Thursday, June 23, 2011

Ariely and Astion - bringing meaning back to the laboratory worker

I am reading “The Upside of Irrationality” by Dan Ariely (2010.  HarperCollins Publishers) and came upon a chapter that struck a chord.  It was one of those very satisfying moments. 

Ariely is a psychologist and behaviour economist; one of those guys who works in experimental design to address basic issues in behaviour.  In this one study he was interested in what motivates people to work diligently. 

The experiments involves asking folks to build some complex characters using the toy building blocks Legos or playing word games on paper.   The study design is essentially giving money for completing the task (either building something or completing the word game) giving more money for completing, but giving but progressively less money each time it is repeated.  The variable is whether the person sees some additional recognition.  In one scenario, the person’s building or word game is saved with they name, in another their work goes into a pile, and in the third, their work is shredded immediately. 

Turns out that folks will repeat the task multiple times, even though they are making relatively less money as they continue if they see the characters are connected to them by name or by preservation.  When their output is ignored destroyed, they do less repetitions, and follow the procedure with less accuracy.   People work more and more accurately when their work is not ignored or dismantled.  People work better when their work has meaning.   

When we put it that way, there is no surprise here.  But this begs the question about working in a modern medical laboratory.  One person receives a requisition and enters data into a computer, over and over.  Another takes the sample, now identified by a bar code and puts it into a tube or cuvette over and over.  Another pushes a button on a machine that makes the machine test the sample.  And another transcribes the machine result into report.  If workers name is collected, it is not for recognition, but rather who to blame when there is a problem.  This is a system that might make Henry Ford or Frederick Taylor happy (2 guys that built assembly lines) but it is tough to find a lot of meaningful recognition in this type of work.

In the microbiology laboratory, the technologist today receives a set of plates that have been incubating overnight, disconnected from the sample, disconnected from the requisition, disconnected from any clinical information.   Total disconnection. 

At our POLQM Quality Weekend Workshop, Mike Astion from Seattle was presenting on human resource issues in the medical laboratory and discussed this very scenario.  He was talking about laboratory workers being disconnected from their work… bored and making mistakes.  We need to connect the technologist back to the real live and living patient.  We need to connect the technologist with a reason for feeling like they are contributing to patient care.  We need to have meetings where the laboratory people actually meet and talk with the patients.  We need to make the laboratory people feel connected and meaningful. 
We need to ensure that laboratorians are clinically relevant.

There are all sorts of ways to make the reconnection.  In one laboratory that I have visited in Tanzania, they have put patient’s pictures on the walls.  Clinical technologist positions send the technologist out to participate in ward rounds.  Clinical-laboratory conferences with patients participating. 
These are all old ideas that were common practice in the 1960’s.  It is time to bring them back.

I love it when information from many sources all comes together.

1 comment:

  1. HI Michael.
    Re:"We need to make the laboratory people feel connected and meaningful" so true.
    Early in my career we used to perform the phlebotomy on the patients we performed tests on and this gave me real personal job satisfaction - I remember bleeding veterans of Japanese POW camps whilst at the Queen Elizabeth Military Hospital and listening to some of them was awesome.-

    Today though my only contact with patients is at the weekly Diabetic clinic were I perform HPLC HbA1C on finger pricks as a POCT service.Some of my colleagues actively avoid doing this as they don't want to meet patients and I find this sad as one of the reasons I do my job is that I know that there is a person at the end the of the barcode.
    I know that in labs that processing hundred/ thousands of samples a day with pre-analytic and track system it is very easy for us to take our eye of the ball and forget that each sample is helping a patient in some way - but I think we should instil in members of our profession/ lab community that there is a patient attached to the results generated -perhaps it would be a good idea to go back to some of the practices of the 1960's BUT I don't think that we have the resources (certainly in the UK) to do so.


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