Addressing management issues

Dec. 1, 2008
Adding new technology

Q What factors should be considered when deciding whether
to add new technology and/or instrumentation in a clinical laboratory?

A Alton Sturtevant recommends, “Review the patient-care and
financial aspects of implementing new technology or instrumentation to the
lab. Completely justify the upgrade to your management staff before going to
upper management. Ask a series of questions before proposing such changes:

  1. What is the annual bottom-line impact? Consider the
    consequences on the annual maintenance agreement in your calculations.
    If the cost per test is the same as the old technology, then the
    warranty period of any new equipment may reduce the total annual outlay
    for the technology.
  2. Will the new technology use less reagent or labor,
    resulting in a measurable cost reduction? Do not use a reduced labor
    cost in the equation unless you can actually save money.
  3. Will there be new testing-related revenue?
  4. Does the proposed change shorten the patient length
    of stay (LOS)? If so, despite lack of cost reduction from the new test,
    there will be a significant cost reduction to the facility.
  5. What is the turnaround time of new vs. old
  6. Is the technology unique to your facility while
    providing a service that enhances the standing of your facility in the

“Finally, prepare a cost-/feature-benefit analysis of the
old vs. the new equipment and/or technology so that everyone clearly
understands the advantages of the change. The minimum categories included in
the comparison are cost per test for equipment, reagent, calibration
material, quality-control material and proficiency testing; cost of
laboratory-information-system interface; turnaround time; sample type;
sample size; CLIA-test complexity; operator qualification and required
hands-on time; special environmental requirements; required special
physical-plant changes; testing availability; CPT coding; the reimbursement
per test; and so forth. This thorough review of the pros and cons paves the
way for discussions with management involved in the final-approval process.”

According to Marti Bailey, “Will the technology improve
patient medical care? If the answer is yes, then you can work through the
other issues surrounding the addition of new technology.

“Physicians will likely continue ordering tests as
off-label use, meaning the test is ordered on a sample type or for an
indication that was not part of the Food and Drug Administration’s approval
of the technology. In these cases, tests may not be paid by Medicare and
other payers. Contact payers prior to billing the service to determine if it
is likely to be covered for the indicated diagnoses.

“With hospital space a scarce resource, you must
negotiate for any additional space required and have a firm commitment
before moving forward.

“If the technology cannot be supported with existing
staff, get a commitment that needed position(s) can be filled before
proceeding. The dwindling availability of medical technologists limits your
ability to add personnel to handle new technology.

“Can capital-equipment purchases be incorporated into
your approved capital-equipment budget? Can your expense budget withstand
the hit of a lease or reagent-rental arrangement? New technology not
replacing existing technology is added expense. Payment rates for lab tests
usually are not generous, and increased payments are irrelevant to
inpatients at any rate. No matter what services you provide to inpatients,
their payment rates for the most part are by diagnosis-related group and
will not change. Consequently, the more inpatient services you provide, the
lower the margin between cost and revenue. Therefore, it is imperative to
look into LOS and better treatment outcomes to offset the new service.
Outpatients require surveying major payers to determine whether or not they
will pay for the service and how much. Revenue projections are frequently
based on discussion and/or negotiations with payers in other areas of the
country and may not be embraced by your hospital’s payers.

“Do not get caught up in being on the ‘cutting edge’ and
ignore the increased costs of in-house procedures vs. sending those to a
reference lab. Reality should rule. That a hospital lab can perform a
service at equal or cheaper cost than a reference lab is questionable. If
there is no clinical need to have a service performed internally, adding it
is unjustified.”

Larry Crolla recommends, “Find out if you have sufficient
volume to support the technology in order to make a financial case. The
volume can be current or based on trends in ordering patterns. For example,
if you do no molecular testing and your current average send-out test costs
$75 (approximate $345,000 yearly) with a volume of 4,600 tests — and if
molecular volume is replacing your send-outs with an average test cost of
$225, you can project your yearly send-outs rising to approximately $693,000
if half of them are converted to molecular-based testing over the next three
years. If you believe you can do in-house molecular testing for $75 per
result, you can make a financial argument to bring the testing in house.
Assured that you can make a financial argument, see if you have or can gain
the technical expertise to support such an investment. Gauge the
availability of technical staff to produce answers using the new technology.
If not, you have to factor into your financials training and/or hiring.”

Bottom line. Making decisions to purchase/implement
new technology and/or equipment involves an analysis of many details.
Determine the impact to staff (i.e., whether or not training or hiring
personnel is necessary). Build your case before making an argument to upper
management. All this hinges on whether or not the technology and/or
equipment meets your laboratory’s high standards for performance and
provides better service for patient care.

Controlling procrastination

Q I am a chemistry supervisor and a serious procrastinator.
Do you have suggestions about how to control procrastination?

A Alton Sturtevant points out, “If procrastinating affects
your career, you may be in the wrong job. If you do not love what you do the
majority of the time, then you need to find your life’s passion and work at
that. This sounds idealistic; but, if you have not seen the video by the
late Randy Pausch from Carnegie Mellon University, go to
or to You Tube video,
to watch his last lecture. His insights might give you reasons to find your
passion, which, in turn, may help you resolve this issue.”

According to Marti Bailey, “Ending procrastination
requires a commitment to change. Develop a new approach to handling your
work. Start by reviewing possible causes in order to better understand your

You no longer believe the task is the right thing to
. Procrastination can result when our sense of what was a ‘good fit’
has changed — not an unusual occurrence in our fast-paced world where goals
or decisions agreed upon or made months ago no longer may be the best. When
you are torn between commitment and intuition, it is better to announce to
those involved in the original goal/decision that you have changed your
mind. Confirm whether you should move forward to implement what now may be a
faulty decision.

You are totally overwhelmed and do not know where to
. The best solution is to just start somewhere. You cannot avoid
occasionally being overcome by your workload, but you choose whether it
becomes a permanent state.

You do not know enough about the task. If you
procrastinate just because you do not know enough to complete a task, do a
rapid evaluation of new tasks to determine if you need to 1) enlist the help
of other people or 2) draw on resources not normally or readily available to
you. Getting assistance when you cannot accomplish a task alone helps you
stay on top of completing that task.

You do not like the task. If you are responsible
for something you do not want to do that really needs to be done, you have
two choices — find someone else to do it, or do it yourself.

You are too busy. Survey 10 or 20 people around
you; most of them will probably say they are also ‘too busy.’

“Here are a few tips that may help in dealing with these

  • Maintain an accurate to-do list; record new tasks as
    they occur and note completed tasks; then
    reward yourself for tasks
    completed with something you perceive as a treat;
  • If you have 10 minutes available, select an
    undesirable or difficult task instead of something less
    challenging. You
    might be surprised that the task is not so bad, and you may want to
    working at it longer.
  • Break projects into small, workable portions, and
    chip away. Working steadily on an unpleasant
    task for 15 to 30 minutes
    dilutes its negative effect.
  • Do not waste time — review routines over several days
    to identify, eliminate, or reduce time
    wasters. Funnel time gained into
    challenging tasks.”

Larry Crolla explains, “All of us have procrastinated. If
I do not put a task on my written ‘must do’ list and assign it a priority, I
find the task will not get done in a timely manner or at all. With a daily
list, I do a better job of performing required tasks. Make the entire list,
no matter how long, and categorize each item based upon importance. I like
to assign a number from one to three, with one being the most important. I
put the most important six items on today’s list and leave the others for
another day — unless I complete today’s list early. I make my list each
morning; on occasion, I create the next day’s task list at the end of the
day. I always feel better and more effective as I check off completed

“Eliminating time wasters (e.g., talking on the phone
unnecessarily, having a messy desk, reading junk mail, visiting with fellow
employees too much, and reading unimportant e-mail), then I am more likely
to complete my high-priority tasks. Send calls to voicemail with a message
that you are not available until a specific, reasonable time (e.g., in one
hour). My managers respect the fact that I close my door for uniterrupted
time for projects. If they really need me, they can knock on my door, and I
will respond immediately. Make an environment that encourages you to become
more effective and less likely to procrastinate.”

Bottom line. Procrastination is not uncommon.
Usually, we are not interested in a task, or we do not know how to
perform a task. Try to jump right into a task, and discover how it feels
to get something done. Begin making daily to-do lists, and focus on
completing the tasks on the lists. Watch motivational speeches online or
read books that encourage action.

Anne Pontius is the president of Laboratory
Compliance Consultants Inc. in Raleigh, NC, and president-elect of CLMA
2007-2009. Send questions to Ms. Pontius at

[email protected] .

“Management Q & A” provides practical, up-to-date solutions to readers’
management issues from a panel of laboratory management experts. Readers
may send questions to the Anne Pontius at
[email protected] . Unless
otherwise noted as “confidential” by readers, all queries will be
considered for publication without further notice to them. Names,
institution, city, and state will be removed before publication. The
following panel of laboratory directors, managers, and supervisory
technologists have provided their input in the answers given in this
column: Marti K. Bailey, MT(ASCP), work unit leader, Pathology, Penn
State Milton S. Hershey Medical Center, Hershey, PA; Lawrence J. Crolla,
PhD, consulting clinical chemist, Departments of Pathology and
Respiratory Care, Alexian Brothers Hospital, Elk Grove Village, IL, West
Suburban Medical Center, Oak Park, IL, and Northwest Community Hospital,
Arlington Heights, IL; and Alton Sturtevant, PhD, laboratory director,
LabCorp, Birmingham, AL.