Working With Baby Boomers: How Other Generations Can Adapt

Baby Boomers were for a long time to largest working generation in the workplace. They are slowly retiring and the next largest generation, Generation Y, is becoming the largest. However, Baby Boomers’ impact on the workplace is still profound and most organizations, if not all, are currently employing many Boomers. They are likely to be working in leadership roles and exert influence on many policies, procedures, systems, and organizational cultures.

Similar to Traditionalists, Baby boomers also appreciate face-to-face meetings. However, their preference for leaving and receiving voicemails is a lot higher than Traditionalists. They also appreciate social media more, especially as their children and grandchildren are using it. Baby Boomers utilize the internet more than Traditionalists and send text messages, even if they still prefer to talk over the phone instead of texting.

Working with Baby Boomers is all about the relationship. Establishing interpersonal connection should therefore be one of your main priorities when collaborating with someone from this generation. Because of the personal nature of their working style, it can sometimes take a few weeks (or longer) for decisions to be made. Calculate that in when working on a proposal or project. Baby Boomers appreciate formal presentations and a consensus-based process.

A Baby Boomers’ approach to leadership centers on incentives, data-driven decisions, and a democratic process. They typically are open to input from peers and their leadership style is friendly. They value receiving recognition, so any award or reward is appreciated and they will often display them publically. Because of their focus on interpersonal relationships, they do not respond to people who are not friendly and who indicate their hierarchy. Instead, make sure that they feel you are listening to them and including them. One way to do this is by taking notes and asking follow up questions.

Baby Boomers’ professional dream is continuing to be useful and productive in the workplace while feeling they are wanted and rewarded. If you want to increase your working relationship with Baby Boomers, connect with them on an interpersonal level by inviting them out to lunch and get to know who they are outside of the workplace. Provide them with positive affirmations, recognitions, and awards to make them feel they are a valued members of the organization and that they input and work is essential to producing results. Baby Boomers bring a lot of patients, experience, and knowledge and they help create and foster a team environment when they feel they are contributing members of the organization. Do not show impatience and question their ways of doing things openly. If you do need them to change something, include them in the process to make it a consensual and democratic process. Adding a Baby Boomer to a team can greatly improve the outcomes and success of that team.

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


I’d like to tell you a story that happened at the ASCP Annual Meeting last October, 2018 in Baltimore.

Lotte Mulder and I presented a course on “Discovering Your Diversity Strengths” to about fifty people. Lotte is a Millennial and I am a Baby Boomer, and we’ve been working closely together for over three years on a daily basis. The presentation went really well and the audience was very participative and interactive. We talked about how different we were, how we complimented each other, and the value of human diversity in the workplace. 

At noon that day, we both participated in a Lunch Roundtable where the topic was Diversity in the laboratory. We quickly learned that those at our table had a strong interest and frustration about working with people from different generations. The focus was primarily on Millennials and Boomers. There were eight other people at our table and they each shared their frustration about working in the lab with either older or younger people.

This was a real opportunity for us to share the generational strengths and differences with each of these people. The Boomers seemed to think that the Millennials didn’t have a good work ethic. The more I asked questions of those in both generational groups, the more I was able to help them to share their opinions and/or frustrations. Most importantly, I made a point of asking each person what was important to them in the workplace.

The Millennials learned that the Boomers were “bred” to work beyond the expectations of their job. Most importantly, they found their identity in their work. This is one reason the “Boomer co-worker” delayed their retirement because of the fear of losing their identity.

The Boomers learned that the Millennials had a very good work ethic, they just valued work-life balance. It was actually Generation X that introduced work life balance to the workplace and the Millennials bought into the concept. The other strength of the Millennial is their passion for finding a purpose in their job.

By the time our hour was up, you could see the difference in how they related to each other. It’s amazing what education and awareness can do for people.

As a final note, the next day we co-taught a course on Stress Management. Wouldn’t you know it, we experienced the same situation at our “Stress Management Roundtable” lunch! It was fun to see how people began to see their co-workers through a different lens.

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-Catherine Stakenas, MA, is the Senior Director of Organizational Leadership and Development and Performance Management at ASCP. She is certified in the use and interpretation of 28 self-assessment instruments and has designed and taught masters and doctoral level students.  

Personal and Situational Variables of Leadership Development

Several aspects influence whether people learn from experiences in order to become a better leader. These variables can either be personal traits of the individual learner or situational aspects of the circumstances. Both personal and situational variables of experiential learning increase the development of leaders.

Personal Variables

Being exposed to experiences does not necessarily mean that people learn from them. There are some personal attributes necessary to foster learning from experiences in order to develop one’s leadership potential. The main variable that influences experiential learning is the capacity and practice of self-reflection. Being able to draw lessons from experiences is indeed what drives leadership development and self-reflection increases the number of lessons noticed in each experience. Furthermore, experiences that are challenging promote learning. How challenging an experience is can be seen as situational, however it is also personal as some people are more drawn to challenging experiences than others. Additionally, motivation to learn increases experiential leadership development. Whether the learning is motivated through goals, actions, or to simply seek knowledge, motivation influences leadership development.

In addition to being reflective, motivated, and challenged, experiential learners also need to think and act. Thinking is important because it allows the learning to plan and strategize. Finally, acting is one of the most critical aspects of learning, because it closes the cycle of learning and creates the next cycle of experiential learning.

Furthermore, assessments bring a deep level of self-awareness about their behavioral and thinking patterns, behaviors, and preferences. Knowing what one does well, where one can improve, and where the developmental gaps are is essential for leadership development. The experience with assessment is both a personal and situational variable, because how people are rated or rate themselves depends on the situation and on the personality of the person being rated. Finally, vicarious learning is learning through other people’s experiences. However, not everyone who witness other people’s leadership challenges, solutions, and behaviors develop their own leadership skills. Therefore, this is both a situational and personal variable as a person needs to be motivated to learn but also needs access to a vicarious learning opportunity.

Situational Variables

Some of the factors that influence learning from experiences are situational. This means that people have to be in a specific type of situation in order to not merely experience something but to increase their leadership effectiveness based on that experience. Experiences in themselves are situational; for the most part one cannot make certain experiences happen but they happen to people instead. However, there are three specific aspects of employment that people can seek that foster situational learning opportunities. The first one is getting a new job, changing job status, or job location. There is a tremendous amount of experiential learning that takes place when one of these aspects of a current job changes. The second is a change in task-related characteristics, such as a process or systems change. Thirdly, obstacles increase learning. Such obstacles can be difficult supervisors or employees, another company launching a similar program, or a crisis. All these experiences promote learning because jobs are central in leadership development, as well as, different assignments and experience with obstacles.

Support is an additional situational variable that increases learning. Support promotes learning because it makes people feel reassured and safe. Feeling safe also increases learners’ motivation, competency, and self-efficacy, which all promotes learning. Additionally narrative accounts shared by leaders and the organization promotes learning from experience, even if the narratives are fictional. Hearing stories about effective and ineffective leadership increases listeners’ own leadership skills through cognitive elaboration and transportation. Finally, allowing people to experience the consequences of decisions increases their learning and develop their leadership potential. Experiencing the consequences will increase people’s understanding of the impact of decisions and how departments and tasks are interconnected.

People learn in many different ways, but we all go through experiences, whether they happen to people directly, through vicarious learning, or through narratives. The better leaders can maximize learning from experiences, the more prepared the next generation of leaders will be to tackle challenges, dilemmas, and problems.

 

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.

Meaningful Metrics

Performance improvement (PI) metrics are a great way to assess the overall quality of your laboratory program. They allow you to track vital data related to CMS outcome measures, which can directly impact the financial well being of your organization. However, labs should be careful when choosing which metrics to monitor, and should routinely evaluate if the metrics they’re using are still meaningful to them.

Even a small laboratory will generate a ton of data throughout the year. The key questions to ask yourself are: 1) What do I want to know? 2) What will I do about it once I have the answer?

There may be different sets of metrics that laboratories will have to monitor and report, depending upon who the target audience of the final data analysis will be. Metrics and reports can be generated for your patients/customers, internal laboratory staff, management, and senior leadership. You may also be called upon to share your metrics with regulatory agencies as well to prove the effectiveness of your quality assurance program.

Ensure your reports are relevant and meaningful to the audience they are being shared with. Customer/Patient centered metrics can include items such as satisfaction survey results, average waiting time for outpatient blood drawing locations, and average cost/revenue per test. Internal laboratory staff metrics can include turnaround time reports for STAT tests, compliance with critical call notifications to providers, and percent completion for required monthly maintenance tasks. Higher level metrics that can be reported to management and administration may include performance on proficiency testing surveys, regulatory inspection results, and percent of corrected reports that were issued.

If goals have been met and sustained consistently, consider raising the bar and challenging yourself even further. Each metric should have 3 goals: 1) Minimum Threshold (must be achieved each review period), 2) Annual Goal (desired overall goal to account for monthly fluctuations in the data), 3) Stretch Goal (motivational tool, achievable but not guaranteed a high rate of success). Increase your minimum threshold limits to be closer to your stretch goals, and see what your particular organization can realistically meet and sustain. Be careful to not set unrealistic expectations, as this can lower morale and result in misleading interpretations of the data. Work with your clinicians and regulatory agencies to determine appropriate, and realistic goals, and utilize national benchmark standards when available.

Metrics that were added to address and monitor a specific known issue or problem should be evaluated for necessity once the issue is corrected. Consider reducing the monitoring of these items from monthly down to quarterly, semi-annually, or annually until you have confidence that it no longer requires monitoring.

When issues are identified, a root cause investigation should be performed with the intent of identifying the true cause of the problem – not to point blame to a particular person. The depth and intensity of your investigation will depend upon the specific metric which failed to meet its goal.

Properly identify the problem. To learn from our mistakes, we must first properly identify them. What may seem like an obvious root cause, may not be the real reason for an issue. For example, turnaround time metrics – if you did not complete STAT troponin tests in <45 minutes, simply purchase a new instrument that is faster. Well, it’s not quite that simple.

Break it down further into pre-analytic, analytic, and post-analytic times. Is the bulk of your 45 minute window taken up in the pre-analytic phase? Are samples being held in a central receiving area for 20 minutes and batched before being brought to the chemistry department? Are you testing serum (which needs to first clot before being spun) or plasma (which can be spun down immediately)? Is there a delay in verifying/releasing results into your LIS where autoverification would improve this process?

Before attributing instrument downtime as a cause, confirm that the outliers were in fact during the time period when the instrument was down. There’s a higher chance you have a pattern of poor TAT performance around change of shifts or meal breaks, than during a 6hr downtime on a single day in the month. Also look at how you are analyzing your metrics to ensure they are accurate. Are you including add-on tests based on their original received time, or based on when the troponin was added to the original order?

Develop a corrective action/preventive action plan. Based on what you identified to be the true root cause(s) that contributed to poor PI metrics, develop a plan for addressing these weaknesses. Identify who specifically will be responsible for performing each step in the action plan, and who will be held accountable for ensuring it was performed.

Implement the plan(s). Document the date the corrections were fully implemented, along with any delays or obstacles encountered.

Collect and analyze more data. Depending on the severity of the failed metric, you may want to begin analyzing the effectiveness of your improvement plan immediately. If there was a spike in the number of employee safety incidents reported last month due to ongoing construction in a department, the work conditions should be monitored daily/weekly for improvements.

Conversely, looking at data too soon may not paint an accurate picture of the true effectiveness of your corrective actions. Some corrective action plans may require several steps or phases for full implementation. For example, a process change will require an update to your procedure manual, retraining of all staff, and then rolling out the new process. This may take several days-weeks before 100% implemented and improvements can be detected.

Monitor the results. Check for sustainability of your corrections – staff may be on their best behavior the first week after being spoken to, but can return to old habits after that. They may not fully understand that although one process is easier for them, it is adversely affecting the overall performance of the entire lab team.

If you are consistently struggling to meet your metrics, consider looking for ways to implement lean process changes. Upgrading to a STAT spin centrifuge may save you 5 minutes on the pre-analytical side; but you may still have room for improvement. Do you consistently receive 20 samples at a time, meanwhile your centrifuge will only hold 8 tubes? Do you receive tubes of different sizes (adult vs pediatric), and is your centrifuge capable of quickly and easily interchanging inserts to accommodate both types?

Ultimately, be sure to engage your frontline staff and listen to their opinions on what is working, and what could be improved upon. They are the ones doing the tasks day in/day out, and are your subject experts on where some of the shortfalls may lie. Even if the answer is simply not having enough staff available, having detailed analytical metrics can help management justify the cost of adding additional team members, and also pinpoint the exact days and times where the help is needed most.

Bio

Kyle Nevins, MS, MLS(ASCP)CM is one of ASCP’s 2018 Top 5 in the 40 Under Forty recognition program. She has worked in the medical laboratory profession for over 18 years, and is currently employed at Northwell Health Laboratories on Long Island, NY. In her current position as a Laboratory Supervisor for the Northwell Consulting Team, she transitions between performing laboratory audits across the entire Northwell Health System, consulting for at-risk laboratories outside of Northwell Health, bringing laboratories up to regulatory standards and acting as supervisor and mentor in labs with management gaps.

-Kyle Nevins, MS, MLS(ASCP)CM is one of ASCP’s 2018 Top 5 in the 40 Under Forty recognition program. She has worked in the medical laboratory profession for over 18 years. In her current position, she transitions between performing laboratory audits across the entire Northwell Health System on Long Island, NY, consulting for at-risk laboratories outside of Northwell Health, bringing laboratories up to regulatory standards, and acting as supervisor and mentor in labs with management gaps.

Over the River and Through the Woods…

Specimen handling and transport is a vital training topic in the realm of Laboratory Safety. There is much to consider here that affects specimen quality and integrity, and ultimately affects patient results. There are also considerations involving employee safety at every step of these processes. One group of employees that can easily be overlooked when it comes to proper safety training is lab couriers. They perform the important role of properly and safely transporting specimens for testing, but without the proper education and tools, these team members can quickly fall into situations of harm.

The courier was running late, and she had one last stop on her route at a medical office building with multiple physician offices and drop boxes. It was cold, and she decided to leave the vehicle running while she went inside to pick up more specimens and deliver lab reports. The car was also left unlocked. When she came back outside, the car was gone. It was found hours later in am empty field, but it had been set on fire. There were lab specimens and reports strewn all over the field and into the nearby woods.

Couriers need to be trained about the importance of their role, and that training should include information about security and protected health information (PHI). Be sure to include HIPAA training for all courier staff. When discussing security, enforce specific processes such as always turning off vehicles before exiting and properly securing all patient specimens and any paperwork being transported. Whether couriers use company vehicles or their own personal transportation for the job, making sure harm does not come to the vehicle nor any contents being transported is key.

The courier knew he had a long drive ahead of him because of the toll bridge, and he had several specimens that needed to be delivered as frozen. He went to the lab’s cooler and scooped a large pile of the dry ice into a big box using his hands. It was cold, but it helped to wake him up a bit. He placed the specimens in the box and placed it in the back seta of his vehicle. It wasn’t very warm out, so as he began his drive, the courier made sure the heat was on high and that all windows were closed. After a few miles, the courier began to fell very tired. He struggled to stay awake, and he couldn’t figure out why. After sitting in traffic on the bridge for a time, he pulled off the road and called the dispatcher to let them know he could not continue. When he got out of his vehicle, he began to feel better.

CAP regulations require that laboratory staff have dry ice safety training, but that requirement extends to anyone who may acquire the dangerous substance in the lab. Make sure staff are aware of the need for proper PPE use when handling dry ice. Insulated gloves, the use of a scoop or tongs, and face protection are necessary when scooping ice into a container. Couriers should carry no more than three pounds of dry ice in a vehicle, and there should always be adequate ventilation, including open windows in the vehicle when transporting dry ice. Dry ice converts rapidly from a solid state to a gas, and that gas rapidly displaces oxygen in the air making it difficult to breathe or stay conscious. High volumes of dry ice in a car can create a very deadly road situation in a short amount of time.

The courier was transporting pathology specimens in a cooler, but was unaware that the lid had popped off of one of the specimens and formaldehyde was splashing all over the inside of the cooler. As time went by, the courier began to feel queasy. After realizing that something did not smell right in the vehicle, she eventually stopped the van and pulled to the side of the road to investigate. She opened the cooler and quickly pulled out dripping specimens and set them on the carpet before feeling too sick to continue cleaning up the mess. She had to be taken to the Emergency Room for formaldehyde exposure symptoms while the Lab safety Officer had to bring spill clean-up supplies to the van to neutralize the formaldehyde. The carpet had to be removed and disposed of properly.

Courier vehicles need to be equipped with spill clean up supplies that can handle whatever types of spills could occur during transport. If formaldehyde is transported, couriers need training in the proper transport and clean up of that chemical. Biological spill kits should be available as well, and spill training should be a regular part of overall courier safety training.

I wish I could say that these were imaginary stories, but sadly, that is not the case. The stories, though, illustrate clearly what can happen when proper safety management and training are lacking. Every part of the laboratory pre-analytical process is important, and every lab team member involved in the process needs to be considered. Employ complete safety training, and assess safety competency on a regular basis. By providing the proper tools and safety training to couriers, you can ensure the quality of lab results, and you can prevent incidents like these with your employees.

Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

Solutions, Not Resolutions

The turn of the year is a quasi-inspiring time for many people who attempt to change something about themselves or their situation with “New Year’s Resolutions.” When my friends and I were heading to brunch on New Year’s Day in southern California, there were many people running (alone or in groups) which I hadn’t seen before and my one thought was, “How long will that last?” When I returned to Chicago after the holidays, I dusted off my gym membership card and logged some treadmill time—my one thought was, “I hope this lasts!” But we are all too familiar with the breaking of these resolutions by most of us, and the ultimate regret we feel in the latter part of the year when our hopes and dreams of thinness/money/power/rare pokemon/fame have been dashed by the collision with our actual lives and the limited time we have to get done what needs to be done. Fortunately, we are human beings and we are allowed to be disappointed with ourselves over this (or these) tiny failings as long as our life trajectory is heading the way we want*. Then there are those handful of people that each of us will ultimately know who stick to their resolution and shed the weight, get a new job, or (hopefully with increasing numbers!) quit smoking! And we are more inspired by their actual doing of these things than by our lack of resolve.

As individuals, this trivial annual mindset is acceptable and even entertaining. But as a society, empty promises and feigned changes are simply unacceptable. To certain things, we must as a society—and as individuals in that society—commit. Recycling, for example, is a strategy that is both an economic and environmental boon. But as of January 2018, our major “solution” for plastics (especially from the West) that was China has now ended. Other nations willing to take these recyclables stopped their acceptance as well towards the end of 2018. What can we do to solve (not resolve) this situation permanently? Each country should consider first the role of plastics in their society and perhaps, like many African nations, simply ban the product(s). Secondly, encouraging personal recycling and reuse of plastics, for example through water filters to refill plastic bottles or fees on reusable grocery bags, can minimize impact. But, ultimately, each nation needs a sustainable recycling plan that represents a balance of production and utilization, creating a negative plastic total impact (i.e., no new plastic created).

In pathology, the theme of recycling is very important for any laboratory but can have major benefits for laboratories in developing nations. Formalin, xylene, alcohol, and paraffin (the four principle reagents for pathology processing), can be recycled using devices or process plans that can have minimal capital costs to set up. Consider that a given country may have shipping challenges such that an order placed today for 10 gallons of neutral buffered formalin may take 6 weeks to 6 months to arrive and cost 3 to 5 times the price in another country. In that setting, recycling formalin is clearly a superior approach and extrapolates to xylene and alcohol. Process approaches to paraffin (e.g., collecting waste paraffin from trimming and lids, using minimized mold sizes, lateral flow to minimize contamination) can optimize the use of the wax and reduce costs.  As these four reagents represent core elements to the process, efficient utilization, reuse, and management can keep costs low and processes running. But the laboratory must commit to this process and adhere to it every moment of every day to change patient’s outcomes for the better.

Similarly, core histology equipment (unlike many clinical laboratory machines) is almost indestructible when properly managed and maintained. Laboratories in developed nations may replace this equipment when it is several years to a decade old when the equipment may have another decade (or sometimes two) left of life. Decisions to replace functional equipment are left to the individual laboratory; however, once this process occurs, functional equipment should not be left to collect dust and should be moved to a new location where it can be of value. Every laboratory considering the replacement of older equipment must ask the question, “What is the remaining functional life of this device?” If that number is many years or the often stated 70%, a plan for donation of the equipment is highly suggested.  It is this philosophy that inspired the ASCP Center for Global Health program along with many other groups to actively seek out donated, functional equipment and transfer it to nations and colleagues who desperately need it to maintain their pathology services (Do you have equipment for donation? Email us!). This is especially important because the perceived demand for histology equipment in many low-income countries is so low that manufacturers and distributors refuse to become involved with the equipment (especially with trade and tariff barriers standing in the way). But, in truth, the demand is the same per population as in any other country with at least one high volume, functional pathology laboratory needed for every 1 to 3 million people (depending on population age structure and clinical utilization).

As we begin a new year together, reflecting on what we did (and didn’t) do in 2018 and what we can (and should) do in 2019 is an iterative process that can guide us through many decisions. I hope that everyone reading this blog takes a few moments (or even an hour if you can spare it!) to delve into 2018 and really plan for 2019 with true solutions in mind for any challenges you identify. And, lastly, always take some time every day to think outside yourself and even your laboratory to others in your local community or in foreign lands. Consider what little (and big) things you can do that may improve the life of just one person other than yourself and commit to those things.

*If your life trajectory is not going the way you want, consider performing a personal SWOT (strengths, weaknesses, opportunities, threats) analysis and think outside the box about where you are and where you want to be. Don’t be afraid to make life changes or new life choices that give you a better piece of mind and stronger sense of self and self-awareness. A room full of happy people who are self-aware and emotionally intelligent can solve problems at light speed because their personal issues (good or bad) don’t get in the way. So, for 2019, I strongly encourage everyone to consider really solving (not resolving) the problems you perceive in your life so that we can all work together to solve (not resolve) the challenges we face as a society moving into the next decade.

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-Dan Milner, MD, MSc, spent 10 years at Harvard where he taught pathology, microbiology, and infectious disease. He began working in Africa in 1997 as a medical student and has built an international reputation as an expert in cerebral malaria. In his current role as Chief Medical officer of ASCP, he leads all PEPFAR activities as well as the Partners for Cancer Diagnosis and Treatment in Africa Initiative.

Contextual Factors of Work

Work is central to the human experience, even though the actual practice of work has continuously changed through the decades. These changes impact personal life as well, since there is a strong correlation between work life and life outside of formalized productivity. There are certain factors that influence how work is practiced that impact people’s approach to work.

The first factor is technology. Technology has significantly altered the practice and implications or work. For example, try to compare what office work was like 50 years ago compared to now, or how laboratory diagnostics were different back then. In today’s age, the majority work tasks are conducted on the computer or through technological advances: emailing, writing, analyzing, diagnosing. Fifty years ago, such tasks were conducted via phone, typewriters, or by hand. Technology has also increased the amount of information available to workers. This information allows organizations to prepare to lead in a VUCA world, namely one that is volatile, uncertain, complex, and ambiguous.

The second factor that influences work is globalization. Through the increase in technology and information as mentioned above, cultural, linguistic, and national boundaries do not impact the work environment as much as they did. Such lack of confines pushes both organizations and individual workers to be more competitive due to reduced market and job security, respectively. On the other hand, it also increases collaborations and opportunities to help others. For example, through telepathology, we are now able to provide diagnostics to people in places that do not have access to local laboratory services.

The third factor that has an impact on work is the psychological contract between worker and employer. During the industrial age, this contract was mostly stable and predictable and was based on the assumption that if workers performed well, had integrity, and were responsible their work created a sense of connection. In today’s work culture, this contract has shifted towards a focus on self-development, experience, and personal long-term goals instead of a long-term relationship between worker and employer.

Lastly, a factor that influences work is the knowledge gap. Since many of the unskilled jobs are now conducted by computerized machines, employers will rely more on workers with specific skills and knowledge. However, educational opportunities are not equally distributed and the lower classes are at a clear disadvantage.

It is important to understand these factors when working with people from different educational, technological, and cultural backgrounds. All these factors influence people and how they perform their jobs.

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.

Training and Competency: They’re the Same Thing, Right?

As a fitting end to my previous 3-part series on how to prepare for and survive your regulatory inspections, one of the hospitals we provide consulting services to was just visited by The CAP. Overall we did great and I’m proud of everyone there, but the inspectors found a weak area for us to improve upon that others may be struggling with as well: documentation of training and competency.

It is a common misnomer that training and competency are equivalent and essentially the same thing. Whether you’re subject to CLIA, CAP or your local state DOH requirements, you will be required to provide proof (documentation) of both training AND competency for each employee, for each task that they perform. This is not just limited to your technical staff, but also includes non-technical personnel (phlebotomists, lab assistants, LIS personnel,transport couriers, etc.), as well as staff outside of the immediate laboratory testing area (respiratory clinics with blood gas analyzers, Point of Care testing, etc.).

Simply put, training is coaching, mentoring, and teaching someone step-by-step how to perform a specific task. Proper documentation of this training includes:

  • Objectives for the training (i.e., “After completing training, staff will understand howto successfully perform maintenance tasks on the hematology CBC analyzer.”)
  • Identification of the methods to be used during the training (direct observation, monitoring recording & reporting of results, review of worksheets & preventive maintenance records, evaluation of problem solving skills)
  • Identification of the materials to be used during the training (cleaning agents, QC samples, previously tested & scored proficiency testing material)
  • Criteria used to assess the effectiveness of the training (minimum score of 90% on critical thinking quiz, ±10% correlation with previously tested sample)
  • Signature of both the trainee and trainer confirming that training was completed, and when

In addition to the obvious routine tasks a lab professional will need to perform (running QC, instrument maintenance, running patients), don’t forget to document their training for the low frequency tasks performed as well. Based on an employee’s job description, they may be involved in additional tasks such as specimen handling, safety precautions, packing and shipping of samples to reference labs, computer system training, telepathology training, and supervisory functions. These tasks too will require documentation of training.

Documentation of all of these tasks can be organized through the use of a departmental orientation checklist. This will help you keep track of what each staff members’ specific job junctions will include that they need to be trained on, and which tasks have been completed by each trainer. Depending on the task, training can be completed quickly after several minutes of demonstration (waived urine hCG testing), or may take several weeks for staff to fully understand and master the task (flow cytometry leukemia work-up). Keep in mind that until a staff member has documented training followed by successful assessment of competency of that task, they should not be permitted to perform or result patient testing independently of their trainer.

Once training has been completed and documented, you must then assess each staff member’s ability to successfully perform these tasks. This is their competency, where you assess if the training was successful and staff are able to perform each assigned task correctly. To fully demonstrate successful competency of non-waived tests, all 6 of the following elements must be documented for each employee, for each task:

  1. Direct observation of patient test performance, including patient identification, specimen collection, handling, processing and testing.
  2. Monitoring the recording & reporting of test results, including when appropriate the handling of critical results.
  3. Review of testing worksheets, QC records, proficiency testing results, and preventive maintenance records.
  4. Direct observation of performance of instrument maintenance and function checks.
  5. Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples.
  6. Evaluation of problem-solving skills.
  7. Observation of compliance with safety protocols (based upon your specific local state DOH regulations).

The documentation of your competency elements should include the date each item was evaluated, as well as a way to identify and recreate the test performance if asked by an inspector. This is most easily accomplished with the specimen ID number, or PT survey name so records can be located or reprinted.

Be mindful of your local state regulations regarding the specific requirements for who can perform a competency assessment. In many cases, assessors will need an additional supervisor competency for themselves to confirm they are able to successfully assess the performance of their peers. If weaknesses are identified during the competency assessment, additional training should be performed with appropriate corrective actions documented. Competency should be reassessed to ensure staff are correctly performing all duties, prior to them resuming patient testing.

So to summarize:

During training, I am showing you how to do something. I will document all aspects of the training steps that I reviewed with you. When I assess your competency, you are showing me that you know how to do the task correctly. You will document your results as you were trained how to do, and I will validate the accuracy of your work.

-Kyle Nevins, MS, MLS(ASCP)CM is one of ASCP’s 2018 Top 5 in the 40 Under Forty recognition program. She has worked in the medical laboratory profession for over 18 years. In her current position, she transitions between performing laboratory audits across the entire Northwell Health System on Long Island, NY, consulting for at-risk laboratories outside of Northwell Health, bringing laboratories up to regulatory standards, and acting as supervisor and mentor in labs with management gaps.