Id like to add my 2cents to the measuring "Quality" topic. I'll make it short. You should have a "Quality Managment" program. It's vital to track errors, trypes of errors, frequency and who etc. This is NOT a tool for blame as we are all adults or we should be. It is however a tool for tracking trends, making improvments and yes if you did see someone making a mistake often, you would have the data to educate particular personel. There are QM tools out there from various organizations. And yes, there are standards of deviations such as the TAT for frozens. There are standards for other thangs as well. Set Standards of excellence with your Pathologist. Make goals. Track them. Follow improvment. So try a google on QM and see if that helps answer any of the original questions. BTW... Merry Christmas Histonettters. :) Kim :D
________________________________ From: "O'Donnell, Bill" <billodonn...@catholichealth.net> To: Maria Mejia <mbmph...@gmail.com>; "Morken, Timothy" <timothy.mor...@ucsfmedctr.org> Cc: histonet@lists.utsouthwestern.edu Sent: Tuesday, December 18, 2012 2:37 PM Subject: RE: [Histonet] Basis for Quality Work in a Histotech Maria - Well said. -----Original Message----- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Maria Mejia Sent: Tuesday, December 18, 2012 11:36 AM To: Morken, Timothy Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Basis for Quality Work in a Histotech Travis, I agree with everyone's valuable thoughts regarding your question. As a supervisor, it's imperative to communicate with people in such a way that they change themselves. With some people the act of "getting the task done," has such an urgent need that can lead them to become careless & aggressive, leaping before looking & even speaking without thinking first. In histology, we know it's more important to avoid making mistakes - to be certain every detail is accurate & in place. And, it's important to find the balance between the 2 intentions of "getting the task done" & "getting it done right!" It's also important to create & develop relationships with those you work with. The desire to contribute to others & be appreciated for what you do, is one of the most powerful motivational forces known. And yes, sometimes you get what you give! Giving appreciation & getting along with others go hand-in-hand - & as a supervisor it's another balancing act. Also when people have the same priorities, a misunderstanding or conflict is highly UNLIKELY. All the best Maria Mejia San Francisco, CA On Dec 17, 2012, at 8:30 AM, Morken, Timothy wrote: > Travis, > > Histology has a very complex workflow AND requires "artisan" level > workmanship to deliver a product. Those two together nearly guarantee > mistakes, mostly minor, but sometimes literally life-threatening to patients. > The goal is to instill a sense of Best Quality in the techs. A large part of > achieving that attitude is to ensure the pathologists and administrators are > behind the techs 100% and ALLOW the techs to do Best Quality - ie, accept > that Best Quality will sometimes mean slower turnaround time. Does that > aspect mean more people are needed? That's your call, but can be determined > by workload accounting. > > The attitude should be that the SYSTEM makes the mistake, not the individual. > It is not likely a person makes a mistake on purpose, but instead is it some > aspect of the system that allows them to make a mistake (though "shortcuts" > can be thought of as intentionally risking making mistakes "on purpose," the > "purpose" being to save time or effort). > > Workflows can be "engineered" to ensure some mistakes don't happen. Protocols > must be followed to the letter by EVERYONE. No workarounds allowed (a > workaround is an indication that there is something wrong in the system - the > employee feels the need to take shortcuts. Why? BTW, Bill Gates said the > most important word in his vocabulary is "why." Why is something done the way > it is? Why does a mistake happen at a certain point? ). In failure analysis a > problem is approached by asking 5 levels of WHY? After asking WHY 5 times > back down the workflow chain you usually find the root cause of a problem. If > not, you keep asking why until the root cause is found. > > For instance, we worked out a slide labeling protocol at the microtome that, > if followed, will ensure the tech does not make labeling errors. All > participated in working this out and so have bought into the system. All new > employees are trained in that system. That will eventually be followed by > barcoding, but that is a year away at least. But our protocol has nearly > eliminated labeling errors (we still get a few sneaking in here and there but > as we catch them we try to figure out how to engineer them away). > > We also finally instituted the printing of cassettes directly from our LIS > rather than using a stand-alone printer or hand-writing. That has almost > totally eliminated cassette labeling errors - we used to have hundreds per > month, mainly by residents putting in cassettes that they did not enter in > our LIS, or making simple typo errors on a stand-alone cassette labeler, or > hand-written cassettes. > > All these methods need to be investigated. > > Rewards are also very helpful. We give out "Bear hugs" that are $5 gift > certificates to the campus store, cafeteria, various food vendors in the > institution, etc. it's a small reward, but people actually appreciate it. We > also have "Star Awards" of $50 gift cards for those times when someone does > something more beyond the usual. The receiver chooses the card they want from > about 2 dozen available (coffee shops, VISA, various stores, etc). > > > Good luck with it! > > > Tim Morken > Supervisor, Electron Microscopy/Neuromuscular Special Studies > Department of Pathology UC San Francisco Medical Center > > > > > > -----Original Message----- > From: histonet-boun...@lists.utsouthwestern.edu > [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J > Buesa > Sent: Saturday, December 15, 2012 8:38 AM > To: Travis Troyer; histonet@lists.utsouthwestern.edu > Subject: Re: [Histonet] Basis for Quality Work in a Histotech > > First I want you to excuse me, but I do not think that you are really > qualified to supervise 2 histotechs if you need to ask for such quality > guidance. > You end by bemoaning about "budget crunch" and because of that it seems to me > that your 2 histotechs are not receiving a "decent" salary and, as everybody > knows, you are getting what you are paying for. > With 10 years of experience you should know that the first step for quality > of sections is quality of fixation and quality of processing. You have first > to manage that aspect. > Quality of sections comes after wards and there is no "standard" for mistakes > and for what you are describing it seems that mistakes are frequent. By the > way, if the pathologists are not pleased, they will not it take on the > histotechs, but on you as a supervisor unable to provide them the quality > they require. > There is no such thing as "instant reward" for a good quality job; the > histotech should not be treated as "dogs receiving a cookie after a trick > performed" but there are 2 tools: you need to keep track of the mistakes → > counsel the HT after a mistake → retrain them → keep a track of mistakes and > there are verbal and written counselings and an annual evaluation, I am sure > you know that. > The ideal limit of mistakes is "0" but there is some acceptable mistakes > limits, as long as they are few and far between. The pathologists are the > ones who can tell you what they are willing to accept as mistakes limits. Ask > them. > It seems that if your 2 HTs do not improve, you should start looking for > replacements, but they should be better paid, and if the mistakes continue at > a high rate, you should put your 10 years experience to work and start doing > some bench work René J. > > > From: Travis Troyer <ttro...@petersonlab.com> > To: histonet@lists.utsouthwestern.edu > Sent: Friday, December 14, 2012 5:34 PM > Subject: [Histonet] Basis for Quality Work in a Histotech > > This is a question for all of the lab supervisors. I am the supervisor of > two histotechs. I am not doing techwork now, but have 10 years of > experience. The pathologists are getting more and more upset at the lack of > quality in the work and the mistakes that are happening. I was wondering if > anyone had some ideas on what sort of a goal to set up and how to > reward/punish for variations from that goal. For example, if the goal is > three mistakes for the month, what is the best way to reward them for making > that goal and what would be best if they had more mistakes in a given time > frame. We are all feeling the budget crunch and the pathologists are trying > to figure out a good solution. > > Thanks, > Travis Troyer > _______________________________________________ > Histonet mailing list > Histonet@lists.utsouthwestern.edu > http://lists.utsouthwestern.edu/mailman/listinfo/histonet > _______________________________________________ > Histonet mailing list > Histonet@lists.utsouthwestern.edu > http://lists.utsouthwestern.edu/mailman/listinfo/histonet > _______________________________________________ > Histonet mailing list > Histonet@lists.utsouthwestern.edu > http://lists.utsouthwestern.edu/mailman/listinfo/histonet _______________________________________________ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet This electronic mail and any attached documents are intended solely for the named addressee(s) and contain confidential information. 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