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Stepwise Success

Direct Observation

Published June 22, 2012 6:08 AM by Scott Warner

We watch each other work all the time. But do we observe?

According to CLIA, the Technical Consultant is responsible for evaluating personnel competency i.e. “direct observation of routine patient test performance, including patient preparation, if applicable, specimen handling, processing, and testing.”

The dictionary defines “observation” as “an act or instance of regarding attentively or watching.” In other words, a tad more than casually watching someone work.

Logically this warps events. Like a split-screen experiment, an observed tech will do A or B depending on how he or she is observed; both behaviors might be different from an unobserved state. Who knows? Techs get nervous, frustrated, angry, distracted, out of their element; Schrodinger's tech produces good and bad results simultaneously.

As a pathologist I knew remarked about direct observation, “It ticks people off.” (He didn’t say “ticks.”)

Yet “direct observation” is vaguely understandable. It suggests a peer or expert evaluation of a process including phases of testing related to quality; it implies a competency benchmark. One might, for example, develop checklists for venipuncture, sample preparation, and test performance that mirror written procedures.

I suspect, no matter how benign, “direct observation” is still insulting and a little humiliating.

The trick -- if there is one -- to getting it to work is answering the tech question, “What’s in this for me?” After all, bench techs are slogging out good results hour after hour, day after day, week after week, and suddenly someone has to look over a shoulder? When trust goes, everything goes.

The answer might be: To make this better for everyone. To do that, direct observation has to be rigorously based on the written procedure. If the observer and the tech both have the same point of reference they are working together to make sure the system functions as intended. For example, everything might work fine for tech A, but tech B has a workaround based on a unique experience. That’s invaluable information.

Focusing on the system -- of which the bench tech is a part -- helps turn observation into “I see!” moments of insight.

NEXT: Barriers to Success


An atmosphere of trust and mutual learning needs to be a point in direct observation.  Expectations need to be transparent so there is an exchange of information; not wrong or right but better.

Steve Bellistri July 17, 2012 11:47 AM


Thanks for commenting!  I think "discomfort" is an apt word, even when both parties agree that direct observation is necessary.

Scott Warner June 24, 2012 7:27 PM

I have been very concerned about the dicomfort caused by direct observation. I found that if you establish a trusting, caring and concerned relationship with the person being observed, the discomfort can be minimized. In fact, a desire to be observed can be cultivated when the observed is encouraged to show off their expertise. I have found that direct observation is a very valuable tool as long as the observer isn't  impolitely critcal, or adopts a "holier than thou" attitude. I agree, a well written procedure contributes greatly also.

Richard Oost, Medical Technology - Laboratory Manager, At Large June 23, 2012 10:18 AM
Machias ME

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About this Blog

    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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