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Changing directions and roles in the lab. Prospective payment is redefining the activities of medical technologists and others in the laboratory.

The role of medical technologists in the clinical laboratory will change, in ways that we can predict, because of prospective payment. It's easy to see that far ahead, even though specific laboratory goals and planning will hinge on how effectively hospitals deal with forces that contribute to laboratory utilization problems.

Those forces include a lingering retrospective payment system--no longer in effect for Medicare acute inpatient services--which encourages consumption of hospital resources; lack of sufficient community services to provide long-term and home health care, which tends to lengthen inpatient stays; unrealistic expectations that prompt patient and family demands for extensive services; pressure on physicians to use instruments, facilities, and services that the hospital has provided, often at physicians' own insistence; and inefficient hospital processing of test results

A number of the factors emanate from clinicians. These include the practice of defensive medicine from fear of malpractice suits; lack of cost awareness, failure to consider costs in ordering, and ordering old tests out of habit when newer technologies may in fact be less expensive; misunderstanding of test results and inexperience, both leading to requests for additional, unneeded tests; and professional peer pressure on residents and staff physicians to order tests or keep a patient hospitalized unnecessarily. Moreover, there's a dearth of direct financial incentives that would encourage physicians to utilize resources less extensively.

Laboratory directors and managers for the time being are in a difficult spot trying to determine what changes to make in the lab. Much depends on the factors that contribute to misuse of laboratory services. Not until solid information on progress toward improving utilization is gathered and analyzed can accurate forecasts be made, enabling management to chart new directions.

Nevertheless, it's clear that the future role of the baccalaureate, registered medical technologist will be different. Fewer MTs will be involved in day-to-day handling of the workload. Conversely, laboratories will employ many more medical laboratory technicians with two-year degrees, and their bench role will greatly expand. Cost constraints alone dictate this change; labs will have to keep a lid on payroll expenses.

Baccalaureate medical technologists will most probably have a larger part to play in supervision. This calls for competence in human resource management. Skills are needed in such areas as human resources planning; recruiting, training, and sustaining development of staff; personnel policies and procedures; employee-labor relations; compensation and fringe benefits; productivity management; and forecasting staffing requirements. It will be equally important for medical technologists to acquire business know-how--marketing and accounting skills, for example.

Critical to the short- and long-term health of the institution will be the efficent and effective use of laboratory staff. Managers and supervisors will face their greatest challenges in trying to improve their own effectiveness, increase productivity and performance, and raise work force morale.

Laboratory leaders will have to receive data at regular intervals on financial performance, utilization management, productivity and performance improvement, and materials management. They will also help define the methods used to identify and collect data relevant to their areas and become further trained in applying the data to improve their departments' performance.

Heightening management effectiveness has an important qualitative side--the creation of a corporate culture or set of organizational values that place a high priority on both cost control and quality of care. Management effectiveness can only be enhanced when managers, supervisors, and employees believe that those at the top--administrators and directors--are genuinely concerned about increasing efficiency and productivity while providing quality care. Managers who do not support this philosophy will become an endangered speries.

Gains in employee productivity and performance help control labor costs, which represent more than 50 per cent of all hospital operating expenses. A variety of strategies, including automation, schedule changes, and staff training and coaching are boosting productivity in many laboratories. (See MLO's special report on "Improving Lab Productivity," March 1984.)

The multidiscipline technologists and other health care generalists should be much in demand, especially in smaller hospitals. By the same token, specialists will have to learn or relearn skills outside their particular discipline. Small and rural institutions will seek individuals capable of performing a broad range of basic health care tasks. It may not be uncommon for a primary care nurse to be responsible as well for chest x-rays, phlebotomy, and blood gas analysis. And a medical technologist with skills in cytology, respiratory therapy, physical therapy, and extracorporeal pump technology will be highly marketable.

These predictions seem far out only because they call for changes in the educational arena. Clinical laboratorians, however, are accustomed to rapid-fire change--witness their adaptability to high tech instrumentation.

The development of human potential is critical to increased productivity. Academic institutions and hospitals, therefore, must avoid the tendency to cut back on education and training. Medical technologists need more skills, not fewer.

Among other things, they have to acquire a basic understanding of business administration and of prospective pricing in particular. MT educational programs should now address these areas: cost constraints and the new incentives under prospective pricing; methods by which resource utilization can be measured for each DRG; delineation of new roles and responsibilities for laboratory managers, supervisors, and employees; skills in budget planning and control under prospective pricing; and computer science technology, including programs for measuring productivity and staffing needs and providing general management information.

Better systems for monitoring productivity are needed. These should include productivity standards, close measurement of units of input and output, and development of staffing ratios. We also have to give high priority to work simplification methods and development of physician test-ordering control systems.

Laboratory managers need timely and accurate productivity reports, and they must know how to make use of the data. Managers and supervisors should have an opportunity to develop a wide range of alternative strategies for improving productivity in their own departments. At the same time, interdepartmental teams should explore such improvements because productivity in one part of the hospital depends somewhat upon activity elsewhere in the hospital.

Any system that is adjusting to reduced resources caused by financial, labor, and capital restrictions may well see an erosion of employee morale. Changes in traditional policies and procedures often appear threatening. For change to have a positive effect, efforts must be made to maintain moral without skirting sensitive issues. Factors affecting morale can be addressed directly through educational activities and in-service programs. Here are possible topics of discussion: resistance to change; job security fears; employee motivation, recognition, and future rewards.

The changing directions in health care require educational, institutional, and laboratory adjustments. Above all, a hospital's ability to respond successfully to the health system's new financial incentives will depend on the understanding and competence of all staff members. Immediate planning and revisions with regard to the training of medical technologists and other health professionals are essential.
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Copyright 1984 Gale, Cengage Learning. All rights reserved.

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Author:Martin, Bettina G.
Publication:Medical Laboratory Observer
Date:Aug 1, 1984
Previous Article:A practical guide to instrument selection.
Next Article:Guidelines for laboratory administration - Part III.

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