global outreach – Page 10

Service Snippets

I’ve gotten some great responses regarding my recent blogs on Customer Service, and want to share some of these with you. Good ideas always generate more good ideas, and I think you will find these fun ideas very interesting. As we know, patients can usually only judge our quality and testing performance by what they see and what they experience at the drawing station…so, with permission to share, here are two excellent ones:

Children are often the most difficult to draw, and take more time and technique than adults. One laboratory draw station, part of a large metropolitan children’s hospital, has a system that works to help keep children occupied and parent’s angst levels lower during the busiest times. When patients show up for a phlebotomy and the wait is greater than 15 minutes, they are given a “restaurant beeper” and a coupon for the coffee/juice cart outside on the patio, and then are paged when the phlebotomist is ready for them.

A 25 bed rural hospital in West Virginia surprises a lot of people when they go out to the parking lot, and do a “vehicle draw” for patients that have difficulty making it into the hospital, for older patients who struggle with wheelchairs etc., or if someone is just too ill to come into the building. The staff is truly committed to serving their patients and proud that something so small can make such a difference.

Perhaps these two fine examples (as well as the one from our colleagues in Africa) will generate some ideas about how your operations might make little changes that accommodate patients, and provide the best service you can offer—which we know directly translates to showing patients the quality we are proud of as laboratory professionals. Explore it with your teams, get some ideas going, and make it work for you.

I will be leaving soon for another global experience with colleagues from another part of our world and we will be working on the pre-analytical processes (including the importance of customer service) for our external AND internal customers. I’ll be writing my next blog “live from Kyrgyzstan!”

In the meantime, I’d be interested to know what you’d like me to ask our colleagues while I’m there. You can email me at bsumwalt@pacbell.net and perhaps we’ll get a little international dialogue on the topic…and as always, I look forward to hearing your comments and ideas for building better laboratories and processes around the world, and at home in our own communities!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Customer Service—A Global Perspective

Last time we talked about how customer service changes the perspective of our patients/customers, and how they judge the quality of our laboratories by their snapshot visit to the drawing station. Over the years, I’ve seen some good, some bad, and some very ugly customer service practices…one I discovered even in my own laboratory one day, just by having my blood drawn in the outpatient phlebotomy draw station!

There are lots of “best practices” around the world, and it is interesting for me to hear from colleagues or observe practices that I think are worth knowing, and worth sharing. One comes to mind in a favorite place in Africa. The rural clinic was always very busy, people everywhere lined up on benches waiting to be seen or for pharmacy or for a lab/radiology procedure. It looked like every busy primary clinic everywhere, except for the lovely colorful headdresses on the women and the different kinds of “baby carriers.” When you looked closely, many people did not have shoes, and also had their lunch nearby in a tin carrier because they were prepared to spend the day. When you looked even more closely, sometimes you see smiles and congenial conversation…but more often you can see eyes showing pain or illness, tears, fear, compassion and concern on the faces of those there to receive care, and those there for support.

In this particular busy clinic, the laboratory drawing room was down a narrow hall off to one side, and had steel bars on the door with a buzzer for entry. A necessity, but not very inviting. My African colleagues were concerned that patients would be intimidated by the negative appearance, as many of them travelled miles to get there with children or family and often didn’t even speak the dialect of the district. So they decided to do what they called “walk around draws.” Two phlebotomists took turns, one in the “caged drawing room” and one with a lab tray “roaming the waiting room.” The “roamer” would ask if the patient wished to have their blood drawn in the room down the hall, or if they would prefer a “bed side draw” right there where they were waiting. It provided opportunity to smile at the children, reassure a grandmother, speak to a caregiver if the patient was very ill, and greet people around the patient while also (bonus!) talking out loud about lab procedures—VERY important in that culture. The patient felt surrounded by the clinic community, which was parallel to being in the healer’s hut in their village while everyone gathered around to hear and see the care being given. It worked for them, and even improved their drawing room wait times.

As we explore how we can make patients more at ease, more knowledgeable, and provide improved access to our lab services, we tend to think in terms of how it will improve the lab processes. I learned a valuable lesson from my Africa colleagues: we should also think of how to improve the “patient experience” in safe and culturally appropriate ways. There are many stories and observations on how we do things wrong, but this is an enlightened one about how our global colleagues are doing it right!

As I mentioned in my last blog, the next time YOU have to have your blood drawn, take a close look around and notice what your patients and customers see. I guarantee you will always be surprised by something, and will leave the drawing room with at least one idea of how your lab can do it better. And, if you have a great example of improving the patient experience in the laboratory, let me know at bsumwalt@pacbell.net I’m always in the market for new ideas to share.

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

The African Century

“In demographic terms, it seems, the Asian century could be followed by the African century…Whether Africa is able to prepare for its coming population boom may well be one of the most important long-term challenges the world faces right now.” So says Max Fisher in the Washington Post article “The amazing, surprising, Africa-driven demographic future of the Earth, in 9 charts.” I found these charts and Fisher’s commentary incredibly interesting and well-worth exploring (especially with the future of health care resources in mind). As he points out, the next century being the ‘African century’ will have good, bad, and unforeseen consequences. Even if it is does not turn out to be the ‘African century,’ continued population growth seems to becertain and will put increasing burdens on resources in African countries. With more people, there is need for more water, more food, more jobs, more sources for transport, etc. More people also mean the need for more health care and thus, increased capacity for laboratory services. Yet another argument for the importance of expanded and improved laboratory (and all health care) services in the next decade.

Another interesting statistic from Max Fisher’s charts is that life expectancy in Africa in the next 80 years is expected to increase by 50%. However, in 2090, it will still not be equivalent to that in the U.S., Europe, South America or Asia. From a health care perspective this is interesting both in the reasons why it will still be the lowest life expectancy in the world, and, in how health care is affected by a growing aging population (much like challenges we are beginning to see and expecting to see expand in the coming years in the U.S.). However, with this in mind, take a close look at his chart number 9 on dependency ratios (the ratio of the population under age 15 and over age 64 and thus ‘dependent’ on others and the government to provide for them). Africa’s dependency ratio is projected to decrease from 80% today to 60% by 2055, while the dependency ratios in the rest of the world are projected to increase. This could mean a more productive work force, and more people to take care of a population that is living longer. As Mr. Fisher points out, however, a large younger population can result in increased political instability.

While these charts are all projections and any number of factors could completely alter the course of these projections, it is fascinating to think about and study, and certainly worthwhile preparing for.

I originally stumbled across Mr. Fisher’s charts through a different article of his in the Washington Post called “40 more maps that explain the world.” This one is equally fascinating and I could have spent hours absorbed in the various maps.

On an unrelated note, a quick update to my post from last month: President Obama nominated Dr. Deborah Birx to become the next Global AIDS Coordinator. Dr. Birx has spent her career focusing on immunology, vaccine research, and global health. From the laboratory-strengthening perspective she is an exciting choice for this role. Her nomination still needs to be approved by the Senate. Her bio on the CDC website.

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Customer Service—The Buck Stops Everywhere!

Laboratories are notoriously hidden in basements, outbuildings, storefronts, and historically have been hard to find, difficult to get to, and in many cases, an afterthought in facility planning. It couldn’t be farther from the truth that “labs should be seen and not heard.” Those of us who live in the lab don’t give it much thought…until we have to get OUR blood drawn, that is!

We all know the scene where someone has a “lab complaint.” It typically centers on having their blood drawn, getting stuck multiple times, having a result not ready, or heaven forbid, having to suffer a “re-draw.” If you think about it, the service we provide that has the customer-facing moment is the specimen collection phase. Our pre-analytical capabilities are where our patients/customers/clients judge the quality and strength of our laboratories. I have often described it to students in this way; if you want to buy a house and its gate is broken, the paint is peeling, the door hinges rusted, and the yard is full of weeds, you automatically assume the house is also “broken down” on the inside. It may have upgraded electricity, brand new appliances and plumbing, and the structure is solid and weather proofed. But you decline to delve further based on the appearance. The second house you see has fresh paint, new hinges on the doors, a little grass and flowers in front, and a nice walkway to the front door with a shiny new mailbox. You are charmed…and, sadly, it has a leak in the main drain, the paint inside is lead-based, the electrical system must be rewired and the structural walls are rotting and soon the stairwell will cave in. Nothing you can really see from the outside, but not something you can judge from the street.

I find that the elements of customer service and the way we present and appeal to our patients/customers is the “face of the laboratory.” Professional presentation and treating each patient and each specimen as if it were your mother’s or your child’s specimen gives our clients the confidence and trust they need to feel good about their test results. Communicating, making eye contact, soothing and reassuring those with “difficult veins” makes any situation go more smoothly. And, since most people are unable to judge the quality of our laboratory work—they have no training or understanding of what goes on in that “black box”—remember the house example. We all tend to judge by our first impressions.

Customer Service is a universal concept, and one that is a challenge in every laboratory, everywhere. One of the most popular international training programs ASCP Global Outreach provides is for pre-analytical phase quality improvement, and it always includes a heavy dose of customer service. Not only with patient engagement, but also with other departments, physicians, hospital staff, and even in community outreach. It is universal all around the world, that customer service makes the difference in how people evaluate the laboratory profession. You may be the best clinical scientist or clinician on the planet and your lab may have won awards for superior performance; but no one will know or care about that if they have a bad pre-analytical experience! The buck really does stop EVERYWHERE!

Next time YOU have to have your blood drawn, take a close look around and notice what your patients and customers see. I guarantee you will always be surprised by something, and will leave the drawing room with at least one idea of how your lab can do it better. Next time, we’ll talk about some ideas I’ve learned about customer service in other countries. And, if you have a great example of stellar customer service practices, let me know at bsumwalt@pacbell.net I’m always in the market for new ideas to share.

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Thinking Outside (or Rather, Inside) the Box

“The weather outside is frightful…” The west is facing unprecedented drought, the east is having debilitating storms, and the Midwest a “polar challenge” that keeps everyone on frost-bite watch. In times like these when we can’t reconcile with Mother Nature, I tend to reflect on the challenges of specimen and supply chain transport. Consider the challenges that we face with those issues when weather isn’t cooperative? Plane flights cancelled = delayed specimens to referral labs = delayed results and diagnoses. Interstate shut-downs = trucks sitting still = reagents too hot or too cold for too long. Blizzard or sand-storm conditions = couriers unable to travel = delayed pick-up/delivery = compromised specimen integrity.

Now translate that to our international colleagues, and you can see the difficulties they face on a daily basis. Long distances in the heat of the deserts, or snows of the tundras. Difficulties with transport, with trucks breaking down or planes unable to fly. Concerns with reliable transport via public buses, taxis, independent drivers/pilots who are not specifically trained in laboratory supply and specimen transport. The quality of the reagent and the integrity of the specimen = the precision of the result. It’s that simple…but it isn’t simple at all, is it?

So while we are dealing with the present weather conditions and issues, be reminded that our global laboratory colleagues deal with these issues in all kinds of weather and climate challenges every day, and have the same concerns. It’s a challenge Mother Nature provides for us, and one we must have contingency plans for in order to provide the best service to our patients.

If you are having weather challenges at the moment, I will hold good thoughts. Stay warm, or hydrated, or whatever the conditions require—and when our weather has passed, try to hold good thoughts for your colleagues around the globe who face it year around! If you want to know how they cope, let me know at bsumwalt@pacbell.net and I’ll share some recommendations I have learned from many of them over the past few years!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

US Global AIDS Coordinator and the Laboratory

In early November, Eric Goosby, the U.S. Global AIDS Coordinator charged with leading the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR) announced that he is stepping down from his position to take a professorship at the University of California, San Francisco, where he will focus on the implementation of health programs in developing countries.

The Global AIDS Coordinator is appointed by the President and confirmed by the Senate and reports directly to the Secretary of State. According to PEPFAR website, the Coordinator:

Leads the U.S. Government’s international HIV/AIDS efforts;
Ensures program and policy coordination among the relevant USG agencies and departments and nongovernmental organizations, avoiding duplication of effort;
Pursues coordination with other countries and international organizations;
Resolves policy, program, and funding disputes among the relevant USG agencies and departments;
Directly approves all activities of the United States relating to combating HIV/AIDS in 15 focus countries; and
Promotes program accountability and monitor progress toward meeting the Emergency Plan’s goals.

Given the influence this position has in the implementation of USG international HIV/AIDS efforts, the search to replace Dr. Goosby is of great importance. This person is in the position to guide the direction of PEPFAR implementation and thus may place emphasis on particular initiatives and programs. This Wall Street Journal article mentions four names that are on the short list for Dr. Goosby’s successor.

Certainly there are many important qualifications and characteristics that are needed to be effective in this position. However, as part of the laboratory community, it is my hope that one of those qualifications will be a high level understanding and knowledge of the lab. With an understanding of the importance of the lab in terms of diagnostics and care and treatment I hope that this person will then guide the implementation of crucial laboratory strengthening programs. From the creation of region specific reference ranges, to better regulated supply chain management, to streamlined equipment and reagent procurement, to the training of personnel, there is much that can be improved in labs at the forefront of the fight against HIV/AIDS. With improved diagnostics, particularly at point of care sites, the care and treatment of HIV/AIDS can be improved, which will not only save and improve lives but will also save money and resources.

Thus, my plea to whomever is appointed, know the lab (or surround yourself with those who do) and make laboratory improvements a cornerstone to the continued work of PEPFAR and USG HIV/AIDS efforts.

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Another Passport Story, Part 2—A Bit of Horsing Around

In my last blog, I left off telling you about my lovely visit “on horseback” in the Kyrgyzstan mountains outside of Bishkek. I had taken off with a guide, marshaling my skills to stay in the saddle on a scrawny but feisty equine. As we traveled up the dirt road-trail, it was evident that my mountain pony was full of energy and a handful. We trotted and danced a bit, and I was using my best skills staying in the saddle. We were passed by a couple of cars racing up the dirt road and leaving a cloud of dust which didn’t help my nervous horse, and my guide kept a close eye on me. After a short ride into the hills he had me weave my way up a side trail so he could take my picture with the rocks and mountains in the background. As he was fiddling with my camera, a car came racing back down the dirt road and stopped just behind him, shouting out the car window. He looked at them, at me, back at them, and then shouted something to me in Kyrgyz, pointing and gesturing. I didn’t understand, so he raced his horse up the hill and shouted “Passport? Passport?” I said yes, I had it in my pocket, and pointed. “Show, show!” he said, and when I dug for it, the money was there but the passport was gone. During the horse-dancing and prancing, it had apparently worked its way out of my pocket and fallen by the side of the road. We looked back toward the car and the driver was waving a very familiar-looking little blue book out the car window and sporting a very mocking grin.

You can imagine that my rapidly increasing unease translated directly to my horse and he started a bouncing act amid trees and rocks, and dangerously close to a downhill cliff behind me. It was nearly impossible to get off without killing myself—but get off I did, handed the reins to my guide and ran downhill toward the car. The driver and his two passengers looked to be about college age, laughing and saying “road, road” and in gestures we communicated they had found it, showed me the picture and said “you!”. Now, since passport pictures are like driver’s license pictures, and I was shaggy and windblown, any reasonable passport control agent would have looked twice for verification…but it was indeed me. What they wanted was money and had they given it back I would have given them all I had, and gratefully. But the young man holding it did not offer it back, and raced the car engine. I was a bit angry and said rather forcefully “that is mine, you give it back!” I reached into the car and grabbed it from him, amid more laughter and a bit of harassment from his passengers that now he’d lost it and “no money!” By then my guide was standing behind me and the two of us were more of a menace than they were interested in, so they laughed and raced on down the road. Whew. After a few deep breaths, my guide looked at me with a very serious scowl and said “put passport HERE!” and demonstrated by shoving his fingers down the front of his shirt. I immediately followed directions and we trotted on back. My ASCP colleagues were waiting for me as we jogged back up the driveway at the resort and I quickly borrowed another $20 bill, tipped my guide heavily and thanked my lucky stars that:1) the passport didn’t fall out of my pocket into the river; 2) the kids in the car were more interested in a little fun money than fencing it and; 3) the driver had slow reflexes. Later that evening over a much-needed glass of wine, I reflected I had probably used up a couple of my “nine lives” on that adventure!

So if you are ever in the mountains outside of Bishkek, Kyrgyzstan and want to go horseback riding, I have a wonderful guide and a rather skinny Cossack pony I can recommend, just contact me at bsumwalt@pacbell.net. However, I would advise putting your passport close to your body somewhere OTHER than your jeans hip pocket!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Another Passport Story, Part 1–A Bit of Horsing Around

On a recent trip to Kyrgyzstan, I had a wonderful time with an interactive training for laboratory pre-analytical procedures and specimen transport with key laboratory leaders. Our sessions were designed to give them a full picture of the challenges and opportunities ahead as they build stronger laboratory systems. The two week stay started with arrival in Bishkek, the capital city, on Easter Sunday morning. (Actually, it was the middle of the night!) It was still dark when we checked into the hotel and we took hot coffee to the hotel rooftop for an “Easter Sunrise”. I cherish sunrises all over the world, and taking a solitary moment to watch the sun move slowly through the haze over the distant mountains and bring the city to life was very special.

Sessions covered two weeks and in between we had a weekend to explore and see a bit of Kyrgyzstan. It was suggested we take an overnight into the mountains, which were covered in snow even in late spring, to enjoy their favorite “resort and spa.” A little relaxation and sightseeing in the mountains sounded excellent….we headed off with our ever-protective and accommodating driver.

One of the treats offered at the resort was a horseback ride along the dirt road into the mountains. Some of you may know I have horses and love to ride, so this was a natural attraction and I immediately signed up for a ride and a guide. They showed up with three of the tallest, skinniest, poorly-tacked horses I think I’ve ever seen and I secretly wondered how these ponies ever survived the tundra temperatures! But the ever tough “Cossack horses” are suited for it and much faster and well-adapted than our overly-coddled pleasure horses, so I quit frowning and clambered on. My mount was too tall and had a cock-eyed saddle, and I’m certain he could feel a bit of nervous body language. Riding takes your full attention and I wanted free use of both hands, and also a safe place for identification and tip money. So I put my passport, tip money, and the hotel phone number and cell phone in my jeans pockets. Safety first! However, this turned out to not be as safe as I thought …

Next time….the rest of the story!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Happy New Year—Making 2014 a Year to Remember

If you are one who likes to make a resolution for the New Year, let’s have a look at the word “resolve”:

re·solve:

verb: settle or find a solution to (a problem, dispute, or conflict); to sort out, solve, deal with, rectify; to decide firmly on a course of action; determine, decide, make up one’s mind, make a decision
noun: resolve, resolution; determination to do something, strength or decisive commitment

Or, another way to define it might be, “re – solve”. Laboratory professionals are trained and skilled at solving problems, particularly analytical ones; why not “resolve” to “re – solve” something? Perhaps this is your year to make a commitment to giving back to your profession, your faith, your future. Consider volunteering, either at your laboratory, your hospital or clinic, your community, or perhaps even globally. There is no end to the list of opportunities for service, using skills and training to add value to improving health. If you want some ideas, just contact me at bsumwalt@pacbell.net and I’d be very happy to explore the idea with you!

This is one of my favorite quotes—let’s make 2014 a Year to Remember!

“How wonderful it is that nobody need wait a single moment before starting to improve the world.” ~Anne Frank

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Season’s Greetings—International Style

In this season of extending kindnesses and gifts and sharing the blessings of family and friends, I am reminded of something I have heard many times; World peace isn’t achieved in government board rooms or international caucuses…it is achieved quietly in each other’s homes, around the table, one-one-one, face to face. I believe that is true; and some of the most lasting impressions I have of the world and the world’s people have been gifted to me in conversation, at the table, exchanging ideas, thoughts and building relationships and forging ways ahead to make health and care better globally. This is the essence of change and the heart and soul of peace and prosperity. May this season bring peace and joy, no matter where you live or what faith you follow, and may we all strive to sing the melody and the harmony together whenever we can.

Happy Holidays!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.