LABORATORY MANAGEMENT Flashcards
Requires leaders to provide directions and managers to get things done.
Effective Laboratory Management
Two stages where most laboratory errors occurs.
Preanalytical and Postanalytical Stage
Two quality management tools that can be used to reduce laboratory errors and increase productivity,
Six Sigma and Lean Six Sigma
The law that regulates laboratory activities.
Clinical Laboratory Improvement Amendment of 1988
Two essential roles within organizations that contribute to overall success and growth.
Leadership and Management
Can be defined as the ability to inspire, influence, and guide others towards achieving a common vision or goal.
Leadership
It involves setting a clear direction, providing motivation, and fostering innovation and creativity.
Leadership
It is not limited to a formal position and can be exhibited at any level within an organization.
Leadership
Often visionary, proactive, and focus on long-term strategies.
Leaders
They empower and inspire their members, promote collaboration, and create a positive work environment.
Leaders
Provides high support but low direction in accomplishing duties.
Supportive Leader
Presents rules, orders, or other defined instructions, but limited rules.
Directive Leader
Provides low support and low direction, allowing competent (generally, more experienced) staff to assume accountability and responsibility to complete goals.
Delegating Leader
Provides high support and high direction by guiding individuals to make real-time decisions with appropriate support and corrective actions as needed.
Coaching Leader
It is the process of planning, organizing, and controlling resources to achieve specific objectives and targets.
Management
Typically hold formal positions and are responsible for ensuring efficient operations and the execution of tasks.
Managers
They focus on creating detailed plans, assigning tasks, coordinating activities, and monitoring progress.
Managers
Often follow established procedures and rules to achieve goals within set timelines.
Managers
Their role is to maintain stability, oversee day-to-day operations, and provide guidance and support to their team members.
Managers
More concerned about completing the day’s work.
o Supervisors
o Team leaders
o Chief technologists
First-Line Managers
Straddle both areas to some degree by engaging in a variety of activities that may be strategic as well as tactical.
o Operations manager
o Division heads
Middle Managers
Concrete on strategizing and planning for the next one to five years.
o Laboratory directors
o Board of directors
o Various C-suite [top-level] executives
Top-Level Managers
Leaders and Managers share some common traits, their distinct difference lies in their ___ and ____.
Focus and Approach
Emphasizes inspiring and influencing people to achieve a shared vision.
Leadership
More about guiding and empowering individuals.
Leadership
Often associated with a long-term perspective, fostering innovation and collaboration.
Leadership
About people, vision, and inspiration.
Leadership
Focuses on organizing resources and ensuring tasks are completed efficiently.
Management
Concerned with directing and controlling activities.
Management
Associated with short-term planning and achieving specific objectives.
Management
About process, tasks, and control.
Management
LEADER VS MANAGER TRAITS:
Administrator
Leader
LEADER VS MANAGER TRAITS:
Organizer and Developer
Leader
LEADER VS MANAGER TRAITS:
Risk Taker
Leader
LEADER VS MANAGER TRAITS:
Inspiration
Leader
LEADER VS MANAGER TRAITS:
Thinks long term
Leader
LEADER VS MANAGER TRAITS:
Asks what and why
Leader
LEADER VS MANAGER TRAITS:
Challenges status quo
Leader
LEADER VS MANAGER TRAITS:
Does the right thing
Leader
LEADER VS MANAGER TRAITS:
Implementer
Manager
LEADER VS MANAGER TRAITS:
Maintains control
Manager
LEADER VS MANAGER TRAITS:
Things short term
Manager
LEADER VS MANAGER TRAITS:
Asks how and when
Manager
LEADER VS MANAGER TRAITS:
Watches bottom line
Manager
LEADER VS MANAGER TRAITS:
Accepts status quo
Manager
LEADER VS MANAGER TRAITS:
Is a good soldier
Manager
LEADER VS MANAGER TRAITS:
Does things right
Manager
Plays a central role in health care.
Laboratory
Plays a leading role in education, research, information technology design and implementation, and quality improvement.
Laboratory
Impact on up to 70% of medical decisions.
Laboratory Results
Remains as a vital tool in the practice of diagnostic medicine.
Clinical Laboratory
The process by which high-level decisions are made.
o Deciding on the objectives of the organization and the need to modify existing objectives if appropriate.
o Allocating resources to attain these objectives
o Establishing policies that govern the acquisition, use, and disposition of these resources
Strategic Planning
Usually based on long-term projections and a global view that can have an impact on all levels of a laboratory’s operations.
Strategic Planning
Planning that consists of the detailed day-to-day operations needed to meet the immediate needs of the laboratory and works toward meeting the long-term strategic goals that have been set.
Tactical Planning
Kind of decisions that may burden a laboratory with unnecessary costs, unused equipment, and/or overstaffing, making it that much harder to change course in response to future market forces or new organizational strategies.
Wrong Decisions
Planning that requires appropriate data collection by observing current and projected conditions in the following areas:
o Social
o Technological
o Economic
o Environmental
o Political
Successful Strategic Planning
Generally, not the work of a single individual but rather involves a diverse and dedicated committee.
Effective Data Collection
An essential factor that each member of the committee must embrace and agree to in the early stages of the strategic planning process.
Commitment
SWOT ANALYSIS:
Use current technology/instrumentation
Strengths
SWOT ANALYSIS:
Have excess technical capacity
Strengths
SWOT ANALYSIS:
Increased test volume will decrease cost per test
Strengths
SWOT ANALYSIS:
Strong leadership support
Strengths
SWOT ANALYSIS:
Financial resources available
Strengths
SWOT ANALYSIS:
Staffing shortage
Weaknesses
SWOT ANALYSIS:
Morale issues
Weaknesses
SWOT ANALYSIS:
Inadequate courier system
Weaknesses
SWOT ANALYSIS:
Need to hire additional pathologist
Weaknesses
SWOT ANALYSIS:
Limited experience in providing multihospital/client LIS services
Weaknesses
SWOT ANALYSIS:
Turnaround times are marginal
Weaknesses
QUALITY SYSTEMS MANAGEMENT:
o Inaccurate patient identification
o Ordering the wrong test
o Improper specimen collection, transportation, and receipt
Preanalytical Errors
QUALITY SYSTEMS MANAGEMENT:
o Inappropriate samples (incorrect blood tubes for particular analyses)
o Calibration errors
o Instrument malfunctions
o Presence of interfering substances
o Failure to verify results
Analytical Errors
QUALITY SYSTEMS MANAGEMENT:
o Reports being sent to the wrong health care provider
o Long turnaround times
o Missing reports
o Improper interpretation of test results by healthcare providers
Postanalytical Errors
This management have been the standard approaches to quality leadership and management.
Total Quality Management (With Continuous Quality Improvement)
A systems approach that focuses on teams, processes, statistics, and the delivery of services/products that meet or exceed customer expectations.
Total Quality Management
Strives to continually look for ways to reduce errors (“defect prevention”) by empowering employees to assist in problem solving and getting them to understand their integral role within the greater system (“universal responsibility”)
Total Quality Management
An element of TQM that strived to continually improve practices and not just meet established quality standards.
Continuous Quality Improvement (CQI)
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Acceptable quality
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Department focused
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Quality as expense
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Defects by workers
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Management-controlled worker
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Status quo
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Manage by intuition
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Intangible quality
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
We VS They relationship
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
End-process focus
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Reactive Systems
Traditional Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Error-free quality
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Organization focused
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Quality as means to lower costs
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Defects by system
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Empowered worker
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Continuous quality improvement
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Manage by fact
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Quality defined
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Us relationship
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
System process focus
TQM Thinking
[QUALITY MANAGEMENT] TRADITIONAL THINKING VS TQM THINKING:
Proactive Systems
TQM Thinking
SIX SIGMA STEPS:
Project goal or other deliverable that is critical to quality.
o Emergency department results in less than 30 minutes from order.
Define
SIX SIGMA STEPS:
Baseline performance and related variables.
o Baseline performance: 50% of time results are within 30 minutes, 70% within 1 hour, and 80% within 2 hours, etc.
o Variables: Staffing on each shift, order-to-laboratory receipt time, receipt-to-result time, etc.
Measure
SIX SIGMA STEPS:
Data using statistics and graphs to identify and quantify root cause.
o Order-to-receipt time is highly variable because samples are not placed in sample transport system immediately and samples delivered to laboratory are not clearly flagged as emergency.
Analyze
SIX SIGMA STEPS:
Performance by developing and implementing a solution.
o Samples from emergency department are uniquely colored to make them easier to spot among routine samples.
Improve
SIX SIGMA STEPS:
Factors related to the improvement, verify impact, validate benefits, and monitor overtime.
o New Performance: Results available 90% of time within 30 minutes.
Control
WHAT TYPE OF MANAGEMENT:
Major Challenges for today’s manager:
o Recruiting
o Hiring
o Training
o Retaining qualified personnel
Human Resource Management
WHAT TYPE OF MANAGEMENT:
Competition with other health care professions has necessitated implementing creative recruitment incentives, such as salaries, benefit packages, and better work environments.
Human Resource Management
WHAT TYPE OF MANAGEMENT:
“If the position remained unfilled or downgraded, how would that impact patient care?”
Human Resource Management
WHAT TYPE OF MANAGEMENT:
Recruiting, hiring, training, and retaining qualified personnel have become major challenges for today’s manager, and projections indicate that these challenges will continue to grow.
Human Resource Management
WHAT TYPE OF MANAGEMENT:
The laboratory is a high-value asset in diagnostic medicine.
Compared to other clinical specialties, the laboratory generates a high volume of tests requiring expensive equipment and skilled personnel.
Financial Management
WHAT TYPE OF MANAGEMENT:
Laboratory Leadership should understand basic financial concepts such as:
o How services are reimbursed
o Why payment may be denied
o Broad regulations that govern reimbursement as well as basic accounting
o Financial analyses
Financial Management
WHAT TYPE OF MANAGEMENT:
Must have an understanding of these is essential to conduct business in a compliant manner and ensure payment for services rendered:
o Charge masters
o Current Procedural Terminology (CPT) Codes
o International Classification of Diseases, 10th Revision (ICD-10)
Financial Management
WHAT TYPE OF MANAGEMENT:
Laboratory leadership should understand basic financial concepts, such as how services (such as laboratory tests) are reimbursed, why payment may be denied, broad regulations that govern reimbursement as well as basic accounting (e.g., direct and indirect costs, budgets) and financial analyses.
Financial Management
LABORATORY DESIGN AND SERVICE MODELS:
Provided in many different ways and can be thought of as a continuum from POCT producing immediate answers to highly sophisticated laboratory tests that may take days to complete.
Laboratory Services
LABORATORY DESIGN AND SERVICE MODELS:
Its relationship to other testing sites within a facility has evolved from discrete hematology, chemistry, microbiology, and blood bank sections to one where boundaries have been obscured.
Functional Design of a Laboratory
LABORATORY DESIGN AND SERVICE MODELS:
A consolidation process on a grand scale.
Regionalization
LABORATORY DESIGN AND SERVICE MODELS:
It is important regardless of the type of laboratory and may be accomplished best by implementing.
Facility Design
Consider:
o Localization of the specimen-processing area
o Patient registration and data entry
o Specimen testing workflow
o Short- and long-term storage
o LIS connectivity requirements
Laboratory Design and Service Models
LABORATORY DESIGN AND SERVICE MODELS:
Laboratory services are provided in many different ways and can be thought of as a continuum from ___ ___ ___ ___ producing immediate answers to highly sophisticated laboratory tests that may take days to complete.
Point-of-care-tests
LABORATORY DESIGN AND SERVICE MODELS:
Creating a ___, ____ ____ offers a number of efficiencies, such as eliminating the purchase of redundant instrumentation and supplies, better use of technology, sharing of common equipment (centrifuges, incubators, refrigerators, etc.), and access to technical expertise.
Centralized, Core Laboratory
REGULATION, ACCREDITATION, AND LEGISLATION:
___ ____ is necessary to avoid legal or administrative repercussions that may limit a laboratory’s operations or shut it down completely.
Laboratory Practice
REGULATION, ACCREDITATION, AND LEGISLATION:
To operate (and receive reimbursement for services), laboratories must be ____ and often ____ under federal and/or state requirements.
Licensed and Accredited
What is the meaning of AABB?
American Association of Blood Banks
It is the technical standards and accreditation of blood banks.
AABB (American Association of Blood Banks)
What is the meaning of CDC?
Centers for Disease Control and Prevention
It is the standards and guidelines primarily related to infection control and safe work practices.
CDC (Centers for Disease Control and Prevention)
What is the meaning of CLSI?
Clinical Laboratory and Standards Institute
It is the standards on all aspects of lab practice developed through voluntary consensus.
CLSI (Clinical Laboratory and Standards Institute)
What is the meaning of ISO?
International Organization for Standardization
It is the standards to facilitate international exchange of goods and services.
ISO (International Organization for Standardization)
What defines standards for quality management in medical labs?
ISO 15189
What is the recognition granted by nongovernmental agency to institutions that meet certain standards?
Accreditation
Is accreditation voluntary or mandatory?
Voluntary
What is the recognition granted by nongovernmental agency to individuals who meet education requirements and demonstrate entry-level competency by passing exam?
Certification
Is certification voluntary or mandatory?
Voluntary
What is the permission granted by the state to individuals/organizations to engage in certain professions/business and it is also illegal to practice/operate in that state without it?
Licensure, you need “License” to practice
Is licensure voluntary or mandatory?
Mandatory
SAFETY:
___ ___ ___ ___ can inherently expose staff, and potentially the public, to a variety of hazards, including infectious biological, toxic chemicals, and various levels of radioactive materials.
Routine Clinical Laboratory Activities
SAFETY:
Laboratories are obligated to ____ ____, implement safety strategies to ____ the ____ and continually audit existing practices to ensure employee compliance.
Identify and contain hazards
It is the frequent safety policy reviews, disaster drills, and employee awareness training help maintain safe patient and work environments.
Safety
In Laboratory Hazard Prevention Strategies:
It is the general procedures/policies that mandate measures to reduce or eliminate exposure to hazard.
Work Practice Controls
In Laboratory Hazard Prevention Strategies, Work Practice Controls:
____ is very important before and after patient contact.
Handwashing
In Laboratory Hazard Prevention Strategies, Work Practice Controls:
Cleaning surfaces with ____.
Disinfectants
In Laboratory Hazard Prevention Strategies, Work Practice Controls:
Avoiding ___ ___ of needles and sharps and ___ ____.
Unnecessary use; not recapping
In Laboratory Hazard Prevention Strategies, Work Practice Controls:
___ bag waste for disposal.
Red
In Laboratory Hazard Prevention Strategies, Work Practice Controls:
Immunization for ____.
Hepatitis
In Laboratory Hazard Prevention Strategies, Work Practice Controls:
___ ___ to minimize repetitive tasks.
Job Rotation
In Laboratory Hazard Prevention Strategies, Work Practice Controls:
No ___, ___, or ___ in the laboratory.
Eating, Drinking, or Smoking
In Laboratory Hazard Prevention Strategies, Work Practice Controls:
___ signage.
Warning
In Laboratory Hazard Prevention Strategies:
It is the safety features built into the overall design of a product.
Engineering Controls
In Laboratory Hazard Prevention Strategies, Engineering Controls:
___-___ ___ for disposal and transport of needles and sharps.
Puncture-resistant containers
In Laboratory Hazard Prevention Strategies, Engineering Controls:
Safety needles that automatically ___ after removal.
Retract
In Laboratory Hazard Prevention Strategies, Engineering Controls:
___ bags.
Biohazard
In Laboratory Hazard Prevention Strategies, Engineering Controls:
___ guards.
Splash
In Laboratory Hazard Prevention Strategies, Engineering Controls:
___-liquid containers.
Volatile
In Laboratory Hazard Prevention Strategies, Engineering Controls:
Centrifuge ___ buckets.
Safety
In Laboratory Hazard Prevention Strategies, Engineering Controls:
____ ____ cabinets and fume hoods.
Biological Safety
In Laboratory Hazard Prevention Strategies:
It is barriers that physically separate the user from a hazard.
Personal Protective Equipment (PPE)
What hazard expose an unprotected individual to bacteria, viruses, parasites, or prions that can result in injury?
Biological Hazards
What hazards exposure occurs from:
o Ingestion
o Inoculation
o Tactile contamination
o Inhalation of infectious material from patients or their body fluids/tissues
o Supplies or materials they have been in contact with or contaminated needles
o Aerosol dispersion
Biological Hazards
Blood, other body fluids, and any unfixed tissue samples are always assumed to be ___ ___ for various ___ ___ pathogens.
Potentially infectious; blood-borne
All clinical laboratories are mandated by ___ to develop and actively follow plans that protect laboratory workers from potential exposure to hazardous chemicals.
OSHA
What did OSHA published requiring the manufacturers of chemicals to evaluate the hazards of the chemicals that they produce and to provide written documentation accompanying each product in the form of Safety Data Sheets (SDS; formally Material Safety Data Sheets or MSDS).
(2)
Hazard Communication Standard (OSHA, 1994b)
Chemical Hygiene Plan (OSHA, 1990)
In the safety diamond:
What does red mean?
Flammable area
In the safety diamond:
What does yellow mean?
Reactivity area
In the safety diamond:
What does blue mean?
Health area
In the safety diamond:
What does white mean?
Special Dangers area
What chemical should be stored below counter level or in their respective cabinets?
Acids
What chemical should be separated from flammable and combustible material, bases, and active metals?
Acids
Should inorganic acids be separated from organic acids?
Yes
Should oxidizing acids be separated from organic acids?
Yes
What chemical should be separated from acids?
Bases
Where should you store inorganic hydroxides?
Polyethylene containers
What should be limited in a work area?
Flammables
What should be stored in approved safety cans or cabinets?
Flammables
Should you separate oxidizing acids and oxidizers?
Yes
What should be separated from reducing agents, flammable, and combustible materials?
Oxidizers
What chemical should be kept away from water and should be stored in a dry, and cool place?
Water-reactive chemicals
What class of fire is cloth, wood, and paper?
Class A
What extinguishers (2) should you use for class A fire?
1) Pressurized Water (A)
2) Dry Chemical (ABC)
In this class of fire, do not use water on electrical fires or burning liquids.
Class A
What class of fire does flammable or combustible liquids belong to?
Class B
What extinguishers should you use for class B fire?
1) Dry Chemicals (ABC)
2) CO2 (BC)
What class of fire is electrical equipment?
Class C
What extinguishers should you use for class C fires?
1) Dry Chemicals (ABC) - May damage electrical equipment
2) CO2 (BC) - Will not damage computers etc.
What class of fire is combustible metals? And should you extinguish it by yourself?
Class D, No
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level is no hazard in health?
Level 0
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level can cause significant irritation in health?
Level 1
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level can cause temporary incapacitation or residual injury in health?
Level 2
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level can cause serious or permanent injury in health?
Level 3
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level can be lethal in health?
Level 4
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level will not burn in flammability?
Level 0
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level must be pre-heated for ignition to occur in flammability?
Level 1
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level must be heated or in a high ambient temperature to burn in flammability?
Level 2
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level can be ignited under almost all ambient temperatures in flammability?
Level 3
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level will vaporize and burn at normal temperature in flammability?
Level 4
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level is stable in instability?
Level 0
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level at high temperature makes it unstable in instability?
Level 1
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level is violent chemical change at high temperature of pressure in instability?
Level 2
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level may explode from high temperature or shock in instability?
Level 3
In National Fire Protection Association (NFPA) Hazmat Diamond:
What level may explode at normal temperature and pressure in instability?
Level 4
In National Fire Protection Association (NFPA) Hazmat Diamond:
What does W mean in special hazards?
Unusual reactivity with water
In National Fire Protection Association (NFPA) Hazmat Diamond:
What does OX mean in special hazards?
Oxidizer
What requirement is a test tube, vial, etc. containing etiologic agent must be securely closed, watertight, surrounded by adsorbent material and placed in secondary container?
Primary Container
What requirement must be watertight, sealed, and placed in an approved mailing container?
Secondary Container
What requirement must be made of fiberboard?
Mailing Container
What is required on primary and mailing containers?
Labeling/Biohazard Labels
What do you call when employees must be trained and retrained every two to three years or when regulation changes?
Training
