[Histonet] RE: Embedding process
improvementandcompetencyassessment
Heath, Nancy L.
NHeath <@t> Lifespan.org
Fri Aug 26 06:10:19 CDT 2011
"If people cheated..... Then people cheated. There will always be that
element. To discard that requirement (the practical) because of the
cheat factor was a silly (remember, this is my rant....not yours) excuse
that I have heard from some people who were part of the decision. What
was lost was the incredable effort that was needed to do that practical
and the experience of being able to produce "registry" quality slides.
That is not cheating themselves, but robbing every pathologist and
patient that followed until that person started to produce quality
work."
I could not agree more with what Bill O'Donnell wrote!! Thank you Bill.
I have students in the clinical portion of there histo training and
though I am not former military my students sure do think I am!! I
strive for perfection from the time they section in their first piece of
tissue till their last stained slide.
Nancy Heath, HT(ASCP)
-----Original Message-----
From: O'Donnell, Bill [mailto:billodonnell <@t> catholichealth.net]
Sent: Thursday, August 25, 2011 4:48 PM
To: Podawiltz, Thomas; Heath, Nancy L.; Jennifer MacDonald
Cc: Histonet Listserv (E-mail);
histonet-bounces <@t> lists.utsouthwestern.edu; D'Attilio, Shelley
Subject: RE: [Histonet] RE: Embedding process
improvementandcompetencyassessment
Tom, (and all those following this thread)
And we got that ;) perfection.
(Warning, long rant ahead... Rene's might have been longer, but he
spread it out over a number of posts)
(Hi Rene, I enjoyed your rant.)
My biggest barrier in assimilating into the "civilian" workforce was
that perfection wasn't required or even at times expected. I still can't
get my head around that. Because of what was expected of me by my unit,
30 years later, my embedding is tight w nice, neat rows, cutting is neat
and aligned and staining is crisp. (However, I will not win any speed
contest) My point in this is not to blow my horn. Most of you out there
turn out the same or better quality. My point is this, when supervisors
and peers stop striving for perfection then there will always be a need
for skills assessments and re-training. There will be little or no
perfection.
Over the last thirty years of training and supervising, I have always
tried to instill the idea that we are dealing with a person's tissue.
Wrapped up in that is a lot of anxiety and stress that the patient is
having. The first thing a new trainee or tech had to do when they came
to me (in the civilian world)was spend a week shadowing phlebotomy so
that they got the chance to see some of the faces behind the samples.
But in the last ten years or so, there has been too much emphasis on
speed as a standard of performance, and in general, there has been a
growing attitude that perfection isn't possible. (many factors to blame,
I suppose)
I once worked for a very demanding pathologist and because of his
expectations, the whole crew put out near perfection. Pathologists that
are "OK" with what they get, so long as they can make a diagnosis, are a
huge part of that problem.
But as supervisors, we only get what we expect of people and strive for
and example ourselves.
(The rest of the rant is anecdotal and not very interesting, but since I
took the time to write it, here it is...)
This was also the period (Navy)when I had to do that monster practical
for the HT. Back then, it was not 7 or 8 slides, but many more with a
large number of special stains as well. I knew if it passed the guys in
our lab, it should be no problem passing the practical. The guy who took
the test at the same time I did, picked his tissues on Wednesday,
embedded them on Thursday cut cut and stained them on Saturday and
mailed them on Monday. He had no concern at all that his work wouldn't
be good enough. He passed the practical with a very respectable
percentile. I think that helps to bolster the idea that an expectation
that is demanded and fostered is one that can be confidently met.
If people cheated..... Then people cheated. There will always be that
element. To discard that requirement (the practical) because of the
cheat factor was a silly (remember, this is my rant....not yours) excuse
that I have heard from some people who were part of the decision. What
was lost was the incredable effort that was needed to do that practical
and the experience of being able to produce "registry" quality slides.
That is not cheating themselves, but robbing every pathologist and
patient that followed until that person started to produce quality work.
(Rany over, thanks to those who hung out til the end.... I hope it was
worth it)
I hope every one has a great weekend, as I am off on Friday and will be
having a great weekend myself. Shalom - Bill
-----Original Message-----
From: Podawiltz, Thomas [mailto:tpodawiltz <@t> lrgh.org]
Sent: Thursday, August 25, 2011 1:21 PM
To: O'Donnell, Bill; Heath, Nancy L.; Jennifer MacDonald
Cc: Histonet Listserv (E-mail);
histonet-bounces <@t> lists.utsouthwestern.edu; D'Attilio, Shelley
Subject: RE: [Histonet] RE: Embedding process
improvementandcompetencyassessment
Man did that bring back some memories. Bill and I worked together in the
same Navy lab and he is correct if a block was embedded wrong you would
get it in either the back of the head or between the shoulders. They
stopped throwing them at me the day I throw the block back at the
microtomist and hit him in the head. We were a tough crew that saw a
lot, did a lot, partied together a lot, but never lost the fact that we
were there for patient care and treated all the specimens and bodies as
if they came from a love one. When it came time for Bill and I to become
the trainers we were brutal in how to embed, section and all other
aspects of histology, I mean we only wanted perfection.
Tom Podawiltz HT (ASCP)
Histology Section Head/Laboratory Safety Officer.
LRGHealthcare
Laconia, NH 03246
603-524-3211 ext: 3220
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of
O'Donnell, Bill
Sent: Thursday, August 25, 2011 1:57 PM
To: Heath, Nancy L.; Jennifer MacDonald
Cc: Histonet Listserv (E-mail);
histonet-bounces <@t> lists.utsouthwestern.edu; D'Attilio, Shelley
Subject: RE: [Histonet] RE: Embedding process improvementand
competencyassessment
Just to throw a somewhat funny situation into the mix. I learned my
embedding skills in the Navy. The basic method for learning all tasks
was 1. explain it, 2. demonstrate it, 3. do it. Each microtomist was
responsible for taking a good look at the block before cutting it. If
the embedding was not spot-on, the block was always returned for
reembedding. The method of return was to throw it at the back of my
head. They rarely missed. Very quickly, I got tired of being hit in the
head and my embedding improved. Can't do that kind of stuff now, even in
the military. Who knew that histology used to be a contact sport? We've
gotten sooooo soft!
As to the other situation, as a histology supervisor, I was over
cytology in one of the labs I worked at. I doubt that I was much of a
manager to them as I knew next to nothing about their work. However, I
took the time to learn some aspects, and then just pretty much left them
alone. (It was a mutual respect, they pretty much left me alone too.)
They did a fine job of making me look good. I trusted them, and they
didn't do anything to betray that trust. Because of that, I would simply
sign-off on the occasional request. Evals were pretty easy as I simply
interviewed the pathologists, checked attendance and moved on. That
being said, I wouldn't want to have to do it again. They deserved
better, but we made it work, since it wasn't going to change.
Have a great day!
William (Bill) O'Donnell, HT (ASCP) QIHC Senior Histologist Good
Samaritan Hospital 10 East 31st Street Kearney, NE 68847 Check out my
podcast at DeaconCast.Net
SERENITY is not freedom from the storm, but peace amid the storm.
Cultivate it in PRAYER!
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Heath,
Nancy L.
Sent: Thursday, August 25, 2011 11:39 AM
To: Jennifer MacDonald
Cc: Histonet Listserv (E-mail);
histonet-bounces <@t> lists.utsouthwestern.edu; D'Attilio,Shelley
Subject: RE: [Histonet] RE: Embedding process improvementand
competencyassessment
Regardless of wether there were 8 blocks or eighteen blocks taking the
practical taught me to be precise with all of the hands on aspects of
Histology. Shame on the older techs from the "practical days" of not
keeping on top of their game with embedding. My comment was geared more
towards the newbies coming out of histo schools who can pass the exam
with flying colors but sit them in front of an embedding center or
microtome and they are all thumbs! As far as a manager, I myself would
rather have someone who has experience with histology over seeing my
work. Just once again the lack of respect of having the HT/HTL behind
your name.
________________________________
From: Jennifer MacDonald [mailto:JMacDonald <@t> mtsac.edu]
Sent: Thursday, August 25, 2011 10:58 AM
To: Heath, Nancy L.
Cc: Histonet Listserv (E-mail);
histonet-bounces <@t> lists.utsouthwestern.edu; D'Attilio, Shelley;
Podawiltz, Thomas
Subject: RE: [Histonet] RE: Embedding process improvement and
competencyassessment
I fail to see the correlation of a non HT person supervising the
Histology lab and the lack of a practical exam for HT/HTL staff. One of
the issues that Shelley brought up was the staff lost or did not develop
their embedding skills. Submission of a practical exam is not proof of
highly developed embedding skills. For the HT exam there were 8 blocks
that were submitted (9 slides). I know of cases where the blocks were
not even embedded or cut by the applicant.
"Heath, Nancy L." <NHeath <@t> Lifespan.org> Sent by:
histonet-bounces <@t> lists.utsouthwestern.edu
08/25/2011 07:11 AM
To
"D'Attilio, Shelley" <SDattili <@t> stormontvail.org>, "Podawiltz, Thomas"
<tpodawiltz <@t> lrgh.org>, "Histonet Listserv (E-mail)"
<histonet <@t> lists.utsouthwestern.edu>
cc
Subject
RE: [Histonet] RE: Embedding process improvement and
competencyassessment
This is exactly why the powers that be should have NEVER gotten rid of
the practical portion of the HT/HTL board certification!
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of
D'Attilio, Shelley
Sent: Thursday, August 25, 2011 9:45 AM
To: Podawiltz, Thomas; Histonet Listserv (E-mail)
Subject: [Histonet] RE: Embedding process improvement and
competencyassessment
Hi Tom,
Thank you for your kind words. I am off the bench almost completely. I
can work in the gross room in a pinch and my counting skills are
excellent, so I can always file slides and block if an emergency
arises:) I occasionally cover a bench in Chemistry as well, but my
staff is all pretty glad that I mostly stay in my office.
Thanks so much for the embedding information. The main problem we are
tackling at the moment is tissue orientation. I have written a pretty
detailed embedding procedure that is being reviewed by the new histology
supervisor. Our plan is to refresh the training of everyone on staff in
conjunction with this procedure, then add specific embedding
competencies to our checklist. I will make sure that the procedure
incorporates the first 6 elements that you listed below.
Currently we have a QA sheet that is given to the pathologist with each
batch of slides. Pathologists provide us with feedback on the slide
quality by filling out the form. Slides with sub-standard
quality--whether in orientation, cutting, staining, whatever--our
reviewed by every histotech in the lab with an aim to education and
improvement of performance. We have a form called the "Slide Quality
Review Form" that details the quality issue. Techs are directed to
review the slides and comment. Difficult cases or those where people
disagree are discussed in our department meetings.
One of our difficulties over the years has been how the work was divided
between the histotechs. One histotech loved to embed and was very good
at it, so he did most of the embedding. He eventually moved to an
overnight shift, which resulted in him embedding even more than he was.
Consequently, other staff people either lost their skills or never fully
developed them. It was introduction of rapid processing that really
brought this issue to the forefront, since different people were
embedding at different times of the day.
Unfortunately, I let my NSH membership lapse this year for budgetary
reasons. I have purchased quite a few resources over the years from
NSH, and even attended the NSH annual meeting a few years ago when it
was in Phoenix. I will reconsider my decision to drop my membership.
For those on the list, here is Tom's response to my question:
Hi Shelley,
I would suggest you join NSH, they have all kinds of reference material
for this type of work.
Please tell me you are off the bench, you have a lot to monitor and if
you are working the bench on top of your management duties my prayers go
out to you.
Embedding:
1. Proper size of mold in relation to specimen size.
2. Proper orientation of tissue, example 5 skin biopsies, dermis must
face the same direction, and be at an angle to the blade so when you cut
the section cuts smoothly and doesn't roll up.
3. Multiple pieces all on the same plane. If one piece is deeper than
the others you must re-embed, or you will cut through the other pieces
before you reach it.
4. Make sure that the embedding unit is wipe down between each case as
are the forceps, this will avoid tissue floaters.
5. Never open more than one cassette at a time.
6. Verify that the piece count on the work sheet matches what is in the
cassette when it is opened.
7. Never hound the staff about speed, accuracy is more important, speed
comes with experience. If its embedded wrong, it will be cut wrong and
this will effect diagnosis.
8. What do you do for QA on the slides?I have a work sheet that the
Pathologist fills out each day about the slides, which is the end
product of embedding.
I hope my tips help you and feel free to contact me if you need
anything.
Tom Podawiltz, HT (ASCP)
Histology Section Head/Laboratory Safety Officer LRGHealthcare
603-524-3211 ext: 3220
________________________________________
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