One of the greatest joys of working in an academic medical center is the opportunity to mentor the future leaders of our profession. Although residents in pathology have just completed medical school, this is often the first time they have a chance to experience the complexity of the clinical laboratory. Dr. Cheryl Maier is a first year clinical pathology resident in our department at Emory University School of Medicine. In this article, she shares her perspective on why overcoming the disconnect between the specimen and the patient contributes to patient safety.
Recently, a laboratory technologist told me how disruptive stroke code specimens were to her routine duties. "They are such a pain," she said. "They come in, and I have to stop what I'm doing. The patient hasn't been registered, so I have to log the specimen in. I don't know why they can't be processed like everything else."
My institution recently received The Joint Commission's advanced certification as a comprehensive stroke center. Because treatment decisions are extremely time-sensitive and hinge on laboratory results, the laboratory had to create a process with a very short turnaround time for testing specimens from patients with suspected stroke. The process we instituted involves bypassing routine specimen processing and directly transporting these specimens to the core lab where they are prioritized over all other specimens.
As this technologist brought to my attention, not everyone was aware of our process and the reasons for such urgency. I realized that in the toil of her daily work, she did not really connect each specimen she was handling with an acutely ill patient in the emergency department, and that this disconnect could compromise patient safety.
Uncovering the Disconnect
I admit that I knew little about my role in patient safety as a first-year pathology resident at the beginning of my clinical chemistry rotation. Certainly, my medical school education included a few essentials about checklists and duty hours, as well as discussions of the seminal Institute of Medicine report, "To Err is Human" (1). As a resident, I was now learning about medical errors that happen in the laboratory—whether pre-analytic, analytic, or post-analytic—and how laboratory staff can minimize each type. But the technologist's remark bothered me and I wondered how I could help her see the importance of her job in a fast-paced, sometimes understaffed, automated environment where a specimen tube has little relationship to the patient who may be having a life-threatening stroke.
I decided to talk to my attending clinical chemist, Corinne Fantz, PhD, about what I had heard. She told me that laboratory staff working in a busy environment may view their work as only handling tubes or specimens, instead of the sample being part of a real person (2). This disconnect can affect lab workers at all levels, including lab directors, and can hinder quality improvement initiatives. Fantz further explained that while automation is very important to reducing errors and improving turnaround times in clinical labs, it also exacerbates the problem by further reducing the interaction of lab workers with the patients they serve. She suggested that I might be able to diminish this disconnect by engaging the technologists with stories about the patients whose specimens we handled.
Positive Impact and Motivation
As I dug deeper into how to connect technologists to patients, I came across studies on something called prosocial impact. University of Pennsylvania organizational psychologist Adam Grant coined the term and proposed that jobs be designed in a way that connects employees with the beneficiaries of their work. This strategy allows employees to understand the personal impact of their work. In an impressive example recently cited in the New York Times, Grant studied student employees soliciting alumni donations at a university call-center. He found that callers who heard a brief presentation from a student benefitting from an alumni-funded scholarship, or evidence of the callers' prosocial impact, showed a more than two-fold increase in weekly pledges and a more than five-fold increase in weekly donation money (3). Grant attributed these results to the enhanced motivation of the callers and argued that employees who received information about the positive effects of their work actually displayed greater levels of motivation as evidenced by the higher donations.
I wondered how I, as a resident, could help technologists understand the personal impact of their work. I decided to try an informal experiment.
I began informally with "two-minute tech-talks" in which we would discuss a patient and the role of the laboratory in his or her medical care. Later, I tried more in-depth, one-on-one discussions with technologists about patients flagged in our weekly exceptions report. Initially, I felt my presence was intrusive to the technologists as I popped in and out of the laboratory to discuss patients with as many staff members as I could. But after about a week, several technologists told me that our discussions helped them better understand the importance of their work. They also provided feedback on how these brief exchanges could be most useful to them.
After hearing the technologist's concerns about the stroke code specimens, I learned more about the process myself and decided to present a 30 minute "technologist in-service" on strokes with special emphasis on the critical role of the laboratory in caring for these patients. We discussed several cases and how the laboratory's results affected outcomes of specific patients, such as helping determine who should receive the clot-busting medication, tissue plasminogen activator. At the end of my talk, a staff member shared her personal experience about two family members who had suffered strokes. Her story helped everyone think of these urgent specimens in a very different way. I was also gratified when the technologist who had been frustrated by the stroke specimen process thanked me for the information and even offered suggestions on how to improve the process. In fact, her suggestions were so good that I passed them on to our hospital's stroke coordinator.
Spread the Word
In retrospect, the benefit of connecting technologists to patients seems like common sense, yet the degree and reciprocity of the positive impact of this experiment surprised me. Relaying the prosocial impact of their work to technologists created a more interactive workplace and helped me learn more about the operation of the laboratory as a resident.
These interactions not only connected technologists to patients, but also strengthened communication between technologists, residents, and lab directors. This point is especially important because patient safety is often compromised by poor communication between hospital staff at different levels. Better communication may help technologists feel more comfortable sharing information with clinical chemists or pathologists, which can prevent medical errors.
Although today's automated systems in laboratories reduce error, we must remember that human work and motivation is more complex. Laboratory professionals from technologists to the chief pathologist need to feel that what they do is useful. Sharing stories about the patients we serve reinforces the value of our work and can serve as an important driver of quality improvement.
- Institute of Medicine. To err is human: Building a safer health system. IOM website. (Accessed May 2013).
- Astion M. Disconnection from patients and care providers: A latent error in pathology and laboratory medicine—an interview with Stephen Raab, MD. CLN 2009;35(4):14–5.
- Grant AM. Employees without a cause: The motivational effects of prosocial impact in public service. IPMJ 2008;11:48–66.