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Stepwise Success

How Many Tests?
July 28, 2014 6:01 AM by Scott Warner

Laboratories revise a test menu based on clinical need or cost. The common “bread and butter” tests I blogged about last time are easy to decide on and often performed on analyzers with volume discounts. But in many cases estimating the volume of tests to be performed can make the decision for us. In other words, is it cheaper to make or buy? Do we bring a test in house or send it out?

Ideally, a test should be brought in if it fills a clinical need that changes patient treatment faster or cheaper than sending it out. Many of these fall under the “soft dollar” umbrella of reducing length of stay -- notoriously hard to sell to bean counters.

Better, a cost per test can be calculated based on an estimated volume and compared to the cost of sending it out. If these “hard dollars” (variable cost) save money, that’s an easy sell. Bean counters love saving beans.

But it’s tricky, especially with new technology or services, pushing us again into that area where the beans are slippery. Here are a few ideas:

  • Look at sendout volumes (easiest) - referral labs provide usage reports or numbers can be pulled from your information system. It’s a good idea to compare your top five sendout tests against your instrumentation menus to see if it’s worth performing these tests in house. Sometimes you can save money!
  • Ask the docs who will order the test (harder) - having a physician advocate for a new test can’t hurt, and docs can have an expert opinion of how many tests are likely to be ordered.
  • Make an educated guess (hardest) - an educated guess can be made easier if you already have a protocol in place; for example, a sepsis protocol which includes lactates can suggest how many procalcitonins may be ordered. If you don’t have a protocol you can ask local medical centers or do research online to guess how many tests might be ordered. The more data-based your estimate, the better.

Note that this doesn’t hinge on keeping techs busy. One way or another we always have plenty to do.

NEXT: Market Your Computer Skills

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Rarely Ordered But Critical Tests
July 23, 2014 6:05 AM by Scott Warner

The bread and butter of labs are those tests ordered on most patients: chemistry panels, blood counts, urinalysis and culture, and to an extent coagulation and blood bank. These are often ordered serially on patients admitted to your hospital, creating a cumulative report of laboratory values. As professionals we tend to be most productive and competent performing these tests, or at least operating the instruments that produce them.

But it is those rarely ordered but critical tests that can drive new technology and make us valuable to clinicians. Not just anyone can run them.

For example, in Maine many people use wood heat or are shut in for much of the winter. Carbon monoxide poisoning is a seasonal risk. These patients arrive at our ED, and it would be good if a physician could have a carboxyhemoglobin level STAT. Instead we offer this test as a sendout to our referral lab. It’s rarely ordered, instrumentation is costly, the docs don’t complain about not having it except (naturally) when they really need it, and when the weather warms it falls off the radar. It’s a good example of test that when the doc needs a result, he or she needs it now and not in two to four hours.

These rare but critical tests present unique challenges. They are expensive to keep in house, sometimes difficult to verify and control, more likely to have expired materials, and are harder for techs to remember how to do. Since they can be ordered in an urgent context, the latter is a real problem. It isn’t a problem to put a STAT chemistry panel on a busy instrument designed to prioritize STATs, but cerebrospinal fluid testing, for example, is always disruptive -- ask any night tech!

“Rare but critical” is the reason laboratories need highly trained professionals. Running routine specimens through analyzers isn’t worry-free, but variables are limited and repetition ensures a degree of competency. But a rarely ordered test ordered on a critical patient is already a problem.

We’re looking at the Avoximeter to resolve our carboxyhemoglogin issue. Is anyone using this?

NEXT: How Many Tests?

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Working in the Cloud
July 18, 2014 3:36 PM by Scott Warner

I blogged about “the cloud” in 2010: “If you’re using any applications that run in your web browser over the Internet, you’re using cloud computing.” While our hospital still uses aging Microsoft Office software and local storage the world has moved up.

And I’ve been writing in the cloud since I blogged about it. Google Apps are as functional as Office for the most part: word processing, spreadsheets, presentations. (You can use online versions of Office software, also.) These aren’t installed as programs on a computer in the traditional sense but instead run in the browser engine. All modern browsers can run Javascript programs embedded or linked to in web pages that are downloaded on the fly and stored locally in your browser’s cache.

Hardware doesn’t matter. I can write on a desktop, laptop, tablet, or smartphone, here or at work. I’ve talked into my smartphone and seen the text appear in real time on my desktop. Since everything is stored in the cloud, I don’t worry about hard drive failures, corrupted file structures, making backups, or printing a paper backup. In fact I never print anything.

And not just my writing, but everything is in the cloud. I store receipts online using an Android app, for example. Sites such as Dropbox and Box offer additional gigabytes of free storage for documents or photographs that can be uploaded and accessed from multiple devices. Anything I upload can be accessed anywhere. This all happens without any extra work. That’s a paradigm shift.

All this translates into efficiency and convenience, at least for me. Working in the cloud is easy.

Healthcare has been slow to adopt these changes and laboratories slower still. But change is happening. We are connected to more systems, our information systems are being configured to meet terms of “meaningful use” set by the Affordable Care Act, and the ubiquity of cheap, vast online storage is making electronic document management a dawning reality. Similar to my own experience, labs will find working in the cloud efficient and convenient.

NEXT: Rarely Ordered But Critical Tests

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What to Put on Your Resume
July 14, 2014 6:03 AM by Scott Warner

I read a lot of resumes, and most are awful.

I recently interviewed a candidate, for example, who waxed eloquent during the interview about how he valued great customer service. He gave examples, talked about involving line staff, insisted that people needed to talk to each other to get things done. Yet his resume didn’t contain the words “customer service.” It looked generic, as though he had prepared it for any job interview.

I’ve read resumes that list every tiny detail about work history, education, and hobbies. I’ve read resumes that list every instrument a tech has ever worked on, boring tasks associated with any job, or too much experience (and too many pages) for too few years in the field.

I’ve flubbed up, too. When I applied for my current position the HR director looked at my resume near the end of the interview and said in good humor, “I can’t help but comment that you haven’t listed ‘Leadership’ as a core skill.” (“Give me that!” I said, and I grabbed it and wrote down “Leadership.”)

But resumes aren’t mysterious. There are only two rules.

  • Write for an interview. The purpose of a resume is to get an interview, so potential employers form a first impression of you from a resume. Trust me, after you’ve read enough resumes they really help in selecting good candidates.
  • Write for your audience. This is such a basic rule that it surprises me how often it isn’t followed. Yet many candidates submit a generic resume that sells them in broadest terms instead of for the job they want.

For example, list core skills applicable to the job you want. If you’re applying for a generalist position, list experience in microbiology, blood bank, and any area that sells you as a generalist. Find out the instrumentation used in the laboratory and list them if you’ve worked on them. Above all list experience selling your core values. If you plan to say you value customer service, for example, make sure those words appear on your resume.

NEXT: Working in the Cloud

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Keyboard Ergonomics
July 9, 2014 11:46 AM by Scott Warner

What started out attached to a desktop personal computer is everywhere. Keyboards are attached to computer terminals, COWs (Computers on Wheels), and many instruments. Yet little has changed in their design (more about that below). They are big, bulky, clunky, difficult to clean, and hard to adapt to a traditional laboratory setting designed for paper.

The OSHA Computer Workstations e-tool offers these tips:

  • Put the keyboard directly in front of you.
  • Your shoulders should be relaxed
  • Your wrists should be straight and in-line with your forearms

The goal is to ensure your posture and joints are in a neutral position. Placing a keyboard too high or low strains joints after hours of repetitive motion. Cumulative strain causes injury.

Adjustments are fine for a single workstation in an office or cubicle used by one person but notoriously difficult amidst specimens, requisitions, reagents, instruments, and on countertops installed pre-computer. We do the best we can.

A keyboard’s switch type -- what’s between the plastic key and the keyboard circuit board -- also affects its ergonomics.

Most use a “rubber dome” switch type, in which a key compresses a polyurethane bubble coated in graphite that completes a circuit. These dome-type keyboards are dirt cheap, lightweight, and reasonably quiet. The downside is they wear out quicker, the keys have a “mushy” feel to them when pressed, and each key has to be pressed down all the way to work. Typing speed is slower, and your fingers have to work a teensy bit harder.

Mechanical switches, these days favored by gamers, used to be common and have a separate switch beneath each key. The design of the switch determines the amount of pressure needed and how loud it is. But generally mechanical keys are more accurate, far more durable, and require less effort to press. (They’re also pricey.) Typing speed is faster, and your fingers don’t work as hard. It adds up.

Recently I dug my old mechanical Microsoft Internet Keyboard (circa 2005) out of my attic and hooked it up using a PS2 to USB adapter. And you know? The keys are better.

NEXT: What to Put on Your Resume

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Take Advantage of Wellness
July 4, 2014 6:39 AM by Scott Warner

According to a Rand Corporation report about half of U.S. employers offer wellness programs. The bigger the employer, the bigger the program, many of which include risk assessments. Despite evidence that wellness is associated with lower healthcare costs and use, less than half of employees undergo screening or participate.

Our small hospital offers a great wellness program. We have health fairs, risk assessments, smoking cessation programs, team challenges e.g. losing weight, and an employee gym. Yet participation seems poor to me.

A 2010 National Institute for Health Care Reform research brief states, “While employer wellness programs have spread rapidly in recent years, few employers implement programs likely to make a meaningful difference in employees’ health...” Experts believe financial incentives are the most effective way to ensure employee buy-in.

This isn’t a matter of employee greed. Undergoing a health risk assessment and sharing this information with an employer can be unsettling. As the Los Angeles Times asked last year, “Would you be willing to share with your employer how much you eat, drink, smoke, or exercise?” Studies of wellness program effectiveness show mixed results; financial incentives can get employees in the door, but sustained gains are still a challenge.

I haven’t been involved in our hospital’s wellness programs, I’ll confess. But I exercise every day at home, which works for me. I don’t smoke, hardly ever drink, don’t have hypertension, and my knees still work. I appreciate how difficult it can be to commit to wellness. It isn’t easy to find the time, energy, or motivation when you have to work so hard for so little. Slow, incremental improvement is the reality of daily exercise. It’s boring and it hurts.

But it’s worth it to take advantage of a wellness program. If your employer offers one, it can be a win-win, reducing their risk and increasing your satisfaction in the long run. I don’t believe there is any hidden agenda to coerce employees to reveal healthcare information about themselves. Good health benefits all, and what better place to learn about health? Finding your inner motivator is the challenge.

NEXT: Keyboard Ergonomics

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Do You Work For a Bully?
June 30, 2014 6:03 AM by Scott Warner

Remarkably, 54 million Americans have been bullied at some point in their careers, either peer to peer or from a boss. Writes author Sherri Gordon in About, “Many times people don’t even realize that their boss is bullying them. Instead, they falsely believe that their boss is just tough or pushes his workers to get results.” She lists verbal abuse (shouting, humiliation, etc.), intimidation, questioning performance, intrusion of privacy, undermining, and other characteristics of these workplace monsters.

I’ve certainly worked for bosses who have annoyed, harassed, and micromanaged me only to blow off their own bullying with “I’m just pushing you to succeed.” Then why haven’t I ever felt like a success working for these jerks?

Jacquelyn Smith describes several bullying bosses in Forbes, from those who throw tantrums to those who are covert, changing their behavior day to day. “These bosses with bullying tendencies are masters at pushing you to the limit ... they may attempt to disguise their demeaning and discourteous behavior with levity, saying, ‘Oh, I was just joking,’ or ‘You’re too sensitive. You know you’re doing a great job,’” she writes.

I repeat: why doesn’t this ever feel like a great job?

While there are bullies at all levels, most are in management. It’s riskier to bully peer to peer but easy to push subordinates around. The above article cites 72% of workplace bullies as bosses in a study done by the Workplace Bullying Institute.

I’ll admit I’ve never found a solution to working for a bully other than quitting. If the bully is boss, chances are he or she was hired by a bully and exists in a culture that tolerates bullying. These poisonous environments are toxic and toxigenic, and they are as unlikely to change as a prison from the bottom up. Smart and creative people jump ship, and victims and enablers languish in the hold.

A bullying boss can be the toughest problem in your career, keeping you awake at night, upsetting your stomach, and robbing joy from your family time. It sure ain’t fun. Do you work for a bully?

NEXT: Take Advantage of Wellness

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A Better Marker for DKA
June 25, 2014 6:04 AM by Scott Warner

The nitroprusside test typically performed with a Bayer Acetest tablet is a laboratory classic. It’s one of the first tests I learned. In the nitroprusside reaction, acetoacetic acid, a serum or urine ketone, reacts with sodium nitroferricyanide and glycine to produce a purple color. I’ve been in labs where two-fold serial dilutions are common. Sample is dropped on the tablet, and you either see a color or not.

Acetone and beta-hydroxybutyrate (BOHB) are the other significant circulating ketone bodies during ketogenesis, a process that breaks down fat when there aren’t carbohydrates to burn for energy. This can happen while we sleep, fast, and in diabetics when there is a severe drop in insulin levels. Since ketones are acidic, the result is a measurable acidosis.

The problem with the nitroprusside test is simple: it doesn’t detect beta-hydroxybutyrate. This is significant in diabetic ketoacidosis (DKA) where the ratio of BOHB to acetoacetate may increase tenfold. BOHB has greater sensitivity and specificity in patients presenting to the ED with hyperglycemia and correlates better with treatment monitoring than anion gap or pCO2.

About two-thirds of patients with DKA have type 1 diabetes and can present to an ED with hyperglycemia, metabolic acidosis, electrolyte imbalance, dehydration, and or shock. From 1985 to 2005 DKA-related hospitalizations increased 42%, according to one source, suggesting this is an emerging problem that likely mirrors our obesity epidemic.

Clearly beta-hydroxybutyrate is a better marker for diagnosis and treatment of diabetic ketoacidosis. There are other applications such as alcoholic ketoacidosis, but in an emergent setting we’re more likely to encounter the former. Since the test needs to be performed STAT, it should be done point of care or in house.

I don’t know how many labs perform the test. I’ve been looking for opportunities to bring this test in house, and recently decided to evaluate a user-defined method for our Siemens analyzer. Our ED director is excited about this test, which is good. But in previous years there was less interest. It’s funny how these things depend on timing, an odd phenomena of laboratory business. It also keeps our job interesting.

NEXT: Do You Work For a Bully?

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Better Counting
June 20, 2014 6:11 AM by Scott Warner

We do a lot of counting in the laboratory: white blood cells, abnormal red cells, urine formed elements, and microbiology colony counts. I’ve worked in labs where these are precise, for example, reporting urine microscopic red cells as rare, few, 0-1, 5-10, 11-15, 11-20, etc. Theoretically, if techs count so many fields to achieve an average there is reliability and less variability.

On the bench we know that isn’t true, of course. There is huge variation between techs, from day to day with the same tech, and from specimen to specimen. It seems nutty to me to attempt precision when counting something prepared from a wedge smear, wet prep, or streaked agar plate. These preparation techniques are designed to separate populations and not necessarily provide a quantitative measure (urine culture loops are an exception).

If the goal is to make sure Tech A counts the same one day as the next and the same as Tech B, there are better ways than vigorous procedural controls. The analytical precision of these semi-qualitative measures should be considered. Similar to a chemistry test, there is a cutoff below which results are too imprecise to be reported.

One approach is to develop significant cutoffs and reduce the number of reported values between them. This eliminates an illusion of precision but simplifies the report for physicians. Examples:

  • Microbiology colony counts - count <10, 10-100, >100
  • Urine white cells - count <2, 2-20, >20 per HPF
  • Urine red cells - count <5, 5-50, >50 per HPF
  • Peripheral smear red cells - count Present, >5 per HPF

Limits such as these are somewhat arbitrary. Is it significant if there are intact white blood cells in a urine sediment between 20 and 50 vs. greater than 50? I’m not sure. I think it’s more important for bench techs to concentrate on looking at the big picture and identifying abnormalities such as granular casts and other formed elements that are important. We can easily be lost in details if a procedure itself is too detailed.

But that’s just an idea. What does your lab do?

NEXT: A Better Marker for DKA

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Are You Recognized?
June 16, 2014 6:01 AM by Scott Warner

Being recognized for what we do is an essential human need. We appreciate a thank you, acknowledgement, or praise at work. The giver and receiver benefit from a sincere “Thanks!” Whether the effort is big or small -- sometimes the smallest things matter so much -- it’s crucial to be noticed. It can make the difference between a place to pick up a paycheck while you’re wishing you could quit and a great job you’re happy to have.

Susan Heathfield has these tips for a successful employee recognition program:

  • All employees must be eligible
  • The recognition must be specific
  • Anyone who performs at the stated standard receives the reward
  • The recognition should happen as close as possible to the performance
  • Avoid management selecting people to receive recognition e.g. Employee of the Month

A reward can be money, but we’re already getting paid. Throwing money at someone sends a message that amount n is linked to specific performance. We work for more than money. Being noticed can be as simple as the boss walking up to you and saying, “Thank you for staying last night to help the evening tech” to an article showcasing your accomplishment in a hospital newsletter.

As one PR firm puts it, “Employee recognition isn’t rocket science – it is an obvious thing to do.” The same site points out that 51% of workers are satisfied with recognition they receive. Many employers don’t recognize employees or botch it. Managers just don’t get it and aren’t trained to do it.

I believe it! I’ve never worked at a place with a recognition culture. Sure, I’ve been recognized here and there -- even a blind squirrel gets a nut once in a while -- but there’s always been a haphazard sense of cherry-picking about it. Any programs that are instituted to encourage and recognize creative ideas never stick, because no one really buys it. And, sure enough, when I started my current position and interviewed techs to see what the top issues were, “Lack of Recognition” was in the top ten.

Are you recognized?

NEXT: Better Counting

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When the House Manager Calls
June 11, 2014 6:13 AM by Scott Warner

Wouldn’t you know it, the one time in six months I’m in Bangor having dinner with friends I get a phone call. The restaurant is noisy, so I have to walk out to the parking lot to hear. It’s the hospital. “Scott, this is Jane the house manager. Your lab tech is sick, and I don’t know who to call to get to work. I’m in the lab right now, and I can’t get in your office.”

I get these nutty calls once in a while.

I’ve been told in meetings that the house manager is in charge of “the house,” meaning everything and everyone, and every so often a tech will complain that the nurse in charge will walk through the lab to check up on them. I’m sure all this is well meaning, but I can’t imagine what the laboratory means to a nurse. It must be a foreign beast. I certainly don’t want to check up on them.

I stepped aside as patrons entered the restaurant, squinted at the evening sun, and asked Jane, “What’s wrong with the tech?”

“She’s in the ER right now,” she said. “We need lab work done. Who should I call?”

She repeated that she needed to call someone in, didn’t know where the phone numbers were, couldn’t break into my office, etc. This was a weird conversation, but I’d heard it before.

“Jane, you’ve called the right person already. I’ll take care of it,” I said.

She reluctantly agreed. My guess is she smelled smoke from another fire that needed tending. As I hung up I didn’t envy her. I wouldn’t want to feel in charge of everything and everyone, especially if I wasn’t sure what that was. These are addressable issues, certainly, but not necessarily my problem.

It’s our responsibility to our patients to make our service an accessible resource to other members of the team, including nurse managers. If a hospital culture puts a single professional in charge, that burden creates an obstacle. Or is this nursing culture? I wonder. What do other labs experience?

NEXT: Are You Recognized?

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Is Your Lab Open or Closed?
June 6, 2014 6:06 AM by Scott Warner

Business models tend to influence paradigms. Open office plans have been around since the 1950s and are in seventy percent of all businesses. The idea is simple: if workers can see each other and don’t have walls between them, creativity and productivity increase.

But as The New Yorker reports, “a growing body of evidence suggests that the open office undermines the very things that it was designed to achieve.” In one study assessing employee satisfaction at intervals after switching from a traditional to open setting, the new space was found to be disruptive, stressful, and cumbersome. Open offices reduce privacy and a sense of control, two elements linked to job performance. When workers can’t control their immediate surroundings -- lighting, noise, etc. -- performance suffers. Workers call in sick more often, too.

A laboratory isn’t an office setting, but the paradigm applies. Workstations are attached to or built around instruments, sequestered in separate rooms off a central hallway, in an open floor plan, or in some combination of the two. Generally, the more open the plan the noisier and more distracting the environment.

A few years ago we moved our chemistry workstation from one side of our small laboratory to the other side of a separating wall, knocking down other walls and creating an open plan consisting of a core work triangle between hematology, chemistry, and immunology that everyone felt would increase productivity. Techs had a clear view of the outpatient area and so could help the phlebotomists during patient backlogs.

This open environment increased the noise level and chaos. Refrigerators, centrifuges, instruments, telephones, conversation, and the radio all contribute to noise, a constant distraction. It’s not uncommon to see techs at each workstation on telephones struggling to be heard or transferring calls and shouting across the lab. I doubt it’s any more efficient.

We had a choice. We could have erected a few more barriers, closing out distraction and noise. (Some days, it’s all about the noise.) Would that have increased productivity? It’s something to think about. What about your lab? Is it open or closed?

NEXT: When the House Manager Calls

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A Better Blood Bank History
June 2, 2014 6:09 AM by Scott Warner

Blood bank is a dangerous department. Giving a patient the wrong unit of red cells can be fatal, something all techs who work in blood bank worry about. I’ve seen this happen once in my career. Truth is we don’t know how often this really happens, since two thirds of the time units will be ABO-compatible. Scary, huh?

Good blood bank practice adds hard stops to make sure the specimen is properly labeled, the order is checked, the unit tag matches the patient wristband, etc. The patient’s transfusion history must be checked, too.

I’ve always worked in labs with thousands of large, index-style history cards in filing drawers stacked in the department. When a crossmatch is ordered, a bleeder arrives in the ED, or an OB sample is received, we look for a card.

This system has always bugged me, for a few reasons.

  • Cards are misfiled. Misfiling varies from one or two cards off to completely buried in another section of the file; mistakes happen in any manual filing system. Names change all the time, too. I’ve read as many as 12% can be misfiled. If a card can’t be found it’s gone.
  • Duplicate documentation. Even if a card is found, it isn’t as good as the blood bank log itself. There’s a chance that a serological interpretation can be transcribed incorrectly. Mistakes happen rarely in this area, but it only has to happen once.
  • Missing information. If a card is found and contains accurate information, it won’t matter if the patient has history elsewhere. A visitor may have received product at another facility, for example.

It’s a myth that we only need to work harder, pay more attention, and double check ourselves to prevent mistakes. The best techs will write down A when they are thinking O, file a card under the first name instead of the last name, and not know that the patient had a recent transfusion at another hospital. Random errors are unpredictable.

What we need is a better blood bank history. What does your lab do?

NEXT: Is Your Lab Open or Closed?

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Are You A High Performer?
May 28, 2014 6:09 AM by Scott Warner

“He’s a talker,” a colleague once described one of his employees to me. “I’m lucky if I can get five hours a day out of him.” Time is money, and any time spent wasted while at work is a productivity hit. Forbes reports that most employees surf the Web at work, for example, wasting time on Facebook, LinkedIn, Amazon, Twitter, or Pinterest:

Respondents said the No. 1 reason for slacking at work was that they don’t feel challenged enough in their job. Other reasons include, (2) they work too many hours, (3) the company doesn’t give sufficient incentive to work harder, (4) they are unsatisfied with their career, and (5) they’re just bored.

Yet there are those people who hit the ground running and work at a high level throughout their day. These people are self-directed, enthusiastic, autonomous high performers who can be depended on day in, day out. They concentrate on improving their skills, innovate new solutions, and continuously improve quality. As one website adds, they also have strong people skills and larger networks.

High performers in your lab are those who don’t grumble when asked to help with outpatient draws, who don’t flinch at handling unpopular specimens, who are the first to volunteer when there is a schedule problem, and who are always willing to help, even if it’s only to listen. High performers are constantly focused on the best for the patient, unlikely to be distracted by petty politics, and constantly learning. They see failure as a challenge to do better, so they expect to fail once in a while.

Any organization is deluding itself if it believes it can hire or retain only high performers. These individuals are few and far between. They lead, inspire, and motivate coworkers with their love for medical technology. They have a unique ability to elevate a workplace from competent to good or even great. I can’t imagine what a workplace filled with high performers would be like, but I don’t think I’ll ever see it.

Does your lab have high performers? Are you a high performer?

NEXT: A Better Blood Bank History

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Computer Scheduling
May 23, 2014 6:07 AM by Scott Warner

Artificial intelligence is everywhere. Ray Kurzweil, inventor and author of The Singularity is Near, has commented that we don’t realize it because it just becomes something mundane that computers do. We expect a virtual analog of ourselves like HAL in 2001, while computers everywhere analyze, filter, translate, decide on, feed us information, and otherwise do smart things.

Scheduling employees is a good example of something artificial intelligence can do. Software can make a schedule from scratch using a genetic algorithm, for example, by making “generations” that survive or mutate in a pseudo-Darwinian model. I did something far simpler, but my program SCHEDULE still generates monthly schedules up to a year ahead.

It’s a neat trick but like magic isn’t mysterious once revealed. That’s Kurzweil’s point.

Here’ s how I did it in (hopefully) plain English:

  • Rotations are stored in an ordinary text file in a format of {employee}={rotation}.
  • SCHEDULE opens the text file and reads the first line. Since the program can’t know where in the rotation or year you want to start, the first line in the file tells it where the closest month starts e.g. feb=32.
  • February is adjusted for a leap year, depending on whether it falls on this year or next.
  • Your “year” begins at whatever month you want, so all subsequent months have a beginning tallied from that point on, adding the days in the month. These are then further offset by the start position in the rotation. Now you know where months start in the rotations.
  • After selecting a month to print, the program reads an employee rotation, appends the rotation to itself until it is at least 735 characters long, and prints from the where that month starts to its end. It skips a line, prints the next employee, and repeats until all employees are printed.

This works for any number of employees or rotation lengths. Techs can print their schedules, plan for vacations, swap weekends, and benefit from the computer doing something we don’t have to.

NEXT: Are You A High Performer?

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About this Blog


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