Q&A with Michael Astion, MD, PhD, editor-in-chief, CLN Patient Safety Focus

I lead a smaller lab that has a lot of pride and skilled staff, but our hospital is struggling financially and we have been unable to get significant investment in lab technology, even if that technology could have a good return on investment and improve patient safety. I confess to being a little worried. What are some inexpensive things we can do to improve patient safety?

Obviously, new space, total lab automation, and barcode-based patient identification and specimen collection are not in your future. However, there is quite a bit you can do to improve patient safety without a dime of investment while also saving time and money. A short list of inexpensive but effective maneuvers are shown in Table 1. The least expensive, but most effective patient safety maneuver is for leadership to stay calm and positive in the face of patient safety challenges. Staying positive means affirming your staff for exhibiting positive patient safety behaviors, including respecting no distraction zones, helping a care provider order the right test, or making “good catches,” such as detecting a problem with a specimen or result.

More importantly, staying positive means recognizing that by and large all staff come to work to do a great job. This is easy to recognize on days when the lab operates smoothly. But bad days are what separates a good lab leader from a great one. When instruments go down, when the hospital is busy, when an unexpected number of lab workers are out sick, when an inadvertent error or two affect patient care, when a physician, nurse, or patient is unhappy with the service from your lab—these are the unwanted mistakes that great leaders recognize sometimes occur despite our best efforts. In this recognition, great leaders own the mistake rather than transferring it to lab workers. This in turn encourages lab staff to be resilient, and points toward better times ahead. It also tacitly acknowledges that staff come to work to do a great job.

I have given this advice to a number of lab medical directors, administrators, managers, supervisors, residents, and others. In return, I often get the response that it is difficult not to become depressed—and even a little panicked—when facing patient safety issues during times of financial adversity. I tell them that it is OK to panic. It is OK to look at the retirement calculator to see when they can spring themselves out of their dilemma. It is OK to express extreme thoughts like “I cannot take it anymore” or “I am really faking it here.” It is just not OK to do so at work. Do it at home with a loved one.

When I asked for a show of hands at a recent lab leadership conference on how many attendees had awakened in the middle of the night worried about patient safety and everything awful associated with patient safety and the lab, every hand in the audience went up. Therefore, you are not alone. We are all in it together. Just have the courage not to express your worst moments to your own staff.

In conclusion, when it comes to patient safety, positive leadership in the face of adversity costs nothing, but means everything. If you combine that positivity with programs that ground your staff in patient safety by allowing them to increase their direct connection to both patients and influential care providers, you will decrease errors and improve patient safety despite the financial duress.

Michael Astion, MD, PhD, is clinical professor of laboratory medicine at the University of Washington department of laboratory medicine, and medical director of the department of laboratories, Seattle Children’s Hospital. +Email: michael.astion@seattlechildrens.org


CLN's Patient Safety Focus is sponsored by ARUP Laboratories

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