Addressing management issues

June 1, 2010
Additional courier considerations

Q What are some key things to look for when hiring a courier service?

A Timely results for medical tests means the samples from the physician have to get to the lab quickly and safely. Most courier services boast of this as their main feature in their advertisements. But you must go beyond the ad slogans and get to the heart of the matter: Is this courier service right for you?

When evaluating couriers, a checklist can be useful. Plan to contact the services that offer all the features your needs such as 24/7, STAT, or holiday services; sample tracking; delivery reports; real-time proof of delivery and pickup; and uniformed drivers in marked vehicles. Some questions to include:

  • Are personnel trained in appropriate safety and packaging procedures?
  • Is documentation of courier training available?
  • What type of tracking system is used to ensure all specimens are actually picked up and received?
  • Have couriers taken a driver safety class?
  • Are all vehicles equipped with proper safety equipment?
  • Have employees received customer-service training?
  • Are all employees OSHA compliant and HIPAA compliant?
  • Do all vehicles have OSHA-approved specimen-transport containers?
  • Have the couriers gone through an extensive background check?
  • Are employees tested for drug use?
  • Are driving records monitored?
  • What other benefits do they offer?

Some couriers can perform phlebotomy duties. Some act as a lab representative to gather customer-satisfaction information and carry other communications back to the lab.

After narrowing down the choices, call some current customers to check on-time delivery statistics and customer references. Then you should be ready to discuss contract terms and prices with the companies that meet your needs.

—Jim Martin
Express Courier Service
Dallas, TX

Bottom line:
Finding the right courier service requires due diligence on the part of the laboratory. The cheapest service provider may cost you more in the long run if you have not selected one that is reputable and has a good track record. Refer to the April 2010 MLO issue [page 56] for more advice on choosing a courier.

Pathologist lab-director qualifications

Q The pathologists in labs where I have worked have always been more involved with surgical pathology and cytology than the clinical lab. I am not sure they understand what actually goes on in the lab. What makes them qualified to direct a full-service lab?

A Your expectations of the lab director may be different from what he was hired to do. It is possible that he was hired and is being paid to simply comply with CLIA regulations regarding medical directorship of clinical laboratories.

In large laboratories, there is often a physician serving as the lab director (sometimes called the medical director or advisor), along with another individual serving as the administrative manager or lab manager. The lab manager would be the person who “sees what really goes on here.” The lab manager is in charge of day-to-day operations, not the lab director. The lab director is involved in the medical issues, and the lab manager focuses on the operational issues.

—Marti Bailey, MT(ASCP), CPC
Work Unit Leader, Pathology
Penn State Milton S. Hershey Medical Center
Hershey, PA

A Pathologists are medical doctors who have post-graduate training in pathology; 85% have been trained and certified in both anatomic and clinical pathology. Anatomic pathology (AP) includes surgical and autopsy pathology, and cytopathology while clinical pathology (CP) includes the major disciplines in the clinical laboratory, chemistry, microbiology, hematology, transfusion medicine, and molecular biology. The training requirement for combined AP/CP certification is two years each of AP and CP. Many pathologists have additional years of training in a subspecialty area such as hematopathology, cytopathology, dermatopathology, forensic pathology, or an anatomic or clinical pathology subspecialty.

The lab director is responsible for overall operation of the lab including:

  • employment of a competent qualified staff;
  • performance, recording, and reporting of prompt and accurate test results;
  • assuring proficiency and compliance with applicable regulations;
  • ensuring that test methods and verification procedures are appropriate for accurate testing;
  • providing consultation concerning test selection and interpretation to clients;
  • ensuring that there are policy and procedure manuals covering pre-analytical, analytical, and post-analytical phases of each test;
  • ensuring that all personnel receive the necessary training before using a new test procedure; and
  • specifying in writing the responsibilities, and the degree of supervision required for each employee engaged in any phase of testing, including a list of tests that the person is authorized to perform.1

Specific supervision of testing may be delegated to others. In general, pathologists supervise hematology and transfusion-medicine areas of the lab because a pathologist is required to make hematologic and bone-marrow diagnoses, and provide medical consultation for hematologic, coagulation, and transfusion-medicine problems. Microbiology consultation is often performed by an infectious-disease clinician, and this area and chemistry are often supervised by clinical scientists.

The decision makers for clinical-lab management and purchases are frequently laboratory managers who customarily are not pathologists, although the lab director, a pathologist, usually must make the final decision on expensive purchases and must perform all of the oversight duties specified in CLIA ‘88.1

Pathologist lab directors and laboratory managers generally learn on the job as they rise through positions of increasing responsibility. Since few pathology-residency programs include training in laboratory management, newly trained pathologists are unprepared to assume business and management responsibilities.2 For this reason, some professional societies such as the College of American Pathologists, the American Society for Clinical Pathology, the Clinical Laboratory Management Association, and American Association for Clinical Chemistry provide management training in the form of programs, books, and articles.

—Christine Dobb, MT(ASCP), Retired
Columbus, OH

Bottom line:
As stated by the experts, medical school does not prepare pathologists for the business side of running a laboratory. But there is nothing like experience to get someone up to speed. In addition to the education provided by the aforementioned associations, the American Pathology Foundation is a non-profit professional society devoted to the business and management of pathology. Pathologists that have an MBA or MHA are very likely to be well qualified to manage a full-service clinical laboratory.


  1. Centers for Disease Control and Prevention. Code of Federal Regulations (10/2004) Title 42, Part 493 Laboratory Requirements, Sec. 493.1407 Standard; Laboratory director responsibilities. Accessed December 15, 2009.
  2. Kass ME, Crawford JM, Bennett BD, Cox TM, Grimes MM, et al. Adequacy of Pathology Residency Training for Employment: A survey report from the Future of Pathology Task Group. Arch Pathol Lab Med. 2007;131:545-555.

MLO’s “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 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.

Anne Pontius is a senior medical practice consultant with State Volunteer Mutual Insurance Co. in Brentwood, TN, and president of CLMA. Send questions to Ms. Pontius at
[email protected].