Man: The Human Factor in Laboratory

Sachin Kale, MDConsultant Pathologist

& Asso Prof. MGM Medical College,Aurangabad.

Manpower in Laboratory

House keeping

Receptionist

Phlebotomist

Data entry operators

Pathologist

Supervisors

Technician

Recognize Priorities: Interview

MoneyUsing your lab as a stepping stoneSomeone might need Stable job and fixed dutyKnowledge levelExperienceHonestyDependability

Maslow's hierarchy of needs

What needs can lab fulfill?MOTIVATION TO WORK

Recruitment: Right person for right job

“Square peg in a round hole”

Job Description

• Some people are able understand their job naturally

• But it is better have it written down and should be signed by staff.

• Also an ISO 15189 requirement

Induction program

• Observe the senior – 1 week• Help the senior with the work – 1 week• Independently carryout the work under the

guidance of the senior – 1 week• Work independently – 1 week

Technician: Issues

Course is not standardised

MLT CMLT DMLT?

Postal courses also..

Qualified but not proficient

EmployTrainRetain

Dissatisfaction with salary

• Dissatisfaction is not with salary • The dissatisfaction with salary - secondary to

workplace dissatisfaction. • Staff who complain about with salary will still

not leave if they enjoy good work atmosphere.• Key: Great Work Place

Skills or Lack of it

• Lack of expertise is a system based challenge. • The lab needs to have a system of employing

qualified personnel • Followed by a strong induction program. • Clarity in roles and responsibilities at the time of

induction• This would then allow the employee to be confident

in delivering the responsibilities. 

Attrition

• Linked to both above • Attrition is a way of life. • It is good to have some level of attrition. • However attrition less likely with

adequately motivated and satisfied.

Noncompliance

• Lack of discipline – • is a personal trait. • This is related to clear expression of value

systems existing in the lab and management. • The values that the lab holds should be clearly

communicated to staff. • When this is done, the compliance to activities

including discipline is much higher.

(Mis)Behaving with patients

•Getting into arguments with patients at reception

•Phlebotomy person collecting sample from hospital

Does the size matter?Small Lab Issues

• The lab size should not be a limitation. • Every staff when adequately convinced about the

reason for a certain activity would follow protocols.

• Staff generally become complacent when they are not aware of the reasons for doing certain activities or are forced to do it without being given clear reasons.

People can be pulled not pushed

Leadership lessons from MS Dhoni

•Lead by example•Back your players•Calmness•Less me and more us

Primum non nocere: First do no harm

From: www.hse.gov.uk

Error analysis

• House keeping person regularly cutting corners

• (Routine violation)• Not properly allowing the control thaw• (Situational violation) • Histopath samples received without formalin• Tissue culture received in formalin

(Knowledge based for new, Lapse for experienced)

Error analysis

• Untrained person operating the machine• (Situational violation, Insufficient staff)• Using HIV buffer between different lots • (Rule based error)• Failing to collect all the tubes when battery of

tests is advised. • (Lapse)

Error analysis

• Cholesterol typed 108 instead of 188• (Slip)• Transcription errors: Interfacing equipment

Management wisdom from Eastfor Lab Managers

Kaizen: Plan-Do-Check-Action cycle

5 -Why Analysis

• The patient's diagnosis of skin cancer was considerably delayed. Why?

• The excision biopsy report was not seen by the surgeon. Why?

• The report was filed in the patient's notes without being seen by the surgeon. Why?

• It was the receptionist job to do the filing.  Why?

5 -Why Analysis

• The junior doctors were busy with other tasks

• The root cause - that the doctors' other tasks were seen as more important than filing. 

• Solution: Change the system. • Send a copy of all biopsy reports to the

consultant surgeon and no reports to be filed unless they have been signed by a doctor.

• “Human resources are like natural resources; they're often buried deep. You have to dig Hard to find them.” 

• You can hire people with money, but to make them work for you, you have to win their hearts