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Saturday, October 30, 2010

PT reflects Management Competency (?)

One of my favorite airplane past-times is to read The Economist.  It is an eclectic magazine with a business slant and a huge variety of topics covered.  So it is not too surprising that I would find an article that pertains to quality and medical management.  For reference the edition is October 23-29, 2010.  The article on page 72 “How to save lives”.  It is also on the economist web-site (www.economist.com).
Two British investigators were interested in asking questions about hospital characteristics associated with  better outcomes (reduced deaths from heart attacks in the emergency department).  So they looked at 1200 facilities (US, UK, Canada, Europe) in a standardized fashion, and not too surprisingly they did find some characteristics with strong correlation.
Of interest the characteristics associated with better outcomes related to management.  Hospitals that perceived they were competing for patients had a better outcome.  Private facilities did better than Public.  Large institutions with lots of staff did better than intermediate sized and the intermediate did better than the small.  So far nothing surprising (well maybe the public versus private).
What caught my eye was the strong performers hired management who were clinically trained (doctors, nurses, technologists, pharmacists,  etc) to a greater degree than those that did not do as well.  In other words having management teams that have no training relationship to healthcare is a bad thing.

So what does this have to with medical laboratory quality?
In CMPT we look at microbiology laboratory performance using the measured outcome percent of annual achievable score met.  For example if a laboratory does 50 challenges their highest achievable score (in our program) would be 4 for each challenge for a total of 200 points.  If over the year they got 200 points, their percent achievable would be 100% .  If they got 180 points,  their percent achievable would be 90%. 

So as it turns out, like the hospitals referred to in the article, there is a strong correlation between size and complexity of the laboratory and performance.  Large laboratories do very well, intermediate less well, small again more less well, and very small even more so.   In a previous entry I showed a 10 year performance trend (see August 22. 2010: For Folks with an interest in Proficiency Testing).

The following depicts an additional year's performance.  While there was a substantial improvement last year in laboratory performance (Hooray!), the same relationship trend remains.

From surveys we have done we have suspected that the correlates with this were number of staff (that would fit with the above), and the progressively poorer access to continuing education,  microbiologist assistance and to newly trained technologists.  All of that makes sense. 

But we have never looked, or even considered if laboratory performance on proficiency testing correlates with other more clinical indicators in the hospital setting, and especially if it correlates with the training and knowledge and background and competency of management.

Now that would be really interesting. 



  1. If mangement have the laboartory training, knowledge, backgound surely they will ensure that their stsff have the same : therefore the laboratory will do well in EQA and proficiency testing

  2. I guess the question would be: If management does not have laboratory training, knowledge and background, can there be effective management?

    I would go out on a limb and guess that it would depend on the level of management and the person itself. Perhaps (and I really am only guessing), the higher up the management, the less important is actual related hands-on knowledge?!? Surely, the higher the management level the more important people knowledge and personality becomes.

    A manager that has GREAT peoples skills will know not only who to talk to....but, more importantly, who to listen to (and who NOT to listen to) when it comes to laboratory decisions on some lower or hands-on level. (However, that does lead to certain dependance that could have a potential of abuse.)

    It is my experience, that whether management does or does not have actual knowledge or laboratory training, it never hurts to visit its people of all levels and listen to their concerns and ideas. This, in my opinion, will help with EQA and proficiency testing just as much as actual technical knowledge. (because a valued employee is a happy employee....and I am sure there are a number of studies that will support my theory...a happy employee will produce better work and a better work environment...which will lead to better other employees....and so on)