[Histonet] Basis for Quality Work in a Histotech

[Morken, Timothy]

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-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Saturday, December 15, 2012 8:38 AM
To: Travis Troyer; histonet <@t> 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 <ttroyer <@t> petersonlab.com>
To: histonet <@t> 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
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