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The times, they are a-changin'.

Rarely has one word struck so much fear into the hearts of so many. It's a harsh-sounding word that evokes threatening images. What one idiom could bring such abject anxiety to the minds of laboratorians? "Reengineering."

Also known under the aliases of right-sizing, retooling, and downsizing, reengineering portends a moratorium on hiring, salary freezes, and layoffs (aka firings). It's no wonder this Faustian term has muscled its way onto MLO's list of NewsMakers of the Year.

"Ultimately, right-sizing translates into layoffs and terminations. It's a necessary evil, but it is a euphemism for cutbacks and everybody knows it," admits James W. Brown, Ph.D., M.H.A., assistant commissioner of health, New Jersey State Department of Health, Division of Public Health and Environmental Laboratories, Trenton, N.J.

"Simplify. Save money. That's the way the industry is headed!" laments Mario Werner, M.D., professor of pathology at George Washington University Medical Center in Washington, D.C.

When originally contacted for nominees for News-Maker of the Year, Werner said, "It's not the people in the industry making the news, it's the people leaving it," referring to those jettisoned due to the mass downsizing that has started infecting labs throughout the U.S.

To soften the impact of reengineering at ground zero, some institutions are opting to reeducate their existing staffs. For instance, some hospitals are training their phlebotomists to take on nursing tasks to avoid having to fire them. While this job-saving move brings with it the added benefit of reducing the number of people who come into direct contact with a patient, it severely increases the amount of stress on those employees, each of whom is now doing the job of one-and-a-half or perhaps two people.

Still others, such as a consortium of hospitals in south Florida, are choosing to maximize their economies of scale. Cedars of Miami, for instance, spearheads 14 hospitals that have agreed to create alternate labs in each of their facilities (making accommodations for only rapid-response testing on site), set up a core lab off site, and funnel all essential testing into that core lab, thus requiring only one payroll and reducing lab expenses overall.

Even for those lucky enough to retain their jobs after a right-sizing, however, there seems to remain the bitter aftertaste of: "Be careful. You can always be replaced by a machine."

A fully automated lab is not without its advantages, to be sure, and it does not necessarily have to push a pink slip into anyone's pay envelope. In fact, Christine Diehl, director of laboratory operations for Columbia/HCA Health Care Corp., is an advocate of robotics in the lab.

She maintains, however, robotics and automated labs should be introduced not to get rid of manpower but to enhance and improve the work done in the lab, thus freeing up technologists to do more of the human tasks, such as giving direct patient care.

Brown agrees an increasing amount of advanced technology will infiltrate the lab, but he takes a somewhat different view as to the impact this technology will have on the laboratorian: "There's always going to be a need for clinical scientists, but the work they do will be increasingly esoteric."

He continues, "More mainstream testing will be done in the physician's office. Less-qualified personnel will be performing this testing due to black-box technology. The instrument will double-check everything. That," says Brown, "is progress."

He adds, "We have to realize it and adjust to it. What laboratorians have to do for themselves is keep on the cutting edge - if their resumes are built up, they're in a better position to weather a downsizing."

When asked if the end of cost-containment justifies the means of eliminating positions, Brown says, "Only sometimes. What's sacrificed is employee loyalty. But we're always going to have to deal with change."

The decision and implementation of reengineering is never easy, notes Northside Hospital Laboratory Director Bonnie B. Hendrix, M.B.A., MT(ASCP), and adjunct professor at the University of South Florida in Tampa. "A lot of the times the decisions are made from people higher up who have a more global view of how to reduce costs effectively," she says. "It's real hard when you're in a room with fellow laboratorians and told to come up with cost-saving ideas that will, in effect, eliminate either your job or the job of the person sitting across the table from you."
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Title Annotation:Newsmakers of the Year; reengineering
Author:Zacharia, Mark
Publication:Medical Laboratory Observer
Article Type:Cover Story
Date:Dec 1, 1995
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