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Stepwise Success

Do You Follow Procedures?

Published January 13, 2014 6:05 AM by Scott Warner

Procedures are the core of every laboratory, but are they followed? Watching people work, I wonder. Most techs have workarounds for the trivial and the critical, from organizing an instrument run to blood bank serology to reading culture plates. It isn’t that tasks are difficult to standardize; procedures can be incomplete, lacking details of variation that lead to significant workarounds causing errors. Thus, many techs believe workarounds are a matter of personal preference so long as results are reliable. Ends justify the means, in other words.

Do workarounds eventually cause error? That’s another matter.

Procedures can do more:

  • Initial training. Students and new hires use procedures to learn how the work is done.
  • Competency assessment. All staff use procedures when assessing competency to make sure the test is done correctly and there are no workarounds.
  • Direct observation. When directly observing a peer or employee, the procedure is traced to ensure steps are followed. Deviations are noted and reviewed.
  • Quality improvement. Management includes details that lead to variation and include metrics to monitor performance in the procedure. Good procedures consider variation in all phases of testing.
  • Incident root cause. When an error occurs, reference the procedure to assess expected vs. actual behavior.

Workarounds are a symptom of who uses procedures. Instead of reading a procedure and reporting that a step is missing, a tech may assume the gap is filled by “professional judgment.” While this can be true -- a procedure can specify such instances -- the cumulative effect of process variation is unpredictable and onerous to analyze.

Developing procedures that reduce sources of variation, include quality metrics, and specify how to validate performance and correct problems aligns with new IQCP (Individualized Quality Control Plan) requirements. Procedures can integrate performance and quality.

Getting techs to use such procedures is tricky. We intuitively understand critical steps in any process and sensibly consider some variation inevitable and trivial. It’s impractical to mirror the complexity of most laboratories, and focusing on details tampers with perceptions. Bench techs should be involved in developing procedures for these reasons.

How about you? Do you follow procedures?

NEXT: Three or Four Steps


Interesting topic. Procedural knowledge contains the "know what" and "know how" with a good dose of tacit or informal knowledge which I think you refer to as "workarounds". It is difficult, even after observations, and rewritten procedures to cover all that a tech might do in any given situation. When the "ends" justify the "means" an ethical or tacit component is in play. We are not just button pushers; something I am currently researching...

Terry, MLS Faculty March 16, 2014 9:57 AM

When we went paperless in order entry, it meant much more than just dumping paper, binders, index cards,

January 17, 2014 6:14 AM

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About this Blog

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