Failure is Always an Option

I had some fun this April Fool’s Day and sent some emails out that stated we failed some CAP surveys. I know I’m evil but you have to have some fun sometimes! The reactions were interesting in that everyone deals with failure differently. Show me someone who has never failed and I’ll show you someone who won’t know how to react once they do. It is inevitable. We try to never experience it but we will and it is how you react that sets people apart.

I am proud and speak of my failures regularly because it gives people strength knowing that they are not alone. In my career I have been involved in a total hospital failure and had to work my way back up the ladder. It is through these failures that we learn the most about ourselves and about situations. When I was just out of school I used to think that experience wasn’t that important. I thought, “I’ve learned what I need to know in school, I should be a supervisor NOW!” I am in the second half of the first 10 years of my career and have learned that every situation brings with it experience that becomes knowledge. That knowledge will carry me into the second and third decades of my career. Both the successes and failures will help me as I move forward.

Experience is gained through those situations and it is up to the people involved to either take it with them or forget about it and be vulnerable to repeat them. As leaders we are sometimes under pressure to work or move forward with options that may not be our choices, but we must get our staff to buy in and perform. These directives usually given from a few pay grades above should be followed so that if you do fail you can show that you followed their directives. You do not want to be seen as someone who is resistant to change or someone who will be an obstacle. This will just get you more headaches and possibly affect your advancement in the future. Having said that always state your concerns as well as present ideas that may be a better option. You do not want to be silent when it matters most.

I have always learned more from my failures than I have from my successes. During an interview a CEO once told me, “You want to make your big mistakes early in your career because the higher you get the less forgiving people are of the big ones.” We make our mistakes during a constant search to be the so-called “polished professional.” When we get to the higher pay grades we should be able to see a failure coming a mile away and be able to safely get out of the way. Successes come with great planning and a dump truck full of experiences. Remember, failure is always an option.

 

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.

 

Tighten the Belt

It seems like healthcare is in a never ending cycle to cut cost and “see what you can do without…for now.” That “for now” statement usually turns into forever and it begs the question as a supervisor/manager, “Should I really tell them what I can do without for fear of losing it forever?” What seems to always happen is goals become increased and the resources needed to attain those goals become decreased.

Here is where my MBA kicks in and says, “Wait, tightening the belt is and always will be a band aid. Shouldn’t we be concentrating on GROWING?” In business, which healthcare most certainly is, we survive only if we keep growing, and I have witnessed how not growing dooms an entity. So why do very smart people concentrate so much on items that make little impact when the real solution is going out and getting new business?

A lot of people are afraid of new, or have a low tolerance for risk. Going out and getting new business is always risky and staying within your walls is safe. It’s easy to tell someone that they can do without something because it’s familiar. It is much more difficult to say “what could we do here that we aren’t already doing?” Growing takes ideas manifested from nothing, cutting just takes a look what is already in front of you.

Another challenge is getting support to fill positions that you have been doing without for long periods of time. On paper it may look like your department is doing a lot with very little. What the paper doesn’t tell you is that your employees are stretched to the extreme because without overtime and part time people working full time hours, you wouldn’t be able to survive.

Looking forward we will be forced to find new technologists that will be able to take our places. This is becoming more difficult as well with more and more technicians graduating and a lack of technologists. I have mentioned this before but the program I graduated from no longer exists and this isn’t rare. It will become vital to partner up with schools to keep pipelines open for future employees and leaders.

Looking forward it is going to take brave leaders to not only take on all of the challenges above but to resist pressures from above to keep cutting. It will be up to you to come up with ideas of new business to keep growing. Go outside your four walls and you will be surprised how much is out there ripe for the taking. Ask any Fortune 500 company or any company that has had an IPO in the last 5 years. Growth is the only way you survive. Summer is on its way and everyone wants to look good. We try to lose weight so we can tighten the belt, but if you ask me, muscle looks better than being skinny.

 

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.

Direct To Consumer Testing: Wave of the Future?

Direct to consumer (DTC) testing is one of the fastest growing industries on the internet, and if laboratories are not careful, we’re going to be blind-sided by it. I wanted to know how this works because in general the websites for this testing have nothing whatsoever on them about the lab. I searched for lab information – accreditation, etc – and found nothing. What I found was that most of these sites are essentially online middlemen between the consumer and the labs – allowing access to lab testing and bypassing the doctor.  I decided to do an experiment and see just how easy it was.

I went online and found a DTC company and ordered tests. I skipped their specials, “test of the month” was a complete thyroid panel, and settled for their most popular, most ordered test. It is actually a group of tests which includes a CBC with differential and a chemistry panel for a total of 27 tests plus six calculated values (eGFR, HDL/total cholesterol ratio, etc). The complete test cost me $97.00 plus tax. I can tell you that those tests run at my institution would cost well over $2500.00, and even at a big reference lab, the best price I could get was about $425.00.

It was when I placed my order that any mention of a lab came into the process. Before I could place the order, I had to make sure there was a LabCorp near me.  I then went back to the website and printed the company’s requisition for the test and took it with me to a LabCorp draw station. They took the requisition, checked it against a photo ID, collected the appropriate blood samples and sent me on my way. Three days later I received an email from the online company that my results were available. I logged on, and it was just that easy.  There were all my test results with appropriate reference intervals and flags. If I want my physician to have a copy, I can have them sent or print them and take them with me.

Amazingly, this is incredibly easy to do, although I suppose you would have to know enough to know what tests to order, or be told what to order by your physician. But I now have the ability to order my own tests, and at significantly less cost than the average hospital or reference lab. If doctors begin telling their patients just what tests to get run and then to bring them the results, this DTC testing will put hospital labs out of business, at least out of the outpatient lab business. There’s no way for a hospital lab to compete with this cost structure. Now all you need is a LabCorp interface to your hospital system and the test results go right back into the chart where the doctor ordered them and the hospital lab is totally outside the loop.

Of course, you will also have people just running tests on themselves after doing some online research, but they will still have to hook up with a doctor somewhere to explain abnormal lab results. I’ve already seen some of that – calls or emails from people off the street looking for explanations of results of metabolic testing. DTC is going to open many, many cans of worms, but it’s coming, nonetheless. I suppose there might be a role for the laboratory professional here, to help the consumer understand their lab results when they do them directly. And hospital labs will always be necessary for STAT and critical tests for inpatients. But the world is changing. We need to be ready for it.

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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.

Dispensaries

I know a lot of you have heard already, but for those of you who haven’t, last week CMS ruled to amend CLIA regulations that will now allow laboratories to release test results directly to patients.  Once you pick your jaw back up off the floor your mind will start processing a mile a minute what this means for individual laboratories.  If you are a supervisor/manager such as me your mind is going exponentially faster thinking of all the ways that this now makes your life more difficult.

Right off the bat as a supervisor/manager you should be thinking about producing an SOP (standard operating procedure) that details how you will handle requests and what you are and are not responsible for when it comes to providing information to patients.  You are going to need detailed information on how you will properly identify the patient, patient’s personal representative; or my personal favorite, a person designated by the patient.  I can hear the phone ringing now.

“Laboratory this is Matt, How can I help you?”

“Yes, Hello, My name is Lenny Lipase and my neighbor Pete Potassium wanted me to call in to your laboratory and get some of his lab results.”

There is most definitely going to be some individual interpretation of this new amendment and each laboratory is going to have to determine how it wants to address requests.  No matter which direction you go a solid policy/procedure for handling these new requests will be your best friend.  When you receive complaints, and you know they will come, you will have something to fall back on that states a definite policy/procedure and that meets the new standard that has been set forth by CMS.

So let us address the 800lb. gorilla in the room.  You have started taking requests for results and a patient comes to your lab, picks up the results, opens them, and then says, “Why is my glucose so high? Does eating a candy bar for breakfast affect this?”  Your worst nightmare, right?  A patient wanting counsel on results will be the biggest challenge for any laboratory and may have been a possible oversight by CMS on this ruling.  One way to nip this right off the bat is to send hard copies of results in the mail.  This assures that patients will not be wandering around your lab asking for counsel on their results.  If you decide to be brave and let patients physically pick their results, I would either have a disclaimer page with every result handed/mailed out or written very clearly in your policy/procedure stating that patients only discuss their results with their physician.  You must protect yourself from liability when it comes to discussing results with patients.  I felt as though the previous ruling was a laboratory professional’s layer of protection against this.  We could not directly give patients results so it forced them to speak with their physicians.

I have read that some laboratory professionals are happy with this saying that patients should take more of the responsibility of their own healthcare.  I agree with this but I also have spoken to physicians who are not happy with this ruling because they want to go over results with their patients to properly explain what they mean.  More than likely a physician will still have to release the results first before a patient can view them but if not you may have a panicked patient calling physician offices or even worse 911.  This may seem extreme but you don’t know how patients will react seeing results they do not know anything about.  We will now be another controller of patient information that has been deregulated a bit.  It is for medical use only of course but how comfortable will you feel being a result dispensary?

 

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.

Bueller?…Bueller?

Attendance in the workplace can be a tedious process that most supervisor/managers loathe because it forces us into an almost parental role that can be downright annoying. However you penalize call-offs or late clock-ins/outs, keeping track of attendance can be compared to balancing a checkbook. Even though it may be tedious it is a necessary evil to make sure all employees are being treated equally and not one individual is taking advantage of arriving early or in some cases clocking out late to rack up small amounts of overtime. All of these examples can affect your productivity numbers and also the workflow of the laboratory.

So the question becomes how do you avoid the attendance issue without having to balance the checkbook every other day? First, address each and every attendance issue swiftly and equally with each employee. This will get the attention of all the employees so they know that you take attendance seriously and expect punctuality. If you want to be lenient and let the first one or two instances slide make sure you record this and treat each employee equally. The first hint of favoritism may cause your employees to lose respect which may lead to a much bigger problem other than attendance. Second, if you have monthly employee meetings (which I recommend), be sure to remind everyone your attendance policy and have each employee sign the meeting minutes so you have documentation that each employee understands the policy. Lastly, the best time to properly introduce an employee to the attendance policy is when they’re going through the hiring process. For some of our young hires, this may be their first job after college and clocking in for a full-time position may be a large change from walking in the door half-asleep for an 8am class.

The last attendance issue that should be discussed is call-offs (unexcused absences) that seem to follow a pattern. Employees may feel they shouldn’t work a Friday before they work the weekend. The generally accepted definition of a pattern is three or more examples of the call-off. So if the previous employee example called-off three Fridays before they had to work that following weekend we would contact HR and see if we could address the situation. Some may feel this is obvious but when employees work every third weekend this pattern may take a couple months to present itself. These are especially difficult as a supervisor/manager because you most likely do not have any direct evidence that the employee is calling-off without actually being under the weather. This becomes especially difficult when an employee has an approved medial leave issue and appears to be using it to their advantage.

In each of the examples above the most important item for you as a supervisor/manager is documentation. You must have a detailed record so when the time comes to use corrective action or even address it with HR you have everything you need to address it with the employee. You don’t want to be walking into your laboratory, see an empty bench, and say, “Bueller?”

 

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.

Customer Service—The Buck Stops Everywhere!

Laboratories are notoriously hidden in basements, outbuildings, storefronts, and historically have been hard to find, difficult to get to, and in many cases, an afterthought in facility planning. It couldn’t be farther from the truth that “labs should be seen and not heard.” Those of us who live in the lab don’t give it much thought…until we have to get OUR blood drawn, that is!

We all know the scene where someone has a “lab complaint.” It typically centers on having their blood drawn, getting stuck multiple times, having a result not ready, or heaven forbid, having to suffer a “re-draw.” If you think about it, the service we provide that has the customer-facing moment is the specimen collection phase. Our pre-analytical capabilities are where our patients/customers/clients judge the quality and strength of our laboratories. I have often described it to students in this way; if you want to buy a house and its gate is broken, the paint is peeling, the door hinges rusted, and the yard is full of weeds, you automatically assume the house is also “broken down” on the inside. It may have upgraded electricity, brand new appliances and plumbing, and the structure is solid and weather proofed. But you decline to delve further based on the appearance. The second house you see has fresh paint, new hinges on the doors, a little grass and flowers in front, and a nice walkway to the front door with a shiny new mailbox. You are charmed…and, sadly, it has a leak in the main drain, the paint inside is lead-based, the electrical system must be rewired and the structural walls are rotting and soon the stairwell will cave in. Nothing you can really see from the outside, but not something you can judge from the street.

I find that the elements of customer service and the way we present and appeal to our patients/customers is the “face of the laboratory.” Professional presentation and treating each patient and each specimen as if it were your mother’s or your child’s specimen gives our clients the confidence and trust they need to feel good about their test results. Communicating, making eye contact, soothing and reassuring those with “difficult veins” makes any situation go more smoothly. And, since most people are unable to judge the quality of our laboratory work—they have no training or understanding of what goes on in that “black box”—remember the house example. We all tend to judge by our first impressions.

Customer Service is a universal concept, and one that is a challenge in every laboratory, everywhere. One of the most popular international training programs ASCP Global Outreach provides is for pre-analytical phase quality improvement, and it always includes a heavy dose of customer service. Not only with patient engagement, but also with other departments, physicians, hospital staff, and even in community outreach. It is universal all around the world, that customer service makes the difference in how people evaluate the laboratory profession. You may be the best clinical scientist or clinician on the planet and your lab may have won awards for superior performance; but no one will know or care about that if they have a bad pre-analytical experience! The buck really does stop EVERYWHERE!

Next time YOU have to have your blood drawn, take a close look around and notice what your patients and customers see. I guarantee you will always be surprised by something, and will leave the drawing room with at least one idea of how your lab can do it better. Next time, we’ll talk about some ideas I’ve learned about customer service in other countries.  And, if you have a great example of stellar customer service practices, let me know at bsumwalt@pacbell.net I’m always in the market for new ideas to share.

 

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

 

New Rule Gives Patients More Access

Yesterday the Obama Administration and the Department of Health and Human Services implemented a regulation that amends the Clinical Laboratory Improvement Amendments of 1988 and the Health Insurance Portability and Accountability Act of 1996 in regards to reporting of patient results. Basically, the new regulations state that patients (or their personal representatives) can receive lab results directly from the laboratory. In most cases the laboratory has 30 days to comply with the request. This regulation goes into effect 3/31/14 and laboratories must comply by 9/27/14.

So what does this mean for laboratory professionals? The language of the final rule gives laboratories a lot of flexibility in terms of dealing with a request for information. In a nutshell:

  • Individual laboratories can set up systems to receive, process, and respond to requests for results however they choose to do so.
  • If a state law is different than the federal regulation, laboratories must comply with the “more stringent” law, with “more stringent” meaning “greater rights of access.” For example, the federal regulation requires results to be given within 30 days of the request; if state law requires those results be given with 15 days, then the laboratory should follow the state law.
  • Laboratories need to have “verification of identity” policies in place. There is no mandate that requires specific forms of identification.
  • Laboratories that currently have patient portals in place may continue to use them.
  • Laboratories CANNOT require patients to make requests only through their providers; mechanisms must be in place for a patient to make requests directly to the laboratory. However, laboratories CAN require patients to make these requests directly to the laboratory.
  • Laboratories can recoup the costs of providing results to patients, but the fees must be cost-based and reflect labor, supplies, postage, and preparation of an explanation of PHI. Laboratories CANNOT charge fees that reflect the cost of searching and retrieving information, nor can they charge fees for costs associated with verification, documentation, liability insurance, maintaining systems, etc.  It should be noted that laboratories cannot withhold future lab results if a patient chooses not to pay the fee.
  • Laboratories must provide results in the form (electronic or paper) requested by the individual if readily producible.  This could be a MS Word or Excel document or PDF as well as access to an electronic portal.
  • Laboratories are required to reasonably safeguard information (electronic or paper).
  • Laboratories are not required to include test interpretations but may do so if desired.
  • Providers are encouraged, but not required, to tell patients they have access to their laboratory results directly from the laboratory.

 

Swails

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