Classified

“I retweeted an Instagram picture someone posted on their Facebook page that shows how to place blood tubes in a centrifuge. There is also a vine of it on their LinkedIn profile.” Confused yet? I’m a millennial, more commonly known as generation Y, and if there is a social network out there people my age are either on it or bored with it already. The question that keeps coming up is where do the social networks fit in to professional life? Perhaps the bigger question is can you be yourself while maintaining a professional persona? Most large organizations have social media policies that prohibit their employees from speaking badly about them on social media sites. Some policies also allow a company to terminate someone if the person lists them as their employer and does or posts something that the employer feels isn’t up to their standards.

The reality is if you are on these sites and you list your employer you must be careful. If people ask my advice on social media I usually tell them to stay as ghosts, and don’t list your employer. In my personal situation I don’t even have my real last name on my Facebook account plus it is private and even if you knew what my name was you couldn’t search it. Now, I really have nothing to hide seeing as I have over 1000 friends on my Facebook account but I not only want to control what goes out but more importantly who sees it. My feelings are, keep your personal life personal and your professional life exactly that.

Some may find it surprising that a young person isn’t posting every aspect of their life but I just feel that my organization doesn’t need to know what I have for dinner after I leave for the day. It is really each individual’s choice on what they want to follow or add but it just seems to me that it is a little to easy to become emotional about something and next thing you know it’s out there for all to see. It is pretty much a daily occurrence that some celebrity has to apologize for something that is taken out of context and the same goes for everyone else. When you tweet out that you can’t stand your boss, smiley face; you may not be around to explain the sarcastic nature of the post.

As a supervisor, I would never recommend being friends with people you lead unless you understand and realize that everything you post will be fair game in the workplace. I think a lot of people either forget that or simply don’t understand the significance of social media until it’s too late. Just because something happens outside of the organization, if one of your coworkers sees it you can bet that it will find its way back to the workplace. This is the personal aspect of social media and if your organization requires you to have a public account as a leader to be available for comment and questions nothing says you can’t have two accounts. Have a public profile and a personal one that you can set to private. When people ask me at work if I have any social media accounts I just tell them that information is classified.

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.

 

Harmonization

What does “harmony” mean to you? And how does it apply to lab testing?

One of the biggest problems that arise where lab testing is concerned is that tests run in two different labs will give you two different results unless the labs happen to be using the same equipment (and sometimes even then the results won’t match!) This is a huge problem for doctors of patients who use different laboratories for their testing or patients who move across the country and need to continue following lab test results.  A prime example of this dilemma is the current state of T4 testing. The same CAP sample when analyzed using different assay methods for thyroid stimulating hormone (TSH) can yield results which range anywhere from 2.66 to 8.84 mIU/L. Although CAP samples are not always commutable with patient samples, thyroid testing on patients shows this same lack of harmony.

This example underscores the need for harmonization. In our increasingly small world, where nearly everyone will soon be using the electronic medical record, and all lab results on a patient will be in one place whether they were all performed at the same place or not, it will be paramount that the lab results for any given test can be compared. Efforts to date have successfully harmonized several important analytes, including creatinine (IDMS-creatinine), cholesterol and hemoglobin A1c.  Efforts are on-going to harmonize vitamin D assays against the NIST standards. These harmonization efforts took a massive amount of coordination and work between the in vitro diagnostic industry, regulatory agencies and laboratory and clinical societies.

Laboratory professionals have long recognized this problem, and sought to inform non-laboratorians of the realities at every opportunity. Lack of comparable test results can lead to patient safety issues, including misdiagnoses and/or inappropriate treatment. Recently an international consortium has recognized the need for harmonization of all lab results and begun to work on the problem. Although this effort is just beginning and the road ahead is long until general test harmonization can occur, it is a road worth traveling.

 

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-Patti Jones PhD, DABCC, FACB, is the Clinical Director of the Chemistry and Metabolic Disease Laboratories at Children’s Medical Center in Dallas, TX and a Professor of Pathology at University of Texas Southwestern Medical Center in Dallas.

Resolutions

Have you thought about your New Year’s resolution yet? Hopefully you haven’t thought about when you’re going to break it. In addition to personal goals, we should all think about resolutions that we can make professionally. Whether it is stick to productivity numbers or finally finish that last credit to get another certification, this is the time of year to think about how you can grow in 2014. Our personal lives can affect our professional life and it is the balance between these two that keeps us sane and able to go back to work day after day. When one takes a little too much of your time you must step back and figure out where that fulcrum needs to be placed.

Growth in any career can be small steps or can be a leap such as another degree or promotion. Every person’s career is on a different trajectory and it really is up to the individual on how far they want to go. It is the decisions we make that shape our careers. Some people will tell you to be aggressive and take what you think you deserve, and others will say be patient, put in the work, and good things will come your way. (I wrestled in high school so you can take a guess at which philosophy I follow!) Whichever one you follow the big decisions and hard work you put in will only take you as far as you want it to. I have met many people my age that are happy working on the bench and have no aspirations of being a supervisor. Whatever you choose to do you should be happy and feel engaged that the work you’re doing is helping people. We are in healthcare and even though a lot of us don’t directly see patients the work we do helps nurses and physicians help the patient.

With only a couple weeks left in 2013 this is a great time to reflect on personal and professional accomplishments while also getting ready to start a new year that is full of new challenges and also new opportunities. As I usually say, no challenge is too large to take on and no opportunity is too small to overlook. For example I wrote an article for Lab Medicine and gave a 5 year progress report on my career and it turned into an opportunity to blog for one of the most important organizations for the laboratory profession. I always wanted to take the ideas I had in my own lab and throw them out there and see what other people thought of them and how they do certain things. When we write these blogs we love to hear comments and discussions of how you the reader interact and “live” in your own laboratory. Reflecting on 2013 I’m thankful for Lab Medicine for this great opportunity and my resolution for 2014; I’m going to be moving up that ladder, one rung at a time.

 

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.

Rising Cost of Send Out Tests

More and more in this day and age, the laboratory is encouraged to reduce costs and streamline operations by using available resources in the most effective and efficient manner possible. One of the areas of the lab that is increasingly becoming a problem when it comes to cost reduction is the send out area. Since most labs can now perform the vast majority of their testing on automated chemistry and hematology analyzers, tests that must be performed at reference laboratories are increasingly esoteric, manual, and/or molecular diagnostic tests. And those tests are expensive.

As an example, my own lab sent out about 10 chromosomal microarray (CMA) tests in 2008; that number increased to  400 CMA tests in 2011 and is  on track to be 865 in 2013. At $1400.00 each, the cost to the lab increased from $14,000 to $1.2 million over that time period. And that’s just one relatively inexpensive molecular diagnostic test. Some of the gene sequencing tests can run between $5000, and $10,000 per test.

Labs are trying a multitude of different schemes in order to try to curb these send out test costs. One method that is fairly effective is to have a “gatekeeper” – a person or persons who review and must approve every test that leaves the lab that costs over a pre-set amount. This particular method is probably one of the best for controlling send out costs, but it requires time and commitment on the part of the gatekeeper, and a willingness to interact with physicians who have ordered the tests that may be less than happy than someone is questioning their order.

Another method used for send out cost control is to include some indication of the cost of the test in the computer system. When the test is ordered, the ordering provider is aware of the exact cost of the test. Some institutions are using a dollar sign system to implement this. For example “$” may mean that a test costs under $50 and “$$$$$” may indicate a test costing over $5000, with other levels in between these two.

A third method is to have a lab “formulary.” Any test found in the formulary can be ordered with no problems. Tests that are not included in the formulary must be approved by the lab before being ordered and sent out.

Whatever method a laboratory uses, it is clear that some means of regulating the rising send out costs is going to be necessary for all labs. Until molecular diagnostic tests become automated and routine, they will continue to be expensive.

-Patti Jones

Succession Planning

You have found yourself as a supervisor/manager ready to take the next step in your career. A position has become open for which you have been waiting and preparing. You get to the interview and then the question you weren’t prepared for comes: “With you stepping into this new role, who amongst your staff will be ready to step into your current role?” Is this possible? With all of your hard work you forgot one of the most important details about you moving on: succession planning. We have all heard it before but it can and will be a limiting factor to your success in your career. Executive management looks for people that can mentor the next in line for when it is your time to claim another rung on the career ladder. A CEO once told me in an interview, “Your moving up in any company is limited by how successful you are in finding and mentoring the people that will follow behind you.”

As a laboratory supervisor I have found one of the toughest issues I face is finding people with the correct credentials that could fill my spot. Bachelors programs in Medical Technology or Clinical Laboratory Science (My degree) are few and far between. I had four students in my graduating class and the university closed the program two years after I graduated. While there is nothing subpar about the associate degree programs, we are bound by regulations that state supervisors and managers have a bachelor’s degree. There are options for people to go back and get the bachelor’s degree and then take the MT test but that adds another level of difficulty (finding people with the desire to take that next step). Identifying the person qualified first, then capable second is the challenge that all supervisor/managers face.

We have to start somewhere so let us start with qualified. This starts with the hiring process. It may be easy to hire candidates with the minimum qualifications to fill that spot you desperately need filled but you must resist that temptation. Look ahead and try to envision where this candidate fits six months or a year down the road. You should always be looking for your next supervisor. If you find yourself hired into a new laboratory you must identify quickly who will be able to take on more responsibility. I would take tasks that you perform and rate them on difficulty and level of problem solving. If an employee shows interest in taking on additional responsibility you give them low level tasks first, then you progress. This allows you to mentor them and let them grow into more responsibility. It also allows you to delegate tasks which can free up more time for you to take on higher level responsibility yourself.

This progressive thinking and working should be happening on a consistent basis. It should be fluid and really start from the top of your organization. If it doesn’t then try to get it started yourself and build up the people beneath you. When it comes time for you to take that next step the person that fills your shoes will be set up for success.

-Matthew Herasuta

Red Tape

I like debates so I’m going to start one and I hope people will comment below and get a dialogue going. How many pieces of paper do you have framed on your wall in the lab from regulatory bodies? If you are a reference lab that serves nationwide customers you may be putting up regulatory wallpaper! I have heard of more and more inspections in regards to laboratories.. My laboratory is inspected by CLIA, CAP, and AABB. With budgetary constraints the importance of the AABB certification has been discussed numerous times. I even feel myself that AABB is becoming more of a consulting company that publishes medically relevant treatment recommendations than an inspection body. I would like to see consolidation between CAP and AABB where the somewhat higher standards of AABB are adopted by CAP and laboratories would not have to pay separate fees for each.

Let’s take it a step further. If CLIA inspections are increasing are there rising tensions between them and CAP? What is making CLIA step up? Do they not trust the job that CAP is doing performing inspections of the laboratories? If CLIA inspections are becoming that difficult what do you as a manager/supervisor put your efforts toward to ensure you will be compliant no matter who inspects you? How does a laboratory go through 3 or more inspections a year and still stay on top of everything else? All these questions must be answered and quickly if you expect to have time to do what is required of you as a manager/supervisor. I don’t think too many laboratorians would care who inspects them, but I do think we would care about having one universal checklist that we can abide by and really dig in to what is important to keep the lab accurate and safe.

How are we expected to grow our business and serve our patients when we are constantly guessing on what checklist to abide by or who is coming to inspect us? We are consolidating in every other sector of healthcare to improve efficiency except in regulatory bodies. Is this just another consequence of big government or do we actually need them all? We should start the discussion and make our voices heard on what we feel we need from regulatory bodies to ensure we are doing our jobs as laboratorians. Are you as frustrated as I am? Or have I inadvertently started my career as a lobbyist for the laboratory field?  Comment below.

-Matthew Herasuta

Acquisitions and Takeovers

Early in my MBA classes I had one professor with over 35 years in Healthcare consulting say to the class, “There are very few examples of actual mergers; usually someone is acquired or someone is taken over.” This resonated with me when my previous hospital was informed that in 90 days we would be closing the doors. Now, it resonates with hospitals at an increasingly rapid rate. If you’re a person who loves keywords, “integration” will be your new favorite on the list. I currently sit on two integration committees (Blood Bank, Education) where we discuss the different ways we do things and how we can standardize our procedures to make sure that a patient receives the same testing at any Cleveland Clinic location. As big healthcare systems acquire more and more independent entities, integration will be the axiomatic factor to their future success.

If you’re a small community hospital laboratory manager/supervisor that has just received word you are going to join in a partnership with a large system, what next? The really big issues that laboratories deal with are instrumentation and supply chain. Once your service contracts are up, you’ll need to switch to the systems the big laboratory uses. You will be thrust into a much larger network of people and more importantly, talent. If you have open spots you will have a larger talent pool to pull from much easier than going to the job sites.

The biggest challenge you will have is watching your services be consolidated. If you were a full service hospital you will more than likely lose some services and this can have an effect on your test menu in the lab. Low volume but high profit tests will almost always be consolidated into a single location to get the most profit out of it. The send out department of your lab may become much busier because of this increased workload. The system will try its absolute hardest to lower their cost structure and this will include changes in your laboratory.

On a personal level the first thing to do as a manager/supervisor when you find out your hospital is being acquired is don’t panic. Very rarely do they come in immediately and “clean house”. They usually have a period of time when talent is evaluated and then decisions are made. The real question becomes do you want to work for the new system? The integration period can be difficult and time consuming. If you feel your hospital may be acquired, stay prepared. Keep your resume updated and just scan the job sites every once and a while and see what is out there. My biggest piece of advice is don’t get caught in a situation you have no control over. You are the manager/supervisor of the laboratory so you are the reason that it succeeds or fails. These are the same reasons the managerial staff is kept or let go once an acquisition has been completed.

This consolidation is only going to increase as the new healthcare legislation takes effect. Decreasing reimbursement from the government will force entities to combine forces and form systems of healthcare. Put yourself at the forefront and know what in your test menu that you could do without and what you could use from a larger system to be more profitable. When the time comes you are the talent they are looking to acquire, not take over.

-Matthew Herasuta