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Press Start: Lead an Empowered Life as a Clinical Laboratorian

What Message are You Sending?
June 21, 2014 3:33 PM by Glen McDaniel
 

In business school my marketing professor was fond of saying, “Marketing is everything.” It was tempting to see this view as the opinion of an overzealous marketer who was trying to convince students of the need to create complex and obtuse business/marketing plans.  But as I continued the course, and long after graduation I realized that to a degree he was right. Marketing is used in several aspects of our lives.

 

Look at the news: some politician with whom we disagree or who appears to be unpopular sweeps the race with a landslide victory.  Companies create a brand that we instantly recognize through a slogan or even a diagram (think of the Golden Arches or the logo of an apple with a bite taken out of it). Celebrities who do something obnoxious or spout off in a politically incorrect way often hire high-priced fixers to rehabilitate their image. That is all marketing. Marketing can be used for or against your cause and is often based on the strength of the marketing campaign rather than on any objective measure of accuracy or reality.

 

What does this have to do with medical laboratory science? Well, I think as a profession we too often pitch and perpetuate a negative marketing campaign against ourselves.  When an “old-timer” tells an enthusiastic new graduate or intern how horrible this profession is, that’s marketing. If someone who has been around for years states that, given a choice, they would have chosen another profession, advises the graduate to pursue another vocation and keeps up a mantra of how burnt out they are, what effect do you think that is having both on the youngster and on other’s perception of our profession?

 

Very often outside the lab, administrators and other members of the healthcare team refer to us in inaccurate ways. They might call us “technicians,” mischaracterize the work we do, minimize our value or even re-state some negative association. We do not have to agree with them; but if we let it slide, we are engaging in a negative marketing campaign against ourselves.

 

Many observers think everyone in a white coat is a “lab technician” with equal expertise and scope of practice, the lab is always losing specimens, every delay in the ED is due to waiting for lab results, and doctors send specimens to a black hole where machines automatically regurgitate results-with no input from a thinking human being. How many times have we heard this line of thinking and sat silently by while it is repeated ad nauseum?

 

Professionals in healthcare are called by their names: nurses, doctors, physical therapists, pharmacists. But we are generically “the lab”, a room in the basement. Until recently our week in April was called “Lab Week” with no mention of the professionals who actually practice the profession. I never use the misleading term, Lab Week, for that very reason.

 

When someone talks about a great hospital experience in my presence or on my Facebook page and thanks all the doctors and nurses, I jokingly say, "Thank all the medical laboratory scientists providing the information used to diagnose and treat the patient. And, thanks to the doctors, nurses and others as well.” I am only partially joking when I reframe the statement; I am practicing deliberate marketing that makes people think a little.

 

Sometimes my smart-alecky comment elicits dead silence, sometimes a chuckle, but very often it starts a conversation where I can educate-and yes, market, our profession. We are all marketers, broadcasting a message. Choose your message wisely.

1 comments »     
Managing Cross-Disciplinary Teams is a Required Skill
May 31, 2014 8:43 PM by Glen McDaniel

 

Those of us in healthcare have worked in silos for so long it has become the norm. In fact we justify it by saying due to the complexity of our body of knowledge, others just will not understand. Physically and psychologically we are more comfortable sharing space and projects with colleagues who are like us.

 

Ideas are shared but usually within the group. Even high quality outcomes tend to have just the perspective of our peers as opposed to any other stakeholders on the outside. We serve on teams and committees, but that’s not fully cross-disciplinary because we tend to come together, give input, accept or reject ideas and then move apart to continue life as usual.

 

It is becoming popular to learn how to cope with inter-generational teams as the workplace changes. It is common to have two or three generations of workers side by side in the same department. But again, that is not inter-disciplinary.

 

In recent interactions with clients and colleagues I have seen the following odd bedfellows, if you will:

-A radiological technologist in charge of the laboratory (in a non-licensure state)

-Point of Care duties shared by a nurse coordinator and an MLS analyst

-A pathologist who is Director of Diagnostics (with the medical laboratory, imaging and sports medicine reporting to him)

-A pharmacist substituting for a pathologist for coagulation consults for laboratory testing

 

In the above situations, laboratorians are forced (“made to”  as opposed to “coerced”) to interact with nonlaboratorians in a significant and ongoing way. This is new territory.

 

Cross-disciplinary work teams are being increasingly created out of the necessity for leaner staffing, need for increased productivity and efficiency.

 

Mark Lanfear, a global practice leader at KellyServices, a company that specializes in providing workplace solutions, believes successful interdisciplinary teamwork always begins with a committed manager.

 

His prescription

-Managers must make the commitment and deliberate effort to start thinking in a more interdisciplinary fashion. They must consider various options and direct the team to think of a “common front.” What is the desired outcome? What do all the stakeholders have in common? What perspectives do they want to consider/include in the project?

-The manager must explicitly communicate the cross-disciplinary nature of the project and the interconnectedness of all team members. There are no winners or losers or head honchos based on the silos they previously occupied

-Make it clear that in the same way that communication and working together strengthen the outcome, failure to fully engage will hurt the outcome.

 

This cross-pollination might be a new, even uncomfortable method of relating. However as laboratorians we will find that this is an increasingly common, efficient and beneficial way of working.

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Why License Tour Guides but not Laboratorians?
May 11, 2014 1:24 PM by Glen McDaniel
 

A recent article in the Economist made me chuckle. It covers in a deliberately humorous way, the story that tour guides in Washington, DC must be licensed, or face stiff fines.

 

The idea is that a certain body of knowledge is needed and the public can be fleeced or shortchanged if everyone and their uncle start offering tours of the city to gullible, fee-paying tourists.  If you think about it, tour guides probably need to be trained, there might even be a good reason for some standardization of facts. But how detrimental could it be if a guide does not seek the extra training required and pay the government a fee to be licensed?

 

The reality is that many careers (which cannot even realistically be called professions) are required to be licensed. Generally,  licensure is required to protect the public in some way. For many professions it is important that there be a demonstrated minimum level of knowledge and that service is delivered according to guidelines. Why doesn’t medical laboratory lab science fall into such an important category?

 

Can you think of a situation in which an untrained-or undertrained- individual could provide incorrect results that could affect patient care? What about providing blood and blood products? Why does the government not have a vested interest in protecting the public health un such areas?

 

The Economist article continues, “In the 1950s only one American worker in 20 needed a permit from the government; today that figure is around one in three. Some jobs, such as doctors, clearly need strict controls. But some states require licenses for florists and interior designers.”

 

They could have added barbers, masseuses, cosmetologists, realtors, electricians, nail technicians and a host of others. In fact, I could go on and on with that list. What is ironic is that medical laboratory science is missing from the long list. There are still, in 2014, only a small handful of states (and US possessions) that license laboratorians.

   

The distraction often used by opponents of personnel licensure is that of the constantly increasing cost of running government. I have suggested in the past, and still believe, that states can minimize the administrative costs of licensure by using reciprocity (as nurses, attorneys and many other professions do). If you have a “clean” license in one state you will be accepted by another state without too many hassles. Instead of developing and controlling their own exams, states can accept recent national certification in lieu of a state exam, except in those very unusual areas where the state requires some narrow body of knowledge.  Once a data base is set up, a clerk reporting to a volunteer Board of Licensure can monitor licensure as just a part of his/her job. Cost can be minimal.

 

Continuing education can be mandated, including issues that relate to state law or healthcare issues that the state feels are especially important.

 

None of us wants to pay any more fees than we have to. But what if for a nominal sum you would be licensed, ensuring job protection from unqualified competitors and protecting the public health at the same time? I fear that the protest against paying a small licensure fee has made the fight for licensure more difficult and has unwittingly increased competition for jobs and artificially depressed wages. If an employer can legally take all comers, that diminishes the value of certified professionals. Sometimes we really can be our own worst enemies.

 

Is it really more important to license the guy who points out the Washington monument to a group of tourists than it is to license those individuals who use critical thinking and independent judgment to provide over 70 percent of information used to make medical decisions?

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In Celebration of Medical Laboratory Professionals Week
April 19, 2014 2:16 PM by Glen McDaniel
 

So, it’s that time of year again. This week we turn our attention to celebrating medical laboratorians.  It is the one week out of the year when we highlight the very important role played by those of us who practice in the laboratory.  Although the information we provide is so vital to healthcare, we are largely invisible. Arguably we provide the majority of the concrete data used in the diagnosis, treatment and monitoring of diseases. By the nature of our work and the technology used, we increasingly also help to rule out illnesses and advance wellness.

 

Each year I have written an article, a blog or two, and participated locally in the celebration of “our week.” Although some of my professional career has been spent outside of the laboratory, I always return to my roots and try to join in the celebration whenever I can.

 

Most of you work long hours, tirelessly, outside the attention and consciousness of the patient, day in and day out. With such little public recognition, I am all in favor of a week of celebration. In recent years, however, I have argued against turning inwards as the only means of celebrating. Mutual pats on the shoulder, wearing t-shirts, hosting baby-picture contests and attending lunches thrown by vendors are great. However, I also advocate aggressively promoting the profession so that others-doctors, nurses, other health professionals, administrators and patients-see who we are, how we think and what we do.

 

Teaching others starts with knowing our own history. For example, how about having a contest in your lab to see how many of your colleagues know the following facts:

 

-There are approximately 300,000 medical laboratory professionals in the USA

-Medical laboratory science emerged as a discrete profession around the 1920’s

-In 1975 a week of celebration, originally called National Medical Laboratory Week (NMLW), was initiated by the ASCLS, which back then was named ASMT. Over the years, other laboratory organizations have joined in cosponsoring the week

-In 2005 the organizers of the week changed the name to National Medical Laboratory Professionals Week; adding the “P” to emphasize the role of the professional, the individual. We are more than a room in the basement; after all, we are a profession.

-Each year, a different slogan was chosen to highlight the week. However, in 2010 a permanent theme was chosen: Laboratory Professionals Get Results. This is very catchy and creates a brand that we can all remember, relate to, and use all year long.

-The week is often called “Lab Week” for brevity and because the official name has changed so much. However that casual term probably perpetuates ignorance of the real name and helps to minimize the role of the professional.

-In 2012 the organizers removed the “N” (National) from the name which had been pretty unwieldy, you have to admit. So the current, correct name is Medical Laboratory Professionals Week (MLPW)

 

This week, celebrate, enjoy yourselves. But whenever possible, use the opportunity to introduce yourself and your profession to those who benefit from your dedication and talent, but know little about you and your skills.

 

Enjoy. Have Fun. Thank you for all you do, and Happy Medical Laboratory Professionals Week (MLPW) to you.

 

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Answering Your Questions About Patients' Direct Access to Lab Results
April 5, 2014 11:48 AM by Glen McDaniel
 

Since my blog last month regarding to the HHS mandate that laboratories must grant patients access to their lab results on request, my mailbox has been inundated with comments and questions. A few questions were asked by more than one writer and so I thought I would seek direct guidance from HHS and answer the most commonly asked questions here.

 

Doesn’t this new requirement reverse HIPAA?

 

No, both CLIA and HIPAA regulations have been adjusted to accommodate these requirements. HIPAA privacy rules had always sought to protect how patient information was secured and protected, and  specify under what conditions such information could be disclosed.  In the final rule published by HHS in February, some restrictions were removed from both HIPAA privacy rules and CLIA regulations.

 

This is a very specific requirement and does not negate, reverse or cancel HIPAA. Maintaining the security and confidentiality of patient results are still very much in effect.

 

Labs will still need to verify the patient's identity before releasing results. In cases where results are requested by a patient’s “personal representative,” the lab must verify both the identity and authority of the patient’s legal designee.

 

Is there no concern for how much this will cost labs?

 

I am not sure about concern from the federal government, but CMS does estimate that about 23,000 labs will be affected. It recognizes that processes, infrastructure and equipment might all have to change. The agency estimates that labs will receive between 175,000 and 3.5 million patient requests annually and the cost of compliance might be as high as $59 million. Labs will be permitted to charge each patient  a reasonable fee for each request.

 

Will this apply to all labs including reference labs?

 

Good question. I suspect the reasoning for this question is that patients do not generally have a direct relationship with reference labs. For most reference labs the client is a referring entity like a hospital, physician etc.

 

CMS says the rule should be applied uniformly and applies to all laboratories. Their goal is to make it easier to access results, wherever tests are performed, so reference labs will not be exempt.

 

What about those states that prohibit release of results directly to patients?

 

As I alluded to in my earlier post, this rule supersedes state law restricting the release of results. About 13 states have some specific restriction on releasing results to patients directly. This rule voids that prohibition and labs must now release results to patients regardless of previous prohibition by state law.

 

Doesn’t this place a legal burden on laboratories being asked to explain test results?

 

The requirement is to provide the result to the patient within 30 days of receiving a request from the patient. The mandate is not to interpret the result or to explain the clinical significance to the patient. In many cases, the patient will have already discussed the result with their physician by the time the lab receives a request. Sometimes the patient just needs a valid copy for their records or to seek a second opinion.

 

Physician groups like the American Medical Association have opposed this rule on the basis that patients are not prepared to interpret their result and having free access without a doctor’s help might actually be more harmful than helpful.

 

HHS responded that this is based on the philosophy that the patient owns his or her own results, and the benefits of direct access far outweigh any theoretical risk. HHS also points out that the rule does not diminish the role of the provider in interpreting and explaining lab results to patients. Diagnoses and treatment will still be based on the full picture, not just a few lab results.

 

It is interesting to note that several studies have shown that providers fail to notify patients of abnormal results about 7 percent of the time. Some estimates are even higher.

 

 Direct access to one’s own results is designed to empower the patient, not to burden labs and not to minimize the role of physicians.

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There is a Great Need for More Useful MLS Research
March 29, 2014 5:45 PM by Glen McDaniel
 

I love science! I always have and I always will. So when I asked recently to be a judge at a science fair at a local college, I immediately jumped at the request.  I was really impressed with the quality of the projects and the soundness of the research, the hypotheses proposed, and the findings.

 

There were no MLS students, but  other healthcare professions were represented. I noticed that most of the cool toys were developed by the computer (IT), engineering and robotics students. I also took note that pre-pharmacy, dietetics  and nursing students  had quite a few papers and posters about the value of their profession to healthcare. Nursing especially had several research projects on nursing skills, nursing practice, expanding scope of practice, value of nursing diagnoses and ideal nurse-staffing standards. There were also several examples of joint student-faculty collaboration.

 

The goal is to have much of the research published in print and electronic journals. The students will receive not just academic credit but valuable exposure and the pride of adding to the body of knowledge of their respective professions. I thought that, given the quality of work I observed, there will be no scarcity of good data which will prove useful (and usable) for their respective professions.

 

A few years ago when I worked on a staffing taskforce for a national healthcare company, we had a tons on research on nurse-patient ratios, patient outcomes based on nursing skill mix and the like.  But we could find nothing except old CAP workload units and generic productivity data for the laboratory. Consequently, nursing staffing was increased based on lobbying and the use of published data, while staffing in several other areas including the laboratory was cut back. Instead across the company they were asked to cross train and work flex hours (including partial shifts) to reduce labor costs. Supervisors were expected to take on more bench work. 

 

We need more MLS research. I don’t mean just academic PhD-level type studies, but we need more useful (and usable) data on appropriate skills mix for the laboratory, the most effective MLS ratio to patient census or MLS/test volume ratios. We should be able to even correlate some outcomes (length of stay, discharge from ICU) to the volume and type of laboratory testing done.

 

This will not happen overnight. However, as I look at what other professions are doing I realize we do not have the same amount of direct, robust research available that would bolster our requests for adequate staffing or inclusion as vital members of the healthcare team. As a simple example: how do you measure productivity? How do you decide your benchmark? What evidence do you have that a particular benchmark is relevant?  

 

 Without specific targeted MLS-specific research we are likely to be considered “ancillaries” and allocated staffing and other resources based not on hard data, but on financial considerations, regardless of effect on patient care.

3 comments »     
HHS Publishes Final Rule on Patient Access to Their Lab results
March 16, 2014 1:21 AM by Glen McDaniel

Health and Human Services (HHS) has issued a final rule that requires laboratories to give patients access to their lab results. A few years ago Health and Human Services Secretary Kathleen Sebelius reaffirmed the Obama Administration commitment to patient-centered care.

 

A part of that initiative, she indicated, had to include a re-assessment of the whole idea of who owns the patient’s information. 

 

We had always believed that the patient could have access to their medical records, but even in that context, providers maintained that certain notes could still be withheld  from the patient as not a material or essential part of the record.  HIPAA (the Health Insurance Portability and Accountability Act of 1996) laid out very specific restrictions on the handling, storage, protection, and sharing or disclosing of patient information. In addition many states severely restricted the release of laboratory results. In most states, lab results can only be released to the ordering provider with very few exceptions.

 

This new final rule by HHS says that patients own their results and have the right to receive access to their lab results. In other words, laboratories must establish a clear process for providing patients with their results if and when patients request such results.

 

Both CLIA’88 and HIPAA had to be amended to allow this expanded access. Patients may still continue to receive results from their provider, of course. But under the new mandate, laboratories must give requested results (including an electronic copy) to the patient and/or the patient’s designated representative. Requested results must be provided within 30 days.

 

The Final Rule goes into effect April 5, with all covered entities mandated to comply by October 2 of this year.

 

The final rule is available at www.federalregister.gov

 

How will your lab comply with this new mandate?

3 comments »     
Glucose or HbA1c..Who you Gonna Call?
March 1, 2014 1:28 PM by Glen McDaniel
 

I have the most instructive conversations with physicians and others outside of our profession. Some day I would like to write a book of such conversations and recommend its use as a discussion point for medical laboratory students. My friend the endocrinologist was gushing to me about how wonderful HbA1c is. “I no longer order glucoses,” she said.

 

Her logic was that glycosylated hemoglobin gives her a more accurate, realistic, long term view of the patient’s glucose management. The patient does not have to be fasting and she finds that she can “bust” patients who watch their diet meticulously a few days before their visit, hoping she will see what she calls “a good number” suggestive of better glucose management than really does exist.

 

She wanted to know why “the lab” has not developed point of care HbA1c instruments for use in clinics and medical offices. Why can’t she have that result when the patient is in the office? I was explaining the state of the art technology available when a pathologist joined us.

 

The endocrinologist recapped the discussion  for the pathologist who immediately furrowed his brow and declared that a glucose is still far superior to a HbA1c. Results from different labs and even from different visits at the same laboratory are not comparable, he said. HbA1c should ideally be used a few times per year for monitoring patient compliance with their medical regimen.

 

He continued that glucose has ben around for ever, the technology is better and it should always be used as the screen which then triggers a HbA1c. Besides, a physician will only be reimbursed for ordering a HbA1c a couple times a year. I had no way of verifying if that’s true or not, so I did not comment.  But when he launched into a discussion on the relative inaccuracy and imprecision of HbA1c compared to glucose,  and the merits of the oral glucose tolerance test (OGTT) I sort of zoned out to protect my brain.

 

This pathologist was an anatomical pathologist, not a clinical pathologist, which is an issue for an entirely different discussion. But the conversation and how it progressed got me thinking about several things.

 

-Clinicians like this endocrinologist are very eager to discuss the use and relative merits of laboratory tests with the experts-whether those are MLSs, pathologists, pharmacists or vendors pushing the newest black box.

- Are pathologists, especially anatomical pathologists, really the right individuals to represent the clinical laboratory as experts on what we do?

-Some research after our talk indicated that fasting glucose variation can run around  8 percent In a single individual day over day, so my pathologist friend was not entirely correct about how accurate/precise glucose determinations are.

-I discovered that the American Diabetes Association (ADA) has been recommending that HbA1c be adopted as an adjunct in the diagnosis of diabetes and prediabetes. Further, agencies like the National Glycohemoglobin Standardization Program (NGSP) has done tremendous work in standardization and controlling coefficient of variation among tests. Consequently, the accuracy and comparability of HbA1c have increased remarkably in recent years.

-Our discussions with clinicians need not be too technical. But we should remind them when they ask about a new test or want a new point of care toy that as scientists we need to look at aspects like ease of performance, specimen requirement, accuracy, clinical utility, and positive or negative correlation with disease or disease risk.  

-People tend to believe us if we speak with authority and have a history of not mis-speaking. 

 

Because of family history and my own personal medical history I have  a vested interest in how my physician uses and interprets glucose and HbA1c, but more importantly, I want medical laboratorians to be informed, to keep current, and to offer sound scientific guidance to clinicians. Nature abhors a vacuum and if we are absent, all sorts of “experts” will jump in, often offering information which is misleading at best.

6 comments »     
As Long as You Don’t Call my Instrument a Machine
February 22, 2014 3:15 PM by Glen McDaniel
 

I had witnessed this situation many times before, but I still paid attention. "It’s an instrument, not a machine, stupid,” the MLS yelled to the entire room  in general, and no one in particular, as she hung up the phone. angrily.  When questioned she explained that a physician had called wanting to know if the “troponin machine” was calibrated because he seemed to be getting high values on his ED patients this evening.

 

Again, I recalled how upset many laboratorians get at the equipment nomenclature. In this case she could have decided to rerun controls, explain the issue might be the patient population: patients presenting with chest pain in the ED, troponin requested on symptomatic patients to make a differential diagnosis . She might also have legitimately explained that of all the troponin tests done that shift only 2 had been elevated. But instead she took umbrage at the terminology  “machine.”

 

A name is certainly important. For example, I resent being called a tech, techinician, technologist or “the lab.” I recoil when laboratorians are mistaken for nurses, or I , as an older male, am presumed to be a doctor.  I do not like being considered a person who pushes buttons and if my “machine” is calibrated, all I have to do is read the number off the screen or a printout. But I do not care if that big hulking piece of metal  which I use to generate results is called Bob, Mary, an instrument or  a machine.

 

To a pilot, their airplane is a machine and instruments are parts of the machine that give information and help to fly the plane. To a surgeon, instruments are the tools of their trade (scalpel, retractors, clamps) while machines (ventilators, monitors) maintain patient function or provide vital information about the patient’s status. To others in healthcare, like respiratory therapists,  the terms machine and instrument are in fact interchangeable. The point is: machines can be very sophisticated contraptions that perform some very vital functions. No other profession I can think of gets as anal and defensive about this innocuous distinction.

 

As a profession our career path is very compressed, there is overlap of scopes of practice between professionals and paraprofessionals, other professions legally co-opt the right to perform laboratory testing. We do not have professional licensure in most states. Our scope of practice is not protected. The public we serve is not aware of our education, value or role in healthcare. Why don’t we expend our energy on changing these anomalies?

 

What do we gain professionally if our tools are addressed respectfully as “instruments”?  Certainly we have bigger fish to fry that getting all bent out of shape because someone outside the profession refers to one of our tools as a machine?

 

 

1 comments »     
Labs Need to Embrace m-Health
February 2, 2014 5:24 PM by Glen McDaniel

We have all got fairly used to the concept of e-healthcare in recent years. It is the odd healthcare organization, laboratory or physician office that depends mostly on paper records anymore. From legibility to patient safety to access to patient information across the continuum of care it makes sense to use computers and the internet rather than paper.

I experienced the seamless use of e-health delivery recently when I went to see a physician who was a member of my HMO. I went to an office that was convenient to where I was  attending a seminar-as opposed to going to see my regular physician. My medical record, including lab results and medication list, was immediately available and my (astute) physician was pretty conversant with my history by the time I saw him in the examination room. I needed a paper prescription and it was printed out on secure counterfeit-free paper and available to me at check out.

A subset of e-health is the area of m-health or mobile healthcare. Just about every business has an app (application) these days that can run on a smartphone operating system platform. Increasingly healthcare is joining the app revolution.  A study by PricewaterhouseCoopers, LLP predict that globally m-health will be a $23 billion market by the year 2017, of which the US will account for about 28 percent.

 

I had the option of getting my detailed discharge instructions printed in the office or emailed to me along with a copy of the receipt for my co-pay. I chose email, instead of detailing with reams of paper with the risk of misplacing them; or having the formation end up in the wrong hands.

 

Providing as much vital information as it does the clinical laboratory must start looking at the adoption of m-health sooner than later. Possible uses include

  • Ability to email a provider directly

  • Receiving lab results by text or email. At a minimum, patients and providers should have the option of being advised that results are ready; and then being able to access a secure portal where the actual result is viewable

  • Being able to easily track, trend  and graph lab results over time

  • Accessing results of lab tests done outside the traditional system (such as while traveling) and therefore not otherwise available to the regular provider

  • Storing scannable patient identification: medical record number, unique identifiers

  • Being able to make and confirm appointments with a provider or the outpatient laboratory through text or email

  • Increased health literacy by accessing information about use and/or interpretation of lab results individualized by patient

     

    To be sure there will be issues of security and confidentiality. Systems must have inter-operability without a significant risk of leaks. Sensitive information has to be restricted and accessible only to those who have a genuine “need to know.” But these requirements can be met; in fact more confidently than with paper records and through telephone calls.

     

    First we had voice and paper, then e-health and now m-health. For the laboratory with its masses of vital time-sensitive data, the opportunities are both positive and endless.

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Never Discount the Power of One
January 26, 2014 2:28 PM by Glen McDaniel
 

We seem to have lots to complain about in this profession: low pay, lack of recognition, a flat career ladder and encroachment on our scope of practice for starters. Next to pointing out our ills the runner up theme is the mantra things will not improve until “they” fix it. Who are they?

 

Depending on whom you ask, the real influential people who can make a difference are professional organizations, employers, pathologists, regulatory agencies and, possibly, the government. Maybe if we formed a group or put together a petition, then we could influence the real powerbrokers. Notice it is never, “What can I do?”

 

The proof that one person can in fact make a difference has been driven home to us over the years. The road of history is paved with examples of heroic individuals who made a difference. Even if they eventually influenced a large group, they often started alone with an idea or belief and then ventured forth while it was still unpopular. One person can indeed make a difference.

 

This idea of the Power of One was demonstrated to me recently. The two-man bobsled Jamaican team qualified to participate in the Winter Olympic Games in Sochi, Russia.

 

 How someone in a tiny tropical island conceived of creating a team capable of competing against world class athletes in a winter sport is a miracle in itself. In any event the team found itself so strapped for cash that there was the real possibility they would not be able to make it to the gamesThen one sports fan in Washington, DC decided to use the magic of social media and start a fundraising campaign on the crowdfunding site Crowdtilt.

 

The news quickly went viral being shared by thousands on social media and covered by major news organizations worldwide.

 

Cash started rolling in and within a couple of days the campaign had netted almost $130, 000. I emailed both the fan who started the campaign and the CEO of Crowdtilt  and they both said they were blown away by the response. All they had going in was a passion for the cause and a belief that they should do something, rather than waiting for others.

 

Think for a minute; what were the odds of success without a big corporation or government (“they”) stepping in and helping? The existence of the bobsled team, their qualifying for the Olympics, one individual starting a fundraiser, the creation of  crowdfunding sites like Crowdtilt; all speak to the Power of One.

 

Success is always great, but it is instructive to remember that many times the most phenomenal feats have been achieved not through a large group of others, but simply by each one of us doing something to start the ball rolling. We all can influence, even  if not totally transform, simply by harnessing the Power of One.

2 comments »     
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?

 

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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.

 

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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.

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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.

 

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