“Are Medical Laboratories becoming Factories?”

 

When we think of the word “factory” in its industrial sense, we normally think of things like large buildings, mass manufacturing, automation, production lines, and a hierarchial employment structure.

Most medical laboratories don’t have big smoking chimneys! However with recent changes in medical laboratories in terms of centralisation and automation, it is easy to see why some people might start to make such an assertion.

In what ways could the medical laboratory of today be seen or perceived as “a factory”?

  • High throughput: There are not that many medical laboratories these days which process less than 500,000 samples per annum. Centralisation has seen to that. This obviously has advantages (more exposure to a greater variety of conditions, & facilitates sub-skilling), but the number of samples mean that the sheer size of the laboratories can make them resemble “factories”
  • Increased automation: Haematology and Biochemistry have been automated for quite a while now, but this automation is increasing yet further with the introduction of automated processing “tracks”. Bacteriology automation systems like the Kiestra TLA and large scale molecular platforms are increasing automation rapidly in microbiology labs. With such systems in place, many samples barely touch human hands on their way through the laboratory. This has very clear advantages in terms of standardisation and error reduction, but it can certainly sometimes feel like a production line, with each staff member often having a very specific (and repetitive) task to help the sample along from receipt to result.
  • Noise: Automated platforms can be noisy, and because laboratories are generally big now, there are often many people on the shop floor at one time. This can create a lot of background noise.
  • Clocking in and out: An increasing number of medical laboratories have implemented or are looking at implementing “clocking in” systems to monitor employees’ time in the laboratory. The modern version of these systems usually involves biometric tracking by recording your fingerprint (I remember working in a hotel in Belfast and “punching a card”…).  I see the benefits to management, but personally I am not a big fan of clocking in systems. For me the ability to perform well at work should be based on trust, not forensics. Clocking in gives the medical laboratory a little bit of a factory feel.
  • Tendered contracts: In New Zealand anyway, medical laboratory testing for a region is usually tendered out to interested providers for a fixed term period. This to some extent “commoditises” the work. Factories tend to produce goods. We produce results…

So there are definitely some reasons as to why medical laboratories might be regarded as factories. In other ways they are definitely not. For example, unlike in most factories, medical laboratory staff are highly skilled. Laboratories are also very clean and well organised. This may not always be the case in factories.

It is during the analytical stage of the laboratory process that I believe it is actually very  important that the laboratory has at least some features of a factory. Analytical processes should be highly automated (and standardised), and less human interference means less errors are made.

And on the other hand, it is during the pre-analytical and post-analytical phases that it is most vital that medical laboratories do not behave like factories.

Pre-analytical:

  • Is this test necessary for this particular patient?
  • Are these the correct tests for this patient given the clinical situation?

Post analytical:

  • How should this test be interpreted given the clinical context?
  • How quickly do we need to notify the clinician of this result?
  • Can we advise any extra tests on the patient on the basis of the result?

The pre-analytical and post analytcial phases are where the focus should be on making laboratories less factory-like.

These phases are when the personalisation of the testing process to each individual patient should remind us that we still work in a laboratory, and not a factory…

Michael

 

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