Why Do Two When One Will Do?

Today I attended a great session on transfusion case studies by Carolyn D. Burns, MD, FASCP, and Phillip J. DeChristopher, MD, PhD, FASCP. The speakers were dynamic, personable, and made learning fun. They presented cases on hematology/oncology, transplant recipients, and HLA antibodies, among others. I won’t go over each case—honestly, there was so much great information I’m afraid I won’t do it justice—but I’d like to share tidbits I found interesting.

-A fact that I had forgotten from my blood banking class oh-so-long-ago: the platelets your body makes live for eight to ten days, an autologous platelet transfusion last four days, and a non-autologous transfusion would last three. If a patient has an immune response to a platelet reaction, those platelet might only live a day.

-Fellows and residents in transfusion medicine don’t actually know how to transfuse a unit of blood product. They aren’t aware of what happens in a blood bank or a transfusion center. Laboratory professionals need to be cognizant of this and be open with information. Use teaching moments when they present themselves.

-Eliminate unnecessary transfusions through dialogue with doctor and pathology. Hence the title of this post: “why do two when one will do?” It’s a mantra for the blood banker to live by.

-Don’t be afraid to question orders. Medical technologists might be the first line of defense, so to speak, and are essential when bringing questionable orders to the attention of pathologists. Don’t be afraid to speak up when your instincts are telling you something is off. Hone your critical thinking skills.

-Blood transfusion is like marriage. It should not be entered upon lightly, wantonly or more often than is absolutely necessary.

-This couldn’t be stressed enough: keep the lines of communication open. Ask the doctor and/or nurse questions about the patient; have a open relationship with your medical director; don’t be afraid to ask questions.

 

 

Do You Know How to Build a High-Performance Team?

How successful have you been in your hiring high performers? That’s a question that opened an excellent session today at ASCP’s 2013 Annual Meeting entitled “Mis-Hires: How to Avoid Making One and How to Avoid Being One.” Lewis Hassell,MD, Director of Anatomic Pathology in the Department of Pathology at the University of Oklahoma Health Sciences Center and a faculty member of ASCP’s Lab Management University, described the “ABC” ranking of employees.

At one end of the spectrum are “C” employees, those that make managers happy when they join someone else’s team, said Hassell. The “A” employees are the ones that always come through for you—the ones mangers want to hire.

“B” employees are in the middle, but in the right environment, said, Hassell, these can become “A’s.”

On average, managers succeed in finding “A” level employees about 40–60% of the time, but studies show that managers can boost that rate to over 90%. How? By altering their hiring practices.

The usual approach—screening CV’s and inviting promising candidates in to interview—favors candidates that make a strong first impression. Job seekers can game this system; they can pad resumes and produce answers they think hiring managers want to hear. This approach, said Hassell, values a candidate’s affability and availability over attitudes and abilities.

On average, managers succeed in finding “A” level employees about 40–60% of the time, but studies show that managers can boost that rate to over 90%. How? By altering their hiring practices.

Managers might gain more insight into a candidate’s judgment, integrity, and passion, he said, by presenting the job candidate with a scenario. Ask candidates about a challenge they encountered in a previous position and how they responded, suggested Hassell. “Candidates who can’t think of a challenge probably aren’t ‘A’ level,” he said. Don’t overlook red flags, he said, or even pink ones. Don’t readily dismiss eccentricities, try not to hire out of desperation, and don’t choose a candidate merely because they’re better than the last person who held the job, he cautioned.

Job seekers can also maximize their career success by carefully assessing the quality of the organization they’re about to join, not just the location or the financial remuneration. Hassell admonished job seekers to do their due diligence in order to join an organization that will enable them to function at an “A” level.

Students of Lab Management University who could not attend this session in person can see a recorded version of it in October at Lab Management University. I encourage job seekers and hiring managers alike to watch it.

-Michelle Hoffman, Director, ASCP Publications

Passions and Pitfalls as an International Consultant, Part II: What Works and What Doesn’t

 

As I reflect on the huge impact 9-11 had on our country, one of the things that speak of who we are as a nation is the concept of Global Health. Even in the strife of conflict, there is never compromise when it comes to humanitarian assistance, and work continues toward peaceful ways to make the world a better place. Once again I am reminded that strengthening and building laboratory capacity around the globe is making a major contribution to the healthcare of nations around the world.

There are passions and pitfalls to consulting in healthcare internationally. Some tactics work well, some don’t—and I have a few short personal examples to share. What typically “doesn’t work” are the smooth and precise operational processes we tend to be familiar with in our lives and laboratories.

“The best laid plans of mice and men do often go astray” and indeed, that happens each and every project I am privileged to participate in. Expecting things to change is the norm, and no matter how carefully planned, the trip never goes as planned!

Each project has it’s “pitfalls”—and they are sometimes concerning, often funny, and always require a huge amount of “go with the flow flexibility.”On one trip we were scheduled to assess seven laboratories scattered throughout a very large geographic area. The hours and hours of driving took so much time, performing thorough assessments was quite a challenge. Providing the very best feedback possible was difficult to accomplish and there were several sleepless nights working over reports and comparing notes. That meant nodding off in a very hot car….and missing the warthogs!! On another trip we were scheduled to assess and offer accreditation feedback to a comprehensive specialty laboratory. It fell to us to spend several days in their new and very modern facility and walk through their processes. As the week progressed we found our assessment team was “in the middle” of a conflict in the stakeholders’ goals and our closing sessions with the laboratory leadership took a fair amount of diplomatic energy to stay focused on the laboratory assessment findings. In this case, experience in cultural differences, being able to read the nuances of unspoken sensitivities, and even the ability to maintain meeting and agenda control were essential skills. If this one had been my “first rodeo” it would have been a disaster!

But what about those things that go as planned? In my experience one thing that always goes well is the receptivity. I have worked on first time visits to new countries and also in the same country multiple times. Without exception I have been welcomed by laboratory and health professionals who are anxious to share information and exchange operational methods and expertise. In all cases they are proud of their laboratories, and eager to show what they do and how they do it. One of the “passions” and something that works very well are the connections with people. We all live, love, want the best for our families, and want meaningful and purposeful work to do in the world. The relationships I have developed over the years are priceless. On one trip my ASCP teammate and I were invited to the rural home of our in-country colleague, and the elder of the family presented us with a parting gift—a chicken! It is traditional to honor guests who are traveling with something to eat along the way so they don’t suffer hunger on their journey….and after a lengthy explanation about why the airlines wouldn’t allow us to take our chicken home, we asked if our host might keep her for us so she could raise many chicks and honor many other guests in the future.That seemed an acceptable compromise, so we named our chicken “Elao” which is the native word for “Lucky”. Poetic irony, but we hope Elao went on to make a bit of history.

Every trip has moments that work well and some not so well, but one constant is “adventures in travel.” Next time I’ll share some stories about my challenges with luggage…and some crazy adventures in strange airports. By the way, if you are ever in Ondangwa, Namibia please order something other than chicken—and if you see Elao the Famous Chicken running around, be sure to contact me at bsumwalt@pacbell.net!!

-Beverly Sumwalt

 

Bump in the Night

When is the last time you spent the night in your lab on the 3rd shift–a month, year… maybe a decade? How many supervisors/managers know exactly what happens on their off shifts? I bring this up because most hospitals require certain staffing levels even if they only see 15-20 labs from ER a night. If this is the case in your facility, you’ve been provided with an excellent opportunity to empower your employees while “doing more with less.” Those duties that are essential but not time sensitive—such as analyzer maintenance, quality control, and batch testing—are well-suited for off shift employees. All it takes is a bit of creative thinking.

When I first started working in my current position, the blood bank was prototypical. We ran all QC on first shift, performed morning duties, and tried to process as many pre-admission testing (PAT surgery) specimens as we could with inpatient specimens mixed in. Second shift was responsible for PAT tests and routine in-patent specimens.  With productivity measures putting pressure on staffing, I thought about how I could rotate duties to allow one of the three 2nd shift technologists to leave early and only work a half shift. First, I made 1st shift responsible for all PAT testing. Second shift was to pour off the Types and Screens and first shift would do them in the morning. Second, to account for the increased workload created on first shift I made the second shift responsible for tube-testing QC and 3rd shift responsible for Gel testing QC. When things quieted down in the evening one technologist could leave.

This is just one way to look at your daily operations and think what could be done to increase productivity. This rotation of duties required a few things.  First I had to teach the off-shifts how to do the QC. This was not a challenge because they were excited to learn something new. Next I had to assure first shift that the other shifts were able to perform these new duties. This aspect was the most difficult even if it meant making their jobs a little easier! Finally, I needed to monitor the workflow to make sure that this change was effective and helped with productivity, which it did.

Working the occasional off-shift has given me insight into what actually goes on in our lab. It is important as managers/supervisors to know the workflow of your lab 24/7. Working a 2nd or 3rd shift is also an opportunity to connect with staff that for the most part you may only see during a shift change. I would encourage all supervisor/managers to be aware of workflow not just during the 8-12 hours you work but for the entire time your lab processes specimens. Try to spend some time on an off shift and see what really goes bump in the night!

-Matthew Herasuta

How We Can Make a Clinical Difference Despite Not Seeing Patients

People assume that I chose pathology because I didn’t like patients but this couldn’t be further from the truth. During medical school, I was a Schweitzer Fellow and volunteered at two free health clinics in the Philadelphia Asian community where I helped start hepatitis B screening and vaccination programs in populations with a high prevalence of this disease. I also served as the student director of my school’s migrant farm worker health clinic where we provided screenings and care to farm workers every summer. In fact, I often was asked to speak with patients because I could convince reluctant patients to comply with care.

But this doesn’t mean that I was the best medical student on the wards or in the clinics; in fact, far from it. Now that I look back, I was often too stressed to quickly triage what was most important to do clinically. But being a trained critical thinker, I could often reason out the answers. A couple of my residents thought that I wasn’t made for clinical medicine because I thought things out in a different way than most.

For an artistic and introspective person like me, I found my home in pathology. I need work that visually stimulates me and provides variety, challenges, and most importantly, enough time to take a breath, gather my facts, and think things through. Sometimes, even my physician friends joke that we are introverts who don’t like patients. They think that we sit at microscopes all day, can’t write prescriptions, make diagnoses in isolation, and prefer to release reports with the words “recommend clinical correlation”  so that other doctors can provide the actual care. All of these things are so untrue.

On my molecular pathology rotation, I was reminded how the pathologist and the clinical lab are integral to the complete clinical care of the patient. A transplant patient on anti-CMV prophylaxis was admitted for diarrhea. His labs were positive for both C.difficile and a very high CMV viral load. He was given antibiotics and an increased anti-CMV medication dosage before being subsequently discharged. He was again admitted a few days later with worsening diarrhea despite medication compliance. He was again C.difficile positive and his CMV load was now three times higher than his previous result. He was put on IV gancyclovir and a repeat CMV load ordered to assess therapeutic response before discharge with a prescription for the same dosage of valgancyclovir he was given on his previous recent admission.

Our techs always compare abnormal results with previous values, so my attending and I were notified of the elevated CMV viral loads. The techs in my facility cannot access patient medical records so I was responsible to work up this case. I’m often amazed at how often they pick up a serious issue even without access to clinical records– more than just looking at the number, they know that something is not quite right.

I noted that the patient had been on valgancyclovir with dosage increases for CMV prophylaxis since discharge from his transplant. His CMV load was previously undetectable prior to the recent admissions. I called the transplant surgeon and suggested CMV resistance genotyping based on the clinical history and blood was sent that day. As the experts in diagnostic medicine, we can impact clinical care even when we don’t physically examine the patient. We must serve as the bridge between the clinical lab and primary physician – both informing them of available diagnostics as well as suggesting appropriate tests – because care is more than just the numbers.

-Betty Chung

Passions and Pitfalls as an International Consultant, Part 1: What We Do and How We Do It

According to the dictionary and the ever-popular Wikipedia, the definition of a consultant is “a person who provides expert advice professionally.” These same sources define “international health” as “an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health focuses on determinants and distribution of health in international contexts from several perspectives including: the pathology of diseases and promotes prevention, diagnosis, and treatment…”

Describing my “avatar life” as an international global health laboratory consultant is both a lofty definition and a mouthful. When people ask what we do as consultants, it’s easy to say “we provide expertise, training and mentoring in laboratory operations, to help strengthen them in process improvements so countries can grow in their capacity to provide the quality of laboratory services needed to diagnose, treat and prevent diseases in their countries.”  What exactly does that all mean?

When a country invites a consulting team to work with them, the first steps are to identify what their particular needs are in their laboratory system. Sometimes it’s developing a classroom curriculum that helps prepare students for laboratory and pathology careers. Often it is preanalytical training so specimen integrity, supply chain, and transportation issues do not compromise results. Other times it is analytical process mapping to identify areas for operational improvements and use limited resources in the most effective ways. And in many cases, it’s helping a lab comply with accreditation requirements. This entails assessing, advising, coaching and mentoring in the areas of procedures and quality metrics.

When a country invites a consulting team to work with them, the first steps are to identify what their particular needs are in their laboratory system.

An in-country consulting project usually has multiple phases. Once a country decides their course of action and focus, a series of visits are arranged to meet the goals set by the country’s leaders and the CDC in their region. That coordination of effort helps maintain focus and leadership so the time and resources are used most efficiently. Consulting teams are then set up depending on the expertise needed, previous experience and familiarity with the country, availability, and other considerations unique to the project. When a team is assembled they work together on logistics, content, accumulating materials needed for the project, and coordinating their efforts. When the project finishes, the team continues to collaborate on follow up, reports, lessons learned, next steps, and sustainability issues. It’s all very fun and exciting. It’s also all hard work as my fellow consultants and ASCP staff teammates can attest to! And that same cycle is being done in multiple countries, multiple phases, and multiple times during the year. Shifting gears quickly and maintaining flexibility are key capabilities you must be able to pull out of your bag of resume tricks or you won’t survive to tell the story!

That is a summary of what we do and how we do it, but that’s just the standard operating procedure. The real purpose is the passion and dedication to improving the health and laboratory conditions alongside our international colleagues and partners. And the outcome? Evidence based results are proving each step makes a difference, and we are seeing growth and change each trip, each project, each step of the journey. Come to the ASCP Annual Meeting and see the progress being made and how the Global Outreach teams are working together!

Next time let’s talk about some of the “pros and cons” of what works…and what sometimes doesn’t. And if you are ever in Kazakhstan, be sure to order beshbarmak…which means “five fingers” because you eat it with your hands. The traditional dish is made of wonderful thick boiled noodles in an onion broth and chunks of a variety of boiled meat…goat, mutton, beef and yes, horse. And if you’re there in the spring, wash it down with the traditional drink of fermented mare’s milk.I don’t have a recipe…but I do have a wonderful friend there who will take you out for an authentic Kazakhstani meal! Contact me at bsumwalt@pacbell.net.

-Beverly Sumwalt