Metrics, Goals, and Lab Leadership

In an April 2015 publication in Lab Manager, then ASCP President Dr. William Finn discussed the Lab Management University (LMU) program “designed to help pathologists and lab professionals take their laboratory management skills to the next level.” He also cited “gaps” in professional training and experience that revealed a lack of management skills in “pathologists, laboratory professionals, and pathology residents.” Utilizing advanced coursework available to them from LMU, laboratorians of various specialties would stand to benefit from this knowledge and effectively influence more positive outcomes for patients.

Within the last year, I’ve been writing about utilizing data from epidemiology, laboratory studies, and community partnerships in an integrated public health initiative combating mosquito-borne illness on the island of Sint Maarten. It is an ongoing multidisciplinary project I started which reaches various fields of study from immunological seroprevalence, to community health work, to social determinants of health, and team leadership and coordination. What started as a group of six students in the fall of 2016, has flourished into a team of now more than fifteen with partners in local government, local NGOs including the Red Cross, social and broadcast media, and our individualized message of local self-motivated disease prevention has reached well into the thousands.

Citing this experience as a process of a simple medical literacy proposal to an expansive public health initiative, I believe there are some significant advantages that being a laboratory professional can give you. Experiences during my time in clinical laboratories gave me many parallels to study as I became a leader of a dynamic and diverse program. Here is what I consider is a highly-oversimplified model for successful problem-solving, leadership, and ultimately measured success. As a common laboratory metric of efficiency/success—and something I have had experience with before—consider turn-around-time (TAT) as a problem many labs face. Compared to the problem of addressing risk reduction and source control for mosquito-borne illnesses like Zika, I found myself in the same model I had recognized many times before.

Example 1: Outside the Lab Addressing Zika as a Public Health Concern	Example2: Inside the Lab Addressing TAT as an Efficiency Metric
START: Clearly and Specifically Define the Problem or Need to be Addressed
With the advent of a local outbreak and information from local government regarding the increase of epidemiologic cases, behavioral change for risk reduction was highlighted as a major obstacle in improving public health outcomes. Creating self-sufficiency in the community would not only improve health but create sustainability.	As a laboratory potentially signs on new clinics or accounts because of local changes in hospital structures, efficiency is being examined as workflow is slated to increase. Staffing, instrumentation, LIS/LAS, and other tools are being considered to reduce TAT and improve overall patient outcomes and strengthen quality control and quality assurance metrics.
Locate Potential Helpful Partners, Staff, or Tools that Can Assist Your Cause
To gain access to resources otherwise unavailable, it is imperative to collaborate with partners in the Ministry of Health as well as NGOs like the Red Cross. To reach communities most affected by the problem at hand, it is necessary to implement cultural liaisons to act as intercessors preserving the autonomy of individuals while creating a safe environment to communicate an effective public health message.	As part of initial assessments to discover a clear problem, vendors may offer instrumentation or technology that would improve the conditions affecting the TAT. It would be highly prudent to reach out to the new accounts or clinical sites to determine if TAT is affected by workflow, personnel, communication, or procedural faults. Assessing the staffs’ skills and competency are also crucial for implementing corrective action.
Implement Initial Intervention, Paying Attention to Results Before/After
In the case of Zika virus education and prevention, initial interventions include utilizing community partners as liaisons to introduce us to targeted audiences/communities. Results should focus on the pre-and-post-survey data collected, referenced in earlier articles regarding engagement, knowledge, and behavior.	In the case of TAT efficiency/improvement, initial interventions should include collecting data points regarding how specimen-to-result turnover is affected at every checkpoint while implementing changes as necessary. Data should indicate success in particular measures which improve TAT incrementally.
Take Measures to Make Further Interventions More Successful Along the Way
Educating communities about the risks associated with standing water and the spread of arboviral infections with clear demonstrations/examples of how to enact improvements. Distribution of educational or advertising materials throughout targeted areas will bolster an effective message.	When staff or other changes effectively improve the streamlining process, they should be recognized and praised. Moreover, clients should be consulted in both inpatient and outpatient settings to inform procedural change and deter further external compromise of TAT.
Implement Follow-Up Intervention, Paying Attention to Results Before/After
Like before, interventions with Zika virus education include community partner meetings to hold engaging discussions about health promoting behavior. Similar surveys collect data before and after the presentation and are correlated with the previous meeting, however, with the addition of data regarding the effectiveness of secondary measures (i.e. advertising and educational materials).	With the implantation of various measures to improve turnaround, assessments of protocol, instrument utility, effective transport, and other previously mentioned aspects would indicate successful outcomes. Combined with the supplemental consultation to steps both inside and outside of the laboratory, an comprehensive conclusion can be established to indicate a permanent solution via these metrics.
Conduct More Comprehensive/Translational Analysis of Intervention Effectiveness
Correlating the primary intervention with follow-up measures can indicate possible opportunities for further improvement. It can also highlight areas of significant success where interventions had the greatest impact. If significant enough, these results should promote the process and further the original cause set forth early on.	Continuous metrics which analyze the TAT as a marker for productivity and efficiency before, during, and after interventions can offer insight into effective changes. Extrapolating this data can improve processes across departments and models made from this process can improve TAT and other metrics in a laboratory.
Share Significant Successes and Challenges with Partners/Staff and Share the Success
Based on standards in current literature, community partners benefit significantly from both repeat-visits as well as becoming involved and informed participants for positive change.	As laboratories face staff shortages and personnel challenges, sharing the success and making sure the rewards are collectively appreciated can improve workplace dynamics.
Create a New Protocol, SOP, or Publication to Influence a New Standard
As with any successful public health interventions, shared information can lead to future improvements elsewhere. Publications often cite the process of creating a platform and approach to tackling social health concerns and highlights emphasize these positive outcomes.	Many productivity projects in clinical settings are difficult, successes should be shared between departments and outside the laboratory. Ultimately, publication might present an ample opportunity for improving standings for overall hospital metrics and larger outcomes.
FINAL: Implement the Same Model Outlined Here for Potential Future Challenges

Obviously, this is a crude and generalized model for how to approach leadership both inside and outside the laboratory, but some of the key aspects of clear goals, interdisciplinary teamwork, resource management, and creativity are paramount. Having my laboratory experience was critical for finding success with my team here with our public health work. Laboratory professionals have strong skills and unique insights for a variety of important fields. Having that experience has truly enabled me to contribute in a meaningful way as I pursue my medical career. As you can clearly see, there are so many useful tools that apply across disciplines. Furthermore, the most important part of managing a project aimed at a positive outcome is answering the simple question: how do I utilize and interpret the data I collect along the way?

And here’s another question: who does data analysis better than us laboratory folks?

Thanks for reading, until next time…

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–Constantine E. Kanakis MSc, MLS (ASCP)^CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.