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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Is this Quality or Just Habit?
January 18, 2014 12:36 PM by Glen McDaniel


The Director of Nursing hotly defended her staff. They had in fact performed quality control on the point of care glucose meters per policy. They had dated and initialed the appropriate line on the sheet. What was the lab complaining about? What did the state inspector mean by citing them?


Let me back up and explain. A few years ago I was associated with an organization where nurses performed glucose and urine pregnancy point of care testing. The nurses were trained to perform quality control and to document QC as well as maintenance on a log sheet. However it was a constant battle to ensure compliance. One day the state came in and found a couple instances were QC was performed, but were out of range. There was no corrective action documented, yet patient testing was performed.


The Director of Nursing could not grasp the concept of running QC to indicate acceptable performance of the test system. In her mind, QC and maintenance were just tasks to be checked off a list. Over the years, I have come to realize that many concepts we medical laboratorians consider fundamental are alien to those in other professions, including nurses.


I have also noticed that as laboratorians we also do some tasks by rote without thinking whether they are logical or not. Some recent examples I have seen with clients: performing 3 levels of QC daily for low volume tests that the lab performs maybe twice weekly. Another client performed correlation on all 82 of their (identical) glucose meters instead of using a representative sample as recommended by CLSI. A small laboratory performs quality control on their chemistry analyzer each of three shifts. Yet another , strapped for space) uses valuable refrigerator space storing their urine samples for a week. Why? Their policy says, "patient specimens are stored for 7 days."


How much of what we do is based on ensuring quality and how much is simply checking off a task on a list? With the increased sophistication of laboratory instruments is it still logical to perform the sort of validation studies traditionally required by CLIA? How often should methods be revalidated?


Another area that needs consideration is reporting results. Increasingly physicians are pleading for decision limits or cut-points instead of a "normal range."  Maybe our reference intervals should provide more information than normal/abnormal, or low-normal-high.


As laboratorians we are very concerned with quality, but I suggest we periodically look at our long list of “tasks” and reconsider which ones contribute to quality and enhance patient care, versus those which are just something on a list and no longer serve a useful purpose.


Is there a task or process in your lab that has passed its prime or that you perform without knowing exactly why you do it?


Create a New Year’s Vision-not a Resolution
December 31, 2013 4:56 PM by Glen McDaniel

A new year starts in just a few hours and this is traditionally the time to make resolutions.  Some people are just pressured into resolving to do better because it is what is expected. Others sincerely pledge to make some positive change in their lives.

The sad reality is, however, that most new year’s resolutions fail. It doesn’t take long either: many New Year’s resolutions go the way of the wooly mammoth within the first few weeks of the new year.

A study conducted last year showed that a full 50 percent of folks abandon their firm resolve, before even making an effort to start!

A goal can be made at any time, not just at New Year, of course. Generally I recommend that in order to be effective every goal should be SMART (specific, measurable, achievable, realistic and time limited). So a goal to further my education and get a higher paying job might be refined to read:

“I will complete my first year in the MHA program at XYZ college by December 2014.”

SMART goals give specific yardsticks by which success can be measured.  In order to achieve a SMART goal, specific, targeted actions have to be taken to ensure the goal is achieved within the time frame. There are maps, goalposts and deadlines.

Making goals SMART is a very sound strategy. However, if you have been unsuccessful in keeping New Year’s resolutions in the past, and if you have only a general idea of what you want to achieve, you may use a modified version of a resolution by creating and writing down a vision. A vision is essentially what you want to be or do or have. It sets a direction for where you want to go, or end up.

Organizations use vision statements as lofty ideas of how they would like to be perceived, maybe in a few years' time. “To be the preeminent provider of healthcare in the TriState region” is an example of a healthcare provider's vision statement.  However, although  it represents a lofty goal, that statement is almost a wish or hope and it does not have the specific and measurable features of a SMART goal.

The good thing about a vision, other than the facts it is less specific, less pressure-laden and less prone to failure is that by its very existence it tends to move an individual or organization in that direction. If an organization or individual uses their vision as a framework or measuring stick for every action taken, they are more likely to move in that direction. It is pretty obvious that some strategies will get you closer to your goal, while others will not.

Another interesting thing about a vision is its psychological effect. Human beings are teleological or goal driven. Even subconsciously they tend to move towards a goal, once the goal has been set. Ever notice how once you become interested in a smart phone, car or appliance, you start seeing it everywhere? You start seeing articles and commercials featuring what you want. Your friends on Facebook start talking about it. That’s how goal-seeking works.

Some might even say there is a conspiracy of circumstances to create your vision once you create it and turn it loose.

So this New Year I suggest that instead of yet another doomed resolution you might want to set a vision. Where do you want to be in 1 year’s time? In 5 years? What do you want to be, to do, to have? Write it down. Read it often. Be open and receptive to nontraditional options. Take actions that move you in the direction of your dream whenever opportunities present themselves-and they will!

I would love to hear your experiences of visioning throughout the year.  I wish you much health, happiness and success in your personal and professional lives for 2014.


Sounds Like a Personal Problem to Me
December 28, 2013 4:38 PM by Glen McDaniel


You might be familiar with the comeback, “Sounds like a personal problem to me.” That expression is usually used to quash a complaint or an excuse not living up to expectations. That expression came to mind recently.


The weather is usually mild in Atlanta where I live. However we had a steady two-week cold snap and my steep, winding driveway froze over. On my way home one evening, I was unable to successfully navigate the slippery obstacle course and my car slid into the bushes, teetering  dangerously close to a precipitous slope.


I called my emergency road service company and they sent a wrecker out to “rescue” me. The driver arrived a couple hours later and immediately complained that he was working alone on a job that should be staffed by two people. Not only were they short-staffed, he said, but there were lots of wrecks because of the weather. He gave me a lecture on safe winter driving, how to navigate a hazardous roadway and the wisdom of never choosing a residence with such a steep driveway.


He then told me he was being paid only a paltry sum by his company and so this very complicated operation was not worth it to him financially. He warned me it was very unlikely my car would not be scratched and damaged even if he could somehow get it on the bed of his truck. I signed the waiver, absolving the wrecker of any liability for damages incurred during the operation. I waited with trepidation, helping to push, pull, steer-whatever he asked me to do.


After an hour of manoeuvers and curses, my car was safely “extricated” and rested on terra firma at the bottom of my driveway where it spent the night until my driveway could be defrosted.


I kept thinking what lousy customer service and how unconcerned I was with all the driver’s “personal problems.”  I paid for a service and expected the company to honor their contract without whining or blaming.


How often as professionals do we whine, blame and play victim when confronted by a deadline or complication?  Our customers (patients, doctors, nurses) feel pretty much the way I did as a customer, “Sounds like a personal problem to me. “  They have certain expectations and we as professionals implicitly promise we are competent to deliver, and capable of making good, on that promise.


Those we serve really do not care if we are short staffed, our equipment is acting quirky, the antibody is “hiding” or our Wright’s stain has artifacts. You say, "Those are realities, so why shouldn't we let them know?”


I believe it’s all a matter of perspective and approach. First recognize we all have the same goal of quality, timely patient care. However at any one time, our priorities and perspectives may be different.  It is normal that we tend to be ego-centic in our views. The suggestion is to acknowledge the clinician’s frustration with not receiving a result in the expected time frame.  Then calmly explain why the result might be taking longer than anticipated. If possible, give an expected timeframe for completion. Finally, when the result is available, go the extra mile of making sure the decision maker knows what it is, or where it’s available to be accessed.


This sounds very simple and almost  too simplistic, but the suggestion is to explain the reality in  non-confrontational  and non-defensive tones. This is an opportunity to practice the Straight A’s of responding to customer complaints: Acknowledge, Apologize and Act.


Acknowledge: I realize/ I agree/ I know that…

Apologize: I am really sorry that…

Act: This is what is happening (this is why we have an issue making service more complex, less timely, or falling short of what’s expected). Then immediately go on to explain what actions you are taking to resolve the issue.

  • This is what I am doing about it

  • Give an expected, realistic timeframe for resolution, if possible

  • Provide result ASAP and inform customer

  • Followup by giving a progress report if the deadline is not going to be met


In most interactions, we do not have to deny the reality or try to obscure the facts. However, those whom we serve, those who are depending on us to deliver, respond very differently based on how we present the reality.

Medical Lab Science is Still a Growth Career
December 22, 2013 3:55 PM by Glen McDaniel


Just this week, the Bureau of Labor Statistics (BLS) released its report of job prospects for the next ten years (actually between 2012 and 2022).



Not surprisingly, healthcare topped the list of attractive fields, projected to grow at almost three percent, adding an estimated 5 million new workers- a third of all new jobs.  The report also breaks down the statistics by occupational role. 


Most of the overall 10.8 percent growth will occur, not surprisingly in service jobs like healthcare as opposed to jobs that produce goods like manufacturing or construction. The healthcare sector is further broken down by scope.  It turns out that healthcare will be  among the four major occupational groups that are projected to grow more than 20 percent—nearly double the overall growth from 2012 to 2022. But healthcare support occupations will surpass healthcare practitioners and technical occupations (28.1 percent versus 21.5 percent. (See Chart 2 and Table 6).



As we all already know, in all areas of healthcare paraprofessionals will be in increasingly greater demand and will be utilized more as the population ages and care needs increase. Does that mean laboratory scientists will be replaced by laboratory aides or technicians? No, that is very unlikely. That fear is as unfounded as the perennial rumor that more instrumentation will eventually make medical lab scientists redundant.


It does mean two things, however. If paraprofessionals are to competently assume greater responsibilities and represent the laboratory even more, we have to make sure they are prepared to safely and effectively fulfil those roles.  Phlebotomists might be trained as lab assistants with expanded auxiliary roles. Customer service reps should be taught scripting to answer common questions and trained on when to escalate issues outside their scope. MLTs may be encouraged to become MLSs and assume more responsibilities. Education and training should be seen as added value; as should seeking national certification.


As roles shift across the entire healthcare team, the needs of the laboratory's customers will also change and we must be ready for the new challenge.  Scientists should jump at the opportunity to interact more with their peers outside the laboratory, instead of performing the more “tasky” duties that are customary.  There can be more effective representation on decision making committees like the Quality Council, Pharmacy, Nutrition and Therapeutics (PNT) committees and the like. 


Long delayed projects related to test utilization and provision of interpretive guidelines can be pursued.  Busy, overwhelmed clinicians would welcome  even the most basic phone consultations, if they were available. There are best practices to be established and research to provide hard data applicable to medical laboratory science practice, much like other professions have done.


Many of us are on our way out, possibly on the way to retirement. However it is heartening to know that our profession will continue to grow.


It’s Not My Job-Or is It?
November 24, 2013 4:32 PM by Glen McDaniel

No matter what your job is, it’s likely you periodically encounter situations that make you consider whether you should just look the other way or take ownership. This might range from a customer service issue with a patient, to an interdepartmental impasse to a human resource issue.


Very often we are tempted to take a pass on resolution of the problem because we already have enough on our plate. We either ignore (or delegate) resolution of what is seen as just a nagging interruption to our already busy day.


But not all challenges are created equal. As laboratorians we wag our fingers at clinicians who constantly over-order or order inappropriately, but we say nothing using the excuse, “He is the doctor,” or “I am just a tech.” Do we have a responsibility to voice an opinion? I do not mean delivering a lecture, or outright  refusal to perform the test. But what about a concerted  push for the development of a team looking at utilization and developing algorithms for test ordering?  Variation from of the algorithm would require some sort of  justification. Pharmacists have developed drug formularies and ordering guidelines that physicians must adhere to. You never hear, “Well, I am just the pharmacist, I must dispense whatever the physician ordered.”


Some issues that arise are not merely policy-related or procedural, they have an ethical component as well. How would you react to the following real-life situations?


-A supervisor who asks staff to “fix” QC and temperature charts before a survey in order not to be cited.

-A lab manager who tweaks quality data like blood stream infection rate or analytical error rate before the data is submitted to the organization’s Quality Council?

- A colleague who accesses the CFO’s medical record because she “heard” he was recently diagnosed with….. (choose an illness)

-An MLS who modifies the rules for manual differentials or microscopic urines in order to end his shift on time.

- A colleague, Mary, who falsifies time by asking a colleague, Tom, to clock in and out for her so she gets credited for more than her actual time worked.

-A phlebotomist who discovers she drew the wrong patient but chose not to correct the error since no one questioned the results. 


These are all real situations I have encountered in laboratories and the laboratorian discovering the ethical lapse was reluctant to act. There is always the extra wrinkle if the policy or ethics violator is a superior, but is that a valid reason to ignore the issue?


I would love to hear from readers who have you faced similar dilemmas in their workplace and how they reacted.


Labs Are Vital 2.0 is Here
November 9, 2013 2:19 PM by Glen McDaniel


In 2006, industry giant, Abbott Diagnostics made a major investment in medical laboratory science by launching a campaign called Labs Are Vital. They spent quite a bit of money and expended human resources in setting up a website and trying to energize the medical laboratory community to help spread the message to the wider public that labs are, well, vital.


What was significant at that time is that no other vendor had made such an investment or even, frankly, appeared to empathize with laboratory professions who felt underappreciated, underutilized and even marginalized. Nursing had their huge Johnson and Johnson advertisement Campaign for Nursing’s Future.



Started in 2001, that campaign is still going strong, offering several ads on major cable TV stations, recruiting students to the profession, and help in the way of scholarships and so on.


The intent was always that laboratorians themselves drive the Vital campaign. I recall a national meeting where Abbott had a booth set up with brightly colored professional-looking posters of various laboratorians. Lab attendees at the meeting were encouraged to have their pictures taken with the hope of being featured on a larger than life poster with an appropriately proud and catchy phrase. Medical laboratorians were also encouraged and given ideas on how to celebrate and promote the laboratory not just during Medical Laboratory Professionals Week (MLPW), but all year long.


Earlier this year Abbott finally turned over Labs Are Vital to the international laboratory community. Currently the sponsors are ASCP, IFCC, International Federation of Biomedical Laboratory Science (IFBLS) and the World Association of Societies of Pathology and Laboratory Medicine (WASPLM).  Abbott continues to provide financial support, but quite appropriately the direction is intended to be set by laboratory professional organizations and their members.


The new website www.labsarevital.com is up and running and features blogs, commentaries, articles, letters and a schedule of upcoming events. Laboratorians have a chance to weigh in, whether just to comment on a topical issue or to offer suggestions for a bold new initiative.


So, visit the website, browse, contribute, get educated, get new ideas, and get energized. Yes, labs are still vital and with your participation, Labs Are Vital 2.0 has the potential to be even more influential than it's been in the past.

It's OK to Say You Don't Know
November 3, 2013 2:37 PM by Glen McDaniel

I wish I knew everything, but I don't. On second thought: it would be pretty boring to have every fact at my finger tips and I never have to learn, to ask, research or dig for information. In any event, has someone ever asked you a question and you hesitated before admitting that you don't know the answer?

I am the king of trivia, so I have a collection of disjointed facts in my head. I am the kind of friend to call as your lifeline if you are stuck on "Who wants to be a millionaire?"  I am not cocky, because I honestly don't even know how and when I stockpiled all that (largely useless) random pieces of information.

Although my family knows that I am a medical laboratory scientist (not a doctor, pharmacist or nurse) they also turn to me a lot for medical information and advice. I happen to know a little about a lot of things, but I am certainly no substitute for a visit to your physician.

I have long espoused the philosophy that as medical lab scientists we have a unique body of knowledge and are the experts on MLS. I strongly support speaking out and provided current and credible information to physicians, nurses and patients. But in order to provide such a service credibly, honestly and safely, we have to make sure we are truly knowledgeable and accurate.

I was in a medical office recently and overheard a physician explain to a medical assistant that it doesn't matter how long urine is centrifuged for a microscopic examination, but "Most people don't spin long enough, I like mine spun hard for 10 minutes to make sure everything settles."

I recently heard a diabetes educator give blatantly incorrect information to patients about lipids and hemoglobin A1C. When I am in the presence of healthcare professionals who do not know my background, I am amazed at not just how they downplay and "diss" our profession, but how they mischaracterize important aspects like specimen collection, storage, patient preparation and interpretation of test results.

We all have stories about the person in the laboratory who will always give an answer to a caller, instead of referring them to an individual who is more appropriate or knowledgeable. Are your phlebotomists and customer service reps trained to say, "I will let you speak to a MLS about this" or "I am sorry I am not sure, but I will find out and call you back."

There is no shame in not knowing. We hurt our credibility and put patients at risk if we choose to give answers because we want to appear to "know it all."

Again, there is a lot of information we can offer; we absolutely should be more aggressive in giving advice and interpretations; we should wear the mantle of "expert" more confidently and proudly. But part of being a true professional who offers real value to those he serves is to know when-and not be afraid - to say, "I don't know."

Here's Another Opportunity to Help Physicians and Patients
October 19, 2013 7:20 PM by Glen McDaniel

In a recent article, Dr. Diane Shannon talked very poignantly of the reason she left the practice of medicine. Shannon said she was burnt out and wanted to be another addition to the statistic that suicide is higher among female physicians than among females in the general population.

That sounds like hyperbole until you hear how much this physician described how she, and other physicians, are often constantly plagued by worry about their patients. Even while away from work, they go down mental checklists and wonder if they ordered the right tests, gave the correct dosage of medications and so on.

Shannon refers to research that indicates that physician burnout might be related to a combination of four factors:

1. Time pressure

2. Degree of control (lack of control) regarding their work

3. Pace of work or level of chaos surrounding work

4. Values alignment between physicians and administration

You will no doubt think, "Those conditions sound familiar." Not very laboratory is characterized by chaos, but the other three factors are certainly pretty typical of Everylab USA, isn't it? So we can certainly relate to all those stressors and recognize them as contributors to the burnout characteristic of our profession; especially among the older crowd.

However, this article made me think of something else. It is a theory I have long espoused. Physicians, stressed, burnt out and inundated with data, would welcome our help in making sense of the information we provide. In fact we can do much more in converting numbers, data, and text into meaningful information. We can offer up ourselves as experts to call or consult for clarification if needed.

Think of a middle aged man presenting to the ED with belly pain, hepatomegaly and is described as icteric. He denies a history of alcoholism, drug abuse and has not traveled outside the country. So the physician starts an IV, orders a hepatic profile and admits the patient.

The result comes back, and all the attending physician sees is an alphabet soup: hepatitis A, B, C; some antibodies and antigens; IgM; surface and core "stuff."   It is the unusual physician who will immediately understand what all that means. Wouldn't it make a lot of sense for us to send an interpretive report? Would not the physician and patient be better served if they could immediately see what type of hepatitis the patient has and whether it is likely to be acute or chronic, for starters.

That does not constitute the practice of medicine. It is certainly within our capability and scope of practice. We'd rather roll our eyes and make snide remarks about physicians ordering the wrong tests and misinterpreting the results.

A simple act on our part -generating a legible, clear, interpretive report- would go a far way towards improving and expediting patient care. It might not be an exaggeration to say it might well contribute to saving a patient- and
possibly a physician as well.

Find Your Passion, Find Your Niche
October 12, 2013 6:12 PM by Glen McDaniel


There is a lot happening in this country these days. As a medical laboratory scientist, I have been used to change, but it seems like the past few years have been typified by huge changes to many people I know personally and professionally.

One of the questions I get asked a lot as I travel around this country and as I read my emails is , "How can I find a satisfying career in this second half of my life?" or something similar. The professional workforce is aging and as boomers approach retirement, many are burnt out. However the reality is that they might not be able to retire for financial reasons, or they feel healthy and vigorous enough that they are not yet ready to stop working. They are asking, "What else can I do now?" Boomers have become "seekers."

The stock answer to a seeker of any age (or of any background) is to say find your passion, do it for a vocation and you will feel like you are not even working. But how do you find your passion without paying a shrink or life coach? I have a simple method.

Take a piece of paper, grab a pen, sit in a quiet place and answer in writing three simple questions.  

What really excites you?For some this is easy to answer, for others it takes some introspection. Think about the things you like to talk about, to watch on TV. What areas are you always following on the Internet? If you go to a bookstore (yes, those still exist) what section do you gravitate to?

What would you do for free?  OK, the tendency is to say, "Nothing." But if you were independently wealthy or won the lottery, what would you choose to do to keep yourself busy, to give back, and to feed your mind? This can be something specific or a general area. Writing down these answers tens to crystallize your thoughts and let you see a pattern as you write.  So just write freely without censorship.

This may or may something you are especially good at. Do family members and colleagues compliment you in a certain area or constantly volunteer you for a certain type of task that you also like to do?

What really annoys you? This one sounds odd, but if something really annoys you, you generally have some idea of how to change or ameliorate that situation. If it's a process, you might have some alternative suggestions of how you would "run" things better.

These are very simple questions, but I suggest you really think about them. Write down your thoughts and revisit the list three, four, five times. Look for patterns and trends.  This technique can be used in any area of your life. For seeking laboratorians it might mean moving out of the laboratory to pursue something else; whether inside or outside of healthcare. But just as likely it might entail pursuing a path within the
laboratory you had not even considered before.

You could be the laboratory liaison to a college, hospital department or the public.  Think of adding value by being the laboratory expert or "go to" person in a particular area. It might even mean creating a brand new job.  You might well have to sell your boss on changing the status quo; so be prepared to do that. The good thing is I have found that in today's changing, challenging climate, managers all the way up to the C-suite are
very open to any idea that increases productivity, that increases the bottom or line or that makes them look better.

So, open your imagination. Get that piece of paper and start writing.

Service Recovery is Part of Quality
September 15, 2013 1:50 PM by Glen McDaniel


In healthcare we often talk about quality. In fact we dredge that word up whenever we want to shame someone into doing whatever we want. In healthcare we tend to think of quality as something that somehow improves patient outcome and is often related to some policy, rule or regulation.

We ensure quality control is in range, temperatures are checked and recorded. Blood stream infections, contamination rates and the like are tracked and trended. But these are largely internal measures which are of more importance to us than to the patients. Patients just assume we are competent, qualified (educated, certified, licensed, trained) professionals. To them that's a given. Their idea of quality is related somewhat to outcome, but their daily assessment of quality is based on how they are treated and how we make them feel during daily interactions.

Healthcare is unique in some  ways, but in terms of service and quality it is very similar to industry and every other service organization.

A couple weeks ago, my car was hit and after the inconvenience of negotiating with two insurance companies (the other driver's and mine), I took my car into the shop. I picked up my car a few days later, only to find an error code as  I drove out of the parking lot. When I took the car back, there was no apology just a defensive promise to "take a look at it , because it was fine when WE checked it earlier."  It took them three hours to get a part from the dealer and install it. I had lost about four hours of work before it was all over.

The car was drivable and seemed fine, but I noticed a light out, and a similar error code showed up in less than 24 hours. My calls to the service department went largely addressed. I was given the run around. The front line employees apologized but could do nothing to help. The manager was always unavailable. So, how do you think I feel about that repair shop? What do you think my next interaction with them will be like? A simple "make it right" repair will not be sufficient anymore.

As a laboratory, what do you do when a patient does not receive the service or treatment he/she expects? Many organizations now have Service Recovery policies or even entire programs dedicated to service excellence. Whatever such programs look like, there are a few principles that apply universally-whether dealing with a disgruntled patient or a dissatisfied customer like myself.

Acknowledge responsibility. It's important to acknowledge that you screwed up and that the customer is
justified in feeling angry and in expecting more than they received. This step is not about blaming a specific employee or promising the customer that a certain person will be disciplined or terminated. It's accepting responsibility as an organization that has delivered sub-par quality.

Apologize.  It's human nature that a simple apology very often diffuses tension. Studies have shown that even in malpractice suits, patients and their families are more likely to settle and go easy on organizations that actually
apologize early on. An apology means simply, "We are sorry we did not meet your expectations."

Correct the problem. As much as possible, do the thing right this time around. Some errors cannot be undone. It's impossible to un-ring a bell. But you can still recover somehow by doing something right. Move towards a solution in some way and don't make excuses for the initial poor service.

It sometimes takes the customer or patient to tell you what they consider reasonable "compensation." It is not always what YOU think. One rule of thumb is that recovery almost always involves added value. If you screwed up, merely doing it right the second time, might not be sufficient to compensate for the "hassle factor."

Another rule of thumb: do not make it difficult for the customer to take advantage of whatever it is you are offering. Owning the problem suggests that you do not compound the customer's inconvenience.

Empower front line staff to act. When a patient or customer has been wronged it does not help (in fact it
might be aggravating) if front line staff has to go up several layers of management to start the recovery process. They should apologize as representatives of the organization and must be empowered to at least start the recovery

If the process is complex, non-routine, or requires authorization from a higher up, front line staff should facilitate that
interaction. They should be empowered to contact management  or a decision-maker and make that meeting/call/interaction as expeditiously and seamlessly as possible.

Perception is everything so if a patient feels that they have not been well served, even clinical outcomes are secondary. They don't care about your  QC and your trends or even your clinical competence. During human interactions, problems are a given, but it is always possible to recover if you just follow a few principles.

Make a Good First Impression: Lessons from Your Favorite Commercial
September 8, 2013 2:44 PM by Glen McDaniel

In the last blog we discussed the importance of making a good favorable impression on a prospective employer;
and  how to tailor your resume to deliver that oomph factor.  Once you have passed that first test and scored an interview, there is another hurdle: how to make  a good impression while facing the decision-makers.

Malcolm Gladwell in his best-selling book, Blink, touches on a decision-making technique used by many people, sometimes unconsciously. He talks about "thin-slicing," or "the ability of our unconscious to find patterns in situations and behavior based on very narrow slices of experience." He explains how too much information can cloud an individual's ability to accurately analyze a situation, and how "in good decision making, frugality matters."  

Decision makers often just look for clues or familiar patterns to arrive at decisions. One small fact can be used to
extrapolate a much more nuanced conclusion. Inundated with information, many of us use thin-slicing as a heuristic or shortcut to arrive at daily decisions. Gladwell writes that we all do it-and in many cases it serves us well. 

Although you never get a second chance to make a first impression, you do get many chances to make the next impression. So the resume is one opportunity to make a good impression, while the interview is another. In both cases, decisions affecting your future can be influenced by some very simple deliberate acts on your part.

Research done at Harvard University suggests that the most successful Superbowl commercials use certain techniques over and over. These commercials strike a chord precisely because of those "secret" hidden elements.
Writer and business consultant Ron Ashkenas, uses Gladwell's thin-slicing as a thesis, and suggests analyzing your favorite Superbowl commercial and incorporating certain simple, but effective, elements from those commercials into your interaction.

Capture your audience's attention. Most commercials "grab" by using emotion, humor or even esthetics. If you don't capture the interviewer's attention within the first five minutes, they have already formed a less than favorable impression which is hard to dispel. So everything from your dress, hair, energy level and eye contact matter more than you probably think.

Convey a clear message. Good commercials have a central theme. They rarely offer more than one message.
Your goal should be to convey your brand very quickly. Answer very early one, something that's in the back of the prospective employer's mind, "Who are you, and why should I hire you?" When you leave, you want this answer  to linger in the mind of the prospective employer. You might even want to restate this premise as you shake
hands before exiting the room.

Focus on differentiation. Differentiation is more than a marketing term. It essentially means how is this product/service different than every other product/service/company? So, you are certified MLS, like all the others who have been called for an interview. You may have comparable experience and familiarity with the equipment. But is there something that gives you the edge?

The thing about differentiation is that it's the seller (in this case, you the job seeker) who has the responsibility  to point out differentiation. You may be qualified, but what makes you extra valuable? What value do you bring to the table? Given two finalists, what gives you the edge?

Ashkenas suggests you can  use these techniques in  just 30 seconds of interaction. Gladwell says most decision makers including employers routinely use thin slicing. I suggest that you incorporate this knowledge into your interactions to create a good first impression and to give yourself the competitive edge.


How to Create a Great First Impression
August 25, 2013 2:54 PM by Glen McDaniel

One reality we have come to recognize is that most people evaluate you, and react to you in a certain way, because of
their impression of you; not necessarily the reality of who you really are or what you can do. The first impression is especially important and you only have one opportunity to make a first impression- for an audience, during a job interview, in a meeting or coaching session with your boss.

Many new grads are looking for jobs right now, and others are looking to change careers or jobs. Even seasoned
professionals are often not experts on writing resumes and interviewing. Since the resume is often your first contact with a prospective employer, it is important that it represents you well; that it creates a good first impression.

There are lots of resources available on how to write a resume. But there are some not so obvious "secrets" that
increase your chances of being selected for an interview. First, employers spend very little time reading interviews. They either "scan" manually or use electronic scanners to select a small select few to be interviewed.

How long do you think employers spend on reading an interview? A recent study indicated that employers report that
they spend an average of four to five minutes on each interview. Some might think that's not a very long time. But using "eye tracking - a technologically advanced assessment of eye movement that records and analyzes where and how long a person focuses when digesting information-shows they actuallyspend only about 6 seconds actually reading a resume.

What are the reviewers looking for? There a few critical elements.

 Critical Elements:

The recruiters spent 80% of this limited time on six key pieces of information:


-Current title/company

-Previous title/company

-Previous position start and end dates

-Current position start and end dates


Beyond those six items the recruiters in the study scanned for keywords to match the position they were seeking to fill.

It is still a great idea to write a simple 1-2 page resume with bolded titles, lots of white space, and easy to read bullets. Customize each submitted resume to include keywords mentioned in the job. For each job/title concentrate on proven abilities and accomplishments over job responsibilities.

In the next blog, I will discussother proven ways to make a good first impression.

Towards Independent Practice
August 3, 2013 9:31 PM by Glen McDaniel

Over the years, I have served on many hospital committees including the Pharmacy, Nutrition and Therapeutics (PNT) Committee. This committee is usually chaired by a physician and has tremendous input from an infectious disease (ID) specialist, microbiologist, pharmacist and registered dietitian.

The laboratory has always acted as an ancillary department; providing information, but creating little if any policy. I worked with organizations in recent years in which almost the entire formulary was driven by pharmacy. Sure, physicians had input, but the protocol relating to choices of medication, storage and security of medication in the facility have been set up by pharmacy.

Georgia, like several other states, has had a problem with abuse of narcotics, including the acquisition of drugs through the use of forged prescriptions. It was the state Board of Pharmacy that spearheaded a move to make the prescription process more secure.  They drove legislation requiring among other measures that prescriptions for all Schedule II narcotics have to be written on the state board of pharmacy approved paper.

Pharmacists announced they reserved the right to reject any prescriptions not meeting those guidelines- or that were otherwise suspicious in nature.

Can you imagine the laboratory taking such a bold move by developing protocol and dictating standards for physicians to follow; albeit to protect patient safety?

Thinking about this difference in perception of- and expectation from- pharmacy and MLS led me to read again the ASCLS statement on the independent practice of medical laboratory professionals.

It reads, in part:

"It is the position of the American Society for Clinical laboratory Science (ASCLS) that clinical laboratory
testing is the  defined practice of qualified medical laboratory professionals and encompass the design, performance, evaluation, reporting, interpreting and clinical correlation of clinical laboratory
testing, and the management of all aspects of these services."

It goes to say that medical lab professionals have the requisite knowledge and skill to perform, correlate, interpret laboratory tests and (with appropriate graduate degrees) direct clinical laboratories.

Functions are firmly grounded in applicable state law and  CLIA regulations, according to the document.

Independent practice does not preclude collaboration with others on the health care team. But the profession does have a unique body of knowledge and scope of practice. "Artificial and arbitrary barriers to (independent) practice should not be erected," states the position paper.

Maybe it's time for us as a profession to test those largely unchallenged barriers.

Importance of Effective Onboarding
July 21, 2013 2:21 PM by Glen McDaniel

A few years ago I was part of a team appointed by a national hospital company to study and make recommendations for staff retention. The organization had a horrendous record for turnover; in fact in some key areas like nursing assistants the turnover rate was 40 percent!

Such a high rate was untenable because of its cost to the organization, but also because it directly affected patient experience (customer satisfaction), team coherence and clinical competence. There were always new staff members learning processes, procedures and trying to blend in. Current staff members were resentful of, and tired from, constantly orienting new staff, only to see them leave.

Our first charge as a team was to find out why staff were leaving at such a high rate. Surprising to many of us, the main reason was not low pay, lack of resources or even poor management. While those figured into the
equation, the one message across 60 plus facilities all over the country was that employees were leaving because they felt let down by the orientation process. They felt they were misled; somewhat like being conned by false advertising. Many felt that they were turned loose and expected to function before they felt

Onboarding is the first step in orientation. It consists of a series of steps aimed at integrating new employees into the organization. Although we did not study laboratorians as a separate group, the lessons learned can be applied to any professional group-and was successfully adopted in the organization.

First day orientation was revamped to be more of a "welcome to the family." We removed many of the heavier paper heavy topics and just initiated a conversation, introduced key members of the organizations and
answered questions of concern raised by the employee.

We also made the conscious choice to have employees guide their departmental and technical orientation.  Different employees have different needs. While we still had a structure and guideline about what should be covered and for how long, we would meet with employees regularly and seek feedback about progress, areas of concern and their comfort level.

Each employee was assigned a (trained) mentor-buddy whose role was to answer peer questions and facilitate movement through the department and organization. Questions could be as simple as parking, location of the cafeteria, who to contact in HR about a problem and who was the technical expert in the laboratory regarding a particular topic.

For two years we sought feedback from employees who stayed and did exit interviews on those who left. We asked what worked and what didn't. One big lesson learned was that the organizational culture was learned best by example and not by mission and vision statements delivered from on high at orientation, or hung on a wall.

Over 2 years the turnover rate for that organization dropped to 11 percent and employee satisfaction rose to the 95th percentile nationally. 

Turnover has tremendous costs to an organization (financially and morale-wise). In my experience, effective onboarding is one proven way to both reduce turnover and improve employee and patient satisfaction in a relatively short time. It's definitely worth the investment and returns a huge return on investment.

Job Hunting on LinkedIn
July 13, 2013 4:12 PM by Glen McDaniel

Most people realize that many job searches are conducted on the Internet. While most jobs are still obtained through personal networking, it is the odd job which is acquired through a cold call or a serendipitous find in a magazine, journal or newspaper.

One site that is a treasure trove of information and is very underused by the typical medical laboratorian is Linked In. Many see it as just a social media site (it is so much more) or a site used only by the most senior executive types (it is not!).

It is a site to connect and network with old friends and colleagues, develop new networks, join professional groups of like-minded individuals and those in the same profession. Of course, you can also use the Job Search tool to search for jobs, applying filters to narrow jobs based on specialty and location.

Richard Yadon, President and CEO of MMS Group has some very useful tips on how to maximize the use of Linkedin in your job search. 

Update your profile.

First create a profile that is accurate and current. Do not lie or embellish because that could come back to bite you. Keep your profile current so that if someone happens to stumble on your profile it represents your most recent experience and the type of opportunities you might be looking for. I suggest you go back just 10 years, unless experience before that time shows diversity and highlights significant achievements that make you more attractive and marketable.

Create references for colleagues.

Peers and bosses, past and present, will appreciate your references of them and their work. This can be brief but give a sense of their value, style and interpersonal skills.


Ask for references.

If you offer references willingly, sometimes without even being asked, those individuals are very likely more than happy to return the favor/ that way you have public accolades associate with your profile. Those references as well as endorsements of your skills can be seen by a desired prospective employer; or even someone just trolling the site. Never underestimate the possibility of being "discovered."


Join and participate in groups.

Look for groups of fellow professionals. Seek out industry (medical lab science for example) groups, including subspecialties. Join those groups and visit them often. If someone starts a threaded discussion, jump in and offer a professional opinion. Craft the response as a professional with valuable experience and something to offer.

Too often we use social networks simply as places to check in periodically and scope out who is there and what's going on. But they offer much more, including viable networking and job hunting options. Make an effort to visit site like LinkedIn often. You don't have to spend hours online, but visit, read threads, participate, expand your network and search for jobs in your area of interest, desired geographical area, or at your dream company





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