Angela Revision Session

Question 1

What might be a reason for introducing a new service into the lab?
How could you get info about these?

Answer 1

• it might improve quality
• it might save money
• it might improve user satisfaction
• it could be due to new guidelines such as Best Practice or NICE
• or could be something simple like the product you’re currently using isn’t made anymore
• could get in touch with other labs who do it that way
• do a cost comparison
• could speak to users e.g. clinicians and find out what they think

Question 2

What does a business case involve? What should you include? Who might your audience be and why is this important?

Answer 2

Used to prove that what you want to do makes good business sense!

• you would use it to present all options and show evidence why you are pursuing your chosen option
• always include the ‘do nothing’ option

Could be a lay person reading it/listening to it such as HR so remember to not overwhelm them with scientific jargon as you will lose your audience.

Question 3

What is CIP? Why do we have to be involved?

Answer 3

Cost Improvement Programme.

NHS needs to save money year on year therefore each Trust is given a target of efficiency savings to make.

Question 4

What are the general ways in which your could make these savings?

Answer 4

• bringing in additional services such as our Portuguese or Dublin work
• automation
• natural wastage of staff
• take on more testing with same number of staff
• make sure staff are doing correct tasks e.g. no band 6s doing wet work?

Question 5

What is it important to remember about CIP?

Answer 5

Needs to be sustainable
Isn’t just for this year - it is forever once you have committed to the saving
Trust take it output of budget each month which can quickly mount up if not actually making the savings

Question 6

How could you identify any potential areas for CIP?

Answer 6

• would arrange a meeting between relevant staff members to have a brainstorming session
• need to include people who are best placed to spot improvements e.g. the people doing the job
• e.g. no point me trying to work out how money could be saved in the extraction team as I’ve ever worked with them!

Question 7

What does SWOT analysis mean and briefly what is it?

Answer 7

Strengths
Weaknesses
Opportunities
Threats

Decision making tool used in many organisations when planning a project.

Question 8

If you wanted to introduce a new service, what might you consider?

Answer 8

• is there a need for it?
• do the users want it?
• does it work for everyone involved? E.g. who else might need to use it?

Question 9

What is often a big barrier to introducing a new service? How would you deal with this?

Answer 9

Change - people don’t like it!

Get people engaged in it from the off - involve them in the process so that they understand why it is happening. Educate them as to why it needs to be done. E.g. Lynch project - gave team a presentation about test but started with the background and talked about the patients involved.

Question 10

What is a non-compliance?

Answer 10

Failure to adhere to an Act or Regulation.

Question 11

What is a non-conformity?

Answer 11

Failure to adhere to an SOP/procedure within the lab.

Question 12

If you’ve made a change to a service what might you have to consider?

Answer 12

• training/retraining staff in what’s changed
• amend relevant SOPs to reflect the change
• create a competency doc/amend competency doc to sign staff off
• set-up audits to check the ongoing competence of staff

Question 13

If an audit identifies a non-conformity what would you do?

Answer 13

• write the audit up including the non-conformity and submit to audit lead
• schedule for a horizontal audit to take place looking at a set number of samples
• if no other occurrences we can put it down to a one off?
• if we find again we need to look at this particular procedure and investigate why it’s happened:
• ?team meeting with everyone involved see if anyone has any ideas,
• potentially change procedure to prevent reoccurrence,
• communicate change to everyone and get them to complete task on iPassport to say they’ve read new SOP,
• schedule another horizontal audit in ?6 months
• depending on the extent of error might want to get someone to go through cases and correct the ones which are wrong

Question 14

How is laboratory performance monitored?

Answer 14

Turn around times submitted regularly
User survey?
EQA - we participate for all tests 
UKAS inspection 
UKAS certificate also submitted to CQC

Question 15

What are the benefits of a robust quality management system?

Answer 15

• document control - SOPs reviewed regularly
• staff trained ad audited against the SOP
• horizontal and vertical audits done randomly to check samples are being processed according to SOP
• incidents are fully investigated and learnt from
• enables us to see patterns in incidents/near misses and identifying underlying causes
• embeds continual improvement

Question 16

What are the different types of training that a staff member might undergo?

Answer 16

Mandatory training - general safety for working in a hospital/with patients

Training in specific tasks you carry out such as analysis - safe doing your specific job

Development - training to enhance your career/help you progress/continual development e.g. conferences, seminars that provide job satisfaction and happiness

Question 17

Why is training important?

Answer 17

• ensure staff are competent to do a task and understand what they are doing
• mandatory training ensures you are safe to work in a hospital and/or with patients - it is for personal safety as well as patient safety e.g. fire training
• results in higher quality service with less mistakes/incidents and resultant complaints
• training also enhances your career and can give staff job satisfaction and improve staff retention

Question 18

What is a PDR and why is it important?

Answer 18

• Personal Development Review
• reviewing staff is UKAS requirement
• periodic review to allow person to reflect on their achievement and identify/discuss any developmental needs
• set objectives for the year ahead
• important as contributes to job satisfaction and employee happiness
• links objectives to the Trusts values and makes you think about how your role fits in with Trust objectives

Question 19

If you were asked to train someone, briefly how would you do it?

Answer 19

• give them an overview/background of the task
• ask them to familiarise themselves with the relevant SOPs
• show them what to do
• watch them do it
• encourage them to ask questions
• use a competency form to sign them off as competent
• schedule an audit to check this competency soon afterwards - completed by someone who hasn’t done the training

Question 20

What is competency? Why is it important?

Answer 20

UKAS requirement - ensures that staff are well trained!

6 sub-categories that cover: qualifications, training, competency assessment, staff performance review, continued education and professional development, personnel records.

• ensures that training is high quality
• high quality training = less chance of errors/incidents and the investigations that go with these
• operator confidence
• user confidence

Question 21

Do you think it’s better to train someone one to one or in a group?

Answer 21

A group - each person will take out slightly different things from the training session
Sometimes people don’t want to ask questions they feel are ‘silly’ but will go away and ask others from the group later
If you’ve forgotten something you can discuss with someone else from the group
Feel like you have moral support
It’s more efficient than doing 10 separate training sessions and everyone gets the same info

Question 22

Would you ever give a result to a patient?

Answer 22

Right now? - NO

However - in future we might be more involved in the clinic situation e.g. new Associate Physicians are working alongside Drs, if asked to deliver genetic results to patients they may request company of a Clinical Scientist to help explain what it means. Especially as genetic testing becomes more mainstream.

Question 23

What is Clinical Governance?

Answer 23

• an umbrella term
• covers things that sustain and improve high standards of patient care
• links together things like risk assessment, information governance, health and safety, COSHH, risk register, incident reporting.

Question 24

What is Human Factors?

Answer 24

Things that can affect patient safety such as staff stress, fatigue, work culture.

For example they can impact about whether a person will speak up when they see an error e.g. mid staffs

Question 25

What is COSHH?

Answer 25

Control of substances hazardous to health.
Assessment which looks at options such as;
- can the chemical be replaced by something else?
- can it be made safer e.g. using it in a hood

Involves a form which is completed to show things like:

• what to do if you spill it or splash it etc.
• states things like what PPE should be used when using it
• they are reviewed regularly and paper copies are stored in the lab for quick reference and also on iPassport.

Question 26

If you were given some money, what would you spend it on?

Answer 26

• probably go back to the lab and hold a meeting with my team and brainstorm what things we could use the money for. Would invite the people who are hands on in the lab who know the processes. Might need equipment, staff, new kit?

My ideas:

• licences for LIMS
• Cytovision licences given increase in karyotyping from NW
• automated harvester/banding/slide-making
• journal access! We don’t have any, we rely on our students and STPs!
• I’m in the social committee and we’re trying to lift morale so I might use some of it to plan something to boost departmental morale. Would come up with some ideas with the committee and put a vote up on our board, what shall we do? Could use it for a fabulous Christmas party.

Question 27

How would you investigate poor quality prep?

Answer 27

• identify why its poor e.g. banding, cytoplasm, damage
• check details of sample e.g. in transport a long time?, small sample, media out of date etc.
• follow sample through lab and check others from the sample date/media batch to identify if it’s a one off or if it’s recurring
• get more slides made, set-up sample again if it’s fresh, could we do a different test so patient still gets a result,
• check LIMS incase another sample has come in.
• if nothing can be done get report out as quickly as possible, don’t sit on it. Sooner clinician knows the sooner they can arrange repeat testing for the patient.

Question 28

How do you perform an audit?

Answer 28

• select a random sample that represents cohort of sample that you want to audit
• obtain copy of relevant SOP keeping in mind any previous versions that the sample may have been run using
• use SOP to check procedure has been followed
• if unsure, ask someone who knows the area better
• keep a record of any non-conformity’s
• once complete discuss outcome with audit lead
• any non-conformity’s will need to be recorded appropriately so that they can be investigated/discussed at the next team meeting
• a repeat audit will be scheduled
• depending on what has been found a horizontal audit may be appropriate.

Question 29

Describe an audit you would like to do…

Answer 29

• recently we have felt like the DNA concentration from our aminos has been lower than usual and we are having to rely on cultures before the array can be processed
• would be useful to audit these samples and investigate if there really is an issue
• where are the samples from? Who was the operator who took the sample? What gestation are they? What are the comments before they are passed through for extraction?
• investigate what percentage are low concentration and whether it correlates with anything
• if it does, could collate evidence and put into clear presentation and take to the fetal MDT? Ultimately would be there decision to make any changes as our success rate is very good, it is just the extended time it takes to get the result out that FMU might not realise the association with low gestation aminos.
  Knock on effect of less time spent chasing samples, less time with patients calling and asking about results.