Chutes and Ladders

Mobility in any career can lead you in multiple directions and usually it is up to you which way you go. The laboratory field has become very specialized in the last twenty years and staying a true generalist or a general supervisor is becoming more difficult. I always tell students to stay generalists as long as possible so that your options are open once you get a sound technical foundation of knowledge. This allows them to become supervisors in a number of different areas when the time comes. Much discussion has been made about the proverbial “career ladder” and whether or not the ladder exists as it used to. As an early careerist I am well versed in navigating the ladder and figuring where I fit, and how I plan to climb the rungs as I enter my second decade of my career. I finished my MBA at the beginning of 2013 and put myself into application mode to see what new positions awaited me.

I learned a few things in my quest to climb as many rungs as I could on the ladder. First, if an application states you need a certain amount of experience but you are one or two years short, apply anyway. Employers will at least speak with you if you are a little short. If you wow them with your experience so far in your career and let them know that you don’t just work but you actively observe you can make up that deficit. Second, do not be afraid of lateral moves. If your goal is to be a laboratory director or higher, moving to supervise a different area of the lab can make you a better-rounded candidate once it comes time to go for that higher position. This is especially important if you have become burned out or in need of a change from your current department. Nothing says you have to stay a Hematology supervisor for eight years before you have the supervisory experience to become a laboratory manager/director. One aspect of the lab I find is a good move is to the point-of-care side of the lab. You get out of the lab more and into the hospital as a whole. Usually this role takes on the Quality side of things as well. This role can be a great transition from a technical supervisor to a more general department supervisor where you can learn and grow.

Finally, never be afraid of putting in an application. I find a lot of people talk themselves out of a position before they even apply. Do not be afraid of rejection. In speaking with laboratory professionals, I have heard of a hospital not hiring a candidate for a position but going back and contacting them at a later date for a different position. It never hurts to interview and get your name and face out there. Go on interviews even if you don’t feel the position is a good fit. Practice is the name of the game. When your time comes climb the ladders and avoid those chutes!

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.

Bird Watching

Every inspection cycle we receive our checklists from the regulatory organizations and that is usually when the latent lawyer in me breaks out like the Hulk and I start interpreting the meaning of every word contained within the document. CAP has said on multiple occasions that some of the checklist items are open to interpretation and that there can be several ways to satisfy them. CLIA has their 6 elements of competency and when I first read them my eyes started to turn green and my clothes started to get a little snug. The element that I think is open to the most discussion is the first: “Direct observations of routine patient test performance, including patient preparation, if applicable, specimen handling, processing, and testing.”  Some of my colleagues have interpreted this as once a year directly observing a technologist/technician perform each test and then signing them off. When I read this element I can’t help but think that once a year is not enough to verify that an employee is correctly performing each test. The question I always ask is how do we know that an employee does it correctly when we are watching but then does it a different way when we aren’t?

I am a very hands off leader. The reason I can do this is because when I train a new employee it is rigorous and I make sure that they can handle pretty much anything that comes their way. When I read that first CLIA element I feel as if they want us to babysit our employees. I understand the importance of direct observation but where is the line drawn that says so much observation is enough? If you ask me once a year is not enough; however, the more we observe the less time we have to do our countless other tasks as supervisors/managers.

When I thought about it, I came up with a couple methods or ways to “directly observe” my employees. The first obviously is to stand behind them and watch them perform a test. Then the question of how do we observe the off shifts without actually being there? We all have smart phones with cameras so could employees could set up their phones to record a procedure and then we could watch it back later. In blood bank I can have each employee save their gel cards so that I can read them at a later time and make sure the volumes in each well look ok. That would qualify as direct observation of their results and process since if the volumes are incorrect I would be able to tell. As supervisors we are also called to consult with other technologist/technicians frequently. Troubleshooting with your employees usually involves something test related and that to me would count as direct observation as well. Finally, we have students almost year round and our employees usually take on the role of teacher when they are in that spot for the day. When I observe them teaching the students how to perform tests this is a great way to confirm that the employee is competent.

My favorite way to observe is when my employees don’t know I’m watching. I have an office that is not directly in the blood bank so I have to wander in and out fairly often. Sometimes I will sit down or file papers all the while observing my employees and their technique and processes. There are many ways to “directly observe” and using all of them ensures that you are meeting the guidelines enforced by CMS. When inspection time comes you can show the signature that says you directly observed but also have a list of answers when they ask how you did it. When I need some practice I grab my binoculars and do a little bird watching.

 

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.

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