LIMS: Loving, Integrating, Motivating Staff Lab Individuals May Succeed!

Stop a hundred people on the street and ask them: what is a clinical laboratory?

You will probably hear something like: “It’s a place with shiny instruments and equipment. It’s also got test tubes, reagents, and viruses.”

Everyone remembers the viruses, but they forget the people. 

Yes, yes, there are people in the lab. These people have various specializations, duties, habits, and characters. However, they are always in short supply: if you ask those involved in the laboratory business about personnel, you’ll hear the word “shortage” sooner or later. So, a laboratory needs people badly and is highly dependent on them.

You might ask yourself, why are they there? You set up the instrument. You assign a robot to the task. You put a sample in on one side, and the correct information comes out on the other. 

Alas, it’s a pipe dream. No matter how hard you try to consolidate lab work, there are always non-standard, complex, or urgent tasks that require creative solutions, experience, and responsibility. Humans are much better suited to such work than robots, but the laboratory routine, like any other, isn’t viewed with much fondness.

People also tend to make mistakes. We make more of them when in a hurry or under stress. There are no magic tools to make us error-free. There are, however, several methods for staff improvement.

1. Training. Being well informed means acting predictably and within reason. 
2. McGregor’s XY Theory. Simply put: people at work need a balance between tight control (X) and freedom (Y). The proportions between them depend on the people and the situation. 
3. Consolidation and standardization of processes. For this purpose, the lab has SOPs that help people understand which situations call for a methodical, robotic approach.

However, a significant question arises: how to use these methods? You’re a team. You think about people. How do you take your compassion and implement it into the real world? What tools can help you improve the lives of the people working in and around your lab so that the quality of their work is high and they want to stay at work?

To do this, let’s start by understanding what roles people play for the lab and what they need in these roles. 

Lab technicians and Analysts: Caring Hands

Lab technicians and analysts are the unsung heroes of the lab, the indispensable guys and girls who do everything with their hands. 

Ordinary people may think that there is nothing especially complicated about their work. They have their little manuals. They completed some training. They received a volume of SOP. They get to play volleyball at a corporate event and feel like a part of the team. What more do they need?

It is easy to overlook the significant amount of responsibility lab technicians and analysts have. In reality, they play a key role in several areas of the lab.

First, they are responsible for the workflow. That means the balance of order against clutter and timeliness against lateness depends on the efficiency of the analysts and lab technicians.

As such, the efficiency of the laboratory depends on them. For the laboratory to perform well and, at the same time, use resources accurately, lab technicians and analysts must be able to organize their work competently.

Thirdly, they are responsible for the number of errors. Samples are usually lost at the level of lab technicians and analysts. The sample cannot escape on its own. Usually, one of the lab technicians or analysts does not mark it or forgets where they put it.

Lastly, lab technicians and analysts are the eyes and ears for what is happening in the laboratory. For some reason, many people forget to mention this. Of course, the manager also knows everything. But from whom? Management only knows as much as their people in the lab tell them. So technicians and analysts have to quickly assess the scope of the problem on the ground: can we solve this ourselves, or should we escalate? That is not an easy task, it takes talent and excellent judgment. 

The lab can have errors in all sorts of areas, from biosafety to automation. Sometimes if you have a lost test tube all you risk is having to retest a sample. Sometimes though, the sample is irretrievable. Not only do you lose the data, you lose the patient too because you couldn’t operate in time. It’s up to the lab technicians and analysts to understand how to appropriately respond to each respective data loss.

It turns out the job of an analyst is not easy at all. And, realizing this, it will not be surprising that these people with capable hands also have capable legs to walk away: turnover among lab technicians and analysts is often high.

Managers: Visionary Realists

Moving up a level in the lab hierarchy we have the managers and supervisors, who are responsible for budget planning and resource decisions in general. It goes without saying that these people have plenty of points of responsibility, too.

First, they must understand what information they need in order to make a decision and where to find it. Making decisions in an information-starved environment increases uncertainty and wastes resources. Leaping to blind decisions is something good managers try to avoid.

Second, they monitor how well the laboratory is performing against its objectives, commonly referred to as quality. Quality is no simple thing to assess, and it is not easy to take measures to meet the required standard. Balancing the resources you can expend to reach that level is not easy either. All in all, being responsible for quality is a big deal.

Third, the manager is also responsible for performance. If a lab doesn’t deliver the performance it needs it loses money and quality slips. If it is overloaded, the same is true. Therefore, you need to ensure an optimal loading strategy; this will also provide the best possible level of quality. Like an internal combustion engine, a lab works best at medium speed.

Fourth, it is difficult for us to understand our place in the world. A laboratory is an organism living within a larger healthcare system consisting of other laboratories and customers with various needs and technologies. Therefore, you should not focus all of your attention inward on your lab’s processes, but also be mindful of your place within the larger context of the healthcare world. For this purpose, there are audits, accreditation, and external quality assessments. In addition, there is a system for introducing innovations. And if we move past minor improvements and start considering larger, more complex ideas, those require higher managerial competencies. It usually goes like this: a vendor comes in with a shiny new toy, and you need to comprehensively evaluate the value of implementing this new thing. The vendor’s goal is clear: he wants to secure long-term sales. However, your lab may have other objectives. Evaluating them is a huge responsibility. After all, any change is a nerve-wracking experience. Innovations require extra work, while results are far from predictable. Sometimes introducing a new thing ends up being less efficient than it was before.  A lab manager must be a visionary, see the future, and understand where to steer the ship. Moreover, they must have the best interests of their people in mind to believe that change is necessary. 

Laboratory Physicians: Seeing it Through to the End

Lab professionals solve many problems. 

The first and foremost of these is result validation. You have to be sure that every result the lab produces under the doctor’s personal signature is trustworthy. After all, we are talking about the patient’s well-being, even though the lab physician may never meet them. 

Second, doctors in the lab perform a number of tests that require them to look through a microscope or computer screen in order to draw their conclusions. To do this, the physician needs to receive the specimen in time, decide what to look at, what we are studying, how many pictures they will need, and finally how to interpret them. 

Doctors are involved in multiple aspects of quality control. They are responsible for the medical part of the process, for the resection of the tests directly, and also play a role in the choice of technologies the laboratory uses in its work. It is impossible to complete these tasks without serious data processing.What advantages does one company’s instruments bring as opposed to another’s? A professional evaluates the tangible benefits for everyone, patient and lab, and chooses an instrument based on that. 

Clinicians: Outside the Walls but Inside the Heart of the Lab

Usually, when we talk about lab staff, we are thinking about people who work directly for the laboratory. But in addition to these people, there are also many who hardly step foot in the lab but rely on it nonetheless. Most notably these are patients and physicians. But there are also phlebotomists, representatives of insurance and transportation companies, and many others. Of course, they all have their own rules to follow, so it’s harder for you to make them comfortable and cozy. But they’re people, too, and they’re worth thinking about. A lab’s boundaries don’t end at its front door!

First of all, let’s talk about clinicians. Historically, they use LIS functions, not LIMS. They are interested in patient data, not testing processes. Clinicians want LIMS to interface well with the system they are working in so that the data just pops up without having to search for it. In addition, the clinician would like the lab to account for crucial things in the test result: “Don’t mess with my prescriptions, but give me the right result.”

The physician does not want to waste time negotiating with the laboratory, they expect the test results promptly and with good quality. It is critical for physicians to ensure that inaccuracies in the test do not affect their decision-making about the patient for whom they are responsible.

Administrative staff: The Invisible Wizards

Last but not least. For a laboratory to be able to conduct its activities qualitatively and develop, it must earn money. At the same time, research should not cost more than a fighter jet. Therefore, if you ask laboratory people what their biggest headache is, it is not surprising that they will answer: “billing” or “reimbursement.” This difficult task falls on the administrative staff, people we don’t always notice. They don’t even attend meetings! Their stress level is through the roof because no one likes to have money shaken out of them, whether it’s an insurance company, a clinician’s office representative, or a patient. No one likes to pay, and making other people pay up is a stressful job.

Let’s not forget those wizards who help keep us stocked on the necessary consumables: controlling inventory and managing the warehouse and orders. Until teleportation becomes routine, someone has to physically bring samples to the lab. Unfortunately, patients get sick when they “want” to, not when it’s convenient for you. The flow is ever changing, and you must try to manage it.

There is also the need to report to federal and regional agencies. This process must be consistent for everyone. Compliance reporting helps the laboratory to adhere to all necessary regulations. The laboratory must meet all the requirements and send all the documents in the appropriate form and in the right time frame. Oversight is not only done on the part of the state, there are also payers. If we want to work with them effectively we must not only deal with specific billing but also support their requirements,understand the prospects for further cooperation, what insurance will be, and so on. 

No matter how omnipotent a laboratory may be, sometimes it must send tests to subcontractors – other laboratories. That means you have to nurture cooperation with them. At the same time, by outsourcing the sample we continue to bear most of the responsibility for what is done with our customers’ data. Selecting reliable subcontractors, organizing communications, and tracking results are all critical administrative tasks.

If we continue to describe the functions of lab personnel, we will have a larger cast of characters than Game of Thrones. But even a cursory glance reveals that LIMS can effectively meet the needs of all these groups of people.

How LIMS Helps Lab Technicians and Analysts

SOPs are great. Their only shortcoming is that they are too abstract. To fulfill them, you integrate them with your lab process, an area where LIMS plays a gigantic role. SOP will only say that you need to mark up the data so that it’s easy to find. But with LIMS, you get a full report with specific sample numbers and the addresses of the refrigerators, shelves, and racks where you store those samples. The process you designed in the SOP emerges in reality. LIMS moves SOP from the level of abstract idea to the level of tangible reality. This is the critical, magical transformation that LIMS enables, the transformation of knowledge into a useful physical object. Completing this transformation manually in today’s environment means slowing down the process, reducing volume, and getting a gigantic number of errors. 

So, LIMS automates sample tracking, results entry, and data management. It drastically reduces the amount of manual work with samples. Optimizing this workflow allows lab technicians and analysts to focus on the critical tasks that require the most attention, thoroughness, or creativity. Tasks for humans, in other words. At the same time, LIMS automates the most repetitive tasks to such an extent that, if you add total automation, it can completely rid lab technicians and analysts of mundane routine. This allows people to spend more time on responsible tasks and perform them better. Additionally, this raises their status because few people like to see themselves performing routine tasks.

Thanks to these things errors in labs are now counted in defects per million rather than per dozen, true cause for celebration.

But to unlock LIMS full potential as a tool, you must put more ingenuity into it. With proper skill, it provides data for analysis that allows you to visualize the source of the error. For example, it can shed light on who makes this particular mistake and allow you to tactfully, carefully train the person so that they do not repeat the same error. If a phlebotomist has consistently high hemolysis, you can help him learn how to take better samples.

Sometimes, there is no specific point of error, but rather a bottleneck where they occur frequently. Then you can say to yourself, “this area is where we most often fall short of the TAT: let’s look at the process and figure out how to improve our quality.”

As for effective resource management, here again, magic is in the air. LIMS helps direct resources to where you most need them, also allowing us to understand where there is room for savings. We can compare like-for-like areas, understand what outcome is achievable, and manage that process. And this is not a tool exclusively for use by upper management!! We need to put this instrument in the hands of the lab technicians and analysts themselves so that they can understand where they are relative to others and take measures to improve their work. When all personnel have access to information, they figure out how to apply it in their area. That saves a lot of resources, motivates people, and takes some of the responsibilities off top managers.

How LIMS Helps Managers and Supervisors

The main thing that LIMS changes for management is that it shifts their decision making process to make it more evidence-based. With LIMS, we see concrete measurements that allow us to make decisions based on fully up to date information. And we can not only look at the integral figure, but we can drill down to specifics in real-time, which helps us make decisions in the here and now. Everything is visible. All the relevant information is at your fingertips. You can back up your gut feelings with objective data.

From the perspective of QA managers, with the right LIMS, we can improve data integrity and compare what we do in reality with the requirements of specific standards, protocols, and guidelines. Quality is contextual and integral. Many components of it are impossible to compare manually without the proper tools. But if you check quality automatically, it allows you to make quick decisions and correct the situation. It’s like a guitar tuning app. You turn it on and immediately realize whether it’s getting better or worse. This ability to quickly make sure that you are turning it in the right direction is a fantastic quality management tool.

Quality control outside the laboratory requires the preparation of documents and data. That is a problem because it does not contribute to the main objectives of the laboratory. You have to put the auditors into the full context of your lab for them to understand what decision to make. LIMS allows you to significantly reduce the cost of preparing this data, allowing the auditors to assess the situation while you spend fewer resources.

If you want to innovate, you should do it in places that are the least efficient. In places where the process is close to maximum efficiency, nothing needs to be touched. Furthermore, the cost of innovation should not be more than the effect. The best situation is a replacement of a 13th-century alchemical mortar with a modern device. The efficiency increases so much that innovation recouped much faster than lead turns to gold. The role of LIMS is to let us know exactly where quality suffers to such an extent that improvements are needed. LIMS checks the entire laboratory organism and identifies the most egregious bottlenecks.

How LIMS Helps the Laboratory Physician

Lab physicians are very LIMS-dependent. Their first task, validating a result, is much easier when there is a LIMS in place. The system surrounds the professional with support and helps eliminate the occasional “stupid” mistakes that even a superhuman like a physician can occasionally make. 

Without LIMS, a laboratory doctor would find it very difficult to organize a joint review of scans and share his opinion with colleagues. And  it is so convenient to delegate technical work to AI!  By processing mountains of data it can identify patterns that no human being would be able to grasp due to incomprehensibly large volumes of information.

LIMS complements the physician and picks up where humans cannot due to natural limitations.

How LIMS Helps Clinicians

Clinicians are always on guard for they understand that despite standardization efforts, each lab is different. They produce results in various formats, forms, and units of measurement. LIMS, with its competency in semantic interoperability, allows the physician to get more consistent information without spending time translating it to the patient. 

LIMS provides not only point-by-point results but also a history of those results, allowing the physician to better assess patient trends and facilitating more accurate decision-making. Plus, if the LIMS is well-integrated with the system the physician is working in, they are getting the correct data quicker because the LIMS got it there in time.

The LIMS can also be a communication medium between the lab physician and the clinician. It turns out that they often do have a lot to talk about, and that only benefits the patients. For example, if the laboratory physician knows that certain medications may affect the results, they can consult with the clinician about what to do to ensure that the patient is properly tested and gets the correct result without interrupting therapy.

How LIMS Helps Administrators

It’s hard to overemphasize LIMS’ active concern for laboratory administrative staff. More than anyone, the system will find and visualize all the friction points. Where did the doctor fail to enter a diagnosis based on which test is needed? Why isn’t insurance paying for this or that? What code pays for what? What does the denial say?

A living person would have to find 4-5 documents and match them against each other, while LIMS will bring them together in one place instantaneously and help to make sense of them. In addition, an advanced LIMS allows you to communicate with the insurance company and others, immediately solving any billing problems. 

Likewise, LIMS helps with process maps as well. LIMS quantity survey data tells you how much material you need and helps you avoid supply mistakes if the demand changes dramatically. A deployed forecasting system allows you to understand what you will need in various cases, how many materials you need to store, and what the operational stock should be. Warehouse information is not always contained in LIMS itself, but to get the best results the warehouse module should work in synergy with LIMS. Then LIMS will provide the warehouse system with primary data on how much material we are wasting and allow it to run efficiently. 

In terms of patient management, we can see the tracking of every patient, specimen, and report we’ve sent off, allowing us to understand what happens if there is a problem on the standard path.

Finally, if we are talking about compliance, truckloads of reports can be prepared automatically by LIMS, removing the mundane routine and allowing us to focus on more critical matters.