The Laboratory 5

“Curmudge, at the start of our tour you said that laboratories of all sorts tend to have common characteristics, such as their need for accuracy, responsiveness, communications with clients, and keeping methods up to date.”

"That’s right, Jaded Julie, but there’s one more thing. Stress is endemic in laboratories, especially among lab managers. That’s why I appear to be in my 70’s but am only 50 years old.”

“Don’t give me that, Curmudge. You are really in your 70’s, but you appear to be 90; and you never worked in a clinical lab. In labs like the one we just visited, it’s certainly less stressful when one can be confident that results are correct and will be available when needed. How can they do that, day in and day out?”

“It’s dedicated people and good systems just like we teach in Lean. Well-trained professionals and technicians performing standard work. If a lab has those, the manager’s stress level is reduced considerably. And of course they have strict quality control protocols, which Mary Dikeman will describe to us. ‘Please tell us, Mary, how you make certain that your results are correct.’ “

“Each test has quality control (QC) samples that are run every day. These have known value ranges and that value must be produced each time, or we must find the reason for the aberration. Patient results are not reported unless the QC sample results are in the proper range. Some instruments also have calibrator samples that also assure that the instruments are working properly and the results are correct.

We also have to do proficiency testing for every test we do. We purchase sets of unknown samples 2-3 times a year and run them exactly like we run patient samples. Then we send in our results and they are graded and compared to others who perform the test. The results are reported to the Centers for Medicare & Medicaid Services (CMS), so they know we are proficient at what we do. If there are failures in any testing event, we have to make changes and improve for the next time, or they may take away our ability to do that test for Medicare patients.

In addition, every instrument has maintenance and monitoring procedures that are performed according to an established schedule of daily, weekly, monthly, and semi-annually. These maintenance tasks keep the instruments working well, prevent breakdowns, and maintain accuracy.”

“Years ago in my environmental lab we had to run proficiency tests, similar to what you do, for the EPA. We were always eager to learn how well we had done. One of our chemists, who happened to be of foreign origin, would complain vehemently when I didn’t share our results the moment they arrived in the mail. I think she learned her English from a drill sergeant. ‘In addition to QC, Mary, perhaps you can tell us about your sample workloads and typical turnaround times.’ “

“We average 2600 tests per day—that’s about 2000 samples. Some have multiple tests per sample. They come from inpatients, outpatients, clinics and other hospitals. Many tests are done within an hour of receipt in the lab. Some take several hours. Some noncritical tests can wait for a batch to accumulate and are run 2-3 times per week. Cultures may take 2-7 days, although TB and fungus cultures are held for 6 weeks. So you see, sometimes ASAP is dictated by how fast something is technically feasible.

The lab is staffed around the clock, with about 42 people in the various departments during the day Monday through Friday, 5-6 people working evening shift, and 2 people working night shift. However, there are fewer people in the laboratory on weekends.”

“So, Jaded Julie, do you have any questions for Mary?”

“I certainly do. If I were starting out in health care and wanted to work in a lab like yours, what sort of education and training would I need?”

“For detailed career information for Phlebotomist (6-12 months), Medical Technologist (BS degree), Medical Technician (associate degree), Cytotechnologist (BS + I yr), Histologist (associate degree + 1 yr), Pathologist (MD +specialty), visit the website of the American Society of Clinical Pathology or the College of American Pathologists.”

“We really appreciate your tour and discussions, Mary, and we now have a better understanding of the lab’s capabilities and complexity. Patients can certainly feel confident in the laboratory’s results. Nevertheless, I’ll try not to be the source of submitted specimens. Okay Julie, shall we go out for a jog?”

“Get real, Curmudge. How about a brisk walk up the stairs?”

Affinity’s Kaizen Curmudgeon