalities and behavioral styles so it is probably unrealistic to expect all personalities to mesh. However in our increasingly diverse workplace it is important to at least learn how to have a collegial working relationship with a wide variety of individuals-with many different personalities.

 

There are various psychological tools for determining personality styles. One very popular one that has been around for quite sometime  is the Myers Briggs Type Indicator (MBTI)  Test.  Another is the DISC Personality style test . DISC stands for Dominance, Influence, Steadiness and Conscientiousness.

 

In any communication it is important to recognize your own style:  how do you perceive the world, where do you get energy, how do you relax, what pushes your buttons, what do you consider important, what do you require from colleagues and bosses?

 

Then the next step is recognizing the personality types of others you interact with on a regular basis. Like a lock-and-key you then adjust your actions and emphasize certain behaviors while minimizing others.  In that way you can indeed work with a variety of personality types and have a harmonious, productive working relationship, even if you are not personal buddies.

 

Let’s look at the DISC personality style more closely, as an example of leveraging personality types.

 

D (Dominance) is typical of a go-getter who relishes fast-paced activities and is task oriented.

 

With that type of person you want to engage them by being more fast paced (matching their style) and direct. They might not want to chit-chat about personal events in your life. They are the “just the facts” types and like executive summaries with the bottom line clearly stated. They eagerly take on challenges. They want deadlines and respect those who set and stick to deadlines.

 

I (Influence). This is also called the Promoter type. They like a fast pace but are very people-oriented. They like working in teams and will probably preface each interaction by discussing their family or asking about yours. Relationships are important to them. They enjoy a compliment or a good joke and will react favorably to either. While deadlines are important they will understand if a family emergency impacts a project temporarily.  The Influencer employee craves recognition.

 

S (Steadiness). This type, also called the Nurturer, tends to operate at a slower, more deliberate pace and is very people oriented  This is the typical laid back, congenial individual who will seek input, try to get consensus and consider the impact of change on all stakeholders. Consistency, dependability, honesty and incremental change are important to them.

 

C (Conscientiousness) or Examiner type enjoys a slow pace and is task oriented. This person is likely to create lists and pore through data. They will analyze before they come to a well-reasoned conclusion. You impress this type most by proving competency, discussing statistics, data, trends and research. If you direct this person you might have to rein them in, because they will tend to research and re-analyze all the way up to the deadline.

 

If you work in a team (and everyone does to a degree) it can be useful to know the various personality types on that team.  Depending on the task at hand it might even be useful to select certain personality types for a particular project. The good colleague or manager plays to the type of the other individual in order to have a more effective, productive  and harmonious relationship.

 

It is important to remember that this is not about being fake or changing your natural personality. Rather it is learning a valuable skill that will pay off  handsomely both in your professional and your personal life.

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Who Inspects the Lab Inspectors?
June 13, 2015 9:02 PM by Glen McDaniel

Labs are used to being regulated. It seems they are always preparing for inspection by the state, CLIA or some accreditation agency-or two. Very often laboratories think inspectors are being too hard, or picky, or even plain wrong in the way they interpret the standards and grade the laboratories.

 

My last blog discussed a very harsh critique of the laboratory profession written by a journalist. One of her claims was that not only was it near impossible to get access to specific accreditation records, but the accreditation process itself may be flawed. In that regard some laboratorians might agree with her.

 

I have been a member of several laboratory inspection teams and I observed  several differences in approaches, thoroughness and (yes) even interpretation of the standards. One big area of difference is the subjectivity of determining whether certain documentation does indeed prove adherence to, or fulfilment, of a certain standard.

 

Part of the reason for the difference as I have also discussed previously is the fact that agencies like the Joint Commission and COLA use professional inspectors while CAP uses volunteer peer-professional inspectors. It’s logical to think the use of part-time volunteers might increase variation between visits -and even during a single accreditation visit.

 

While accreditation is voluntary, licensure and certification are mandatory. Under CLIA, CMS has granted most accreditation agencies deemed status which essentially means CMS will accept the accreditation visit/finding in lieu of conducting its own visit. State agencies will often perform the role of CLIA inspector.

 

So how can a laboratory be sure that its accreditation agency is being not just fair, but accurate as well? CMS does routine validation of a subset of inspections. CAP indicates that CMS will routinely re-inspect about 80-120 CAP-accredited labs per year. They then look for differences in findings. Such differences are called disparities or misses.

 

So how much of a difference is considered acceptable? In the last round of summary reports produced by CMS they found a variation of about 17 percent for CAP-accredited laboratories. A disparity level of 20 percent is the benchmark at which CMS takes a closer look and reconsiders its deemed status. In fact they perform a “deeming status review.”

 

So are validation visits more likely to find “something missed by CAP or another inspection agency,” or are they more likely to overturn an adverse finding? Details are hard to come by, but it appears the former is more common.

 

Are discrepancies more likely to show up in some standards than others? Yes, it seems the following 5 areas are the primary source of disparities: test validation, proficiency testing, competency, personnel records and responsibility of the medical director. Given this knowledge and the fact that a validation is more likely to mark you “down” these should be considered areas of high concentration for your lab.

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More Negative Press for the Laboratory
May 17, 2015 1:58 PM by Glen McDaniel

 A little while ago I wrote a blog in which I referred to a great, balanced, intelligent article written about the medical laboratory  and printed in The US News and World Report. That article was remarkable by its rarity. I asked my readers to respond directly to the writer, thanking her for a positive article. Many of you contacted the journalist by email and Twitter, much to her delight.

This morning, another article crossed my desk. This one is a hatchet job written by a journalist for the Journal Sentinel. It is an indictment of the laboratory written using sources who have been harmed from inaccurate results generated by laboratories. Everyone from accreditors to MLSs/MLTs are assigned blame. Reference is made to shoddy habits like the use of expired reagents and mixing up samples.

To read this article it seems like there is no standardization, there is no quality assurance, and every lab test has the potential of leaving ruined lives in its wake.

Some of the "experts" who commented for the article are laboratorians and I would like to think they were misquoted or their words were taken out  of context. It's disheartening to think fellow laboratorians would allow such a biased and unbalanced piece to see the light of day.

There is a lot of buzz on social media about this article: mostly hurt feelings and righteous indignation. But as I pointed out on Facebook, commiserating among ourselves is not going to educate the journalist or the public; and will not change anything.

I strongly suggest you read the article and weigh in here. Feel as indignant as you want to, but , more importantly, respond by contacting the journalist ( reached at egabler@journalsentinel.com or (414) 224-2071) and her editor.

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Five Tips for More Productive Meetings
May 16, 2015 4:56 PM by Glen McDaniel
 

Sometimes it seems like those of us in healthcare just love to hold meetings. We seem to even hold meetings simply to figure out how to plan more meetings. Not surprisingly, as busy professionals, always on some sort of deadline we hate attending meetings as much as some people love holding meetings.

 

One reason that meetings are so dreaded, other than the sheer volume of them, is that they are often not very productive.  Since some meetings are in fact necessary, it’s important to know a view hints that can make your meeting more productive-and less dreaded.

 

Get clear about the reason for a meeting.  This seems like a no-brainer, but too often we think about the reason to meet in vague terms or try to squeeze too many subjects into one meeting, “While I have everyone together” is a common justification. Big mistake. Some attendees will be totally disconnected and the presenter will be less focused if the agenda is too loaded.

 

 State the purpose of the meeting simply and clearly in the invitations. That way invitees can start thinking about the subject. Their contribution is likely to be more considered and thoughtful that way.

 

Set a time.  I mean set a time literally and figuratively. Yahoo’s CEO Melissa Mayer is known for holding 10 minute meetings. Some studies show that 15 minutes is the ideal time for a meeting if the goal is to be focused and productive.

 

I have found that even for a staff meeting where you might discuss several items and solicit feedback from various individuals, a 1-hour time frame is the maximum. In any event set a timer and wrap up quickly (no matter where you are on your discussion list) as soon as the timer goes off. Meetings are not the time and place to do research and in-depth thinking.

 

Assign extra detailed work to a subgroup. If discussions are running too long, schedule another meeting later on. You will get more accomplished in four15 minute meetings than you will in a rambling  1-hour session. Say goodbye permanently to long drawn out gatherings unless the goal is to leave everyone feeling numb, uncommitted and frustrated.

 

Ban phones. This seems to be a no-brainer but we all know how distracting it is when someone’s cell phone goes off, they break the mood, apologize and turn it off. Then it happens to someone else.  Some of us “live” on our smart phones so it becomes a habit for many  to constantly check their phones even during a meeting.

 

Have a basket or bucket to “check” phones that made it to the meeting. It is not enough to just ask that they be silenced. The tradeoff for a long meeting is a much more focused meeting while actually engaging all the stake-holders' undivided attention.

 

Assign A Directly Responsibility Individual.  If a task has to be followed up on, assign the responsible individual publicly in the meeting.  The DRI (another trendy term) should know exactly what to do and be given a deadline for getting it done. Don’t be vague and don’t assign to an entire group (unless it’s for the group to meet and work out details).

 

Don’t abandon tips that have worked up till now. It is still good practice to have an agenda, send out the agenda before the meeting, send out a draft of the minutes and ask for corrections before distributing the final copy of the minutes, use email rather than distributing hard copies if at all possible.  All those habits still make sense.

 

The big danger with unfocused untimed meetings is that any activity tends to expand to fill the time allotted. If there is no drop-dead time, discussion just goes on much longer than necessary. If you can make just one of the changes above in the short term, I suggest setting a time-limit and sticking to it. Over time your attendees will learn to come prepared to work and get out. Your staff will be grateful and you will surprise yourself at how much more productive your meetings are.

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New Direct Patient Access Law Ups the Ante
May 10, 2015 1:36 PM by Glen McDaniel

An ongoing debate within the medical laboratory science profession for several years now has been the idea of  patients having direct access to the laboratory.

A new law recently passed in Arizona allows patients to order their own laboratory tests legally. This law goes the farthest, that I am aware of, in terms of explicitly empowering patients to order tests cafeteria- style and get the results themselves. 

In our traditional paternalistic model where big brother knows best and doctors always know best, the conventional wisdom has always been that laboratory tests should only be ordered by providers (never patients) and the results should be sent to the doctors (never directly to patients).  Many states, in fact, have laws prohibiting direct access testing (DAT), or allowing  DAT in very limited instances.

Going back as far as the Clinton administration, continuing through the Bush administration and finally in the Obama era,  the Department of Health and Human Services (HHS) has suggested that patients should be empowered to have access to their own health information. In fact there is now a specific mandate that laboratories MUST allow patients access to results if the patient asks for them.

This new democratization of healthcare has coined phrases like The Empowered Patient and the Quantified Self Movement.  Here we have the most educated, intelligent and tech-savvy generation in our history. So why should they not be able to access medical services without an intermediary? Why should their own information be withheld from them or doled out like candy to children? Why not take advantage of the available technology to access services, receive results, track and monitor progress?

The traditional approach has its place and will continue to be the norm for a long time.  

This trend of patient empowerment, frankly, is not going away and will expand. States that currently limit DAT might find those laws challenged.

It is interesting that CLIA is silent on this issue.  CLIA authorizes the regulation of laboratories that conduct testing, not the individuals who order the tests or receive test results. However most states either prohibit or severely limit DAT. It will be interesting to see how legislators in those states weigh the medical lobby against  the inevitable consumer pressure. 

One concern I have is that MLS practitioners have had a hands off attitude when it comes to patients ( I chose this profession so I don't have to deal with patients, I'll do whatever the doctor orders, once the results are generated I'll just pass it on and patients must discuss the results with the doctor.)  The effect, intentionally or not, has been to minimize in the minds of the public and legislators the role of the MLS professional.

Labs might be looking at increased test volumes as consumers start ordering (and possibly paying for) their own tests. But lab professionals can be more valuable than ever in stating reference intervals, talking to patients about test selection, specimen collection/storage, factors that affect test results and when a result might indicate further intervention by a medical provider. 

This might well be an opportunity to position the MLS practitioner more strategically-and appropriately- on the healthcare team. This could be a win/win situation for all stakeholders. 

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When Is it OK to Mention Your Employer on Social Media?
April 17, 2015 9:11 PM by Glen McDaniel

It goes without saying that we live in the world of social media. I am not ashamed to say (maybe I should be) that this not-so-young guy spends way too much time online. Among friends of my generation, I am the go-to guru for interpretation of social media terms and recommendation for the latest technology or app. I get lots of news on social media. In fact my Twitter feed often beats the national networks to broadcasting some event of national or international significance.

 

Perhaps it is because of this wide exposure afforded by social media that many organizations now have a Social Media policy. Such a policy generally addresses not just the access of social media at work and using company computers, but also spells out what can be posted and what is prohibited.

 

No organization wants to be portrayed negatively by a current employee. That is why certain posts can result in immediate termination. However, healthcare organizations have a unique concern: that of privacy and security.

 

Some employers say posting pictures, patient-identifiable information are all prohibited. Generally healthcare organizations are very prescriptive with their policies directed at employees and even non-employee physicians. 

 

None of this comes as  news, I am sure.

 

While organizations often use social media to advertise or  post positive news about themselves, should they require employees to do the same? Should an organization  “strongly suggest” that their employees post at least one feel-good post per week  reflecting positively on the organization? What about requiring employees to “reach out to friends on social media to raise X dollars” as part of a fund-raising campaign?

 

I encountered a couple of those “requirements” recently and though the requirement odd at best. What do you think? Does your employer require or strongly encourage you to post on their behalf?

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Happy Medical Laboratory Professionals Week
April 17, 2015 8:12 PM by Glen McDaniel
It's time of year again we celebrate and acknowledge Medical Laboratory professionals (technicians, scientists, specialists, pathologists and others).

The American Society for Clinical Laboratory Science (ASCLS) website has a very concise history of this celebration which, like the profession it highlights, has experienced many changes. It was started in 1975 as National Medical Laboratory Week under the auspices of American Society for Medical Technology (ASMT) which later became ASCLS.

Over the years several other laboratory organizations signed on as co-sponsors. For example, this year there are 14 organizations cooperating in the effort  to salute the nation's estimated 300, 000 medical laboratorians.

In 2005 advocates from ASCLS spearheaded a change to rename it NMLP Week, with the "P" standing for Professionals. This was a deliberate attempt to emphasize that the celebration was for actual, real, live,  talented, educated, hard-working professionals and not simply a room (the lab).  This change was small but significant and evocative.

Traditionally each year a group of professionals selected a catchy slogan as that year's theme;  often a catch double entendre. In 2010 it was decided to brand the celebration with a permanent recurrent theme, "Laboratory Professionals Get Results."

Then in 2012, the word "national" was dropped from the name to make the title less unwieldy. So here we are many years later celebrating the latest iteration: MLPW.

Much has changed over these 40 years. We have seen regulatory changes, emergence of disruptive technology, nanotechnology and healthcare reform. But one thing has not changed: the skill, knowledge, competence and dedication of a cadre of medical laboratory professionals who work diligently, often behind the scenes, to advance the health of this nation.

To all my colleagues, I say: take a bow. You deserve it. Happy MLPW!

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CAP Q-Probe Looks at Physician Satisfaction with the Laboratory
March 29, 2015 4:49 PM by Glen McDaniel
 

A recent College of American Pathologists (CAP) Q-Probe investigated the level of physician satisfaction with what the laboratory has to offer. I always find satisfaction surveys instructive and this one was no exception.

 

This Q-Probe is certainly not the first of its kind or scope, but is the latest. The study’s authors Shannon McCall, MD and Larry Massic, MD  had a sample size of 2425  physicians from 81 institutions and asked  16 laboratory-service related questions.

 

-The overall satisfaction was 4.2 on a scale of 1 to 5 (this compares to a 2007 study in which the score was 4.1)

-Physicians  were most satisfied with quality of results, test menu and staff courtesy. They were least satisfied with turnaround time (TAT) for STATS (inpatients and outpatients), and esoteric tests.

-Interestingly, in terms of what providers considered important to them, clinical report format scored fairly high as a service category

-Only 69  percent of respondents were satisfied with the ease of use of electronic order entry. This was a surprise; as ubiquitous as that function is these days.

-95 percent of physicians said they would recommend their laboratory to another physician.

 

What are some of the takeaways?

-Physicians are confused by the increasing amounts of data they must process and find it harder to extract what’s significant and actionable.

-Physicians in smaller hospitals tend to be more satisfied with laboratory service than those in larger settings. The study authors theorize that this difference might be due to closer, more frequent interaction between providers and the laboratory staff in smaller facilities

-Overall, despite some degree of frustration on both sides, physicians are basically satisfied with the lab, but would welcome greater interaction and “help” in several areas including selecting and interpreting lab results

-Turnaround time rates low on satisfaction because it rates so high on the “importance” scale. So whatever we can do to reduce TAT is welcome and is translated in a physician’s mind to “better  service.” We could also do a  better job of educating doctors as to what is included in getting a test from order entry to result. They do not necessarily understand all the steps involved, or the differences for different tests. Again, that is where communication comes in.

 

Dr. McCall gives the following advice, “Pay more attention to order selection and entry, as well as the method and frequency of communication of results in the post analytical phase. Then maybe we will see an improvement in physician satisfaction.”

 

This is just the latest in a growing number of studies where doctors say what they need from the lab. It is not coincidental that "help" and "communication" are repetitive themes. To me, this represents a real opportunity for laboratorians to expand their scope, boost satisfaction and contribute to enhanced patient care ; all at the same time.

 

 

 

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Time for More Virtual Meetings Using AvailableTechnology
March 22, 2015 1:47 PM by Glen McDaniel
This is the time of year when the major medical laboratory organizations hold their national meetings. These gatherings are a great opportunity for laboratorians to get together with their professional colleagues from around the country and also to listen to major players in the profession and on the cutting edge of science.

 

 The advantages of national face to face meetings are undisputed: to learn new information, exchange information with each other, to network and to interact socially. Many meetings are held in interesting cities, so attendees also take advantage of what the host city has to offer; with many partying or getting much-needed rest and relaxation.  Some even take this opportunity to have a family vacation. Most meetings have a vendor exhibit or exposition (ranging from modest to gargantuan) of some sort associated with the meeting.  This offers a unique opportunity to talk to vendors, to see and touch advanced technology.

 

The thing is, it has become more and more difficult for the average bench MLS/MLT to attend national meetings. Most organizations do not offer financial sponsorship for meetings and, increasingly, laboratorians have to use their own money and often utilize vacation time or PTO. What’s a laboratorian to do?

 

While highly structured meetings are important for the reasons above, the reality is that organizations must offer alternatives for those laboratorians who cannot reasonably attend a meeting in person.  Communication technology has advanced to a great degree to offer several viable options.

 

-Webinars where an individual could pay to “attend” one or more presentations

-Live streaming of presentations and vendor exhibits

-Sale of CDs after the meeting

-Access to a password-protected website for audio and visual presentations

-Use of social media like Twitter and Facebook for some presentations where individuals can participate and ask questions in real time from wherever they are

-TED-like presentations of keynote addresses and high-interest topics

-Use of technology available on smart phones like the recently launched Meerkat application

-Offering CEUs as appropriate for participation through these virtual means

 

 

All of these options can be monetized ( I hate that term) of course. It is possible to charge so that laboratorians would pay a sort of “fee for service” cost. These charges would defray costs for the organization or, more likely, be a nice source of revenue for the presenting organizations.  Even if the cost was higher than the meeting registration fee, it would still be a cost savings because the individual would not have to pay for travel, meals away from home, hotel etc. and the other typical go-to-meeting expenses.

 

Not every organization has the wherewithal to offer all these services out of the gate, but it would be nice to see an incremental move in that direction.

 

 Vendors  have a vested interest to subsidize some of the cost, by the way.  Here is a likely scenario: Vendor A allows a virtual tour of their expo booth, ability to have a Q&A online and then allow the viewer to see one presentation for free (could be a big keynote or a scientific session).  The vendor bears all the cost. I can even see a situation where the exhibits are less gigantic, with some of the savings being used to facilitate virtual attendance and participation.

 

Face to face meetings are hard to beat and will not go away any time soon. However, the reality is that they are inconvenient and expensive to attend. Luckily technology offers many convenient, affordable alternatives. It is time to take advantage of this technology.  I know many meetings sell CDs, I know some offer some CEUs after the fact, but I am suggesting something much more comprehensive, bold and overarching. .

 

The technology is there and the laboratorians are there. It’s time to bring them together.

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The Laboratory’s Expanded Role in Managing Kidney Disease
February 22, 2015 4:30 PM by Glen McDaniel

Kidney disease is one of the most significant chronic ailments affecting Americans. Renal disease is often a sequela of one of several maladies that plague Americans: diabetes, hypertension, glomerulonephritis, autoimmune disease, polycystic kidney disease and others.

 

An estimated 20 million Americans have chronic kidney disease (CKD) some managed by diet, exercise and medication alone, while others need regular dialysis.

 

Quality of life can be adversely affected and impacted by kidney disease.

 

The laboratory plays a crucial role in the diagnosis and treatment of renal disease. One of the ongoing challenges for providers is the variation in tests performed by different laboratories on different platforms using different reagents.  There have been several attempts to create harmonization to standardize results and make it easier to interpret results from various labs and even from visit to visit.

 

In late 2012 some guidelines called the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for the Evaluation and Management of CKD were introduced.

 

These guidelines were developed  through the collaboration of many international experts and build significantly on lessons learned from previous guidelines. One very important aspect of this guideline is that it contains strong recommendations for laboratory input and involvement in the process of care. It only makes sense that the experts who provide the information used in decision making should understand the recommended best practices and the rationale for such practices.

 

Not surprisingly, laboratory involvement will require a more active participation, rather than the typical passive behind the scenes “just do what the doctor orders” traditional approach.

 

Among the “Key Factors for Laboratorians” required by the 2012 KDIGO Guideline are the following

 

-Ensure good communication between laboratory professionals and relevant clinicians, such as nephrologists and primary care doctors.

-Aim for common laboratory practices in a region so patients receive the same care with comparable results from visit to visit, regardless of location where the testing is performed.

-Ensure creatinine results are aligned to an isotope dilution mass spectrometry standard (IDMS)

-Select an appropriate glomerular filtration Rate (GFR) formula for your population.

-Laboratories should use the same units, number of significant figures and clinical decision points for both serum creatinine and eGFR reporting.

-Laboratories should understand, and provide information on, their creatinine method, including any limitations and interpretation

-Laboratories should provide measurements of urine albumin and urine creatinine using traceable assays. These tests might be part of a periodic monitoring protocol in a high-risk population such as  known diabetics.

-Laboratories should provide Albumin/Creatinine ratio (ACR) and do so in a clear, consistent manner to help clinicians make correct decisions regarding declining renal function in any one patient from site to site and visit to visit.

 

All of these recommendations make good sense and offer yet another chance for the laboratory to be an active participant in patient care. This involvement should provide job enrichment as the laboratorian assumes a greater proactive and professional role. However, these are recommendations, not mandates.

 

 If laboratorians are hesitant and acquiescent then another player will step forward. Then once again, someone outside the laboratory, perhaps with limited knowledge of MLS, will direct “the lab” on what to do. It’s our choice, really.

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Laboratory Inspectors: Using Peers Versus Employees of the Agency
February 15, 2015 3:39 PM by Glen McDaniel
 

I  was speaking to a group of laboratorians including a pathologist, and the conversation turned to laboratory inspections. At first everyone was on the same page: inspections are a necessary evil in the sense that it is important to have some neutral measure of quality, but the inspections could be very stressful.

 

Each person recounted horror stories of overly-picky inspectors or citations that were just arbitrary or inexplicable as far as they were concerned. The pathologist was very adamant that medical directors should be exempt from such scrutiny. One older scientist told the group stories of lowered practice or low-quality practices being adopted at the urging of medical directors who in fact had the real power in the lab. The pathologist insisted, quite rightly, that such occurrences were probably few and far between.

 

I then asked the group should inspectors be practicing peers drawn from sister- laboratories or should they be professional inspectors employed by the agency or the state.  I have witnessed both practices-Joint Commission , State, CLIA and COLA professional inspectors  on the one hand, and CAP peer-inspectors on the other.

 

The group was about evenly split. The pathologist liked the idea of peer pathologists (doctor to doctor). A couple of scientists insisted it takes someone in current practice to be  knowledgeable and realistic enough to “judge” their colleagues. They suggested professional inspectors were often retired individuals “ who had not seen the inside of a real lab in years- except during inspections” They might not understand current medical laboratory practice and their expectations were often unrealistic, for example.

 

Interestingly, the younger members of the group unanimously thought it would be better to have only professional inspectors instead of peers who only volunteered from time to time. Why? They thought professional inspectors  would be better trained, more current on the standards and would adhere to interpretation of standards in a more objective way. Peer-scientists tend to be more subjective and tend to “judge” laboratories more in comparison to their own experiences. In short, they were more rigid and there was more variation among visits and among inspectors, they thought. Interesting.

 

I guess there are advantages to both models. But since most laboratories are CAP-accredited, using volunteer peer-laboratorians it seems, the issue is of more than academic interest. Do you prefer being inspected by a team of practicing scientists who are just taking time off from their own labs, or would you prefer a team of professional full-time inspectors, who do nothing but laboratory inspections?

 

I would be interested in hearing your opinions.

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The Laboratory: Operating Behind the Scenes
January 31, 2015 1:01 PM by Glen McDaniel
 

The mantra of most laboratorians is, “We get no respect.” The wrenching truth about that is that it is a self-fulfilling prophesy. We provide the majority of empirical data used to make clinical decisions, we are among the most educated of healthcare professionals. Yet the truth is we are under-recognized and often underpaid, as compared to our healthcare colleagues.

 

I am not sure what medical laboratory education is like these days, but when I was in school, our studies were heavily scientific. We studied the biochemistry of human functions, the anatomy of the body and a good deal of time was spent “diagnosing” based on laboratory data.

 

Then we graduated, interned in an actual  medical lab and found that our knowledge and critical thinking skills were grossly underutilized. To make it worse, burnt-out laboratorians slapped us down (figuratively) whenever we dared to be audacious enough to think we could offer an opinion.

 

I have written several blogs discussing research that indicates that what physicians want from the lab is accurate, timely results. In fact, they are lost without that. That’s a given. But they also want consultation. They want help selecting and interpreting tests. When they call they want to speak to a professional laboratorian to have their questions answered, someone who will help them solve their dilemma. Plus they want to do this without too much trouble. In one CDC surveydoctors said they often just hung up as they were transferred from person to person when all they wanted was something as simple as what swab to use and why one specimen was acceptable and another not. They wanted “why” not some snide comment  like “that’s just what we use” or to be told “ask the pathologist” for just about every technical or clinical query.

 

I call the “no respect” prediction self-fulfilling  because as we get disillusioned and shut down or don’t bother to keep up with clinical and technological advances, physicians and nurses trust us less and assume they know more than we do. Even about OUR body of knowledge and our scope of practice.

 

Articles written about the lab often reflect the same dumbed down narrative of who we are and what we do. A few days ago, I was very heartened to read an article in US News and World report that talks about the value of the laboratory and the fact that, despite our pivotal role, we still operate largely behind the scenes.

 

The article accurately describes the roles of laboratorians, even using the correct title of medical laboratory scientist, and walks the reader through some common scenarios in which the laboratory’s actions make a difference in diagnosis and treatment.

 

The author of that article, Lisa Esposito is an RN by training and in an email to me she reminisced on how, as a nurse, she often waited anxiously for critical lab results or blood for a transfusion. “Without the work you do, we would have been at a standstill in patient care," she says.

 

Articles like these are far too rare. Sometimes it takes others to remind us of our value. Please share with your friends.

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Happy MLK Day
January 17, 2015 3:37 PM by Glen McDaniel

Martin Luther King Jr.  was born in Atlanta, Georgia on January 15, 1929. Best known as "the slain civil rights leader" his mission was fighting for civil rights through nonviolent means.  His birthday is now a federal holiday celebrated in all 50 states, although with some reluctance, on the third  Monday in January. This year it will be observed on Monday the 19th.

MLK's life was one of service and in recent years the emphasis has been on celebrating the holiday through some act of community service.  The idea, as someone said, is to have " a day ON and not simply a day off."

Our profession is by definition one of service. It is no surprise that on Monday, while many Americans will be celebrating a day of rest and relaxation,  many of our colleagues will be at work providing healthcare as we do 365 days a year, 24/7. But for those who will not be working, what will you be doing? This is a perfect day to volunteer to help someone less fortunate or who can benefit from your expertise, knowledge; or even your physical effort.

Service is always about the other person, not us, but it is still an opportunity to teach others who we are and what we do. I have met many friends and professional contacts through volunteering, which is something I enjoy and feel compelled to do.

A simple pleasantry like "Where do you work?" or "So what do you do?" is always an opportunity to educate and to advocate for the profession.

The primary function of service is to GIVE, but one can always do well (and derive some benefit) even as one does good.

Whether you are at work or not, I urge you to make this MLK Day a day "on" and not a day off.

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What Has Happened to the DCLS Degree?
January 11, 2015 5:12 PM by Glen McDaniel


 For several years now there has been talk about a doctorate in Medical Laboratory Science (DCLS). This idea was advanced by ASCLS to support the idea that medical laboratory science has a unique, distinct, significant body of knowledge that MLS practitioners  should be able to practice independently as do other professionals with similar education and training.

 

ASCLS developed and published a substantial toolkit which serves as a reference for educators wanting to craft and offer a DCLS program. Professional groups worked with NAACLS, the agency that accredits MLS programs, to develop standards and guidelines for accreditation of DCLS programs 

 

In recent years many professions that contribute significantly to patient care have asserted their right to have their own doctorate, with pharmacists being the most well-known non-medical “doctor” in the healthcare setting. Others like physical therapy have also advanced the idea of a doctorate as an entry level practice degree.

 

Despite the hard work that has gone into floating the idea of a DCLS, very few schools have made the leap to actually offering such a degree and enrolling students. I suspect it might even be difficult to convince universities to  authorize a new program without a clear return on investment for the university.

 

I think there are several reasons for this lackluster response to the DCLS:

 

-Many MLS practitioners still think of themselves as “only techs” and do not believe there is a viable option for advanced practice or a more significant role in health care for “lab techs.”

-The contents and goal of a DCLS curriculum are not clear. Even those who support the idea of a DCLS describe the ideal program in several very different ways. Will a DCLS focus on clinical research, advanced practice, clinical consultation, directorship of a medical laboratory? All of the above? Will there be the option to specialize in one area, as pharmacists often do, for example?

-With no clear or reasonable assurance of a niche in healthcare, few want to expend the time and finances involved in completing a doctoral program

-Neither healthcare administrators nor pathologists are advocates of the DCLS role. Healthcare administrators are concerned about increased labor cost, while pathologists might fear competition and usurpation of their role as “the lab doctor.”

-Entry requirements for DCLS programs seem very rigid. One program says “Only those with an MLS(ASCP) will be admitted.”  A successful program, especially one that is largely experimental should be more flexible, offering online options, allowing specializations and so on. This can be done while maintaining academic rigor. Just look at the flexibility of many advanced practice nursing programs.

 

While I continue to be an advocate of the DCLS idea, I feel more needs to be done to clarify the role, to market the benefit to employers and regulatory agencies, and to make the degree more attainable.

 

It is unlikely that the DCLS will catch on as a first professional degree (as the MD or PharmD) needed to enter the profession.  If folks balk at the idea of professional licensure (for professionals who already meet the requirements for licensure) they are unlikely to go for a higher entry-level degree.

 

The DCLS is much more likely to be an advanced practice degree, gained after a first degree (and some experience) where the practitioners assume roles over and above that of the “typical” bench MLS/MLT. The question remains “What roles?”

 

The DCLS is unlikely to gain popularity until that question is answered satisfactorily and all the players (MLS practitioners, clinicians, employers, regulatory agencies and even the public) can see some benefit for themselves.

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Know the Difference Between Cost and Value
December 31, 2014 2:38 PM by Glen McDaniel

In casual conversation we use the terms cost, price and value almost interchangeably. That might seem to be just semantics, but I think we send mixed messages or act inappropriately when we start believing these concepts are identical.

 

Anyone who has a teenager probably knows all too well how they are guided by peer pressure. All the girls tend to wear the same fashion. Young people of both genders hanker for the latest “trendy” shoes, gadget or new toy. To many the cost does not matter and the sellers (knowing the demand) over-charge accordingly.

 

A friend of mine told me his  son who is unemployed borrowed $200 to acquire a pair of sneakers because they were the “it” shoes of his generation. I have driven a luxury car for the past few years but as it aged the repairs became never-ending and very expensive. So I traded it in for a sturdy, dependable Japanese car and am shocked at the many comments I have received. You would think condolences are in order because I have been “reduced” to a non-luxury car with much less status.

 

OK, so that gets me back to the various terms I started this blog with. I am writing this not only because of recent experiences, but because I believe they have significance to all our personal lives and also our professional lives. How do you value yourself, your colleagues and your profession?

 

Let’s just define those key terms simply, instead of using the formal economic definitions.

 

Cost: is whatever is spent to produce goods and services. So it might be what Toyota spends to make a car, how much Apple pays a worker in Asia to make an i-phone, or how much your employer is out of pocket to have you work for them (recruitment, salary, benefits etc).

 

Price:  is the what is charged or received by a seller. Again, using the car/employer analogy, it’s what someone pays the dealer for a Camry, or what your employer pays you to do a job as a phlebotomist, MLT or MLS  for them.

 

Value: is whatever the customer believes a certain good or service is worth. Value is a much more subjective quality, but it is what really drives the price.  The perceived value of "it" sneakers or an I-phone have very little to do with their respective cost of production. You can look at various professionals and realize that pay is not commensurate with education, work ethic, competence, service provided and so on.

 

My teenaged neighbor was willing to go into debt and pay hundreds of dollars for a pair of sneakers because of the value he assigned to those shoes. Employers will pay certain employees more because of their perceived value in the organization.

 

We tend to regard anything with a high price tag as being valuable, or more significant and important. The converse is also true: if we can convince a customer or employer that we are valuable, important, critical, crucial to their success, then our value increases.

 

These might appear to be subtle differences, but not knowing the difference often results in being undervalued and underpaid.

 

Here’s to recognizing and explaining your value (and fetching an appropriate price) as you move into the New Year

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