The practice of laboratory medicine is undergoing rapid change, both leading as well as reflecting changes in our healthcare system.  These changes are driven by new technologies, specialties, digital data collection, integration, dissemination and storage; evolving societal expectations for personalized and evidence-based medicine, regulations, and the vertical and horizontal integration of all health care. The laboratory is in the center of these massive changes, with clinical laboratory test results a key factor in 70% or more of all medical decisions. This has resulted in the transformation of the clinical laboratory from a passive service to an active participant in patient diagnosis, treatment  and management.

The clinical as well as economic value of properly trained laboratory professionals assisting physicians with test selection and interpretation is evidenced by the following statistics: 17% of healthcare spending in the U.S. is due to test overutilization; and nearly one third of total healthcare spending may be due to potentially avoidable clinical care..

While the doctor-patient relationship has always been considered the center of medical care, this relationship does not exist in a vacuum.  Today, it is supported by interrelated systems of individuals, procedures, technologies, regulations, and organizational structures associated with the care provided.   Laboratories are an integral part of this larger construct, and the improvement in patient safety achieved is shared by all systems involved.

The Role Of Teamwork                                     

The adage “It takes a village to raise a child” can be applied to patient safety as well.  Quality care is the child of effective teamwork, where competent individuals work together (through all phases of the testing process) to ensure that the most accurate test results are provided in a timely manner to the requesting physician. Teamwork can be categorized as internal, i.e., within the laboratory; and external or ancillary, as relating to other departments or systems within the greater organization.

Teamwork Within The Laboratory

Internal teamwork plays a key role in enhancing patient safety and creating a culture of continuous quality improvement within the laboratory.  A necessary component for success is management leadership.  This goes beyond staff management, as it often sets the environment  and pace of the laboratory. Good leadership can inspire laboratory members toward greater productivity and creativity, trust, and proactive feedback.

Steps to creating a culture of quality through team work

  1. Encourage two-way communication between management and staff. Be open to new ideas, feedback and suggestions.
  2. Reporting of issues, problems, events and errors is encouraged and supported, but culpable behaviors are not tolerated.
  3. Learning culture: issues, problems, events and errors are handled as learning opportunities, with corrective actions for the lab team;  not used to denigrate employees.
  4. Ensure that all new employees are mentored into the team culture of the laboratory, as well as properly trained and vetted for competency
  5. Recognize achievement.  Celebrate successes due to combined efforts of staff; thank people for doing a job well; publicly recognize hard work; praise staff commitment during difficult times.
  6. Help all employees succeed. Provide employees with the resources and support to do their work, and as they show signs of readiness, be willing to entrust them with new tasks and greater responsibility.
  7. Use employee satisfaction surveys to empower employees. This anonymous approach to asking about the organization, customer service, compensation, benefits, working environment, professional growth, communication, and employee attitude toward supervisors and physicians can provide vital information to everyone involved, and provide guidance for teamapproaches to problem solving.

Institutional Teamwork

Improved quality patient care and enhanced patient safety also require an understanding of how the testing process involves institutional systems beyond the laboratory. It can be described as a multi-phase process, wherein multiple people, tasks, technologies, and environmental and organizational factors interact to determine the outcome.

Teamwork is a two-way process, where open communication between laboratory professionals and those in other departments meet regularly to discuss issues of mutual concern.  When carried out with mutual respect, careful planning, open and honest assessments of common needs and issues to be addressed, the result is enhanced quality of patient care.

Competency Assessment

One area of special importance is ensuring the competency of all ancillary staff involved in the pre-analytic and post-analytic phases of testing. We tend to think of front office personnel, including those who may also perform phlebotomy, or order lab supplies, as “other than” laboratory people;  however, they play significant roles in the operation and success of the lab.  This is especially true for the pre-analytic phase of patient testing, as office staff are often involved in getting important patient information, ensuring that specimens are sent to the requested reference labs, and performing data entry on the office computer system. This multi-tasking may also extend to post-analytic activities such as receiving specimens collected off-site as well as the receiving and filing of reference lab reports.

It is just as important that all front office personnel, including receptionists, medical assistants, secretaries, phlebotomists, couriers, and even the office manager, are properly trained for  anything they do that affects any aspect of the laboratory operation. This training should be documented.

This need extends beyond training to competency assessment.   One possibility is to consider incorporation of competency assessments of laboratory-related activity into staff evaluations. It is also important to remember that this is often the staff that interacts directly with patients providing pre-test preparation information.

An added bonus is that this increased level of interaction provides pathways for building trust and a sense of community between the front office and the laboratory.

Participation in Multi-disciplinary Committees

Laboratory management also should ensure that there is appropriate representation on all institutional committees handling issues of mutual concern.  These committees could include:

  • Medical Executive
  • Pharmacy and Theraputics
  • Transfusion Services
  • Infection Control
  • Safety and Employee Health
  • Waste Management

There are many more ways in which teamwork for the mutual goal of improving patient safety can be achieved, but the key here is to see the laboratory as part of the entire institutional team, not as a separate insular department striving for quality care on its own.

Original published in ADVANCE for Administrators of the Laboratory Quest for Quality Column.

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