Dealing with younger techs.

Q As younger employees enter the laboratory, how do we older techs avoid the daily frustration of finding important tasks performed improperly or haphazardly? The older group takes its profession and patient care seriously in order to give our physicians the best possible results. If we find that someone has submitted an order that we know is wrong, we believe we are responsible to question it. The younger crew believes that it is not their responsibility. If we all thought that way, patient care would be out the window. What do we mature professional techs need to do? We cannot just "roll with the punches" and not worry about practices that are being done improperly or not being done at all. How best can older lab employees handle this workplace change and the ensuing stress with which we suspect most older techs are dealing?

A Alton Sturtevant advises, "Most of us older techs have learned over time that we must look out for each other and the patients at each turn we take in all of the institution's processes. I, too, get frustrated when an error made by any staff member goes through the entire process without getting caught and corrected. I have always said that at least two people touched the error along the way for it to go through the system uncorrected.

"I have found that a system that trains personnel to find errors at each step, coupled with an environment that expects them to do so, will be more successful in delivering a more perfect product. To do that, we provide written procedures to define each step and design as many checks in the computer system to find the errors and alert the personnel. When an error is found, it should be shown to the appropriate personnel to turn it into a positive outcome. That can be done by making a copy of the appropriate documents and giving them to the person in the process that made the error and her manager."

Dr. Sturtevant adds, "If possible, the error should be corrected by the person who made it, so she will get immediate feedback and the necessary training to prevent future errors. This should be accomplished in a positive manner to ensure more constructive results. The errors should be reviewed frequently by management and required procedure changes, training, and computer checks instituted to result in fewer of the same errors in the future. I have found that a group of all of those involved in the processes--not just management--should review these at least monthly. Lists of errors by type (individuals' names withheld) should be posted so the entire team can be encouraged to focus on the importance of this process. This type of group therapy tends to make the entire lab become more focused on the issues. The entire process is designed to improve the procedures, but it will also identify those who are not able to work effectively in the process. They should be removed if their behavior cannot be corrected."

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Larry Crolla points out, "You should make your concerns known to upper management and the pathologists, and see if you can arrange an in-service for everyone that explains what the responsibilities include. Emphasize at this in-service that the primary responsibilities are four-fold:

* To provide the right result on the right patient at the right time;

* To ensure no harm comes to any patient through medical errors of any kind;

* To ensure the lab is always ready to handle any inspections at any time; and

* To help maintain the financial stability of the institution thereby maintaining their own financial stability through employment."

Marti Bailey opines, "I sense from your letter that you are looking for a judgment on who is right and who is wrong here. Most people ascribe to the philosophy that if they think something is right, then everyone should be okay with it. Likewise, you will find most people think their way of doing something is the best way.

"I have found that techs are particularly set in their ways and beliefs, possibly related to the requirement to perform laboratory procedures according to standard protocols. So, I am not surprised you feel frustrated by behaviors that are in conflict with your beliefs. I think it is admirable that you continue to go the extra step by recognizing and taking personal responsibility for issues that could compromise patient care. The example you cited is one of those little things that can add up to make the difference between excellence and mediocre or standard care.

"The fact is, you cannot expect everyone to perform according to your standards. One reason the younger techs may not pick up on things you do is that they just have not had enough experience and do not recognize the things you do. Another reason may be they recognize the same things that you do but choose to ignore them. I am not sure from your letter if you have really confirmed the latter or just assume it. I believe your best approach would be to continue doing as you have been, but resist trying to actively change the behavior of the younger staff members. Maybe just setting an example of excellence without trying to force it on others will rub off."

Bottom line. It is the job of every person who works within the system to ensure that a quality outcome is achieved for each and every patient. Work with your staff to create an environment designed to catch each and every mistake made all along the line. This includes incorrectly written orders, improper ordering, incorrect patient or specimen registration/accessioning, testing, reporting, and billing.

Christopher S. Frings, PhD, is an internationally known consultant and speaker on the topics of leadership, managing change, time management, reaching goals, and stress management. His consulting firm, Chris Frings & Associates, (www.chrisfrings.com) is in Birmingham, AL.

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