James Hernandez, M.D., Associate Professor of Laboratory Medicine and Pathology, and Medical Director and Chair of the Division of Laboratory Medicine at Mayo Clinic in Scottsdale and Phoenix, authored an article in Clinical Laboratory News on quality and safety in the laboratory.
Dr. Hernandez provided thoughts on the following questions:
Why can't I just fire someone who makes a mistake?
"The key is to determine whether the mistake was a slip or lapse (most common), or an egregious, willful error (rare)—or perhaps something in between."
Why is it so difficult to implement a just culture in the lab?
"It takes enlightenment and constant reinforcement from leadership to establish and maintain a just culture. It’s easier—but unwise—to blame problems on a bad apple."
What's all this jargon about systems thinking?
"A high-quality system that is safe, effective, patient-centered, timely, efficient, and equitable is every bit as elegant as the coagulation cascade. The key is to work with fallible human beings to convince them that this is so."
Why do some labs seem to make a lot of progress, while other labs flounder?
"We need to learn to revel in failure because that is the only way we will learn what does and doesn’t work. Ultimately, managing change is 10% book knowledge but 70% experiential. You are not alone if you find this absolutely fear-inducing."
What do I need to know right away if I am thrust into a leadership role?
"Become comfortable making others uncomfortable by asking pesky quality questions. Know the effect of errors on patient care and your laboratory. Listen to the voice of the customer, including your bench technologists and phlebotomists. They have skin in the game.
"Understand how your processes and people are connected. Understand that you cannot wish your way to better quality and safety by writing procedures ad infinitum. If the lab keeps making the same mistakes, it is up to leadership to find out why."
Isn't this all up to management to figure out anyway?
"The College of American Pathologists, the Joint Commission, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, and an army of regulatory and accrediting bodies don’t see it that way. They are pretty clear that this is up to laboratory leadership, especially the designated CLIA medical director, to guide."
What do I do if a group of us have suggestions for improvement, but we can't get others to engage?
"Reframe your suggestions using what’s called appreciative inquiry that begins with a focus on what’s going right. Be deliberate and persistent."
There is a lot of pain and very little gain in improving the system. What's in it for me?
"Quality-improvement projects take a lot of backbone and persistence. Frankly, you may never see the full fruits of your labor in your career. You could be doing something else that pays more or gets you more peer-reviewed publications and citations. Ultimately, this is legacy work."