[Histonet] Re: Cutting Blocks

WILLIAM DESALVO wdesalvo.cac <@t> outlook.com
Fri Oct 26 18:43:43 CDT 2012

I have been following this thread and echo many of the comments that this discussion is exactly why we like, use and will continue to use the Histonet. I would like to add my 2 cents worth. Working at a Six Sigma company for the past 10 years has taught me two very important points, that I believe are vital to this discussion; 1.) Productivity metrics without Quality metrics are useless; 2.) You cannot Manage what you do not measure. I have also learned that every Histology lab is different when it comes to metrics. A block in your lab may or may not produce the same number of slides as produced in my lab. We have way too much variation in our processes and Histology, in general. I have found that all published data on productivity can, at best, only be used for that particular site and possibly provide a beginning reference for my or any other lab. Again, we have way too many variables (cases, specimens, cassettes, slides, tests) that contribute to the workload/productivity metric. I have also found that most of this data used for our discussion is collected using short term time studies or year end numbers, not daily, continuous data collection, and, I believe, this can skew the results. A specimen does not receive the same dissection protocol, a block does not have the same embedding protocol, a block at microtomy does not have the same cutting protocol; so why do we try to fit all of Histology into one productivity metric? When we as a discipline, Histotechnology (both the technical and , does not provide valid data collection, minimum standards and acceptable defect rates, it is at the mercy of other industry methods and standards. Before we start discussing productivity numbers, we should all ask ourselves why do we need this information and what are we going to do with it and what does our pathologists want? Again, productivity in a manual process, without a quality measurement means nothing. I think productivity and quality metrics are essential to the growth of Histotechnology, Histotechnologists, Pathologists and the well being of the patient. We have many pressures on our profession and setting arbitrary or after the fact standards, w/out a strong partnership of the technical staff, professional staff and administration, will not help any of us develop a quality process to meet the patient's needs. What do you plan on doing with workload metric data? Who cares how many specimens are grossed, how many blocks are embedded, how many slides are cut or how many slides stained, if it cannot be performed at the highest quality level or does not add value to the patient. Productivity is so much more than a number. What is the proper workflow and workload, taking into account the mix of employees, complexity of specimens and level of automation (better said semi-automation)? This "number" should never be static and must fluctuate according to change in the variables in your lab. I believe that we are all struggling to make better sense out of the Histology black hole of metric data. Yours,and my leadership demands better information about what we can do, when can we do it and what value can we add, before they will consider investing the needed dollars to bring us out of a total manual process. Metrics are not designed or should they be used to provide a maximum standard or be static. As your process changes (materials, instruments, people) so will your metric. As all have pointed out, concentrate on quality first, last and always; then move to development of a productivity metric, ALWAYS merged w/ a quality metric, to create a tool that will help you understand the capability and capacity of the quality process. Do not try to make these decisions w/out partnering w/ the pathologist. None of this makes sense if it is not used to create a teamwork and improve quality. Make the tuff decision to find a way to collect daily data; track, trend and improve your process; communicate what you are doing and why to every person working in or invested in your process and make a difference in a patient's life. We MUST never lose site that we produce patient results, not just blocks and slides. I may have added a bit more than 2 cents worth. 
William DeSalvo, B.S., HTL(ASCP)

Production Manager-Anatomic Pathology
Chair, NSH Quality Management Committee

Owner/Consultant, Collaborative Advantage Consulting

 > From: thiggins <@t> cddmedical.com
> To: histonet <@t> lists.utsouthwestern.edu
> Date: Fri, 26 Oct 2012 09:47:20 -0500
> Subject: [Histonet] Re: Cutting Blocks
> All great points, awesome information, that’s why we all enjoy histonet.
> One thing I've learned over the 20 plus years in histology is every person 
> is different and you cant stick them all in the same box.  I personally 
> don't believe 40 blocks an hour is unreasonable as an average as long as you 
> account for time spent doing other functions in the lab.
> Some supervisor, admin. heads, whomever, want to divided the number of 
> blocks cut by a 8 hr. work day, not fair to the employee who also has to 
> load the slides, clean, answer phones, get interrupted by pathologist, use 
> the restroom (god forbid) and the hundreds of other tasks that some they are 
> not given credit for.
> I am all for high production with quality sections, it can happen with a 
> well taught ,seasoned, hard working technician that strives to be a good 
> tech.  That is another part of the equation, some tech (hard to believe) 
> don't care to be "the best they can be" and just want to get in there and do 
> there work and go home.  You can try and shoe horn them into the same mold, 
> or you can try to understand that not everyone is dedicated and has the same 
> skill set.   This is the time they get evaluated and receive the same 
> evaluation as the work they have put forth.  Best way for them to get the 
> message you are trying to get across given you have been up front with them 
> preceding the evaluation.
> Tough subject and everyone has a opinion on what is right.
> My two cents.
> Tim
> Joelle Weaver MAOM, HTL (ASCP) QIHC
> > From: contact <@t> histocare.com
> > Date: Thu, 25 Oct 2012 11:23:07 -0500
> > To: histonet <@t> lists.utsouthwestern.edu
> > Subject: [Histonet] Number of blocks
> >
> > Hi,
> >
> > To most folks that number does seem high but I've met many old school 
> > techs who can do this easily. One of my first learning experiences was 
> > watching a 57 year old woman crank out tons of slides with no errors and 
> > who regularly got praises from the pathologists for producing the most 
> > beautiful slides.
> >
> > While I have never been required to produce a certain amount within a 
> > certain window, I have built up the ability to cut a lot more than 50 per 
> > hour. I have even doubled this number. Of course it depends on the tissue 
> > type, but assuming properly decalcified bone, nothing popping out of the 
> > block, and a cold block of ice, it's very easy for me to produce a high 
> > quality slide at 3,4,5 microns. I get compliments all the time of my 
> > slides.
> >
> > My methods are quite different from most techs though. When facing, I 
> > don't waste movements. I actually count the rotations and spend less than 
> > 8 seconds facing each block. I also get the right section usually in about 
> > the third or fourth crank and I only put at the most two sections in the 
> > water bath to pick up.
> >
> > I don't cut unnecessary ribbons just to have them sit in the water bath 
> > and eventually have to wipe away with the Kimwipe, which in my opinion is 
> > wasteful of both materials and time. I also make sure I have enough ice to 
> > keep the blocks very cold and adequately hydrated.
> >
> > I'm not sure if being in decent physical
> > shape matters but I think it gives me the arm stamina to do this. I use 
> > only my wrists and fingers and not my whole arm in the rotational motion.
> >
> > Hope this helps,
> >
> >
> > M
> >
> >
> > www.HistoCare.com
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