2956_Ch09_575-596 30/01/14 4:28 PM Page 575

9
SECTION

Management &
Education Review
2956_Ch09_575-596 30/01/14 4:28 PM Page 576

Management &
Management Skills and Styles Education Review 576

SKILLS
Organizational Ability to apply management process, systematize workflow, make decisions, communicate with
coworkers.
People Understanding theories of human needs & work motivation.
Financial Effective use of & accounting for company’s monetary assets.
Technical Skills to transform resources into products/services.
STYLES
Authoritarian Manager makes all decisions without input from others. Quick decision-making. Least acceptance &
commitment from staff. Poorest quality decisions.
Democratic Manager makes decisions after polling staff. Better quality & acceptance. Decisions take longer. Those
in minority might feel ignored.
Consensus Manager tries to get at least partial agreement from all staff. Everyone has input. Highest quality
decisions. Good acceptance & commitment. Time-consuming.
Laissez-faire Manager leaves decision to staff. Least effective approach. Manager abdicates responsibility.
2956_Ch09_575-596 30/01/14 4:28 PM Page 577

Management &
Management Principles Education Review 577

FOUNDATIONS
Mission Organization’s purpose
Goals Organization’s broad, long-term ambitions
Objectives Directives that describe how a goal will be achieved. Should be SMAART:
Specific
Measurable
Achievable
Agreed-upon
Realistic
Time-bound
PROCESSES
Planning Establishing goals & objectives, formulating policies to carry out objectives.
Organizing Coordinating resources to achieve plans. Defining working relationships, including line of authority & workflow.
Directing Communicating, motivating, delegating, & coaching. Creating a climate that meets the needs of individuals & the organization.
Controlling Defining standards of performance, developing a reporting system, & taking corrective action when necessary.
2956_Ch09_575-596 30/01/14 4:28 PM Page 578

Management &
Laboratory Management Education Review 578

TITLE RESPONSIBILITY FOCUS

Director Establishes goals & priorities. Broad policy making. Organizational goals
Administrator Runs organization within framework of policies given to him/her. Organizational goals
Manager Oversees activity to achieve goal or purpose. Work environment
Supervisor Oversees activities of others to help them accomplish specific tasks. People, operations
2956_Ch09_575-596 30/01/14 4:28 PM Page 579

Management &
Maslow’s Hierarchy of Needs Education Review 579

NEED DEFINITION WORKPLACE COUNTERPART(S)

Physiological Survival needs. Food, water, air, rest Income
Safety Physical & psychological security Insurance, safe work environment, job security
Social Sense of belonging, acceptance, affection Social relationships with coworkers
Esteem Respect, independence, appreciation, recognition Job title, privileges, respect of colleagues
Self-actualization Realization of full potential Challenging work, autonomy, professional growth
2956_Ch09_575-596 30/01/14 4:28 PM Page 580

Management &
Personnel Required in High-Complexity Education Review 580
Laboratories Under CLIA ’88
TITLE RESPONSIBILITIES
Laboratory director Overall operation & administration of lab.
Technical supervisor Technical & scientific oversight of lab. Must be available on as-needed basis to provide on-site, telephone, or
electronic consultation.
Clinical consultant Consultation regarding appropriateness & interpretation of tests.
General supervisor Day-to-day supervision of lab.
Testing personnel Specimen processing, test performance, & reporting of test results.
2956_Ch09_575-596 30/01/14 4:28 PM Page 581

Management &
Employee Performance Appraisal Education Review 581

COMPONENTS
Job description Basis for evaluation.
Standards/criteria What is expected. Should be objective & measurable.
Measurement instrument Instrument to compare actual performance with desired performance.
Evaluator Person trained in use of instrument, familiar with intricacies of job, time to dedicate to process.
Feedback mechanism Plan for sharing results of review, taking corrective action, planning for future.
EVALUATION ERRORS
Error of central tendency Everyone is rated toward middle of scale.
Contrast error An individual is rated lower than justified because of comparison with another exceptional individual.
(The opposite may also occur.)
Error of leniency Everyone is rated high. (The opposite may also occur.)
Halo effect Good performance in one area influences evaluation in other areas.
Reverse halo effect Poor performance in one area influences evaluation in other areas.
Recency phenomenon Judgments are made based on recent events or unusual incidents.
2956_Ch09_575-596 30/01/14 4:28 PM Page 582

Management &
Testing Personnel Competency Assessment Education Review 582

Frequency Semiannually during 1st yr, annually thereafter, & whenever there’s a change in test methodology or instrumentation
Methods Direct observation of routine patient test performance
Monitoring of recording/reporting of test results
Review of intermediate test results or worksheets, QC records, proficiency testing results, preventive maintenance
records
Direct observation of performance of instrument maintenance/function checks
Assessment of test performance through testing of previously analyzed specimens, internal blind testing samples,
or external proficiency testing samples
Assessment of problem-solving skills

Required by CLIA ’88 for moderate & high complexity labs.

2956_Ch09_575-596 30/01/14 4:28 PM Page 583

Management &
Laboratory Operating Costs Education Review 583

DEFINITION EXAMPLES
Fixed costs Expenses that don’t fluctuate when Instrument leases, maintenance contracts, computer services,
volume of work changes over short equipment costs, facilities upkeep, management salaries,
term custodial salaries, employee benefits, depreciation, lease
payments, rent, taxes
Variable costs Expenses that fluctuate directly with Labor costs, supplies, reagents, disposables
change in work load
Direct costs Costs associated with performance of Supplies, reagents, controls, standards, disposables, equipment
a test costs, equipment maintenance contracts, equipment deprecia-
tion, technical & supervisory labor
Indirect costs Overhead Administration, plant maintenance, security, utilities, building
depreciation, rent, taxes, insurance, housekeeping, purchasing,
billing, regulatory expenses, laboratory information system
(LIS) expenses
Unit cost/cost per test Total of direct & indirect expenses of
producing a test result
2956_Ch09_575-596 30/01/14 4:28 PM Page 584

Management &
Break-Even Points Education Review 584

ANALYSIS FORMULA
Break-even price per test Annual fixed costs + variable costs
Test volume
Break-even test volume Total fixed costs
Averagerevenueper test − variable costper test
Break-even revenue Total fixed costs
(Averagerevenueper test − variable costper test)/averagerevenueper test
2956_Ch09_575-596 30/01/14 4:28 PM Page 585
Quality Management
SYSTEM
GP26-A4: Quality Management System:
A Model for Laboratory Services
ISO 15189: Medical laboratories-Particular
requirements for quality & competence
Lean
Management &
Education Review 585
HIGHLIGHTS
Quality management system developed by Clinical & Laboratory Standards Institute (CLSI)
to organize all policies, processes, & procedures for preanalytic, analytic, & postanalytic
activities. Based on 12 quality systems essentials (QSEs): organization, customer focus,
facilities & safety, personnel, purchasing & inventory, equipment, process management,
documents & records, information management, nonconforming event management,
assessments, continual improvement. Similar to ISO 15189.
Quality management system developed specifically for clinical labs by the International
Organization for Standardization (ISO). Based on ISO 17025 (General requirements for the
competence of testing and calibration laboratories) and ISO 9001 (Quality management
systems-Requirements). Accreditation to ISO 15189 is mandatory in some countries, but
currently voluntary in U.S. The College of American Pathologists (CAP) offers an ISO 15189
accreditation program. It doesn’t replace the CAP Laboratory Accreditation Program.
System developed by Toyota to improve quality by improving workflow & eliminating
waste. Focuses on equipment layout, standardization of processes, cross-training, inventory
management. Turnaround times are improved by grouping automated analyzers in core lab
& replacing batch processing with single-piece flow.
continued...
2956_Ch09_575-596 30/01/14 4:28 PM Page 586

Management &
Quality Management continued Education Review 586

SYSTEM HIGHLIGHTS
Six Sigma System developed by Motorola to improve quality by determining & eliminating causes
of defects/errors & reducing variability in processes. Uses DMAIC methodology (define,
measure, analyze, improve, control) to improve processes & statistical methods to mea-
sure quality improvements. Six sigma = only 3 errors per million tests. Select employees
are trained to become experts & lead efforts, e.g., “Green Belts, Black Belts.”
Lean Six Sigma Quality improvement system that combines principles of Lean & Six Sigma.
Tracer Methodology Internal audit tool to evaluate quality of patient care by following a specimen through
preanalytic, analytic, & postanalytic phases of testing. Used by The Joint Commission &
CAP as part of accreditation.
2956_Ch09_575-596 30/01/14 4:28 PM Page 587

Management &
Sentinel Events: The Joint Commission (TJC) Education Review 587

Definition Unexpected event involving death or serious physical or psychological injury, or risk thereof
Example Administration of ABO-incompatible blood
Goals Improved patient care
Requirements 1. Root cause analysis: Analysis of why event happened. Examines proximate causes, e.g., personnel, equipment,
environment, leadership, corporate culture, communication, external factors. Focuses on systems/processes,
not individuals.
2. Action plan: Establishes risk reduction strategies & measures of effectiveness. Should delineate responsibilities
for implementation/oversight & establish time lines.
3. Implementation.
4. Monitoring.
Reporting Reporting to TJC is optional but encouraged so that event can be added to database & used as educational tool to
help others avoid similar events. Confidentiality is maintained.
2956_Ch09_575-596 30/01/14 4:28 PM Page 588

Management &
Point-of-Care Testing (POCT) Education Review 588

Definition Testing performed at site of patient care. Also known as decentralized, bedside, or near-patient testing.
Goal Provide rapid test results where immediate medical action is required, e.g., emergency department, intensive
care units.
Common POCT tests Urine reagent strips, glucose, electrolytes, blood gases, activated clotting time (ACT), PT, APTT, hemoglobin.
Regulations Determined by test complexity. May operate under clinical laboratory’s CLIA certificate or separate CLIA
certificate.
Optimal staffing Director: MLS or pathologist responsible for administrative, financial, & technical decisions.
Point-of-Care Coordinator (POCC): Oversees testing & responsible for compliance, training, QC, proficiency
testing (if required).
Designated contact/trainer at each testing site: Liaison between POCC & testing personnel, assists with
training/competency assessment.
Testing personnel: Qualifications determined by test complexity of testing. Usually phlebotomists, lab
assistants, nurses, respiratory therapists.
Considerations Cost, performance specifications, ease of use, turnaround time, impact on quality & cost of patient care, data
management/connectivity/interface capabilities.
2956_Ch09_575-596 30/01/14 4:28 PM Page 589

Management &
Competency-Based Instruction Education Review 589

Body of Knowledge Task Analysis Certification Exam

(competencies required Content Online
to do job)

Objectives

Instruction

Evaluation based
on objectives

Feedback
2956_Ch09_575-596 30/01/14 4:28 PM Page 590

Management &
ABCs of Writing Behavioral Objectives Education Review 590

COMPONENT QUESTION(S) ANSWERED EXAMPLES

A Audience
B Behavior
C Criteria
D Degree
Who?
What?
Under what conditions? When? How?
Expected standard of performance.
How many? How much? How well?
The MLT student; the phlebotomist; the laboratory assistant
Perform; demonstrate; explain; list; outline; label
Following the directions in the Blood Bank Procedure
Manual; after a lecture, demonstration, & practice session;
without use of notes; within 30 min; without coaching
10 normal & 3 abnormal differentials; in complete agree-
ment with the instructor; with 90% accuracy; within ±15%
of reported value; within ±2 SD of instructor

VAK Learning Style Model

STYLE PREFERENCE EFFECTIVE TECHNIQUES
Visual Seeing Reading assignments, pictures, slides, diagrams, drawings, graphs, videos, demonstrations.
Auditory Hearing Lectures, tapes, discussions. Stimulated by changes in vocal tone, pitch, pacing.
Kinesthetic Doing Laboratories, role-play, group work.
2956_Ch09_575-596 30/01/14 4:28 PM Page 591

Management &
Domains of Learning Education Review 591

DOMAIN ELEMENTS KNOWLEDGE LEVEL APPLICATION LEVEL PROBLEM-SOLVING LEVEL

Cognitive Facts, knowledge Recall & comprehend Apply information in concrete Manipulate information in new
facts/information situations situation or context. Analyze,
synthesize, evaluate.
Psychomotor Physical skills Observe & imitate a Practice a skill Adapt existing skills to meet
skill new demands or originate new
procedures.
Affective Attitudes, feelings, Receive & respond to Assess attitudes/feelings Organize & internalize values
values information about into system that guides behavior.
attitudes/feelings
2956_Ch09_575-596 30/01/14 4:28 PM Page 592

Management &
Bloom’s Cognitive Taxonomy Education Review 592

LEVEL ABILITY TO EXAMPLES OF VERBS FOR OBJECTIVES AT DIFFERENT LEVELS

Knowledge Recall specific facts Cite, define, identify, label, list, match, name, pronounce, quote,
recite, reproduce, state
Comprehension Grasp meaning of material Change, describe, explain, give examples, give main ideas,
illustrate, interpret, paraphrase, rephrase, summarize
Application Use material in new & concrete situations Apply, classify, compute, demonstrate, predict, prepare, present,
show, solve, utilize
Analysis Break down material into component parts Analyze, associate, conclude, determine, diagnose, diagram,
differentiate, discriminate, distinguish, examine, infer, outline
Synthesis Put elements together to form new whole Combine, compile, compose, create, design, develop, devise,
generalize, invent, modify, originate, plan, propose, project,
revise, rewrite, synthesize, theorize
Evaluation Judge value of material for given purpose Appraise, assess, compare, conclude, contrast, critique, deduce,
evaluate, judge, weigh
2956_Ch09_575-596 30/01/14 4:28 PM Page 593

Management &
Instructional Methods Education Review 593

INSTRUCTOR CENTERED STUDENT CENTERED

Lectures Labs
Demonstrations Discussions
Role playing
Simulations
Case studies
Cooperative learning groups
Writing assignments
Presentations
2956_Ch09_575-596 30/01/14 4:28 PM Page 594

Management &
Testing at Different Cognitive Levels Education Review 594

LEVEL DEFINITION EXAMPLE

Recall Recognizing or remembering isolated information Which enzymes are elevated with liver disease?
Application Interpreting or applying limited data 15 nRBCs per 100 WBCs were observed on a differential. The
automated analyzer reported the total WBC as 15 × 106/L.
What is the corrected WBC count?
Analysis Evaluating data, solving problems, or fitting A patient’s RBCs agglutinated in anti-A, but not in anti-B. His
together a variety of elements into a meaningful serum agglutinated A1 cells & B cells. What might account for
whole these results & how should you proceed?