management/administration

Proficiency Testing (PT) Part 2: Investigating Failures

Last month we discussed the rules and requirements for how to properly perform proficiency testing (PT) within your laboratory. In part 2 of this 3-part series we’ll review the rules associated with evaluating your results, and how to investigate any unsuccessful surveys. Still to come in part 3 we will look into how to utilize your PT results to monitor for trends and shifts in your values.

The rules:

Performance Review: Laboratories must initiate and document a review of their PT performance evaluations within 2 weeks of notification that results are available. This includes a review of both graded and non-graded/educational analytes and events as well.

Key things to note: Even though educational samples are not formally graded, you should still verify the accuracy of your results, with appropriate follow-up for any failures. CAP specifically requires you to evaluate these educational challenges as well. Whether the sample is graded or not does not change the fact that you had an incorrect result.

Unsatisfactory Performance: For any unsatisfactory results, you are required to perform a root cause analysis to determine why (see below for guidance). This also includes any clerical errors – you need to evaluate your process and find ways to prevent these simple errors from happening again. If they are happening with PT samples, it is possible they are happening with patient samples as well.

Cessation of Patient Testing: Unsatisfactory events indicate that there was a problem with that particular survey; whereas unsuccessful events indicate there has been a pattern of unsatisfactory events/samples and a larger problem exists. If a pattern of poor performance is detected, you may be asked by your local state department of health to cease all testing for a particular analyte.

Key things to note: This also applies to clerical errors. Even if there was no technical problem with the accuracy of your results, failure to submit results on time or clerical errors made while submitting can also have severe impacts on your ability to continue offering that test.

Remedial Action: If you’ve been notified by your PT provider or state DOH to cease testing, there are extensive steps that must be completed to prove that the problem was correctly identified and corrected. You must also identify where samples will be referred to for tests you are unable to perform in-house.

Key things to note: If testing has been removed from your laboratory, you will be required to demonstrate successful performance in 2 consecutive PT survey events for the analyte(s) in question before being granted permission to resume patient testing. This can cause significant delays and financial impact for your organization.

Root Cause Analysis: Investigate to determine who, what, why, when, and how the event occurred. Be sure to evaluate all phases of testing to ensure you identify all potential causes.

Pre-Examination:
- Human Resources – evaluate the training and competency records for staff involved in the handling and testing of samples.
- Facilities – reagent inventory control & storage temperatures, equipment maintenance and function checks
- Standard Operating Procedures (SOPs) – staff compliance with written policies, bench excerpts are current and valid, document version control up to date
- Specimen –test requisition/order entry (was the correct test code ordered/performed?), labeling (were aliquot/pour off tubes properly labeled?), transport (was appropriate temperature requirements maintained until testing performed), quality (was there visible deterioration with the sample prior to testing or cracked/damaged tubes received?), quantity (was the original sample spilled or leaking causing an incomplete aspiration of sample by your instrument?)

Examination:
- Method Validations – were instruments current with calibration requirements, any bias noted during instrument correlation studies, values being reported within the verified AMR
- Environmental Controls – temperatures/humidity within tolerance limits, for light sensitive studies (bilirubin) was there excessive exposure of the samples to light prior to testing, excessive vibrations occurring that may have affected results (nearby construction or a running centrifuge on a shared work bench)
- Quality Control – did QC pass on the day of testing, was QC trending or shifts noted that month
- Analytical Records (worksheets) – were sample results transcribed correctly between the analyzer and worksheet, between the worksheet and LIS
- Instrument Errors – were any corrective actions or problems noted for the days before, during, or immediately after testing of PT occurred
- Testing Delay, Testing Errors – were samples prepared and not tested immediately leaving them exposed to light or air which may affect results (blood gas samples), any errors or problems noted during testing that may have caused a delay or affected accuracy of results

Post-Examination:
- Data & Results Review – check for clerical errors, was data trasmitted correctly from the instrument into LIS, was data entered correctly on your PT provider entry submission forms
- Verification of Transmission – did your results correctly upload to the PT provider website, was there an error or failure with submission
- Review of LIS – are your autoverification rules set up correctly, is the autoverification validation current with no known issues
- Patient Impact – perhaps the most important step to take when reviewing PT failures, you need to determine what impact your failure had on your patient results. Depending upon the identified root cause and how different your values were from the intended response, this can potentially pose a severe impact on your patient values tested at the same time as the PT samples.

Involve your medical director to determine if the discrepancy in results is clinically significant. Perform a patient look-back to review patient values for the same analyte with the failure during the time period in question. Evaluate the bias that was present, and if deemed to be clinically significant then corrected patient reports will need to be issued with a letter from the medical director explaining why. If it was decided that the discrepancy is not clinically significant, document this in writing and keep on record with your complete investigation response.

Corrective Actions/Preventative Actions – use the following set of questions to help guide you in ensuring that the problem identified during your root cause analysis will not occur again:

What changes to policies, procedures, and/or processes will you implement to ensure there will not be a repeat of this problem?
Do any processes need to be simplified or standardized?
Is additional training or competency assessment needed? If so, identify specific team members to be trained, and who will be accountable for performing and documenting this training.
Is additional supervisory oversight needed for a particular area or step?
Are current staffing levels adequate to handle testing volumes?
Would revision or additional verification of the LIS rules address or prevent this problem?
How can the communication between laboratory, nursing, and medical staff be improved to reduce errors in the future?

Continuous Process Improvement – after identifying the true root cause(s) for the failure and implementing corrective/preventative actions, you need to evaluate the effectiveness of those improvements. Have they been sustained? Are they working to correct the original problem? Have you created new problems by changing the previous process?

Quality Management Meetings – if necessary, increase the frequency of these meetings during the evaluation period for timely feedback to management and staff
Implement internal audits and quality indicators to check for potential issues
Access the specimen transport conditions to ensure they meet test requirements
Evaluate and monitor your turnaround time metrics to track problem specimens and impact of testing delays
If necessary, increase the frequency when QC is performed or calibration frequency if stability issues are identified

Performing a thorough root cause analysis for any failures will allow you to implement appropriate corrective actions that will address the true issues. Having a robust quality management program will help ensure these issues are identified and corrected in a timely manner, and reduce the potential for the dreaded Cessation of Patient Testing letter from your local DOH.

Coming up in the final installment of this series on PT testing, we’ll review all of the quality indicators and data that can be found in your PT evaluation reports to help ensure you’re on track for accurate patient values.

-Kyle Nevins, MS, MLS(ASCP)^CM is one of ASCP’s 2018 Top 5 in the 40 Under Forty recognition program. She has worked in the medical laboratory profession for over 18 years. In her current position, she transitions between performing laboratory audits across the entire Northwell Health System on Long Island, NY, consulting for at-risk laboratories outside of Northwell Health, bringing laboratories up to regulatory standards, and acting as supervisor and mentor in labs with management gaps.

The System

Outside the city of New Bern, in Craven County, North Carolina, there is a particular system for residents to dispose of their garbage. Locals must go to the nearest participating gas station and purchase stickers which cost about $2.00 each. These stickers must be placed on each bag of garbage generated in the household, otherwise they will not be picked up during the weekly trash collection. In order to save money, a group of widows has formed a club in which members scout out the open dumpsters in town (usually behind stores or gas stations). Then they call and let group members know where they can covertly dump their trash for free that week.

This story may seem funny, but for the most part, it is true. I have no doubt this also occurs in other parts of the country where the system for trash collection is similar. Why do people behave this way? Are they purposely trying to circumvent the trash collection system in place or is the system just not easy for locals to utilize? If you’re having difficulty getting people to change safety behaviors (like PPE compliance) in your laboratory, you might need to determine that for the systems you have in place and ask similar questions.

In one laboratory the manager struggles with staff who work part of the day in a clean office and another part in the lab itself. When the employees go into the lab for brief periods, they often fail to don their PPE. Upon further investigation, you would learn that staff are not allowed to keep their lab coats on their chairs and that all PPE is kept in one lab store room located on the opposite side away from the offices. The system is set up to reinforce PPE non-compliance.

In another lab the manager placed a permanently-mounted counter face shield in the chemistry department so that staff would be forced to use it when popping specimen caps. Staff loaded instrument racks behind the shield, but when they carried the racks over to the analyzers, their faces were not protected from splashing. Exposures continued to occur. Here the system is at play again. A face shield was put in place to change behaviors, but it was only a partial solution. In order to protect staff fully here, they would need goggles or a face shield that can be worn. Offer light-weight reusable or disposable face protection that staff can use easily. Be sure to give them a say in whatever option is chosen.

Sometimes the system issues are not apparent until there is a safety event, and unfortunately, that can result in bigger problems. If your training program does not include regular fire safety training, a small fire situation may get out of hand quickly. Does your staff have experience handling a fire extinguisher? Would they easily be able to put out a fire? Do they know their evacuation routes and meeting places, and could they get there with ease? What about the lab emergency management plan? Have staff participated in a table-top drill so they have a basic understanding of how to respond during a chaotic disaster? These are examples of some safety systems that need to be in place to keep staff ready and safe at all times.

When people take shortcuts or find ways to circumvent the system, there is usually a pretty good reason, Often, it is the design of the system. In New Bern, elderly women can’t lift large heavy trash bags, so they use smaller bags. They don’t want to pay the same price for a garbage bag sticker that others are paying for big bags. There’s a problem with the system- and those ladies found a way around it. What problems do you see in your lab safety system? If you don’t know what they are, ask around. Staff will talk. It’s better to find out what the workarounds are now and to fix them before an injury or exposure occurs.

–Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

Working with Generation Y: How Other Generations Can Adapt

Generation Y is coming and they are coming in strong! It is fast becoming the world’s largest working generation and their impact on the workforce will become even clearer in the next few years. These digital natives find communication natural, in any shape or forms it comes. They prefer texting and instant messaging, but also appreciate face-to-face meetings and hand-written notes. They use social media for both personal and professional use and consider it essential to know how and where to access information. Instant gratification has become one of this generation’s key values, because they grew up with the world of information at their fingertips. They value professional development and feedback and they are at work to learn and grow.

When working with a Millennial the first step is to show them that you respect them and what they bring to the table. This generation has received more negative attention than other generations, but they have a tremendous amount to offer to the workplace (as do all the other generations). They value collaboration and learning opportunities, so they are typically quick to adjust when giving constructive feedback. Because of their collaborative approach, they value inclusion and Social Media to bring people together. They are well versed in finding information and can typically solve smaller technological issues without any help.

This generation is focused on having their work mean something, to have a purpose that is larger than simply getting a paycheck. They dislike long email and voicemails and anything that is a waste of paper. They appreciate flexibility and sending documents electronically. They experiences high academic pressures, so they are comfortable working in a fast-paced environment. They are comfortable multitasking and handling multiple projects simultaneously.

Millennials who work in larger organizations are on the brink of entering leadership positions. However, there are many self-starters who have had to learn leadership skills along the way. Because this generation values collaboration, leaders tend to encourage group work and giving people an acknowledgement for trying. They dislike people who are afraid or do not want to learn new technology and cynicism as they are a generally very positive generation.

When working with Millennials, note that they respond well to a participation work environment so ask for their input and suggestions. Be open about any processes, systems, and share information freely. Provide them with lots of feedback to help them learn and grow. Millennials respond well to a faster pace work environment, so do not try to slow them down. They dislike formality and stiffness, so allow flexibility whenever possible. For example, invite them to provide input for their own goals and do not hover over them. Give them multiple things to work on simultaneously so that they can go from project to project when their energy shifts. This generation is crucial to bring your organization to the next level, so mentor them, help them grow and develop and you get their dedication, passion, collaboration, and positivity in return.

-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.

What’s the purpose? That’s the question that most Gen Ys, or commonly known as Millennials, ask of their job. Why am I here? Can I make a difference in the world if I remain doing what I am doing?

The Baby Boomers worked because they felt an obligation to put in a hard day’s work whether they liked doing what they were doing or not. It was a job. The Generation Xers introduced a focus on work-life balance, which was not the case for the Baby Boomer. The Boomers never heard of the concept of “work-life balance” until their children, the Gen Xers, made it a job requirement and reality.

As for the Millennials, they need to really believe in their job and what they are doing. Millennials ask questions that the Boomers and Gen Xers wouldn’t think of asking. This is often misinterpreted as being lazy or looking for the easy way out. This is not the case. The Millennials took the best of their predecessors. Most Millennials have a good work ethic and they definitely look for balance. However, they’re also searching for a purpose.

My favorite story of a Millennial is centered on the importance of taking lunch at work. This topic surfaced from a Roundtable Discussion with laboratory professionals last October 2018, at the ASCP Annual Meeting in Baltimore. The actual topic for this Roundtable Discussion was “diversity.” However, that quickly changed when the nine people at the Roundtable focused on generational differences. This roundtable was rich in generational diversity. The table was comprised of Boomers, Gen Xers and Millennials. Boomers stated that they found it both necessary and easy to work through lunch. Why? It’s because they pride themselves in their incredible work ethic. The Boomers praised themselves for being better than “most Millennials” who often don’t and won’t work through lunch. Instead of that mindset, perhaps the better approach would be “What can we learn from Millennials in the work place?” That answer is “purpose and balance.”

-Catherine Stakenas, MA, is the Senior Director of Organizational Leadership and Development and Performance Management at ASCP. She is certified in the use and interpretation of 28 self-assessment instruments and has designed and taught masters and doctoral level students.

Proficiency Testing (PT)Part 1: Are You Doing it Right?

Every laboratory knows that they must participate in proficiency testing (PT) for all of the regulated analytes they report. But did you know that there is more to it than simply checking your overall score in each survey you participate in? Whether you utilize samples from the CAP, API, or have developed your own in-house blind sample testing algorithm, there is a lot of data available to help you assess the quality of your laboratory program. In the first of this 3-part series, we’ll review why PT testing is important and the rules that must be followed. In part 2 we’ll discuss how to properly perform an investigation when scores are <100%. Lastly, in part 3 we’ll look at how to review your results so that you get the most out of them for a successful quality laboratory.

Why participate? Well frankly, because you have to. It is a CLIA/CMS requirement, and if your lab has additional accreditations, those agencies will have their own rules and requirements as well (we’ll get to the rules in a little bit). But outside of the regulations stating you must participate; all labs should want to participate. It’s an opportunity to check your accuracy against peers who are using the same instrumentation as you. Similar to utilizing an affiliated QC report, this is a way to see what the “real” value is supposed to be (despite what a manufacturer may claim it to be), and how close/far off your lab is to that true value. It can help you identify potential problems before they become huge problems with patient values being affected, and it’s also a great way to satisfy competency requirements for your staff.

The rules:

Participation: For every regulated analyte being tested under your laboratory permit¹, you must participate in a CMS-approved PT program².

Key things to note: This only applies to testing performed using non-waived methodologies. Waived testing is exempt from PT requirements; although it is still recommended that participation occur if an evaluation program is available. Additionally, this only applies to your primary instrumentation. For example, if you have an automated urinalysis reader and your backup methodology is to read dipsticks manually, you are only required to participate in PT for the primary methodology. (Your backup method would then be evaluated for accuracy through semi-annual correlation studies.)

Routine Analysis: Unless otherwise instructed by the provider of your PT samples, PT samples are to be treated the same as patient samples. Meaning they are handled, prepared, processed, examined, tested and reported the same way you would perform patient testing; AND by the same staff who would handle patient testing.

Key things to note: If nursing staff perform a particular test within their unit (for example, ACT testing in the cardiac cath lab), it is those nursing staff members who must run the PT samples. You cannot have the laboratory perform PT testing unless the laboratory also performs the patient testing. Additionally, PT samples should be rotated among all staff members who perform patient testing. Meaning all shifts, and all days of the week that the test is performed – don’t let the day shift get all the fun.

Repeated Analysis: Similar to rule #2, unless you routinely perform duplicate testing on your patient samples, you cannot perform duplicate or repeat testing on your PT samples. You cannot run a PT sample in duplicate “just to make sure.” Patient samples are just as important to be accurate as a PT sample, which is why we participate in a PT program in the first place.

Key things to note: After the date that laboratories are required to report results back to the PT provider, you are then allowed to use the samples for repeat testing. This can be used to check for uniformity in grading of reactions among staff members, and to assess annual competency. But only after the submission date has passed.

Interlaboratory Communication: You cannot discuss the results or samples from a PT survey with any other laboratory (or Facebook user group) until after the results submission deadline has passed. Doing so before that time would be considered cheating. The point of PT testing is not to see how good your networking skills are, but to ensure accuracy of your own results. Plus, the other lab may not be as good as you think they are.

Key things to note: If your laboratory is part of a larger integrated health system, be careful that you have separate designated staff assigned to enter results from each location. Entering results for more than one permit number by the same person would be considered a violation of the interlaboratory communication rule as they could compare results from Lab A to Lab B prior to submitting. Also, be mindful of what you put on social media. User groups are a great networking resource and learning tool, but you still need to follow the rules. Violating them in a public arena such as Facebook for all the world to see would put yourself and your organization in great jeopardy if you were caught.

Referral of Samples: You are not permitted to forward or share your PT samples with any other laboratory until after the result submission deadline has passed. Similarly, if your laboratory has received PT samples from another lab, state regulations may require you to notify your local Department of Health to inform them of the violation.

Key things to note: The intended purpose of performing PT testing is to verify the accuracy of your own laboratory testing. If you would routinely send a positive sample to a reference lab for additional confirmation testing, you would not do so in this case. Simply report out the values for the tests that your laboratory performs only. The reference laboratory will have their own PT samples to check accuracy for the confirmation testing they perform for you. Ensure your testing menu is up to date and accurate so that your PT provider is not expecting values for a confirmatory test if you do not physically perform it in-house.

Records Retention: Ensure that all records and documents related to the testing of PT samples are saved for the amount of time required by your regulatory agencies (typically 2-5 years). This includes instrument print outs, LIS chart copies of the filed results, QC records for the day of testing, and any associated worksheets used to document your results.

Key things to note: Retaining a copy of the instrument maintenance logs and QC records along with the actual PT results will help you investigate any scores that are less than 100%.

Attestation: Both the laboratory director and all personnel performing testing must sign the included attestation statement. This is not just a way to track who performed the test, but is a legal binding document assuring that testing was carried out appropriately as per the rules defined above.

The penalties for labs that are caught violating the rules (whether intentionally or not) can be quite severe. These penalties can include the revocation of your CLIA permit; a ban for the laboratory owner and laboratory director; as well as possible financial penalties and fines.

Coming up in the next blog we’ll review the rest of the rules related to evaluation of your scored PT results, and how to perform a thorough investigation into any unsuccessful survey events.

1: https://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/cliabrochure8.pdf

2: https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/ptlist.pdf

The Educational Audit

The Lab Safety Officer (LSO) had years of experience, and he was proud about how far he had advanced the lab safety culture. He had focused on fire safety for a long time because when he started, very few staff members knew how to respond to fire drills or alarms. He studied fire regulations and educated staff about them. He performed safety audits, looked for and corrected potential fire safety issues, and overall felt fairly certain that he had learned all there was to know about fire safety.

When the hospital accreditation inspector walked through the laboratory, the safety officer accompanied her. The inspector opened a freezer containing patient specimens in one of the specialty labs. The safety officer had opened that freezer many times during audits, but this time the inspector asked a staff member if anything other than serum was stored in the specimen tubes. The staff member stated that there was methanol and other reagents added to the tubes. The inspector turned to the lab safety officer and stated she would need to cite the lab for inappropriate storage of flammable materials. According to NFPA-45, a national fire code for labs using flammable materials, these specimens need to be stored in a freezer that is designated as explosion-proof. In all his years, the LSO had never seen that regulation. Upon further investigation, he also learned that every laboratory refrigerator needs to be labeled as to whether or not it is capable of storing flammable materials.

Later during the accreditation walk-through, the inspector noticed that the flammable cabinets in the laboratory did not have self-closing doors. The LSO asked if that was a requirement, and if so, where was it stated. The inspector said that self-closing doors was a requirement of the International Fire Code (IFC), and it was required if the state adopted the code. Again, upon further study, the LSO learned that 48 U.S. states had adopted IFC, and he now needed to consider replacing his flammable storage cabinets with self-closing units.

When the auditor reviewed the lab’s Exposure Control Plan, she asked how education about Bloodborne Pathogens was given to the staff. The LSO was happy to show the inspector staff education records which showed that every employee viewed a mandatory computer-based training program which covered all aspects of bio-hazard education. When the inspector asked how employees could inter-actively ask questions about bloodborne pathogens as required by the standard, the LSO could not answer. When he researched the OSHA standard, he found the requirement, and he told the inspector he would work with the hospital to figure out how to make the changes to their annual education.

As you might imagine, the safety officer wasn’t feeling quite as proud of his lab safety program after this inspection. In fact, he felt more than a little surprised that after so many years in the field that there was so much he still had to learn about lab safety regulations. He was disheartened, but he was able to turn that feeling around into a resolve to make the necessary corrections, to learn more about the regulations, and to continue to make improvements to the lab safety program.

One of the benefits of having an outside auditor come through your lab is having that new set of eyes in an area that you may see every day. Maybe the inspector has a very different background- perhaps they were a fire inspector previously – and they can enlighten you about specific regulations you hadn’t considered before. Be sure to look at audits as an educational opportunity, even if (or especially if) you receive several citations you were not expecting. The world of safety is always changing, and there will be changing regulations and other regulatory agencies you just didn’t know about. Take that as an opportunity to learn, to grow, and to always be working to improve your lab’s safety culture.

Working with Gen X: How Other Generations Can Adapt

Generation X is sandwiched between the two largest generations alive today: Baby Boomers and Generation Y/Millennials. This means that Generation X will never be the largest generation at the workplace, but even so, their impact is significant. Gen Xers are in a unique position as they started their careers relatively recently and can understand the challenges Millennials face, while also starting to enter leadership positions and can therefore relate to Baby Boomers.

One of the things that make Generation X stand out from other generations is that many of them have young children and aging parents. This means that having a work-life balance is important to them as they often have responsibilities to take care of their family members. They typically also prefer a divide between their personal and work lives. This is not to say that they do not make friends at work or not hang out with colleagues after work, but they tend to have a “business first” approach to their work relations.

When working with Generation X, note that they appreciate it if you use their time efficiently. When presenting an idea of have a meeting with them, make it as productive as possible and focus on what is in it for them. Gen Xers value brevity, fast turnarounds, and efficiency. This is a stark contrast with Baby Boomers, who focus on interpersonal relationships before getting a task done. Making your communication, whether it is in-person, over the phone, or via Gen X’s preferred mode of communication (email), as concise and to the point as possible will increase your effective collaboration with this generation.

As leaders, Gen Xers dislike micromanagement, both as a leader and as a follower. Their leadership style revolves around trusting others to get the job done and they expect the same courtesy in return. They value people doing what they say they are going to do, so do not promise Gen Xers that you will do something if you know you cannot. Their leadership style is therefore quite informal as they expect people to follow deadlines and get the job done, while giving their workers a high degree of freedom.

Generation X is an efficient generation who hate wasting time with empty words, promises, and incompetence. They appreciate immediate actions, a focus and straightforward approach to work without long social interactions. They respect child-friendly environments, such as being able to have a flexible schedule that allows them to accomplish their professional tasks while also taking care of their family members. They can brief and blunt, but they have an authentic and results-orientated approach to work. If you work with a Gen Xers, give them freedom to do their work and explore and only make promises you can keep. Keep your emails and interactions to the point and follow up quickly after a meeting. Having an efficient but friendly approach will take you far with this generation.

So what does working with a Gen Xer really mean? Does it only apply to the laboratory, or do we work with people outside of the laboratory? Hmmm. How about our family, friends, social and community relationships? That said, I took this question to the streets as well as the laboratory and asked these questions.

Boomers, what’s it like working with a Gen Xer?

Gen Xers have a good work ethic; however, their family often ranks higher than their job. Boomers pride themselves in their work ethic. The Gen Xers are still so busy taking care of their aging parents, as well as, their kids, even when they’re off at college. They are the “Sandwich Generation.”

Millennials, what’s it like working with a Gen Xer?

I took this question to the classroom where I teach. My students are all working on their Masters Degree, and by the way, I have three Gen Z students in my class. Both the Millennials and Gen Z students found that the communication with a Gen Xer is different. The stated that the Gen Xers use email, messaging and Slack. As a Boomer, I didn’t know what Slack was! The Generation Y and Z students felt that the Gen Xers were resistant to change and to some technology.

One Millennial by the name of Erika shared that she found Gen Xers relatable and at ease. I found her most profound statement to be that she said the Gen Xers seemed like they were in-between and strike a balance between the Boomers and the Millennials. Hmmm…. They are known as the “Sandwich Generation” because they are often taking care of their parents and their children, but it’s interesting Erika saw them “sandwiched” in a different way.

Time to hear from our Gen Xers and how they feel about working with the Boomers and Millennials.

Gen Xers, what’s it like working with the Boomers and Millennials?

My first Gen X interview came from a regional director of a Beverage Company. As a Gen Xer, he felt that he was more effective working with the Boomers when the communication was face to face, or on the telephone. Emails worked, but he definitely noticed the Boomer preference. On the other side of the coin, this Gen Xer found that the Millennials who worked for him or with him preferred the technology communication.

The Gen X laboratory professional I interviewed found the Boomers resistant to change. This was interesting because this is how the Millennials felt about the Gen Xers! Again, is this the “Sandwich Effect!” Overall, this Gen Xer appreciated the depth and vast knowledge of the Boomer and how they wore that hard work as a badge of pride.

Lastly, on a high note, the Gen X laboratory professional really appreciated the Millennial’s enthusiasm. The grass doesn’t grow under their feet in the work place. If they perceive there’s no place to climb the ladder, they’re off and running. The Gen Xers let go of the “Boomer Job Loyalty Program,” however, they are more stable than the Millennials in the work place. Again, they possess the gifts from the Boomers and Millennials. They are “The In-betweeners!”

Lean Principles

Last month we touched on implementing lean principles to help improve efficiency within the lab, as opposed to relying strictly on physical changes. For example, purchasing a larger centrifuge as opposed to switching to a different methodology completely for your STAT testing needs. But what exactly does “lean” mean?

The overall focus of a “lean” laboratory is efficiency: optimizing delivery of results by efficiently utilizing resources, thereby reducing costs and improving speed (turnaround time). If a step or action does not add value, lean laboratories will seek to remove or minimize this perceived waste.

There are 8 key areas where lean processing can be applied to minimize waste, improve efficiency, and prevent unplanned downtime:

Defects: This can apply to both your consumables (reagents, controls) as well as your instruments and equipment. QC reagents that are not as stable as the manufacturer claims them to be can lead to failures, repeats, and extra costs (and time). Older equipment may be more prone to failures and breaking down, leading to additional downtime. Ensure all maintenance tasks are completed on time to prevent these interruptions.

Overproduction: Performing testing that was not requested by the customer uses staff time and resources, and cannot be billed for. Evaluate your critical value policy – are you repeating and verifying every single critical result, even though the patient has been consistently running that way since admission? Consider tightening your delta check rules and only verifying values when the result is either new, or a significant change from the prior result.

Waiting: If a process is idle or stagnant, resources are being tied down that cannot be used to add value. There is value to batching certain tests due to QC requirements or cost (ELISA plates, electrophoresis gels); however waiting to batch CBC samples on an automated analyzer does not provide the same return value. Similarly, waiting until an instrument runs out of reagent completely before loading more on board can cause further delays if the reagent has special handling requirements (thawing, reconstituting) or has not yet been calibrated.

Evaluate your workload to ensure you have appropriate staffing levels that match your testing volume. If your laboratory receives a large drop off of samples from outpatient clinics at 5pm, consider staggering your work schedules so that you have coverage when you need it, while minimizing the amount of staff waiting for work to arrive.

Not engaging all employees: Your staff on the front lines are the experts – utilize this valuable resource by tapping into their creativity. Ask them what is working in your current process, and what they would like to see improved. You may be surprised by the innovative ideas they come up with, and they will have a vested interest in making the improvements work.

Transportation: Excessive movement of reagents or samples can lead to time wasted. Try to keep heavy or commonly used items stocked near the location they are used in. It is much easier to transfer a 5 gallon reagent cube from a storage shelf within the hematology department than to bring it up from a central supply room 3 floors below the lab. When possible, utilize automation to process samples and organize completed tubes ready for long-term storage.

Inventory: Determine appropriate par levels for each consumable, and avoid over ordering when possible. Excess inventory ties up capital budget, space, and depending on the product can risk wastage due to short expiration dates. For items requiring a long lead time (heavy reagent cubes traveling via ground shipping), plan accordingly to avoid excess rush delivery costs. Within your inventory management system, include all necessary information so that all staff can reorder supplies when the par threshold is exceeded: full description of the item, photo, physical location where it is stored, supplier, item #, par level, amount to order.

Motion/Distances: Reduce excess travel and motion of both your staff and your samples to improve efficiency. Strive to create a continuous process flow when designing your lab work areas. Work should move along the process path in a smooth and uninterrupted stream; rather than having to keep returning back to a different bench or department. If different departments frequently share specimens (CBC and HA1c on the same tube), consider colocation of these areas to reduce excess motion between them.

Extra processing: Performing non-value added work, having redundant paperwork, or overly complicated processing steps can lead to errors and wasted time. Focus on simplification and standardization. For example, consider implementing a barcode scanner to reduce transcription errors associated with manual entry of values.

When looking to implement lean processes within your lab, start small. Look to see which departments or processing steps are generating the most waste and focus your efforts in those areas first. Even small steps can yield a big return when executed well. Efficient labs lead to happy techs; happy techs lead to successful labs.

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