Healthcare providers are familiar with superiors or physicians sometimes demanding that providers act in a manner against the provider's better judgment, scope of practice or established policy and procedure "because!"

Recently, I  was privy to 3 separate instances in which laboratorians were "ordered" to act simply for the convenience of someone in authority. An ED physician insisted that electrolytes be performed on an EDTA specimen because the nurse lost venous access to a hard to stick patient and after several attempts they could collect only a CBC specimen. All entreaties and explanations from the technologist and laboratory supervisor- that the anticoagulant contained significant amounts of potassium -went unheeded. The physician essentially said "I am the physician, do as I order and I will evaluate the results as I see fit."

The second instance involved a nephrologist insisting that "all creatinine clearances from your lab are useless" because his manual calculation differed from the one on the laboratory report. It's true the lab did not correct for the patient's body surface area, but the explanation of typically reporting clearances based on a "normal" BSA just drew more ridicule and expletives from the doctor.

The last instance was of a director who had acquiesced to a cardiologist's demand to adopt reference intervals and diagnostic cut points from another local hospital lab that the cardiologist admired. The director pressured the lab, despite ethical, regulatory and scientific concerns. One wonders why a physician would want to substitute a laboratory interpretive report (based on faulty science) for clinical judgment. And why would that dangerous precedent not be evident to the director?

Our reputation, value and perception -as true educated professionals with critical thinking skills and independent judgment -are compromised every time a laboratorian acquiesces to an order "just because."

I would love to hear from readers about examples of similar demands, your response and your view on this entire matter.

For years the Joint Commission has been the accreditor of hospitals including all its departments (including laboratories). Although many are not aware of it, even hospital laboratories accredited by CAP (College of American Pathologists) are also reviewed when their hospital is accredited. To many the review is transparent because Joint Commission has chosen to accept CAP accreditation of the lab; rather than conduct its own accreditation all over again. But it could if it chose to!

Joint Commission has gone through various iterations and has been know as the JCAOH (hospitals) then JCAHO (healthcare organizations), Jayco and now simply "Joint Commission." The Joint (as it is also known) has had a love-hate relationship with hospitals as it has changed its focus from education to inspection and back again several times over. Hospitals have often viewed their relationship with Joint Commission as "paying to get beaten up."

Now finally, there is a new game in town. A new company called DNV Healthcare Inc. is the first new accreditation agency in over 40 years. DNV (Det Norske Veritas) integrates ISO 9001 quality standards with Medicare's Conditions of Participation, so hospitals choosing DNV accreditation will continue a seamless relationship with Medicare.

DNV will conduct annual visits and touts a collaborative, nonadverserial relationship with hospital customers. They concentrate on outcomes over processes and encourage a variety of approaches as well as adoption of best practices.

It will be interesting to see how much market share DNV captures and -more importantly- whether they gain and maintain maintain popularity and longevity.

In the past 3 weeks I heard from 2 different individuals who I used to supervise a few years ago. They both made me proud by saying I was the best boss they ever had. These are phenomenal women in their own right who both were very easy to manage, in my view because they were very competent, detailed oriented and made my job easier. Also in many ways, they made me look good to my boss!

But I was interested in what qualities make someone a good boss. This Wiki article  says it so well, I could not improve on it.

I agree with everything it says. A boss is really just a position on the organizational chart. A good boss is much more than a manager or someone in charge. Just about anyone can lay down the law or quote policy. But it takes a leader to recognize and draw on the strengths of his employees, support them, trust them, give them credit, empower them and mentor them. Good bosses realize that employees are a not just a resource; but the most valuable asset the organization has.

What do you consider a good boss? A bad boss?

I was listening to a speaker the other day and just about dozed off in boredom. The topic she was discussing was very important and she was making some valid points. But for some reason she tried to impress everyone by overusing jargon and technical terms. She also latched on to the one technical expert in room and traded terms back and forth with him that no one else present understood. Mind you, the presentation was meant to educate and persuade those present. What a totally missed opportunity.

Recently I read a magazine interview with an analyst who had been asked about his forecast for technology spending by a sprawling medical complex in 2009. His reply: "Expect commoditized processes to be optimized and varying instances to be consolidated and standardized on middleware platforms." Words like "optimized," "commoditized," and "standards" are buzzwords that mean nothing to most listeners, but the use of such language does serve a purpose-to elevate a person in his own mind!

Wikipedia says "buzzwords are typically intended to impress one's audience with the pretense of knowledge."

When individuals hear jargon their eyes glaze over, they don't see how the topic affects them personally and they assume the speaker is a showoff.

Imagine trying to promote server virtualization throughout a company by saying, "Server virtualization is the masking of server resources, including the number and identity of individual physical servers, processors, and operating systems, from server users." That's a technically accurate definition but so full of jargon that it is meaningless to most people.

Now imagine if the IT professional told the CEO, "I'd like to show you how we can save money on our energy bills by consolidating our sprawling server farms into fewer pieces of hardware."

 What's the difference? The simple version is easy to understand and clearly answers the question, What's in it for me? (in this case, for the CEO and the company). 

Jargon is not just overused when speaking to those outside the profession. Sometimes those in medicine or clinical lab sciences try to show "breadth of knowledge" by pretending to be experts in other areas like business, technology or computer science. They think they are impressing their peers, when they are just boring them.

Your goal as a speaker should always be to help listeners follow your message, not to impress them with your knowledge; and certainly not to leave them more confused.

Whining is very unattractive! But it is more than just annoying; it's obstructive, kills morale and lowers productivity and team spirit. What can you do other than suffer silently?

There are a few simple strategies you can utilize whether you are a boss or a colleague.

First, look in the mirror.  Is your own conduct encouraging negativity? You can feed negativity by doing your own complaining, being hyper critical or by not addressing legitimate concerns as they are expressed. It doesn't hurt to ask someone else "Do I complain too much?  Am I more negative than positive?" Just be prepared for the answer and use it constructively.

Second, are you enabling the behavior? Generally this is done by lending a listening ear or not calling someone out on their negativity. Employees who gossip or get sucked into destructive discussions (even if they don't initiate the discussion) are enablers.

Third, when confronting the complainer use very specific examples. One of the most common devices used by complainers is to use a broad brush to paint everything from the work environment to the boss to the organization to their peers. Often there is little detail; just a broad set of dis-satisfiers.  Sometimes they even malign others' character or integrity without discussing specific actions.

Since negative people thrive in generalities, it is important when confronting those who complain, or otherwise disrupt the workplace, to use specific examples that they cannot deny.  Say something like "Janice, when you discuss other people's behavior with me over lunch, it makes me very uncomfortable and I feel stressed and uncomfortable. I'd rather not be drawn into such a discussion starting today."

There are various ways of stating the behavior and your decision not to be a collaborator. You can be more direct or not based on the individual and the level of negativity. Most likely they will initially try to deny the effect of their action, but they cannot deny the action itself. If you persist and give concrete examples, in time they will have to concede that every behavior (including their own negative words and actions) has an effect on those around them.

If you are a boss when you discuss specific negative behavior with an employee, then at the same time it is very important to also ask for their commitment and buy in. So you might say "Bob, I have noticed that at the last staff meeting you cut Mary off repeatedly when she tried to give her opinion. You rolled your eyes and sighed when Martha gave her report a few minutes ago as well. I really would like everyone to be treated with respect including allowing them to speak without interruption. Can I count on you to allow others to speak without interrupting or making sounds like sighing?"

Do not discuss his motivation, just his actual behavior and its effect on others. When he says "yes", sign the deal by saying "Thanks, and I will help you by reminding you, if you forget to honor that commitment. Of course, I'll do that for everyone else as well."

The bottom  line about dealing with negativity in any form is that you 1. call it out and 2. refuse to be an actor in the drama

You cannot turn on the TV or log onto any popular website like AOL without being greeted by the latest update on the swine flu pandemic.

Over the weekend, I spoke with friends who were planning a vacation to Mexico next week and are now concerned about the wisdom of making that trip. Others are just scared to travel anywhere away from home now that there are several incidences of the swine flu (up to 40 as of  writing this blog) in the US.

Swine flu is caused by Influenza A (H1N1). Since swine flu can be definitively diagnosed only by a lab test, it makes sense that clinical laboratorians should be able to provide some basic information to friends, family, neighbors and so on.

Here's what the CDC's web site says about swine flu symptoms: "The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea."

The World Health Organization (WHO) today said there are "gaps in knowledge" about the new swine flu virus -- which actually contains a mix of swine, human, and bird (avian) flu viruses into a brand-new virus.

The WHO has asked all countries to be on the lookout for the new virus, but it's not yet ready to bump up the pandemic alert level from phase 3 to phase 4

Many credible news organizations have culled information from public health authorities and published pretty good Q and A lists for the general public.

 The latest credible information (including a case count) can always be found on the CDC Swine Flu website.

Other considerations: has you facility made any plans to deal with increased ED visits and the lab processing more specimens? Will you send every positive influenza specimen to the state public health lab for confirmation and genotyping? Has your lab developed or changed protocol to testing all Flu specimens under a hood? Is the lab involved in any preparedness plans your organization is making regarding swine flu?

The scenario is far from over and we can play our (vital and appropriate) role in educating the public and health care colleagues. I certainly do not advocate giving incomplete or incorrect information. So I urge you to keep up with the facts from the most credible sources and feel free to advise others within the comfort level of your competence.

In its 34th year, NMLPW- initiated by American Society for Clinical Lab Science (ASCLS)- is now jointly sponsored by 10 laboratory organizations. This year's theme is "Laboratory Professionals Get Results."

Of significance is the fact that in 2005 the committee added the word "professionals" to what was formerly National Medical Laboratory Week. That was a deliberate move to emphasize the significance of the individual, of each single laboratorian.

What is your laboratory planning? It's a great time to celebrate your accomplishments. Breakfasts, T-shirts, commemorative items are all great. But what an opportunity to teach others outside the lab about your contribution, education, skills, competence; your real value to the healthcare team.

This should be an ongoing endeavor. But NMPLW is a great opportunity/excuse to look  not just inward, but outward. This is a time to not just celebrate; but to advertise the brand.

Happy National Medical Laboratory Professionals Week to everyone!

There are many reasons for the personnel shortage in clinical lab science. Not the least of which are low pay (compared to lesser educated health care providers), high stress, terrible work hours and little recognition.

I have dealt with root causes and strategies elsewhere and in many settings, but I just read the results of a survey that made me stop and think. In a Workforce Survey published in Modern Healthcare magazine, they examined the results of asking nurses directly why they think there is a nursing shortage.

Not surprisingly, in order of importance were the following

I suspect the reasons would be similar for clinical laboratorians except for 2 interesting observations. First, the numbers have decreased-signaling improvement- over the years e.g. in 2002 58% of nurses though the salaries and benefits for nurses were poor, compared to only 32% of nurses in 2008. In 2002, 38% of nurses saw the hours as undesirable, compared to only 26% in 2008. Negative perception of the work environment decreased from 29% in 2002 to only 15% in 2008.

So these findings suggest progress is being made in nursing. Is the same thing occurring in clinical lab science?

The second difference is that nurses identified that there are not enough educators to accommodate the numbers of qualified applicants to nursing schools each year. The fine print explained that educators with advanced degrees felt the pay for educators is not attractive enough. With more teachers, existing programs would admit more students and some new programs might even open.

I suspect that for CLS, schools are closing due to lack of funding and other reasons such as less interest in entering a profession with low pay, little recognition and limited autonomy. To the educators out there: are you having huge influxes of qualified applicants each year, but you cannot accommodate them due to an insufficient numbers of teachers in your program? To those whose programs have closed: did you close largely because of not enough staff, or for other reasons?

While the reasons for a shortage of laboratorians might mirror the traditional reasons for a nursing shortage, it appears that nursing has started addressing the core issues. In fact, there is such a renewed interest in nursing that current nursing programs cannot accommodate all the qualified applicants.

A few years ago when the doctor told me my blood sugar was borderline high  I was terrified. Having a family history of diabetes and cardiac disease as well as an elevated cholesterol, I knew my risks.

I decided to attack the problem with a vengeance and made a pledge not only to get in shape but to run a 5K race within 3 months.  I joined the gym, got a personal trainer (coach) and spoke regularly to a friend of mine who is a life coach.

Well, my initial goal of running a race in 3 months was a little unrealistic (as both coaches pointed out) but within  a year I did end up losing  almost  25 pounds and ran a 5K race, coming in first in my age group.

There is so much we are coping with in our professional, economic and personal lives these days. No matter what the challenge is (career, personal, health) it just might be a good idea to get a coach.  A coach helps you to get clear on your goals, formulate realistic goals, develop action steps and hold you accountable for commitments you make.

A coach's job is to is to help you bring out your best, overcome limitations and move closer to your self-determined goals.  A coach is part cheerleader, confidante, conscience and friend.

If you would like to achieve a skill, make a transition, cope with change, strategize about some goal or achieve a breakthrough in some area, consider consulting a coach.

Coaching is certainly not a panacea nor is it a substitute for hard work. But it is just one more tool available (and a powerful one) to make you more successful and self-actualized.

Over the years, tests like CRP and ESR have fallen into the category of pretty useless tests when ordered by themselves. After all, they indicate an inflammatory process somewhere without being correlated to location, cause or degree.

Cardiologists, for one, would not generally order C-reactive protein (CRP) as a primary test for patients with suspected cardiovascular disease. However, recently high sensitivity CRP (hs-CRP) has shown great promise as a biomarker for cardiovascular risk.

A recently published study--"Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)"--confirmed the role of  hs-CRP as a biomarker of  cardiovascular disease (CVD) and established its importance in monitoring the impact of cholesterol-lowering therapy, not just in people with known risks, but even in asymptomatic individuals previously considered at low to normal risk for myocardial infarction, stroke or death.

Published in the New England Journal of Medicine (N Engl J Med 2008; 359:2195-2207), this exciting study underscores the importance of inflammation in CVD and discusses the superiority of hs-CRP over traditional markers like LDL-C.

Principal investigator Paul Ridker, MD, said this landmark study is a major turning point in preventive cardiology.

For one thing, physicians should know this is not the "old CRP" but a new high sensitivity version available in assays down to detection limits of something like <0.3mg/l.

This is exciting news for everyone in healthcare, and clinical lab scientists have another opportunity to educate patients and physicians on the correct use, reporting and interpretation of this marker.

I was made aware once again how quickly nonlaboratorians identify themselves with their primary profession even years after a career change. It seems laboratorians who have left the laboratory setting will proudly associate themselves with their current profession. With prompting, they might admit, "I worked in the lab,"  "I used to be a lab tech" or "I was a med tech back then." Why is that?

If physician-CEOs and nurse-administrators wear their clinical training as a badge of honor, why don't we?

In my forays outside of the laboratory and moving up the administrative ladder, I have always proudly proclaimed my clinical laboratory origins. I have also drawn on certain valuable skills such as the ability to ingest and simplify large amounts of data, cope with change and meet regulatory requirements without blinking an eye--skills which I learned in the laboratory.

Besides, I have also noticed laboratorians apply a sort of critical thinking not universal among administrators with a purely business or healthcare management background. We really should be proud of our origins.

Believe it or not, it is still possible (and more necessary than ever) to convince your boss to give you a raise. Merit increases in the budget are likely to be smaller, and therefore spread more thinly these days. Expect lean operations to continue for a while longer, but don't assume you have no chance of receiving a salary boost.

The trick in getting a raise is to prove value to the organization and to be fully in the forefront of your boss's thinking while s/he is considering how to slice that dwindling pie.

• Prove your worth. The onus is on you to highlight, document and recall your accomplishments over the year. While managers love a smooth running department, they sometimes forget to reward the person who made that possible. Operating under the radar cuts both ways--no problems or need for  interventions, but no special accolades either. Copy your boss on significant decisions and keep your own file of your accomplishments. At evaluation time, pull it out and make a summary list for your boss. You can always provide details if prompted.
• Know the market and use it to your advantage. As employers cut back, employees leave for more stable employment and employers try to get more out of the valued employees they retain. You can often use a competitor scale or counter-offer to justify an increase.
• Ask for an off cycle review. This is not an option with all companies, but sometimes you can get a 6-month review with a minor adjustment, away from the fray of the annual merit increases. If you are starting a new job, using the same strategy, you should ask if there is any possibility you can have your performance reviewed (and have your salary adjusted) in 6 months.
• Ask for non-monetary perks. Think of the ways you spend your money and where you could use help. Instead of paying a straight increase, employers might find it easier to pay subscriptions, offer free parking, allow you to telecommute, pay mileage for short job-associated travel and so on. Think outside the box.
• Ask! This is a no brainier, but many employees just assume because of the state of the economy and the company's P&L you have sit back and settle for whatever is offered. Not true!

Paul Levy, president and CEO of Beth Israel Deaconess Medical Center, Boston, in his recent blog "Running a Hospital," proudly published his hospital's nosocomial infection rate and boldly challenged other hospitals to do the same. He also threw down the gauntlet to insurance companies and state healthcare agencies.

Nosocomial infections result in millions of dollars annually in extended hospital stay and extra treatment. Organizations like the Centers for Medicare and Medicaid Studies have identified these infections as being among the "never events"--events that are avoidable and should therefore never happen and for which they will no longer cover the extra cost of care.

Levy published his organization's central line infections going back to October 2005 and proudly points to at least one life saved in January because of prudent infection control practices.

Levy proudly and boldly challenged his colleagues. What if all the hospitals in the Boston area committed to reducing nosocomial infections? What if they all published their infection control data publicly? What if they all committed to sharing their best practices with each other? What if they shared in case reviews and joint training?

These are all ambitious challenges, but would certainly improve patient care and reduce length of stay and reduce hospital costs.

I have long advocated personnel licensure for clinical laboratory professionals because I believe licensure protects our scope of practice as well as protects the public welfare.

If you think about the people who are licensed--barbers, drivers, attorneys and almost every healthcare professional--you will see it is important to ensure only "qualified" individuals practice a profession.

Organizations such as the American Society for Clinical Laboratory Science (ASCLS) have supported model personnel licensure bills in many states, almost always to the strong opposition of the College of American Pathologists (CAP).

The official reasoning for nonsupport of the CAP--sometimes joined by ASCP and state pathology associations (at the urging of CAP, usually) --is licensure would exacerbate the clinical personnel shortage.

Actually, every independent survey shows this not to be true. In fact, there is some evidence professionals would be more attracted to the profession and would not leave due to burnout--more pay, more prestige, a protected scope. Without licensure, unscrupulous employers can hire non-certified individuals and pay them less to work side by side with certified laboratorians. Talk about a morale buster for everyone!

In some states, other professionals have seized on the non-licensure of laboratorians, encroached on our scope without the unique body of knowledge laboratorians have. Pharmacists and dietitians often order lab tests; pharmacists perform glucose testing, pregnancy tests and so on in pharmacies. Some practice acts have been rewritten to expand other health professionals' scope (nurses, respiratory therapists, etc.) to include "order and/or perform laboratory testing."  In California, pharmacists lobbied to be included on the list of those eligible to be clinical lab directors. Licensure would restrict or clarify such rights and help to protect both our profession and patients.

Recently CAP has revised its position on universal opposition to laboratory personnel licensure.

CAP will now support bills that:

• make it clear the pathologist-director is in charge of all laboratory personnel;
• do not create conflict between scope of practice of the pathologist and non-MD laboratorian. An added benefit is they can continue to bill for reviewing and overseeing procedures;
• allow on-the-job training as a route for becoming a clinical laboratorian; and
• ensure state laboratory licensure boards mirror CAP's position.

This is a step in the right direction, but is certainly not ideal. The CAP is all about protection of the scope of practice of the pathologist and protecting their economic welfare.

Pathologists feel others should not be allowed to encroach on their scope of practice and I certainly understand and support that desire. However, I think non-physician clinical laboratorians also deserve the same logic.

It makes perfect sense to them to give detailed instructions, and then follow up every step of the way, managing details of the task and even dictating which one of several viable options must be pursued. They have no sense of the stress their style causes or the demoralizing effect it has on their subordinates.

So how can you tell if you are a micromanager? Well, if you routinely control every detail, or your staff says you do (although we both know they are mistaken, right?). Sorry to say, you are a micromanager if:

• You tend to specify exactly how something must be done.
• You reserve and exercise approval rights even for routine tasks.
• Delays occur because others must await your feedback or approval before they can proceed.
• You change deadlines or ask for feedback before the agreed on date.
• You hover.
• You give unsolicited feedback often.
• You are convinced if you take a day off the lab will go to hell in a handbasket.

If you are a micromanager, there are some steps you can take to stop being one:

• First you must admit you have a tendency to micromanage (but concentrate on your behavioral patterns, not your individual self worth or motivation).
• Deliberately choose to give up some control. This will be uncomfortable at first, and you might have to do it a step at a time. Give someone a project that is not critical or does not have to be completed in 24 hours. Allow for a variety of options, not just your preferred way.
• Set mutually agreeable, realistic deadlines for progress reports and stick to them. Promise to be available for support and clarification, but do not keep butting in. If things are not proceeding as expected or on schedule, renegotiate a timeline.
• Ask a respected colleague to prod you when you slip back into micromanaging, and be prepared to back off.
• Address performance issues in more constructive and traditional ways like retraining, counseling and reassignment, rather than being dictatorial.
• Take a brief time off and don't call in. It is important to prove to yourself life goes on even without you.

Remember: micromanagement is a habit like any other, and can be changed.