CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
May 2019—CAP Press released this month its second edition of Laboratory Administration for Pathologists, first published in 2011. It covers management of personnel, laboratory space, pathology information systems, and quality in laboratory medicine and in the anatomic pathology lab. That’s just to start. Among its other chapters: patient safety, the pathology position, lab laws and regulations, legal affairs, ethics, and financial management of the lab and of the pathology practice. And there is more in the 296-page book edited by Elizabeth A. Wagar, MD, Michael B. Cohen, MD, Donald S. Karcher, MD, and Gene P. Siegal, MD, PhD.
CAP TODAY recently asked Dr. Wagar about the latest edition; what she told us appears here, along with an excerpt. Dr. Wagar is professor and chair, Department of Laboratory Medicine, University of Texas MD Anderson Cancer Center.
Dr. Wagar
Did you get feedback on the first edition and, if so, can you share some of it, and did it guide you in updating the book?
Yes, we had a lot of feedback, much of it good. I know that many residency programs now use it as a text for management and leadership training. And many pathologists find the appendices helpful, with everything from formats for procedures to sample interview questions. However, as time passes, changes occur, especially in the areas of quality and safety and in regulatory affairs.
Also, I felt it was time to expand the authorship and editorship of the text. Originally, the text was created based on more than 10 years of personal experience educating residents in five different residency programs in Los Angeles. We had a good core curriculum, but it was important to invite others to contribute from different regions of the country with different perspectives and different specialty skill sets. The editors intentionally asked younger pathologists and enhanced the diversity of authors to achieve this renewed perspective of the topic.
CAP president Bruce Williams, MD, writes in the foreword that there is a “growing consensus that burnout is an urgent priority for each of us.” What effect, if any, did that attention to burnout have on your update of the book?
Over the course of my career, I have found that burnout often arises from being too tightly focused on our role and job and not being aware enough of our surroundings, especially the people we work with in health care. It can create what I call a “persecution complex,” which pathologists are particularly prone to develop. The topics in this book focus on interactions and skills we need to interact with others. Also, the text provides skills for managing ourselves within an institution. It is important to renew those skills if you are a pathologist, and certainly it is important for trainees to understand them. Use of the skills in this book will allow a broader understanding of how others in the health care profession interact within our systems and prevent an over-focused approach to our daily professional efforts.
Your own chapter on financial management contains so much essential, practical information about test cost analysis, financial performance, and budgeting. Is there anything you could not or did not include, because of its complexity or for some other reason, that is necessary to know in laboratory administration?
Deciding the “need to know” is the secret to the success of this text. As working pathologists, the editors and authors are not simply MBAs, but have a wealth of management skills targeted to the unique aspects of pathology practice. I believe the credibility of the text is enhanced by the writers’ abilities to determine the components of administrative skills that are essential to running a safe, high-quality laboratory medicine and pathology operation.
In the chapter on patient safety and high reliability, “just culture” is defined as one in which errors are viewed as opportunities to improve the understanding of risks and all employees are held responsible for their choices during an unintentional error. Dr. Williams writes in his foreword that you inculcate this in your laboratories. Do you have any sense of how prevalent this learning culture is in laboratories? That is, do you think it’s fairly common today or still lacking?
“Just culture” is a growing knowledge base in health care across the United States but probably has not reached every institution or every health care system. It is unique in that it requires a second look at how we treat mistakes in health care. Do we immediately insert a “blame game”? Or do we instead focus on the processes that might have contributed to the slips and lapses that can occur in a highly complex organization? Using the knowledge of employees “on the ground” helps sort these questions out rather than immediately blaming one individual and extinguishing other questions related to why a mistake really occurred. It is the “why” questions that lead to more successful corrective actions. “Just culture” does not imply, however, a complete lack of personal responsibility. These will always exist at whatever professional level employees and pathologists operate.
Would you like to say anything about your three co-editors and the contributing authors?