[Histonet] Basis for Quality Work in a Histotech

[O'Donnell, Bill]

Maria - Well said.=20

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> li=
sts.utsouthwestern.edu] On Behalf Of Maria Mejia
Sent: Tuesday, December 18, 2012 11:36 AM
To: Morken, Timothy
Cc: histonet <@t> 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 su=
pervisor, it's imperative to communicate with people in such a way that the=
y change themselves.
With some people the act of  "getting the task done,"  has such an urgent n=
eed that can lead them to become careless & aggressive, leaping before look=
ing & even speaking without thinking first.  In histology, we know it's mor=
e important to avoid making mistakes - to be certain every detail is accura=
te & in place. And, it's important to find the balance between the 2 intent=
ions of "getting the task done" & "getting it done right!"

It's also important to create & develop relationships with those you work w=
ith.  The desire to contribute to others & be appreciated for what you do, =
is one of the most powerful=20
motivational forces known.   And yes, sometimes you get what you give!  Giv=
ing appreciation & getting along with others go hand-in-hand - & as a super=
visor it's another balancing
act.  Also when people have the same priorities, a misunderstanding or conf=
lict is highly UNLIKELY.

All the best
Maria Mejia
San Francisco, CA


On Dec 17, 2012, at 8:30 AM, Morken, Timothy wrote:

> Travis,
>=20
> Histology has a very complex workflow AND requires "artisan" level workma=
nship to deliver a product. Those two together nearly guarantee mistakes, m=
ostly 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 achiev=
ing that attitude is to ensure the pathologists and administrators are behi=
nd 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 m=
ean more people are needed? That's your call, but can be determined by work=
load accounting.
>=20
> The attitude should be that the SYSTEM makes the mistake, not the individ=
ual. It is not likely a person makes a mistake on purpose, but instead is i=
t some aspect of the system that allows them to make a mistake (though "sho=
rtcuts" can be thought of as intentionally risking making mistakes "on purp=
ose," the "purpose" being to save time or effort).
>=20
> Workflows can be "engineered" to ensure some mistakes don't happen. Proto=
cols must be followed to the letter by EVERYONE. No workarounds allowed (a =
workaround is an indication that there is something wrong in the system - t=
he employee feels the need to take shortcuts. Why?  BTW, Bill Gates said th=
e 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 ana=
lysis 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 pr=
oblem. If not, you keep asking why until the root cause is found.
>=20
> For instance, we worked out a slide labeling protocol at the microtome th=
at, if followed, will ensure the tech does not make labeling errors. All pa=
rticipated 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 b=
arcoding, but that is a year away at least. But our protocol has nearly eli=
minated 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).
>=20
> We also finally instituted the printing of cassettes directly from our LI=
S 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.=20
>=20
> All these methods need to be investigated.=20
>=20
> Rewards are also very helpful. We give out "Bear hugs" that are $5 gift c=
ertificates to the campus store, cafeteria, various food vendors in the ins=
titution, etc. it's a small reward, but people actually appreciate it. We a=
lso 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 fr=
om about 2 dozen available (coffee shops, VISA, various stores, etc).
>=20
>=20
> Good luck with it!
>=20
>=20
> Tim Morken
> Supervisor, Electron Microscopy/Neuromuscular Special Studies=20
> Department of Pathology UC San Francisco Medical Center
>=20
>=20
>=20
>=20
>=20
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu=20
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J=20
> 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
>=20
> First I want you to excuse me, but I do not think that you are really qua=
lified to supervise 2 histotechs if you need to ask for such quality guidan=
ce.
> You end by bemoaning about "budget crunch" and because of that it seems t=
o me that your 2 histotechs are not receiving a "decent" salary and, as eve=
rybody knows, you are getting what you are paying for.
> With 10 years of experience you should know that the first step for quali=
ty of sections is quality of fixation and quality of processing. You have f=
irst to manage that aspect.
> Quality of sections comes after wards and there is no "standard" for mist=
akes and for what you are describing it seems that mistakes are frequent. B=
y the way, if the pathologists are not pleased, they will not it take on th=
e 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 hi=
stotech should not be treated as "dogs receiving a cookie after a trick per=
formed" but there are 2 tools: you need to keep track of the mistakes =A1=
=FA counsel the HT after a mistake =A1=FA retrain them =A1=FA keep a track =
of mistakes and there are verbal and written counselings and an annual eval=
uation, 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 o=
nes who can tell you what they are willing to accept as mistakes limits. As=
k 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 d=
oing some bench work Ren=A8=A6 J.=20=20=20=20
>=20
>=20
> 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
>=20
> This is a question for all of the lab supervisors.  I am the supervisor o=
f two histotechs.  I am not doing techwork now, but have 10 years of experi=
ence.  The pathologists are getting more and more upset at the lack of qual=
ity in the work and the mistakes that are happening.  I was wondering if an=
yone had some ideas on what sort of a goal to set up and how to reward/puni=
sh for variations from that goal.  For example,  if the goal is three mista=
kes 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.  W=
e are all feeling the budget crunch and the pathologists are trying to figu=
re out a good solution.
>=20
> Thanks,
> Travis Troyer
> _______________________________________________
> Histonet mailing list
> Histonet <@t> lists.utsouthwestern.edu
> http://lists.utsouthwestern.edu/mailman/listinfo/histonet
> _______________________________________________
> Histonet mailing list
> Histonet <@t> lists.utsouthwestern.edu
> http://lists.utsouthwestern.edu/mailman/listinfo/histonet
> _______________________________________________
> Histonet mailing list
> Histonet <@t> lists.utsouthwestern.edu
> http://lists.utsouthwestern.edu/mailman/listinfo/histonet


_______________________________________________
Histonet mailing list
Histonet <@t> 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. If you are not an=
 addressee, or responsible for delivering this email to an addressee, you h=
ave received this email in error and are notified that reading, copying, or=
 disclosing this email is prohibited. If you received this email in error, =
immediately reply to the sender and delete the message completely from your=
 computer system.