Clinical laboratory management review : official publication of the Clinical Laboratory Management Association最新文献

In 1993, Hammer and Champy inspired many health-care institutions to initiate reengineering projects with their prediction that America's largest corporations would fail if they did not apply the principles of business reengineering. Many of these companies reengineered to simplify their processes but did not achieve radical gains. Who or what is to blame for the failures? Does health care's complexity play a role in these failures? A 1981 study found that health care is more than 2,000% more complex than the standard business. It concluded that "routine" management strategies do not provide a sufficiently comprehensive theory for managing health care's complexity. This article addresses the need to reengineer on four levels--the mind, career, system, and department--to circumvent these complexities. Reengineering on each level enhances the chances for success on the other levels. In today's tumultuous health-care environment, you need to understand your role in reengineering at each level so you can implement it, support it, and live it. If you succeed, you will achieve radical gains, add a valuable tool to your repertoire, enhance your self-confidence, and become a leader in the industry.

Change, chaos, and uncertainty touch every part of every institution. The laboratory is not immune. Managers content to continue on their familiar path soon will find themselves bypassed. To meet today's challenges, directors of technical operations, laboratory directors, team leaders, and coordinators need plenty of creativity--from everyone on their staff. It is no longer just "nice" to improve group output and problem-solving skills while staying within a "shoestring" budget. It is absolutely necessary. In this article, we explore strategies laboratory managers can use to tap the creative potential and commitment of their people. These strategies work. Whether it involves using humor, creating "idea centers," or "deconstructing the bureaucracy," the goal is the same: to encourage clinical managers to think beyond their technical and managerial experience. The examples in this article may not suit the needs, situations, or tastes of all laboratory managers. They are "food for thought." The concepts and strategies these examples illustrate are every laboratory manager's keys to adapting successfully to future challenges.

The dynamism of change in the evolution of integrated health-care systems is driving change in the skills and competencies required to manage diagnostic services. Formal educational preparation and practical experience in a wider array of disciplines will be essential to the backgrounds of those who will be chosen for these new and ever more complex roles. Curricular elements relevant to this educational challenge are outlined herein. This article is intended to expand on the position of CLMA as reflected in the position paper "New Path for Health-Care Leadership: Clinical Systems Management," issued in August 1997 (1).

The purpose of this study was to determine the impact of support and commitment on job performance and turnover intentions of professionals working in a team environment. As hypothesized, the results indicated that job performance was influenced positively by both professional and team commitment as well as by perceived organizational and team support. Intention to quit the organization went down as organizational support and commitment went up, and intention to leave the profession similarly was related to team support and commitment Interestingly, professional commitment had a deleterious effect on intention to quit the organization, whereas organizational support had a positive effect on professional commitment.

Staggering adjustments are being demanded in the medical world. New laws, regulations, technology, and competition are forcing decision makers to adopt new approaches relating to how they manage their institutions. This article discusses an organized program that employs an array of management tools and techniques that can be of great value to those who are embarking on a program of deliberate methods change.

Significant changes have occurred in many hospital-based laboratories over the past few years. The demands from the medical staff to deliver the highest quality test results in the shortest possible time coupled with the mandates from hospital administration to become cost efficient have given laboratory managers many challenging opportunities. Information management is a basic component of the process required to meet the timeliness goal. Best demonstrated practices for the various sections within our laboratory resulted when combining five components of daily management. These are instrument automation, using a laboratory information system to auto-merge and auto-release tests, consolidating workstations, redistributing work among the technical and nontechnical personnel, and implementing key indicators to follow improvement.

A convergence of concepts has allowed clinical laboratory automation to proceed in a greater number of laboratories: developing automation control interfaces, direct track sampling, and adopting a universal interface. The laboratory automation system (LAS) must interface to the laboratory information system (LIS), which provides the information necessary for routing and scheduling and for future rules-based processing, an important component of the LAS. The automation system also must operate in a real-time or near real-time environment and use the single tube per carrier paradigm. LAS capabilities should span the clinical laboratory and run parallel to the LIS with respect to information flow. The laboratory automation software will control the automated technology and the transportation system that binds clinical laboratory instruments together. It must be able to both drive the hardware components and interface with patient information sources, and it should further the goals of the health-care delivery system by supporting outcomes optimization and utilization management of laboratory resources. The development of workcells based on disciplines such as chemistry or hematology is having and will continue to have a significant effect on the acceptance of clinical laboratory automation technologies.

The present assessment of laboratory quality is primarily a qualitative summary process. The objective of our study is to convert a qualitative standards document into a quantitative, weighted scoring system. We selected a laboratory testing standards document, Ancillary (Bedside) Blood Glucose Testing in Acute and Chronic Care Facilities, C30, developed by the National Committee for Clinical Laboratory Standards (NCCLS), as our prototype and used a two-stage, modified delphi technique. Sixty-nine criteria were identified from the C30 document. Using a two-stage, modified delphi technique, members of the NCCLS committee that developed the guideline weighted the relative importance of each criteria. This weighting system then was used to evaluate the quality of bedside glucose testing at the 14 general hospitals located within the city limits of Boston.

Objective: To determine whether introducing a new laboratory test, ionized magnesium (iMg++), would affect outcome, where outcome was defined as the rate of arrhythmias in a population of postoperative cardiopulmonary bypass (CPB) patients.

Design: A prospective randomized trial.

Setting: Cardiothoracic surgical intensive care unit of a university hospital.

Patients: One hundred fifty consecutive post-CPB patients with randomized to two groups, one of which received routine reporting of iMg++ levels on all postoperative electrolyte requests while the other had access to total magnesium (tMg++) levels on demand and no access to iMg++ levels. Groups were compared for rate of arrhythmias, total amount of magnesium repleted, and demographics.

Measurements and main results: Eighty-five patients were randomized to the tMg++ group and 65 to the iMg++ group. The two groups did not differ in the rate of arrhythmias (chi-square test): 13/85 (15%) of the tMg++ patients and 12/65 (18%) of the iMg++ patients developed an arrhythmia. The groups also did not differ in the amount of magnesium sulfate (MgSO4) administered (2 tailed t-test): tMg++ patients received 1.5 +/- 0.15 (SEM) gm of MgSO4, whereas iMg++ patients received 1.3 +/- 0.15 gm.

Conclusion: The study does not support the hypothesis that magnesium repletion titrated to iMg++ reduces arrhythmia development in post-CPB patients. The lack of a difference in the amount of magnesium replacement between the two groups suggests that tMg++ level is a reasonable indicator of iMg++ level. Routine measurement of iMg++ does not, therefore, appear to have advantages over tMg++ in the postoperative management of CPB patients.