Follow a "world-class service" blueprint.

Cleveland Clinic Foundation wins the MLO Medical Laboratory of the Year 2004 Award

Its commitment to patient satisfaction through a metrics-based "world-class service" program put the Division of Pathology and Laboratory Medicine of the Cleveland Clinic Foundation (CCF) at the top of this year's competitors for the MLO Medical Laboratory of the Year 2004 Award! Located on the shores of Lake Erie, Cleveland's reputation as America's "Comeback City" is based partly on institutions like the CCF, a leading center for medical research, education, and technology.

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Customer service is just one area in which this facility excels. CCF client services are provided 24/7. In a nine-month period, CCF employees submitted over 250 ideas for improving patient care to their "world-class service" program. These suggestions included providing patients with information on the Corporate Angel Network Inc.--a free air-transport to distant treatment centers for cancer patients--and distributing pagers to patients and families waiting for procedures or updates.

In a typical month, CCF's 13-member customer-service team--comprised of medical technologists (MTs), client service representatives (CSRs), and clerks--fields 7,000 incoming calls, makes 3,500 outgoing response calls, and in two years has decreased the speed of answering phone calls by 39%. The team achieved excellence by implementing vital standards, such as using scripts and FAQs for routine situations and putting in place a triage system for MTs to directly handle more complex calls. When more than three calls are in queue, an alarm sounds to alert the CSRs. Clerks free up CSRs by calling or faxing requested services, contacting clients for missing or incomplete information, and delivering add-test orders to the central processing area. Through a telephone-skills review system, the customer-service supervisor monitors a minimum of 10 calls per day to assess the issues presented and the quality of interaction; then recommendations given to the team help members respond more expeditiously to calls.

Comments from clients and patients attest to the fact that customer service is a CCF priority. In one case, the CSR quickly researched a newly available test and provided information to a doctor before his patient left the office. In another instance, the lab did not think it had received a specimen that a client insisted was sent. The CSR reviewed computer records, using different name spellings and found the needed results. Despite the fact that the patient's name had been misspelled on the form originally submitted by that client, the CSR managed to resolve the issue and correct the records.

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Vision and single purpose aid team

Department Administrators Warren Morris and Barbara Kirkley say teamwork among its nearly 700 employees is absolutely essential for a laboratory of such complexity. "We are very fortunate to have great employees who work well as a team, blending their individual talents into a creative, collective force," points out Morris. "A well-defined vision and a singleness of purpose are essential to establishing the foundation on which the team is built. The team needs to know management's commitment to the task or project at hand in order to develop the trust needed to be successful.

"As managers, our job is to serve the workforce, by ensuring an open climate of communication, developing roles and responsibilities of members, bringing together complementary skills, providing the tools and resources to accomplish the job, expecting mutual accountability, and always striving for continuous improvement while taking meaningful measurements along the way."

Kirkley adds, "The team approach has become an integral part of our daily culture. Whenever possible, we include employees in decisions that directly impact their day-to-day activities. The aspect of the team environment that I find most rewarding is the opportunity to be involved in a variety of projects on various levels. For employees who are accomplishment-motivated, the team environment provides a wonderful atmosphere to thrive and grow professionally. It is very rewarding to see the self-satisfaction and pride in accomplishment from employees who have participated in these many initiatives."

Recognition brings rewards

"Equally important is to make sure reward and recognition is part of the team experience," Morris interjects. "People need to know they are contributing and do play a major role in the success of the organization, lest we run the risk of complacency. CCF's success can be attributed to our employees!"

Since the large CCF lab organization meant many employees were not acquainted, a division promotion team encouraged them to meet and to develop a greater understanding and appreciation of the many tasks necessary to the operation through an employee-recognition program, "You are Key to Our Success." This catch-me-at-my-best campaign allows employees to immediately reward co-workers for positive actions outside of their regular job duties--volunteering to work overtime, helping a co-worker finish a task, assisting a patient, or cheering up a glum co-worker. Deserving employees receive recognition "key" cards by those who have observed or benefited from such activities. The recipient exchanges the "key" card by "unlocking" a "pirate's treasure chest" (designed and built by a team member) and exchanges it for any one of a variety of items (snacks, notepads, key chains, and stress balls). "I like being able to immediately show my appreciation to someone without clearing it with my supervisor first!" says one participant.

Completed recognition cards--posted weekly on a special bulletin board--replace those from the previous week, which are next placed into a drawing for a gift choice (purchased through the lab's budget) from local businesses. A third tier, soon to be introduced, will recognize employees possessing five "keys" (each for a different action from a different person) with a certificate and a key-shaped pin. In the past 16 months, 175 employees put their "keys" in the treasure chest. According to one recipient, "Receiving the award created positive energy."

Quality control initiatives adopted

In light of CCF's dedication to patient satisfaction, it is no surprise that quality control also ranks high on its list of priorities. An online patient-incident reporting system is in place, supporting the institution's patient-safety performance-improvement initiatives (PIRS). Any CCF employee can use PIRS to report an incident within 24 hours of the event. Upon validation of the report, supervisory staff initiate necessary changes to ensure patient and visitor safety. The improvements are then incorporated into the organization's performance-improvement and risk-management activities.

Adopting the FDA's good manufacturing practices helped establish open dialogues with users of CCF's lab services. Through documenting, implementing, and directing quality systems from design concept through various groups and processes according to current regulatory and legal requirements, Administrator Joanne R. Bratush notes, "We have really made an effort to break down walls and remove ourselves from our silos."

CCF's barcode-driven specimen-identification system, SPECTRA (for specimen tracking), is used by couriers who transport specimens from outside facilities to CCF, and aids in validating the collected specimens. Upon receipt, CCF's central-processing personnel check the specimens against the client's packing list, reducing the number of misplaced specimens in the laboratory.

While CCF obviously excelled in all nine criteria used by the MLO judges, its outstanding performance is summed up in one patient's comment: "I'm a registered nurse, and coming to the Cleveland Clinic renewed my faith in healthcare."

The MHHS whole is more than the sum of its Texas parts

"Our ability to focus on the laboratory organization as a system--rather than as individual laboratories--has been key to our success," says Jim Faucett, vice president of a network of Memorial Hermann Healthcare System's (MHHS's) Laboratory Services in Houston, TX, a city that covers more ground than any other major American city. The organization's recognition as First Runner-Up in MLO's Medical Laboratory of the Year 2004 Award is, according to Faucett, "fantastic! We have 562 outstanding staff and management who have demonstrated operational excellence for a number of years and are certainly deserving of the award."

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How did MHHS turn the MLO judges' heads? Teamwork seems to be the motto for the 24/7 MHHS laboratory staff serving two hospital-based core laboratories and six community hospital-based essential-service laboratories, and overseeing a complex courier system providing services for 3,171 licensed beds and 335,000 annual emergency-room visits. Maria Parra, lab director at MH Northwest Hospital, explains, "In spite of the merging of two large hospitals into our system at different times, we have been able to standardize our policies and procedures." Upon learning of the award, Millie Rivera, lab director of MH The Woodlands Hospital, remarked, "We, as a team, have done something special." Process Excellence Coordinator Melody Peeples, MEd, MT(ASCP), notes that the two MHHS core labs provide a broader menu than the community hospital-based essential services, offering flow cytometry, virology, consultative special coagulation, and will be expanding to include PCR methodologies. The six community hospital-based labs rely heavily on cross-trained staff to function in blended sections, such as the combination of hematology, coagulation, urinalysis, and serology.

As MHHS' only certified Six Sigma Black Belt, Peeples is acutely aware of measurement-based strategy that focuses on operational excellence and quality. "With the operating philosophies of 'systemness' and teamwork," she says, "our success lies in the standardization of policies and procedures, instrument platforms, reagents and supplies, reference testing, information systems, test menus, and quality processes. Our major initiatives for the coming year include implementation of outreach services, development of proactive strategies to address workforce issues related to our aging employee population, and preparations for the migration to a new laboratory information system."

MHHS' innovative Lab Homepage gives personnel a shortcut to network-shared files--quality indicators data, policies and procedures, and teammeeting Minutes--and offers an Outlook lab services calendar to schedule lab meetings and functions, facilitating attendance and reducing event conflicts. A monthly newsletter includes a quarterly feature on quality improvement; a traveling continuing education library offers a collection of audio and videotaped presentations, as well as semiannual educational challenges for lab staff, and an annual lab-education week with a dozen P.A.C.E.-approved offerings. Content-expert speakers add to the MHHS effort to meet or exceed internal needs and add value for customers.

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With an annual 9.3 million reportable results received, nearly 99% of testing was performed in-house during 2003--a 10% increase from the previous year--and with this additional workload, staff was decreased by 9.3 FTE, ranking MHHS in the 98th productivity percentile when benchmarked against its peers.

Marilyn Ruzicka is the transfusion-services manager at MH Southwest Hospital. "In today's healthcare setting," she says, "the challenges that laboratorians meet every day are opportunities to better serve our customers. New technologies, stricter regulations, and fewer resources all combine to help us work smarter, not harder." MHHS' award proves its laboratory staff members do just that.

New Orleans celebrates "schools to careers"

New Orleans' flamboyant Mardi Gras is famous among American celebrations, but this month our celebration is one of a job well done. The Second Runners-Up for the MLO Medical Laboratory of the Year 2004 Award are the 300 Pathology Services employees at the Medical Center of Louisiana at New Orleans (MCL-NO), which presented "The Foy of Laboratory Science" [our italics] at the Louisiana/MS CLS Joint Annual Meeting last year.

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In addition to performing 4 million tests last year, the lab's community outreach program, "Schools to Careers," challenges its professional staff by having them introduce students to the laboratory field. In 2003, nine middle and high schools visited by one of the three MCL-NO lab teams experienced on-site lab demonstrations. A total of more than 600 students attended, and 500 more will have that opportunity this spring.

Daniel E. Haun, director of Client Services at MCL-NO, notes, "Our approach is to introduce the concept and mechanics of a blood-film examination, and then let the students participate in a simulated differential. In the classroom, we use a CD version of our website exercise. The simulation has two brief 'commercials,' one on the career path and one on the risk of bloodborne-pathogen exposure, specifically HIV." Kudos came from students and teachers alike: "This was great!"... "My students loved it!"... "Great job. Please come back." The laboratory's Web-based teacher resource and lesson plan--www.mclno.org/labpartners/index.btm--was featured in MLO's September 2003 Observatory.

Another impactive lab-outreach program is MCL-NO's affiliation with the Delgado Community College (DCC). Through its phlebotomy program, nine students trained this year at the MCL-NO Pathology Services lab. Also four DCC students are enrolled in MCL-NO's Specialist in Blood Bank School. All of these students are incorporated into a receiving process to replace unskilled workers, and are offered a career path to the medical technician level with a bachelor's degree via distance learning with tuition exemption.

Eight students are currently enrolled in the practicum from Louisiana State University's Health Sciences Center (LSUHSC) and train at MCL-NO. Nory Buck, MLT(ASCP), soon to graduate from LSUHSC, says, "This was an incredible opportunity! I got to work in a lab while I was studying the material in class. This made the material much more relevant. I found myself wanting to learn more. After rotating work assignments though all the lab sections, I am able to provide client information as well as most veteran technologists because I know how and when each lab performs a test."

"We observed that MLTs were seeking advancement," says Haun, "but were having a difficult time meeting the requirements of clinical lab experience in all required lab sections. Our candidates rotate work assignments in six-month blocks through microbiology, hematology, chemistry, and immunochemistry. They do shorter blocks in special hematology and send outs. They spend about 30% of their time in specimen receiving.

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"Once enrolled in school, they do a 14-day blood-bank rotation, using vacation leave--just like any other enrolled CLS candidate," continues Haun. "The advantage to us is that these people have broad knowledge of how our department works and what each section does. They provide a lot of oversight and problem solving in receiving. In short, we think of them as our future 'super-techs.'"

With the outreach example set by the Pathology Services professionals at the Medical Center of Louisiana at New Orleans, the future of the American clinical laboratory looks bright and promising!

Working with You for Better Health

This year's National Medical Laboratory Week (NMLW), April 18-24, is set aside to recognize and celebrate the 265,000 medical laboratory professionals and 15,000 board-certified pathologists who perform and interpret medical laboratory tests NMLW originated in 1975 to help increase recognition for the profession of laboratory professionals, the development of which began in the 1920s.

Panel of Judges -- Our esteemed MLO Editorial Advisory Board members who served as judges for the Medical Laboratory of the Year 2004 Award are:

Daniel M. Baer, MD, Professor Emeritus of Laboratory Medicine

Oregon Health Sciences University, Portland, OR

Christopher S. Frings, PhD, CSP, President Chris Frings and Associates, Birmingham, AL

Sharon M. Miller, PhC, MT(ASCP), CLS(NCA)

Professor Emeritus of Clinical Laboratory Sciences, College of Health and Human Sciences, Northern Illinois University, Dekalb, IL

By Dottie Dunham, Associate Editor