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Time to end the lab leadership controversy.

Time to end the lab leadership controversy

The question of who should be the director of a clinical laboratory has been a major issue for as long as I have been a clinical laboratory scientist, and that's a long time! It won't be settled unless all concerned sit back and objectively analyze present laboratory needs and the breadth of competence required to meet those needs.

The analysis should focus on what skills and knowledge are needed and set aside tradition, voluntary agency standards (e.g., those of the Joint Commission on Accreditation of Healthcare Organizations and the College of American Pathologists), and Federal and state regulations. If the laboratory professions all agree, they can work together to promote necessary changes in present laws and regulations. If, however, they base their considerations on the existing framework, they will not be able to perform an objective analysis.

The analysis should start with a look at the operational needs of today's clinical laboratories, which will vary among the different types of labs. Assuring appropriate patient outcomes from quality laboratory services depends on three distinct components--administrative, technical, and medical.

All laboratories must have someone who is qualified to administer day-to-day business operations. This person would oversee planning, financial, productivity, personnel, and purchasing functions as well as interactions with other departments. The laboratory administrator would also serve as part of the institution's management team in hospitals and large independent labs.

Technical leadership covers all of the functions involved in supervising and coordinating production of test results. They include collecting, handling, and verifying specimens properly; reviewing test results and monitoring quality control; participating in test, reagent, and equipment selection; maintaining staffing levels and procedure manuals; interpreting and correlating test results to insure clinical relevance and accuracy; and monitoring technical productivity and costs.

The medical side of running a laboratory deals with diagnostic and therapeutic concerns. The functions include consultations requested by clinicians, review and interpretation of significantly abnormal or unusual results, medical and technical consultation to all laboratory sections, participation in appropriate medical staff activities and committees, and active involvement in laboratory quality assurance programs.

Given these functions, what qualifications are necessary to insure an effective and efficient operation?

To perform the managerial functions, an individual would need management and business education as well as demonstrated management experience and strong people skills. A knowledge of laboratory operations is preferred, but not essential if responsibilities are limited to the business side.

A technical director must possess instrumentation skills and experience, the ability to apply and correlate clinical sciences, expertise in quality control, and organizational abilities. A specialist in a particular clinical science can serve as technical director, but a generalist background would provide a more comprehensive understanding of all laboratory sections.

The medical functions would fall primarily to a physician skilled in diagnostic interpretation and therapy. In a hospital setting, this may require a hospital-based physician, but clinicians very often assume this responsibility for their patients when using independent laboratories.

If you accept the premise that all three functions are necessary and distinct, the final question is who can best meet these requirements. There is no single answer because so much depends on the type and size of a laboratory and the scope of services provided. The larger the laboratory, the likelier it is that all three functions will be under the direction of different individuals. In smaller laboratories, however, the administrative and technical components can be combined.

There may be competent individuals who can cover the responsibilities of all three positions, but there is no single profession that does. A medical or clinical science degree does not automatically make a person qualified to direct, a laboratory. Unless physicians demonstrate competence in the management and technical areas as well as the medical, they may not be competent to provide overall laboratory direction. Similarly, only when doctoral, master, and baccalaureate clinical scientists demonstrate competence in management and general clinical sciences can they be considered competent to serve as administrative and technical directors.

Isn't it time we recognized that most clinical laboratories have outgrown the single director concept? Regulations should acknowledge the three distinct function areas and that these areas may require different kinds of expertise. In addition, different laboratory locations may have different needs.

This does not preclude the possibility of one individual serving as laboratory director. But holding that position should mean demonstrated competency in all three areas.

Taking an objective and analytical approach to this issue and establishing needs before qualifications should end the controversy once and for all. The outcome can only benefit patients, clinicians, and all laboratory professionals.
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Article Details
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Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Jun 1, 1988
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