Guest Essay

Diana Mass, from Arizona State University, shares her thoughts on how the continuing success of laboratories may have contributed to their downfall. As laboratories continue to do "more with less" management seems to expect them to do even more with even less. What can labs do to prevent this downward spiral? Diana has a few remedies.

Clinical Professor and Director, CLS Program
Arizona State University
Tempe, Arizona

This article is reprinted with kind permission of Diana Mass and The ASCLS Today, 6/00, Vol XIV, No. 6

Recently, I escorted a photographer to one of our local hospitals to take images for our Clinical Laboratory Sciences program's web site. How proud I felt as I saw the photographer's eyes widen with amazement at the expert execution and delivery of sophisticated and timely medical information upon which a patient's healthcare plan would rely. Should the patient be admitted? Can the patient go home? Will the patient need to have surgery? What medication? What dosage? The medical questions we help answer are endless. The health care delivery system has evolved because technology, in general, and the clinical lab, in particular, provides information-nation which impacts on the diagnostic and therapeutic decisions necessary to be cost-effective and patient-appropriate.

In the name of quality consciousness we in the lab have developed systems that are accurate, precise, sensitive, specific and reliable. We have quality controlled and quality assured each aspect of the clinical laboratory. We have truly developed successful processes and procedures. But in the name of cost consciousness we have also been restructuring, re-engineering, cross training, consolidating and downsizing. Now, however, we have reached a point where the reality is that many labs are capsizing due to the neglect of a very essential element - clinical laboratory sciences personnel.

The clinical laboratory has become its own kind of "sweat shop" - "doing more with less", while management is thinking we are "working smarter not harder". Soon, we will be doing "less with less". Actually as a profession we really are not a success - we truly have become disabled and even dysfunctional. We have made clinical lab work look so simple and easy that decision makers in corporations and government believe that all we have to do is push buttons. If that is the case, then why are there so many classified ads for baccalaureate and associate degreed clinical laboratory professionals with certification? Because first line supervisors know the truth - lab testing requires cognitive skills that are not apparent to turn-key management consultants. They are simply observers brought in to perform their "magic" which ultimately disserves the patient. Our clinical labs have become lab rats in management's ill thought out experiment in understaffing to cut costs.

In the meantime - short term financial gains will lead to long term financial losses and the potential death of the CLS profession. While some might say that change is necessary, that change is good I say, no this type of change hurts patients. Unfortunately, when corporate America and the "global economy" is approaching an era absolutely dependent on information, our profession's brain trust is experiencing a brain drain.

As professionals we feel exhausted, frustrated and betrayed - but we are meeting our corporation's expectations day in- day out. Our lab's success breeds greater expectations and in our innate desire to comply we put our shoulders to the wheel, forge ahead, and breed more success. We have been successful in making our tasks look easy, but alas we have become the victims of our own success. It is our weakness that we appear strong and infinitely productive!

Being called a victim sounds rather harsh. Webster defines a victim as one that is adversely affected by forces of the social system or injured, destroyed or sacrificed under any of various conditions. When one looks at how we have reached this point in the profession's demise, I can list many conditions such as apathetic individuals who believed their actions would not make a difference, or who waited for others to take care of them, or managers who became co-opted by administration to meet the quarterly budget reports, or educators who did not prepare students to accept professional responsibilities, or reference labs who sold cheap pap smears to obtain the bulk of other testing from physicians, or government who believes that all testing can be done as cheaply as reference labs sold them to doctors, the list goes on .....

The recent Institute of Medicine Report (IOM), entitled "To Err is Human: Building a Safer Health System", has focused the attention of media and the medical community on medical errors. My intuition tells me that if they truly look hard enough they will find that "laboratory" errors are not necessarily found in the analytic phase of laboratory testing because those of us competent few still working in labs have perfected that area. But the errors will be found in the preanalytical and post-analytical phases.

What now? The fact of the matter is that Medicine cannot succeed without a laboratory that is served by competent caring professionals, but not all healthcare providers understand or appreciate this fact. We must take our labs back - we must take our rights back as professionals - we must again become committed to that profession which we once cared for. To bring about the necessary changes each and every one of us must become his/her own advocate for the profession and the patients we ultimately serve.

With so many professional organizations claiming to be the voice of advocacy for the clinical lab, one would think that our profession would be in a position of strength. Unfortunately the reverse is true - too much division and diversion has led us to a position of weakness - and to a faceless profession experiencing a severe shortage of competent personnel. Although each organization is trying to survive - we must understand that our personal survival and that of our profession is also in our own hands. Peter Block writes about this in his book, the Empowered Manager. He writes about entrepreneurial organizations who have employees who take charge and responsibility for their own survival. These are individuals who become self-advocates and show characteristics of self-determination. These are individuals who know their value and are aware of their position of strength.

Each clinical laboratory professional must become a power of one. Each clinical laboratory professional must recognize that their singular contribution and actions make a major difference to the necessary outcome. What is this outcome? It is the preservation of an honorable and necessary profession without which modem medicine cannot exist.

As an advocate you will have to maintain or defend issues and proposals to improve the status of your lab. You may have to report and alert your management or even govemmental agencies about inappropriate actions which are occurring in your lab which you know lead to poor patient outcomes. To operationalize this and to become a persuasive advocate you must:

1. Identify your strengths and weaknesses along with potential strategies to use your strengths and compensate for your weaknesses
2. Set goals and monitor progress toward these goals
3. Practice techniques for effective communications which include listening and being assertive

We live in a free society with individual rights and responsibilities. However, clinical laboratory professionals like many health professionals have taken this right for granted. Although each of us must become individual advocates, major changes to protect and preserve the profession can only take place when all the individuals in your lab or state organization work together, recognizing that at the heart of your issue is your professional credibility, image and the safety of your patients.

However, there is no substitute for a constituency, and your success will depend enormously on the depth and breadth of this constituency. There are many ways to move many people in the same direction and they enhance rather than substitute for a deep and broad, membership driven organization. No social movement was won by a few advocates. Rather they were won by mass movements grounded in disciplined organizations with large numbers of people who had a direct self-interest in the issue. Patient safety is our vital issue.

The IOM report will surely uncover laboratory errors which we have all witnessed. Now is our opportunity to be proactive, demonstrate the role clinical laboratory professionals play in patient safety, and gain the recognition and respect we have so long been denied. Let our banner be "Victims No More".