Professional Societies Abroad

In my last post I wrote about how Lab Week was being celebrated around the world. In that post I mentioned two medical laboratory associations that are up and coming in their respective countries and working hard to provide a voice for laboratory professionals. These organizations are the Association Ivoirienne de Biologie Technique (l’AIBT) in Cote d’Ivoire and the Medical Laboratory Scientists Association of Tanzania (MeLSAT). These two organizations are among a growing group in Africa recognizing the importance of professional associations to provide a voice, educational resources, and other tools for medical laboratory professionals.

Over the past few years the Centers for Disease Control has been a leader in helping facilitate the development of the African Society for Laboratory Medicine (ASLM). According to the ASLM website, the organization “is a pan-African professional body working to advocate for the critical role and needs of laboratory medicine and networks throughout Africa.” ASLM provides membership opportunities, continuing education, publishes a journal, and implements the WHO AFRO framework for improving medical laboratories in Africa called SLIPTA (Stepwise Laboratory Quality Improvement Process Towards Accreditation).

While ASLM focuses on providing services and member benefits across the African continent, L’AIBT and MeLSAT serve the local communities in their respective countries. You can find more information about l’AIBT on their facebook page, which features photos and posts on l’AIBT activities in Cote d’Ivoire and their website.  For more information on MeLSAT, you can visit their website, which also has a job postings page for lab professionals looking for opportunities in Tanzania. Both organizations have benefited from mentorship support from ASCP and have begun a dialogue with each other to exchange information and best practices. As they continue to develop and grow they will be important resources for local laboratory professionals and can provide an important network of professionals throughout the continent.

 

Levy

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

A Trifecta: It’s About Time!

I am always amazed and interested at how events often occur in 3’s. If you are from Kentucky (or follow the “ponies”) you are likely familiar with the racing 3’s, aka the Triple Crown, of which the Derby is the opening event. There is also the trifecta which is defined as a successful bet for the top three winners in a race: win, place, and show. Well, I believe we have recently (and I might add, finally) achieved a trifecta for Patient Blood Management (PBM).

The trifecta of which I speak is the long-awaited and anticipated national recognition of PBM and thus, transfusion safety.

The first of the three events which initiated my designated trifecta was the American Medical Association and Joint Commission Overuse Summit which took place in 2012. Blood transfusions were recognized and listed within this committee’s top five over-utilized procedures/therapies. A complete discussion of the findings of this summit has been published on the Joint Commission’s website.¹

The second and equally important event was the soon-to-follow Choosing Wisely Campaign, sponsored by the American Board of Internal Medicine (ABIM) Foundation in 2013. Two of the top 5 recommendations pertain to PBM. Restrictive transfusion practices and minimizing overuse of laboratory testing which avoids iatrogenic blood loss anemia were both highlighted.² Several professional societies have embraced the Choosing Wisely Campaign and now have published specific recommendations for their own subspecialties. These include the American Society of Hematologists (ASH), American Association of Blood Banks (AABB), the American Society for Clinical Pathology (ASCP), and the American Society of Anesthesiologists (ASA). The list continues to grow. The American Hospital Association (AHA) has subsequently published a white paper mirroring these recommendations.³

And then the veritable “icing on the cake” has been the recent 2014 release of the AABB Standards for PBM.⁴ These standards place direct focus on the numerous distinct elements of a robust PBM program with levels of activity for all facilities/systems large and small. I imagine many of you have seen the May issue of the AABB News.⁵ This entire publication speaks to the integrated efforts of the ABIM, AHA and other groups that now have joined, in unison, the song of PBM.

Many of us have been beating the PBM drum for several years. Even those of you that are early in your “journey” are embracing it readily in your loco-regional arena. I applaud you! We should be pleased and proud that the drums have finally resonated with leaders of our nationally-recognized societies, accreditation bodies and medical professional groups. This will help to bring PBM and our mission for transfusion safety even more directly into the limelight.

I’m a good old Kentucky girl and I love to score a trifecta. This is a good one and it’s about time!

References:

¹www.jointcommission.org/overuse_summit/

²www.choosingwisely.org

³www.aha.org

⁴www.aabb.org

⁵AABB News, May, 2014; 16: 1-22

 

Burns

-Carolyn D. Burns, MD, is a Board Certified Pathologist who has worked as a medical director for transfusion services and an assistant clinical professor of pathology. She frequently speaks about topics such as transfusion reactions, transfusion in solid organ transplant, and anticoagulant/antiplatelet reversal strategies.

 

Improving Healthcare Delivery: Effective Performance Improvement

How do you conduct effective performance improvement for your clinical laboratory when facing the complex challenges under the Affordable Care Act (ACA) 2010 and regulatory compliances? Producing healthy revenues and manageable costs are crucial components and challenging objectives for any organizations. Healthcare organizations have performed strategic renewals and redesigned their business operations by enlisting performance improvement plans. However, after all that hard work, many organizations still end up with large deficits to their operational budgets and non-compliances on their accreditation agencies’ regulatory requirements that may require drastic measures to rectify (such as employee lay-off or early retirements). Some organizations, even after performance improvement programs or formal business reengineering, will end up closing their doors. According to Harvard Business Review, among Fortune 1000 companies, success rates of business reengineering is lower than 50 percent and can be as low as 20 percent! What can be learned from this? How do you get employees on-board to performance improvement plans toward improving healthcare delivery?

Management should not expect that employees share their desire for change when the organizations are not performing well. Nor should management create teams and expect those teams to produce changes without providing the context for that change. Effective performance improvement does not start with solutions that are prescriptive and instructional; however, it should start with shared diagnosis and mutual engagement involving all employees that result in shared values and collaboration. These in turn help build the organization’s culture toward long term success and not just temporary fixes. High levels of employee commitment result in higher productivity, creativity, and collaboration. This, in turn, creates successful performance improvement programs.

According to Bert Spector, scholar and author in organizational change management and Director for Emerging Executives for the Federal Bureau of Investigation, these five elements create high commitment among employees when implementing performance improvement:

  1. Clarity of the organization goals by employees at all levels,
  2. Teamwork
  3. Shared Information
  4. Organic Controls
  5. Individual development opportunities

Employee communications play a significant role in the success or failure of any major performance improvement or change program. Management needs to get feedback from their employees, and employees need to have a safe environment in which to give that feedback. A good understanding of theories for effective performance improvement (especially those that deal with employee motivation) is a crucial step in improving healthcare delivery.

References:

Spector, B., (2013), Implementing Organizational Change: Theory into Practice, 3rd ed., Upper Saddle River, New Jersey: Pearson, pp. 51-98.

Barrett, D. J. (2002). Change communication: Using strategic employee communication to facilitate major change. Corporate Communications, 7(4), 219-231.

 

Information on policies or practices are solely from my personal experience ONLY and have NO relation to my affiliation with any regulatory or government agency.

satyadi

-Caroline Satyadi, MT(ASCP), SM, DLM, SLS, MBA, MS, CQA (ASQ) has been a laboratory management professional for over 25 years. She has worked with several different medical industries for CLIA/CMS, FDA/ICH/ISO, TJC/CAP/COLA/HFAP accreditation survey readiness.

 

My 3Ts: Trials and Tribulations of Technology!

Like so many others, I figured it wouldn’t happen to me. Like countless others, I have been through the fires of Hades trying to straighten out a “hacked” email account. Like numerous others, I’ve come away from the experience knowing more and enjoying less of my techno-challenged universe! Changing your email address is about as complicated as changing your DNA. Consider, it’s not just closing down “yahoo” and opening up “gmail.” It’s re-capturing the twenty-year list of professional and personal contacts that were compromised and will never be found again. Or the list of archived documents that hold the history of your collective files, reference materials, all the “stuff” you keep. Never mind the cartoons and pictures…I gave up on those long ago.

After my gnashing of teeth and ultimate resolve to fix the issue, it occurred to me what a huge problem it would be to re-create a “hacked laboratory.” In the laboratory, it would be like wiping out every send-out log, every result, every known micro or blood bank patient history, every phlebotomy encounter, and every patient demographic that exists. Well, you get the picture! It’s a “do over” at the highest level. Back-up and clouds aside, it would be very difficult. What computers have done FOR us is to standardize and streamline data collection, improve error rates, and decrease turnaround times for diagnoses, test results and treatment. All VERY good things. I would also propose that….if a process is broken or not working, adding computerized technology only speeds it up and makes it go really really fast….it doesn’t fix the process! Technology is an enabler, and should be used to enhance where needed. As laboratory professionals, in addition to learning the skills of “medical technology”, we are also rely on LIS systems, HIS integrations, and the other “non-medical technologies” that make our systems more efficient. I encourage us all to remember that we must also focus first on improving our processes, so that when they go fast, they also go well. Having someone hack my email forced me to look at my processes…and indeed, some of them were going fast but needed improvements!

Technology is what we do. Technologist is in our title and licensure. It seems to me that science geeks, which most of us are, weren’t prepared to be computer geeks as well….and therein lies the hope for an even better next generation of “medical technologists.” Are we indeed still medical, still seeking continuous improvement and quality processes for our patients, or are we just highly computerized technology teams who can deliver results really fast? Something to ponder…

Cheers!

 

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

Halfway Through…and What’s Left to Do

I had originally started writing about a recent article I read on residents organizing as a collective bargaining unit for salary negotiations. But I’ll leave that for another day and give you a more informal blog post today.

So, for those of you who don’t know, I will be transferring to a program in my home state of NJ for personal reasons for my last two years. When I initially applied to residencies, I didn’t apply to any of the three programs in NJ because I wanted to be in a large (>4 residents/year), urban program that served a significant number of underserved minority and immigrant patients. Chicago was a familiar choice as I had attended college at The University of Chicago alongside my brother here many moons ago. It was also where I first began working with minority and immigrant community advocacy and grassroots organizing groups and my oppas (“older brothers”) and unnis (“older sisters”) then, are the leaders of these groups now.

But two years later, circumstances in my life change, priorities change, and the reasons to go home were more compelling than those to stay. It wasn’t an easy decision. My chairman and attendings here have been very supportive, especially of my extracurricular activities and research. I know that when I go to fellowship interviews, people will ask why I transferred. The reasons are innocent and legitimate enough but I do wonder if they may affect how programs will view me as a potential candidate when they hear my reasons. After all, fellowships are more competitive to obtain than residencies and any small possibly of negative perception, whether true or erroneous, can make or break whether you get those fewer positions available.

I took this week off to deal with moving tasks and my apartment is a mess of half-packed boxes. I need to get as much done before I’m back at our busiest surgpath site again next week until I leave for NJ. But the déjà vu act of packing, calling up moving companies for quotes, and selling items in order to lighten my load has put me in a contemplative mood. I realize that now I am almost halfway through this part of my journey to become a practicing pathologist.

Sometimes, I feel as if I have been weighed and measured and found wanting in terms of where I should be in AP. With my research and heavy science background, CP has always been a comfortable fit. I haven’t had any cytology rotations yet but I get to do four months in NJ. In terms of surgpath, I’m knowledgeable enough with the “bread and butter” that I see during sign-outs but not knowledgeable enough when it comes to unknowns. I know I should read more and often wonder why I don’t do as much as I could.

But now that I’ve come to this fork in my journey, moving back to NJ and thinking about applying for my first fellowship, I wonder what do I need to become the best pathologist I can with the time I have left? I don’t want to be cramming everything I should’ve learned in three years into my last year when boards studying fever hits. If anyone has some advice or anecdotes about their training to illustrate something that is working for them, please feel free to share.

And yet, even though our studies and service duties are, of course very important, how should we engage in molding our profession into the pathology of the next age? What are the most salient skills we need to acquire and how do we show the clinical care teams that are evolving within healthcare reform just where our place is within it? What are the most pressing issues for residents? Salaries, autonomy to influence our education, didactics, service duties, or clinical care? Where should we most focus our efforts?

 

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

 

It’s That Time of Year Again

It’s a few days after a major holiday (Memorial Day in the United States), and clinical microbiologists knows what that means. It’s foodborne illness season! According to the CDC, Norovirus and Salmonella are the biggest culprits, but several organisms can be implicated.

If your lab doesn’t recover Salmonella, Campylobacter, or E. coli O157:H7 often, consider brushing up on the identifying characteristics of these organisms. (Do you know which one doesn’t ferment sorbitol?) It’s also helpful to keep the patient history (in particular, their travel history) in mind when reading enteric cultures or performing a microscopic ova and parasite examination. Also, now is a good time to be sure your reporting procedures (including local public health contact information) are up to date.

Check out the CDC’s website for more information on foodborne outbreaks, including how many people are affected.

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

 

Improving Patient Safety: Effective Communication for Performance Improvement

In 2014, the Joint Commission updated its National Patient Safety Goals (NPSGs) in order to address areas of concerns for patient safety to reduce harms to patients. These goals include standards for clinical alarms, transfusion errors related to patient misidentification, reducing likelihood of patient harm due to anticoagulation therapy, reducing the risk of healthcare-associated infections, implementing evidence-based practices to reduce healthcare associated infections due to multidrug resistant organisms, and prevention of central-line associated blood stream infections. A multidisciplinary team comprised of all clinical areas including nursing, laboratory, pharmacy, radiology, biomedical engineering, and environmental services are necessary to become compliant in all of the NPSGs.

How do you effectively communicate the NPSGs (or any other change initiative) to all personnel? Sometimes organizations will implement initiatives and performance improvement training with score cards, only to find that the initiatives did not produce the expected results. Prior to launching any new initiative for performance improvement toward NPSGs compliances, management needs to take the extra steps to communicate clearly to employees the background of the current situation within the organization, explain why there is a need for performance improvement, and emphasize what the stake are if the organization isn’t compliant.

The transformation process in change management involves changing employees’ behavior to enhance personnel capabilities. According to Kurt Lewin’s model in the traditional change management, there are three phases of change: (1) unfreezing, (2) change, and (3) refreezing that specifically focuses on employees’ behavior or involvement. In general, employees would not necessarily change their behavior just because the organization performs poorly or there are new standards to follow. Employees will keep their attitudes or behaviors when they feel comfortable or safe with the current behavior and there’s no sense of urgency to change their behavior or the work environment allows them to choose not to change. Lewin’s model identifies that in the unfreezing phase there should be open communication and motivation to employees to understand the situation fully. Allowing employees to question the status quo or feel discomfort with the current practices creates “buy-in.” Employees feel invested in the process and that in turn facilitates employees’ participation in the next phase: “change,” when the new improvement strategy is adopted. The last phase, “refreeze,” is implementing and sustaining the change.

Employees’ attitudes are structured along three dimensions labeled as cognitive attitudes (beliefs), emotional attitudes (individual feelings), and intentional attitudes (evaluations based on past or intentional behavior). Communication to explain and motivate employees will help overcome uncertainties and enhance employees’ control and well-being, which in turn promotes empowerment. McEwan studied the indicators of personal empowerment include improved perceptions of self-worth, empathy and perceived ability to help others, the ability to analyze problems, a belief in one’s ability to exert control over life circumstances, and a sense of coherence about one’s place in the world. McEwan pointed out that within the empowerment framework change begins at an individual level; as an individual becomes more empowered, their increased personal capacity makes a positive impact on an organization or group, and ultimately, the wider community. In general, people are not resistant to change; however, they mostly object on being told to change. By investing the extra time and efforts on open communication to motivate employees and create buy-in, the organizational change initiatives will have a much higher probability of success and sustainability.

 

References:

http://www.jointcommission.org/assets/1/6/HAP_NPSG_Chapter_2014.pdf

Lewin, K. (1947), “Frontiers in group dynamics”, Human Relations, 1(2), 143-53.

Pideret, S.K. (2000), “Rethinking resistance and recognizing ambivalence: a multidimensional view of attitudes toward an organizational change”, Academy of Management Review, 25(5), 783-94.

McEwan, Alexandra B,B.A. (Anthropology)(Hons), L.L.B.(H., Tsey, K.,PhD.(Social Sciences), McCalman, J., & Travers, Helen J,GradDip Primary Health Care. (2010). Empowerment and change management in aboriginal organizations: A case study. Australian Health Review, 34(3), 360-7.

 

Information on policies or practices are solely from my personal experience ONLY and have NO relation to my affiliation with any regulatory or government agency.

satyadi

-Caroline Satyadi, MT(ASCP), SM, DLM, SLS, MBA, MS, CQA (ASQ) has been a laboratory management professional for over 25 years. She has worked with several different medical industries for CLIA/CMS, FDA/ICH/ISO, TJC/CAP/COLA/HFAP accreditation survey readiness.