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Book Review |
Address correspondence to Ulysses J. Balis, M.D., Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696, USA; tel 617 371 4922; fax 603 250 3139; e-mail balis{at}helix.mgh.harvard.edu.
Authors: Frederick L. Kiechle and Rhonda Ingram Main, William Beaumont Hospital, Royal Oak, Michigan (ASIN 1890883727, AACC Press, Washington, DC, paperback, 132 pp, 2002)
In an era of ever-growing dependence upon workflow and process automation technologies and techniques to address the steady increase in volume seen by many, if not most, clinical laboratories, this book fills a much-needed void for anyone interested in quickly grasping the essence of this expanding subspecialty of laboratory medicine. In its refreshingly lucid and process-oriented style, Kiechle and Main have effectively surveyed an already large and complex field without ever losing focus on the task at hand – increasing throughput while maintaining excellence.
The Introduction highlights the manifest evolution and consolidation of the practice of laboratory medicine into large regional centers and paints a justification, in broad strokes, for the critical need to implement and enhance process efficiency in the laboratory setting – for laboratories small and large alike. The authors, however, are cautious to point out that automation and process reengineering are not panaceas and in no way lead universally to the decreasing of necessary staff. Rather, these are a set of tools to be leveraged to provide increased efficiency in settings where workflow practices have not been examined recently, or perhaps in a very long time. Thus, this text delineates a method for effectively analyzing current practices and discovering new opportunities.
The areas of process enhancement covered by this text include 2 major thrusts: increasing test volume and reducing unit test cost. Clearly, these worthy goals are interrelated and this text does an excellent effort to tie together both approaches, whenever appropriate. Each major thrust is subdivided into component sections, with prominent topics, eg, laboratory outreach, laboratory consolidation, robotics/automation, point-of-care testing, laboratory staff diversification, and reduction of patient length-of-stay.
Workflow simplification is another major emphasis, and the authors provide useful examples of methods to improve process workflow as well as ergonomic workflow (an often-overlooked, but important aspect of optimal process engineering).
In planning and implementing process changes, there is often the unavoidable complication of cultural dissonance with changes in habits and the need to manage expectations during the crucial transition period. Here again, the authors skillfully identify critical components of process evolution and provide useful insight and functional knowledge for effectively implementing a process reengineering plan, once it has been crafted and pilot-tested.
Finally, the review of personnel diversification is excellent and highlights an often-neglected area for further extraction of efficiency from any system. Keeping an eye on the stark realities of current availability of laboratory professionals, Kiechel and Main elegantly cover a number of strategies that ultimately lead to more patient-focused care.
In light of the effortless manner in which these monographs address the general and the specific issues of pursuing increased efficiency, this text is destined to become a classic for this niche of laboratory medicine, in a similar manner as already accomplished by "The ABC’s of LIS," by Franklin R. Elevitch.
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