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CLMA-SAFMLS MEMBERSHIP INFO

SAFMLS is currently partnered with the Clinical Laboratory Management Association (CLMA) and offers a CLMA/SAFMLS bundled membership for $50 annually. The membership renewals are now due in January each year. The membership period is from January - December. Lastly, if you want a discount on registration for KnowledgeLab 2019, you must be an active member prior to registration to the conference.

Please CLICK HERE to apply for a new membership or renew last year’s membership.

UPCOMING EVENT

For more KnowledgeLab 2019 information click the picture below

KnowledgeLab 2019 will take place in Grapevine, TX 29 March - 3 April.

Information

  1. FUNDING: Must go thru your local TDY Conference process. There is no central funding. I will send out my conference packet, once I have it complete. The justification will be helpful as a template if you haven’t completed one in the past. Please keep in mind that there may be different requirements for your packet, so ask at your location what the requirements are and who they need to be routed through.

  2. REGISTRATION: Please register NOW. You can SAVE to pay later. See attached for step-by-step process. CLMA needs our numbers to plan, so please register as soon as possible, if you hope to attend. To get the discounted SAFMLS/CLMA price for the conference, be sure your SAFMLS/CLMA dues are current first ($50 for membership for Jan through Dec 2019. Payment for this only must be done now and can also be completed on the CLMA website). Once your packet is approved there is usually a process for the registration to be paid via government purchase card, locally.

  3. FLIGHT: Plan to fly in Saturday MORNING, 30 March; Fly out the afternoon of Wednesday 3 April. There will be an early dinner (restaurant TBD) with an informal talk/Q&A concerning Army restructuring/reallocation of billets Saturday afternoon/evening. All other Army breakout sessions will take place Sunday and all CLMA conference/Army activities will be complete by noon Wednesday.

  4. HOTEL Per diem rate is $164 for the area. I am not aware if rooms have been blocked off specifically for military yet but MAJ Baltazar was able to reserve a room at the Gaylord Texan Resort from the MARIOTT REWARDS website. You can reserve rooms using special rate government. This will give you the $164/night rate. One night will be charged to the your personal credit card when you book, so remember to request reimbursement to your personal credit card and charge the total to your GOV CC when you check in.

  5. MI&E: $61

  6. Resort Fees: $20/day

  7. TRANSPORTATION: Super Shuttle from DAL Airport: $57; TAXI from DFW Airport: ~$50

  8. Texas Hotel Tax exemption form can be found by CLICKING HERE

  • Please present this form when you check in to the conference center.
  1. UNIFORM:
  • If you are presenting a session or having to stand next to your poster (non-Army Breakout Session): CLASS A
  • If you are only an attendee: CLASS B
  • If you are presenting at the Army Breakout sessions (Sunday): CLASS B
  1. TENTATIVE SCHEDULES:

MAJ Melissa Baltazar, USA

BOD ELECTION ANOUNCEMENTS

The time has come to elect the next SAFMLS Board of Directors. Open positions are as follows:

  • President - To be represented by the Army; 1 year term

  • Vice President - To be Represented by Air Force or Navy; 1 year term

  • Treasurer - May be represented by any service; 3 year term

  • Secretary - May Be represented by any service; 3 year term

  • Army Member at Large - 2 year term

Individuals may be nominated (self-nominations allowed) and should submit an “intent of office” for running. Also a bio for each potential applicant will accompany the application package.

All packages must be submitted to Lt Col Aaron Lambert: secretary@safmls.org no later than 1 February 2019.

Lt Col Aaron Lambert, USAF

SAFMLS 2018 ANNUAL AWARDS

Nomination Instructions

SAFMLS Awards

Outstanding Clinical Scientist. Recognizes outstanding contributions by a SAFMLS laboratory officer in pay grades O-1 through O-3 who has excelled in clinical laboratory operations, laboratory management, or as a staff officer, with special emphasis on advancing the growth and professional goals of SAFMLS. Individual should have demonstrated outstanding leadership in pursuit of excellence for his or her country and service.

Outstanding Laboratory Manager. Recognizes outstanding contributions by a SAFMLS field grade officer in pay grades O-4 through O-5 who has excelled in laboratory management, either directly or as a staff officer, with special emphasis on advancing the growth and professional goals of SAFMLS and the practice of laboratory medicine. Individual should have demonstrated outstanding leadership in pursuit of excellence for his or her country and service.

Outstanding Enlisted Service Member. Recognizes outstanding contributions by a SAFMLS enlisted service member who has excelled in clinical laboratory operations, laboratory management, or as a staff NCO, with special emphasis on advancing the growth and professional goals of SAFMLS and the practice of clinical laboratory medicine. Individual should have demonstrated outstanding leadership in pursuit of excellence for his or her country and service.

Outstanding Reserve/Guard Laboratorian. Recognizes outstanding contributions by a SAFMLS Reserve/Guard member who has excelled in clinical laboratory operations, laboratory management, or as a staff officer/NCO with special emphasis on advancing the growth and professional goals of SAFMLS and the practice of clinical laboratory medicine. Individual should have demonstrated outstanding leadership in pursuit of excellence for his or her country and service.

Outstanding Civilian Laboratorian. Recognizes outstanding contributions by a SAFMLS civilian member of any civil service grade who has excelled in clinical laboratory operations and/or laboratory management, with special emphasis on advancing the growth and professional goals of SAFMLS and the practice of clinical laboratory medicine. Individual should have demonstrated outstanding leadership in pursuit of excellence for his or her country and service.

Outstanding Clinical Research Scientist. Recognizes outstanding contributions by a SAFMLS member in pay grades E-1 through O-5 who has promoted laboratory science through clinical research activities, with a special emphasis on advancing the growth and professional goals of SAFMLS and the practice of laboratory medicine. Individual should have demonstrated outstanding leadership in pursuit of excellence for his or her country and service.

Distinguished Service Award For Excellence. Recognizes substantial contributions above and beyond normal expectations by a SAFMLS member who has promoted and advanced the growth and professional goals of SAFMLS and the practice of clinical laboratory medicine. Individual should have demonstrated outstanding leadership in pursuit of excellence for his or her country and service. Nominations for the Distinguished Service Award will be forwarded to the SAFMLS past president who will chair a selection committee to determine the recipient of the award.

Nominee Eligibility

Award nominee must:

  • Be a regular member of SAFMLS (or associate member for enlisted nominees). Note: SAFMLS Board Members are not eligible
  • Be a member in good standing (dues paid in full).
  • Be in the appropriate pay grade at time of award receipt.
  • Not have received the award for which they are being nominated in the past three years.
  • Receive approval from local leadership prior to submitting nominations for awards.

Nominee Accomplishments

  • Accomplishments cited must have taken place within three calendar years prior to the nomination date.
  • Accomplishments should reflect positive impact on the field of military laboratory medicine, to include support of SAFMLS and development of junior laboratory personnel.
  • Accomplishments that advance the practice of clinical laboratory medicine at the laboratory, installation, or headquarters level may include, but are not limited to:
    • Leadership
    • Management
    • Innovation
    • Resource savings
    • Positive patient impact
    • Support to healthcare providers
    • Accomplishments that promote SAFMLS as an organization may include, but are not limited to:
    • Board membership
    • Written contributions to the Society Scope newsletter
    • Workshop, Short Topic, and/or Poster presentations
    • Annual meeting committee involvement
  • Accomplishments that enhance the professional development of junior laboratory personnel may include, but are not limited to:
    • Mentorship
    • Job knowledge and training
    • Advanced education
    • Recruitment
    • Community activities

Nomination Instructions

Nomination packages must:

  • Indicate the title of the award for which the member is being nominated.
  • Include an email or memo indicating local leadership approval for award submission.
  • Include a brief biographical sketch of the nominee, not to exceed one type-written 8.5" x 11" page.
  • Describe, in detail, the nominee’s unique accomplishments, formatted as follows:
    • A maximum of two double-spaced 8.5" x 11" pages.
    • Narrative style, in paragraph format. NO BULLETS.
    • Formatted with one-inch margins.
    • Font no smaller than 11 characters per inch.
  • Be submitted to the Awards Committee Chairperson, Capt Amy L. Bogue at amy.bogue@us.af.mil
  • Be received NLT 22 Feb 2019.

Please direct any questions to the Awards Committee Chairperson,

Capt Amy L. Bogue, at 937-938-2531 or via email: amy.bogue@us.af.mil

BOARD OF DIRECTORS

MEMBERS-AT-LARGE

EX-OFFICIO MEMBERS

ADDITIONAL KEY BOARD MEMBERS

President’s Message

What’s In A Name?

Each of us are at different points in our clinical science careers; as such, we each have varying professional needs: networking, career mentoring, skills education, continuing medical education for certification maintenance, or perhaps, even preparation for advanced certification. We all may need each, but the needed mix will almost certainly be different.

Those of you that have been around for a while have been exposed to SAFMLS in both its iterations: first, as the DoD-specific Society of Armed Forces Medical Laboratory Scientists; and then recently, to the more inclusive, Society of American Federal Medical Laboratory Scientists. Legal challenges may have forced the change, but that unforeseen course has offered us the chance to re-make ourselves into an organization that could both expand our network and better deliver upon the professional needs of our members.

To stay solvent, we needed to merge with a civilian organization. Military contracting rules make it difficult for those in uniform to sign contracts for an organization that may mistakenly be construed as part of the government. The two years lost to the federal re-examination of conference travel gave us the chance to find an organization that shared our primary focus - Laboratory Management - and enter into a partnership that benefited both organizations. We’ve now had several years for CLMA and SAFMLS to become comfortable with one-another.

As clinical scientists, we’re used to routine reflection, re-focus, change implementation, data collection and then doing it all over again. Well, we’ve reached the point of data collection and we need your help. We need you to help us decide how our relationship with CLMA should evolve and what SAFMLS needs to deliver for you.

Are we giving you the right experience, the right mentoring, the right career advice, the right mix of educational offerings (science, management, other.), enough CME’s,…? We need you to take part in a survey, talk with the SAFMLS elected officers and members-at-large, let your consultant/specialty leader know how SAFMLS is [or isn’t] serving you, and even for you to speak up at the annual business meeting. Soon, we will be sending out a link to all current members. Please participate. Your imput is vital to the sucess of our organization.

You haven’t finished reading this yet, but I want to thank you for taking part. We need every little bit of data that we can get. Many of you are holding answers we haven’t thought of yet and we need those new ideas to keep improving the SAFMLS experience. In the end, we may still be SAFMLS, but the experience we provide can be as different as we all need it to become.

CDR Todd Tetreault, MSC, USN

Editor’s Corner

Maj Rochelle Hase, USAF and CPT Jason Reeves, USA

Here ye Here ye! This is the call for submission of articles to the Society Scope! Maj Hase and I know that there are incredibly talented laboratorians in the military medical field and we want to hear from you. The Society Scope is a great way to show off the talent of you and your staff as well as raise important laboratory issues within our community. Your peers, consultants and your leaders all read the Scope…because they too are members of SAFMLS! SAFMLS is continuing to grow, especially now that we have partnered with CLMA, this provides a wider audience within the laboratory community. Publishing an article is an excellent way to stand apart from your peers and spotlight the accomplishments and leadership involvement in the laboratory.

The articles we seek do not have to be research in nature. If you look through our PREVIOUS PUBLICATIONS, you will see we have articles about regulatory compliance, career corner, clinical applications and leadership development, for example. You can send us an overview of your experience from deployment or a spotlight of an event from your current hospital. We love those pictures!

There is no length format. If you have published your article in another publication, we can reprint as long as you request permission from the original publication. Don’t forget that any article you submit for publication must be approved by your unit/base public affairs office. It is a fairly simple process with far reaching impact. Showcasing the hard work and accomplishments both at your home base and downrange is a great way to keep the SAFMLS organization growing and expanding.

So put those writing skills to test! We need to know what is taking place with you and at your unit.

Submitted Articles

Select the author(s) tab below to reveal their article.

CPT ERICKSON

Optimizing Current Resources to Maximize Access to Care During Extended Hours

Written by CPT Sam Erickson, Chief, Laboratory Operations, Ft. Meade MEDDAC

Introduction

In July of 2017, Kimbrough Ambulatory Care Center’s (KACC) primary care implemented extended clinic hours. Primary Care’s hours were extended to include 1630 to 1830 Monday - Thursday. This change mandated that auxiliary services also extend their hours. Though the hours were extended, no additional hiring was authorized. KACC adapted to new operating hours by optimizing current resources and augmenting work schedules.

These extended hours were inspired by the National Defense Authorization Act (NDAA) of 2017. According to NDAA 2017, “The primary care clinic hours at a military medical treatment facility . shall include expanded hours beyond regular business hours during the weekdays.” The leadership at KACC decided to heed this guidance and extend the hours of KACC.

Extending the hours, while not authorizing more personnel created a problem. The saying of “do more with less” suddenly became very applicable.

Several courses of action were discussed on how to make the new hours work. Not knowing how many patients would be coming during the extended hours, we placed one person at the desk, one in phlebotomy and one to two bench techs. Later it was determined that we could get away with one person covering the front desk and phlebotomy.

Our two bench techs changed schedules to have four 10 hour shifts. With three days a week of two people closing, and two days a week of one person closing.

It also became apparent that we needed to have at least one more person trained in closing procedures, as emergencies arise and last minute adjustments to the schedule would be needed. We also found that it worked best to have an enlisted Soldier be the closer and work the front desk and phlebotomy during closing hours.

The Department of Clinical Operations provided data on the number of appointments booked during the extended hours, versus during the normal work day. During normal working hours KACC has an appointment utilization rate of 88%, meaning 88% of the available appointments are being booked (see figure 1). However, during the extended hours, there is a utilization rate of 95% (see figure 2). Data was from July 2017 - June 2018

An automated queue system was used to quantify the number of patient encounters the laboratory experienced during the pre and post extended hours. We found that in the course of a year, the lab saw an additional 1,029 patients (see figure 3).

The extended hours have been a success. During the transition to the extended hours, KACC experienced some issues. Although several internal issues were encountered, the ultimate goal for greater access to care was accomplished. More patients are booking appointments and being seen by their providers. The alternate work schedule the laboratory adopted has proved to be effective.

Figure 1 Figure 2 Figure 3

Disclaimer: Beginning 1 October 2018 the KACC lab no longer participates in the extended hours due to a shortage in personnel.

2D LTs GRAYBEAL AND ROSE

Commissioning as a Biomedical Laboratory Officer in the United States Air Force

Written by 2d Lt Timothy Graybeal and 2d Lt Jonathan Rose

Disclaimer

All links are current as of the publishing date of the article and they may be subject to move and/or be removed from the article without notice. The authors do not recommend any specific schools or programs to guarantee selection. Any mention of specific schools, training aids, or programs are utilized for aids to illustrate the commissioning process an individual undergoes as a Biomedical Laboratory Officer in the United States Air Force only.

The Beginning

Your dreams of being a Biomedical Laboratory Officer starts NOW! Everything you do from this point forward, to when you turn in your commissioning package is extremely important for your chances of selection. The choices you make in the beginning will dictate the path you go down for the rest of your Air Force (AF) career, so make good choices. Ensure you set attainable goals when aspiring to become an officer in the United States Air Force and always remember that you are doing them for the right reasons. Before we get ahead of ourselves ensure you read and understand, AFI 36-2013 (OFFICER TRAINING SCHOOL (OTS) AND ENLISTED COMMISSIONING PROGRAMS (ECPS) to ensure you meeting all general commissioning eligibility criteria.

Get your education done

Right out of tech school, you are eligible to sit for the Medical Laboratory Technician exam and you have earned approximately 89 credit hours toward your CCAF. That is more than enough for an associate’s degree, however, you will be missing your general education requirement, unless you have prior college. Gen Ed includes:

  • 3 credit hours Oral Communication
  • 3 credit hours Written Communication
  • 3 credit hours Math
  • 3 credit hours Social Sciences
  • 3 credit hours Humanities
  • 6 credit hours Leadership/Management (ALS meets this requirement)

If you are missing these classes, you can earn the credit through CLEP or DANTES testing. Your local library has all the study materials required to pass these tests. Furthermore, if you have prior education, you must transfer your credits to CCAF. You will need to work with your local education office to transfer these credits. At this time, you may still be completing your CDCs. They should be completed before you are allowed to begin any off duty education, but check with your supervision. When you are allowed to begin off duty education, you can sit for CLEP or DANTES exams at the same time you are taking other classes. Review the published CLEP and DANTES pass rates when considering which exam to take: CLICK HERE for full excel doc or review tab 1 below.

When you are selecting the college you wish to attend, there are several factors to keep in mind with respect to the commissioning process. Ensure your school is regionally accredited. Focusing on a Laboratory Science program that is NAACLS accredited is beneficial, but not required. There are several online programs that will enable you earn your degree in a timely manner. Ask your supervisor and chain of command if you require assistance or more information as you go through the process of selecting an institution. Working with your local base education office to submit your degree plan and educational assistance request to AFVEC website (AF portal) to receive Tuition Assistance (TA) is an integral piece and will ensure that you are following your educational goals. The Free Application for Federal Selection Aid (FAFSA) may be available to you, so don’t forget to apply.

Get your Certification

Another vitally important requirement for applying for a commission as a Biomedical Laboratory Officer is to earn your certification. There are several agencies that offer certification, but in this scenario, both individuals were certified as a Medical Laboratory Scientists through the American Society of Clinical Pathologists. There are several routes to earn this certification, researching the opportunities at the website (www.ascp.org), or similar websites of other accrediting organizations. You will have to provide proof that you meet the requirements to be certified, pay possible applicable fees, and then test to pass the certification exam. There are numerous study tools that can be utilized, but don’t forget that your Career Development Courses (CDC) will be very beneficial.

Build your Package

Once you have met the educational and certification requirements, the real fun begins! It is time to start building your commissioning package. The requirements will include:

  • Personal Letter
  • Letter of Recommendation from Wing/Group Commander
  • Letter of Recommendation from two outside sources
  • Letter of Recommendation from Immediate Supervisor
  • Original Transcripts (no photocopies/scanned or unsealed versions issued to student)
  • Licensure/Board Certification
  • Interview Worksheet from designated interviewer
  • Copies of last five (5) EPRs
  • Personnel Data (Brief/Surf/vMPF) dated within 45 days of board
  • AF Form 422 (Physical Profile Serial Report)
  • Fitness Summary from the AF Portal
  • Statement of Understanding for Physical Fitness (COT)
  • Commander Quality Force Review Letter
  • AF Form 24 (APPLICATION FOR APPOINTMENT AS RESERVE OF THE AIR FORCE)
  • Locator Information Letter/Assignment Preference Worksheet

The requirements may change over time, so ensure you are working on the most recent version. Remember, you do not necessarily have to have a Bachelor’s degree in Health Science or laboratory related field to commission. You just need to meet the requirements and pass the ASCP Board of Certification exam as a Medical Laboratory Scientist (Generalist). Any specialist certification will set you apart, but is not mandatory.

First, you will have to send in an unofficial copy of all your transcripts to AFPC/DP2NW to ensure your degree will meet all requirements. You do not want to waste time if your credits will not be accepted by Air University. Once you are certain you meet all of the requirements outlined, order official copies of all of your transcripts and have them sent to:

AFPC/DP2NW

550 C Street West, Suite 27

JBSA Randolph, TX 78150

Now is the time to start working on your Letters of Recommendation. You will need at least four, one from your Wing/Group Commander, one from your immediate supervisor, and two from outside sources. These two should be from someone within the laboratory community, but outside of your current chain of command. I recommend requesting the Letters of Recommendations prior and routing them for approval. You should meet with your Group Commander to discuss your package before they sign your Letter of Recommendation. As always, keep you leadership up to date on your intentions. You should write your Letter of Intent to describe why you want to be a lab officer and describe how your experiences and qualification will benefit the Air Force, if selected. Do not describe how it will benefit you, but how you can help the Air Force if granted the opportunity to serve as an officer. Each of these letters should be one page in length, at most.

The next part of your package includes your SURF, which you will print from Virtual MPF (vMPF) or Assignment Management System (AMS). It tells your story during your time in the military, so ensure it is accurate. Ensure all of your individual awards and decorations, and all your applicable professional military education commensurate to your rank, and civilian education are present. You will also need to have an AF Form 422 completed that states you are world-wide deployable, fit for duty, and commissioning qualified. This is initiated by going to Medical Standards and requesting the form to be completed. You may be subject to completing a physical.

There will by several assorted letters and forms that you will have to fill out and have signed by your leadership. Follow all of the instructions thoroughly and completely. The AF Form 24 is a lengthy and strenuous form to fill out. Fill in all information and do not leave out section unanswered. Begin by filling in these forms and routing them for signatures within two months of the deadline for submission of your package. The deadline is typically in the fall, around the month of September, but it is subject to change, so pay close attention to dates. Once your package is complete and has been reviewed by yourself, your mentor, your leadership and other applicable individuals that would like to see the package, consolidate all paperwork into one PDF file and send to afpc.dp2nw.workflow@us.af.mil.

The Board

To be competitive at the board you must separate yourself from all the rest. This can be done in a number of ways and will greatly improve your selection chances. Some examples of ways to stand out from your peers would be to show progression in your career, continue past the minimal requirement of Bachelor’s degree and go for a Masters, or get ASCP certified in other specialty fields such as Specialist in Microbiology or Specialist in Blood Bank. As always, having a good GPA is beneficial. You can obtain rank quicker than the rest, or earn awards and accolades that will reflect on your EPRs and always make an effort to get a stratification. Gaining experience in all sections of the laboratory will be beneficial. Certifications such as process improvement (Green Belt), managerial, or human resources related ones can also be helpful.

The board usually meets in late September or early October to consider all applications. They will review each package and make selections based on those packages. You may then be contacted to have an interview with a representative of the board as the second part of the application process. The interview may be over the telephone or face to face, whichever format the board decides. Once the board makes their final decisions, notification should be sent to your leadership.

The Next Step: Commissioning

If you are selected, then the Air Force believes you have what it takes to be a Biomedical Laboratory Officer. All the hard work has paid off and now you can lead the next generation of lab professionals and leaders in the United States Air Force. Remember, becoming a lab officer comes with many responsibilities. Do not forget where you came from and always pave the way for others to come after you. If you are not selected, do not give up. Go back to your mentor/leadership and discuss how to improve your package to increase your chances when you resubmit your package. There are a limited number of slots available, so the cut off is always high. Good luck in your future endeavors!

NOTE: This presentation was created as guide centered from our experiences applying. One should not use this as the sole source of information of the application process.

MAJ LOWERY

The critical thought paradigm: Closing the chasm across the healthcare enterprise.

Written by Lionel Q. Lowery II, AHI, MT (AMT), MLS (ASCP)cm; Major, Medical Service Corps, US Army

The Decision Cell concept

“The Decision Cell concept”

The careful introduction of the thought

When I was young, I was quiet and reserved so I observed more than I spoke. Watching people afforded me the opportunity to view the actions of others. When I would see someone do something mean to someone else, I wondered what provoked the unnecessary anger? When I would see someone smile at someone else, I would wonder, what created the kindness and compassion? There were times when I would see someone cry when she was happy and the similar tears, would fall when she was sad. The emotion was different but the chemical composition of the tears was the same. Then as my mother was driving me to my grandmother’s house, in the pouring rain, it hit me. As I was looking out the car window, I touched the cold glass and became enamored with the patterns of the blowing rain as it formed droplets on the rear window. These two particular raindrops were separately blowing when all of a sudden they merged together and quickly separated just as fast as they blew together. Because each raindrop touched they were no longer the same because each one was carrying part of the other one with it, therefore it was different than they were just moments before.

In the same way, as I was entranced by the rain, I realized that life is beautiful, if we take the time to enjoy the view. But sometimes we don’t want to take the time to see it. In this digital age and the desire to be connected, we are disconnecting ourselves from each other. We allow life to get us so busy, we’re going so fast, we don’t take the time to do anything. We even rush in our relationships so much that we don’t even want to take the time to get to know people, focus on what they are saying to us, or listen to them. Perhaps even as you read this article, you are struggling to focus while your mind is vying for your attention. We’re constantly swiping and scrolling, scrolling and swiping, we’re not sure which came first- the scroll or the swipe. We don’t know, don’t care, we just want to do it fast. At the same time, we’re trying to stay connected. More than watching the rain, more than staying connected, we should focus on the thought. Our thoughts are independently blown in all different directions, drifting from place to place, and each time we touch, talk, look at each other (ever so slightly) we always leave a trace with each person.. .leaving each person slightly different than they were before. I thought that I had an epiphany, but later read a story similar to the self-realization and new-found knowledge that I experienced. Years later, I would read a similar story about a transference of emotional expression and come to the understanding that emotional and social intelligence rides in the vehicle of the human thought. Every emotion that we feel, anything that we do, all of the things that we say, stems from our thoughts. Let’s talk about more about the thought.

I often read James Allen. He was a British author and philosopher who was known for inspiring others. He said, that “The thought is a subtle element, although it is invisible to the physical sight, it is an actual force of substance as real as light, heat, cold, water or even stone. We are surrounded by a vast ocean of thought-stuff through-which our thoughts pass like currents of electricity. You can pass your thoughts from pole to pole and fly many times around the world many times in a single second. Scientists tell us that thought is compared with the speed of light. They tell us that thoughts travel at the rate of 186, 000 miles per second. Our thought travels 930,000 times faster than the sound of our voice. No other force or power of the universe, yet known, is as great or as quick. It is a proven fact, scientifically, that the mind is a battery of force. The greatest of any known element.” Why am I talking about the thought? Because how we help and care for other people, how we work with each other, and how we make decisions for our patients, starts with our thoughts.

Our thoughts gives rise to the balancing act of our decisions

In my current capacity, I am a nationally certified Medical Laboratory Scientist, Medical Technologist, and Allied Health Instructor. Before all of this, I am a Soldier in the United States Army Medical Command (MEDCOM) and I am a Medical Service Corps officer, with a mission that’s nested in the Army Medical Department (AMEDD).

The MEDCOM is the largest direct reporting unit to the Chief of Staff of the Army and possesses command authority over 69,000 healthcare personnel as well as hundreds of generating force health readiness organizations and platforms. The AMEDD’s mission is to provide sustained health services and research in support of the Total Joint Military Force to enable readiness and conserve the fighting strength while caring for our Soldiers for Life and Families. This mission is accomplished by Army Medical Department personnel assigned across the Army around the world, 24-hours a day, 365-days a year. While Army Medicine directly enables the Army’s service responsibilities outlined in Title 10 of the United States Code, it is also foundational to the Joint force in the execution of Globally Integrated Health Services.

What am I saying? Well, I articulate all of these statistics to communicate that while I am humbled to serve the Military service members (both past and present) and their precious Family members, I know it’s a tough job. However, you don’t have to serve in Military healthcare to work hard. Whoever you are, and wherever you serve, you too operate in a world filled with uncertainty. To do this, you must wrestle with a myriad of competing requirements each and every day. I am saying- I am you and you are me. I could be your patient and you could be my patient and we must elevate our level of thought for the purposes of who we serve. Elevated thought gives rise to better decision-making for all who may benefit from the things that we do.

Bacterial colony morphology leads to microbiological identification. In this same way, please continue to read, join me, and look into my magnifying glass as we connect our thoughts with our decisions.

Bacterial colony morphology leads to microbiological identification. In this same way, please continue to read, join me, and look into my magnifying glass as we connect our thoughts with our decisions.

I once read a great book that connected our thoughts with our decision-making process, by an insightful author by the name of Susan Scott. The book was entitled, “Fierce Conversations”. Dissecting the title “Fierce Conversations”, she describes the first word “fierce,” as robust, intense, strong, powerful, passionate, eager, and unbridled. In the second word, “conversation”, she describes using this fierce passion and employing it into a conversation to develop a relationship. She emphasized, “Coming out from behind yourself and make the conversation real.” Her constant emphasis on Fierce Conversations eventually highlighted its true importance as it progressed. One of the tools she used was called the Decision Tree. She used a tree analogy and basically stated that there are four categories of decisions. The analogy of the four parts of the tree: root, trunk, branch and leaf decisions indicate the degree of potential harm or good to the organization as an action is taken at each level. Simply put, leaf decisions are less impactful and these types of decisions can be made without consulting anyone and root decisions cannot be made by oneself because the results could have an organization-wide impact.

This is a very good analogy and a wonderful tool. As a botanist or a gardener, it might be more aligned with their interests. But, as a Medical Laboratory Scientist, in the context of Army Medicine, I imagined the thought process in a much different way. As a laboratory professional, we provide healthcare in a hospital setting which is more patient-centered as opposed to her “tree and leaf” analogy in a business environment which is customer and product-focused. People all around the world have tools of their trade: a carpenter has a hammer, an accountant has a calculator, a physician has a stethoscope, and a medical laboratory technician has a microscope. I would offer that you prepare your eyes, and peer into my metaphorical microscope, as we look at the Decision Cell.

The Decision Cell Defined

The cell is the basic structural, functional, and biological unit of all known living organisms. A cell is the smallest unit of life. Cells are often called the “building blocks of life”.

In contrast with The Decision Tree, The Decision Cell only has three categories: Cell wall decisions, cytoplasmic decisions, and nuclear decisions. I reduced the number because when dealing with human life, we need to expedite our thoughts and make decisions faster. A common medical abbreviation for urgent or rush is STAT. In medical situations, we need to think quickly, we need urgency, we need to have a STAT mindset when it comes to saving a human life. As we look at the decision cell, I will focus your attention on three anatomical parts of the cell: The cell wall, the cytoplasmic area, and the nucleus.

The Decision Cell: The Cell Wall

The word cell is Latin for cella meaning small room. Every room has walls surrounding it, so we’ll start with the cell wall. Aside from the primary function of the cell wall which is to give support to the cell and keep cell contents together, it is selectively permeable. The membrane allows some materials to enter the cell but not all. Water, oxygen and carbon dioxide freely pass through it, however; many other chemicals cannot. It is strong, yet constantly moving. In this same way, there are decisions that you make every day. Cell wall decisions, you don’t have to tell anybody about the actions, just do the actions. If you’re walking and you see a piece of trash, pick it up. If you’re looking through a patient’s chart, if there’s a minor mistake fix it. If there’s a patient who looks lost, help them. You don’t have to tell anyone about it, just do it, just fix it, and just take action. Do what needs to be done. If you see someone frowning, smile. If you see a patient who’s having trouble walking, get them a wheelchair. If you see a patient who’s feeling down and you need for them to follow you, tell them to walk like an Egyptian. Make them laugh, make them smile, add light to an otherwise dark day. There are so many reasons why people are in the hospital, but usually, none of them are good. Very few people come to the hospital when everything is going well. Even for a check-up, the patient has been fasting for hours and they want to get their blood drawn so they can eat. Every time you walk past someone, they are thinking something like, I wonder what the x-ray will show? I wonder if my lab results are all right? Do I have Cancer? Did the Cancer go away, is it cured? I wonder if they will have my medication this time? I hope they don’t cancel my surgery!

We should take time to think of those little things, think of what we would like someone to do for us, and build relationships and trust as a result of our actions.

The Decision Cell: The Nucleus

For now, let’s skip the middle area, the cytoplasmic area and talk about the nuclear area. Let’s talk about nuclear decisions.

The nucleus is the center of the cell, it contains the genetic material like DNA and chromosomes. The nucleus controls many functions of the cell. It is the center and some call it the brain. It is for these reasons that nuclear decisions are made jointly, with input from many people. In a Military hospital, the nucleus sits in the command suite and nuclear decisions are made by and/or consulted with the Hospital Commander, Command Sergeant Major, and the Deputy Commanders. Department Chiefs and other key hospital leaders are involved as well. In a civilian hospital setting, it is the Hospital CEO, Deputy CEO’s, and the Executive Leadership who serve in the nucleus and are heavily involved in making the nuclear decisions. These are the decisions that, if poorly made and implemented, could cause harm to the organization. These are also decisions that, if implemented in a good way, could improve the organization.

Do you want to be able to recognize another employee for exceptional service? That’s a Nuclear decision. Do you want to change the hours of your clinic? Another Nuclear decision. An easy way to remember nuclear decisions, is that Nuclear decisions are about people, places and things. More people, more places, and more things. More specifically, Nuclear decisions involve “the assignment of more people to work with us”, “the addition of the amount of space in which we work”, and “the addition of equipment, to put in the spaces for us to use”.

  • Do you need to create a new position to add to your overworked staff? (a “more people” decision)
  • Do you need to reallocate space? (a “bigger place” decision)
  • Do you need to purchase large pieces of equipment? (a “more things” decision)

Nuclear in a slightly different, yet relevant, context

Besides the relationship of the nucleus of an cell, another way to view nuclear is, in the context of nuclear energy, as the nucleus of an atom. An Atom is made up of three particles: electrons, protons and neutrons. In the core of the atom, where the protons and neutrons are found, is called the nucleus. A great deal of energy exists in the bonds that hold the core, or the nucleus, together. The bonds are stronger bonded together, than apart. But, when something is strong enough to break them apart, and when those bonds are broken (i.e. nuclear fission) either something good or something bad will happen. A negative, or bad, result would be nuclear radiation. The nuclear chain of reactions that lead to an uncontrolled nuclear radioactive explosion isn’t good. Not only is it bad, but nuclear radiation can affect millions of people not only in the moment, but for years to come. A positive, or good, result of this would be electricity. Harnessing that energy to produce electricity is good. Electricity is great, electricity is necessary, and electricity is vital to our everyday life. In this same way, we can harness our thoughts and make decisions that can strengthen our bonds within the nucleus in a positive way, and the spark of our decisions can conduct electricity throughout the organization.

A nuclear decision in action

About a year ago, I noticed some recurring patient safety challenges across the departments within our organization. Instead of a typical class, I decided to write a song and develop a storyboard for a music video. Because I viewed this as a Nuclear decision, I presented the storyboard to our Hospital CEO. He liked the idea and approved it to move forward to the Public affairs team. Shortly thereafter, I started working with the videographer and started directing the music video. The video while funny is about a serious subject: reducing patient safety risks. Reducing risk by labeling samples at the bedside and reinforcing the importance of patient verifiers, improving awareness regarding proper laboratory collection requirements, and enhancing awareness by portraying the serious nature, and life-ending catastrophic situations, that could occur as a result of a simple sample mix-up. We also filmed and recognized our teammates throughout the hospital which reinforced the message that while we have challenges from time to time, we’ll get through them together because we are a family. At the end of the video, all of the Hospital leadership, to include the Deputy CEO of Quality and Safety, states their commitment to Zero Harm for the patients who are entrusted to our care. Bottom line, Nuclear decisions can’t be implemented without approval which is also supplemented through financial support. Simply put, without that approval of the CEO, decisions that involve the people, places and things, can’t be purchased without the authorization of those who comprise the nucleus.

The Decision Cell: The Cytoplasm

Now, let’s go back to the cytoplasmic decisions. The cytoplasm is important but just look at it. The mere appearance of it shows you that it’s complicated. Our body is made up of mostly water, our body is made up of cells and the cytoplasm holds a large percent of that water. Besides the liquid content that is so vital to our existence, the cytoplasm is also filled with all kinds of organelles: Endoplasmic reticulum, vacuoles, Golgi apparatus, ribosomes. It’s a delicate balance because there’s a lot of important functions that take place in the cytoplasm. To be honest, the cytoplasm is messy. Much like the cytoplasm, cytoplasmic decisions are a delicate balance too. Quite often, there’s a lot going on from day-to-day so there’s a delicate balance we need to maintain.

Often there are times when there’s something going wrong and we need to tell somebody. You can make the change on your own, but you don’t need to tell anyone right now. You might have made a decision that helped someone’s medical condition improve, but you don’t need to stand on the CEO’s desk to let him or her know about it right then. You might have helped a patient after hours but you don’t need to call one of the Deputy CEO’s at home when they’re probably asleep. Cytoplasmic decisions need to be reported up the Endoplasmic reticulum-chain in due time. There are opportunities to report these actions at the appropriate time, you just need to determine the right time. As a supervisor or a leader, when you openly communicate with your team, they know what is important to you and they know when to tell you about it too. It might be daily or weekly. Sometimes, my teammates stop by my office daily to give me an update if it’s required. If it can wait, they’ll tell me the next day. Whether today or tomorrow, may not be important, but one thing for sure, they always seem to figure out the best time to tell me.

A Cytoplasmic decision in action

In my book, I talk about perceptive intuition coupled with communicative engagement. To accomplish this, I like to focus, be present, and be engaged in every conversation. When I’m in my office, and I’m in a serious discussion, I try to keep the door closed so I don’t get distracted. But, but every once in a while, the door inadvertently gets left open. When this happens, there are times when someone is standing outside my office. If so, I glance up and see who it is. If we make eye contact, either one of three things happens- they turn around and walk away, they give me a short nod, or they give me a long stare. When they turn around and walk away, that means it wasn’t imperative. They wanted to share some news about their family, they want to tell me something interesting that they just found out, or they’re having a good day and they want to check in with me. Maybe they observed that I was deep in thought and they wanted to make sure I was doing ok. A short look means that I need to find them before one of us goes home for the day. A long stare means I might need to stop the current conversation for a moment to receive a quick update because the teammate has a serious situation they need to share with me. This is not something that we have discussed formally per se. It is the subtleties of communicative engagement. I know that my teammates respect my time, and they don’t want to interrupt other people, because they respect their time too. They know that the information they have is not more important that someone else’s information, but just as important. However, when a human life is in the balance, it becomes serious. If it is a situation that can wait, they start taking care of the situation and communicate their progress on their slides and at the weekly Lab Manager Synchronization Meeting. When I see it on the slide, especially if it’s in red, I’ll ask what I might be able to do in order to support them. When the leadership is doing hospital rounds that provides another cytoplasmic time to update the nucleus. Our hospital has some daily/recurring meetings that occur first thing in the morning called Daily Check-in (DCI) and the Morning Department Chief’s Meeting. If your hospital has a daily meeting, telling your supervisor prior to that meeting is a great time and provides a wonderful opportunity for him/her to share it with the nucleus. You can also tell your supervisor and the supervisor can report it during the Hospital staff meeting with the CEO. If you look, you will find there’s plenty of opportunities to share this meaningful information so take advantage of all of them. There you have it, the three anatomical parts of the cell: The cell wall (cell wall decisions), the cytoplasm (cytoplasmic decisions), and the nucleus (nuclear decisions).

The “Data, Information, Knowledge, Wisdom” (DIKW) Construct

The last thing, I’d like to share is- always be mindful of the quality of your thought processes. Many of you have seen or heard of the DIKW pyramid:

Source: Internet

Source: Internet

There is often a lack of understanding of the difference between data, information and knowledge and the ways in which it can be employed to make wise decisions.

Source: Internet

Source: Internet

  • Data are the pure and simple facts without any particular structure or organization, the basic atoms of information. The data of knowing that the light is red is not enough.
  • Information is structured data, which adds meaning to the data and gives it context and significance. Knowing the location of the light, in and of itself is not particularly helpful.
  • Knowledge is the ability to use information strategically to achieve one’s objectives. The knowledge that you’re driving toward the red light will help you achieve the objective.
  • Wisdom is the capacity to choose objectives consistent with one’s values within a larger social context. The wisdom to stop the car could save your life!

Another way to look at it is like this…

Source: Internet

Source: Internet

Or like this…

Source: Internet

Source: Internet

Don’t just tell someone that the toilet is overflowing in the patient’s bathroom. Take note of the room number, call housekeeping to clean up the immediate spill so they can post the “wet floor” sign, submit the work order with J&J, and document the work order on the safety board. Don’t just give your supervisor data. Elevate your level of thought towards the betterment of knowledge. This will in turn, help your supervisor make a wise decision.

DIKW in action

One day, I discovered a problem. With a bit of research, I found out what we needed and who the approving authority was. Then, I drafted a message for my supervisor to send to the approving authority. In other words, I wrote the message as if my supervisor typed it. I also tried to mirror, or mimic his writing style. Then, I attached all of the supplemental documentation and preemptively completed the required forms with all of his demographical information. All my supervisor needed to do was digitally sign the form(s), add those signed forms as enclosures, copy-and-paste the verbiage, and send the email. In short order, the request was approved. Something that we expected to take more than a week, took a day. In this way, I took the data infested problem and disinfected it with a knowledgeable solution so my supervisor could wipe it off with a wise decision.

I always find time to talk with my supervisors on a variety of topics because it helps me gain a better understanding of his or her thoughts. This continual collegial dialogue becomes a critical enabler for better decision-making and rives rise to the strategic thought that I now speak. Please allow me to provide an example of this. One day, I was talking to my supervisor in the waiting room. In our conversation, one of the thigs we discussed was the appearance of the Waiting room furniture and how it was no longer in good repair. The furniture was soiled and even I felt uncomfortable sitting on it. If I felt uncomfortable, I could only imagine how each patient feels about them. The waiting area is the first thing the patient’s see and dirty furniture gives them a poor first impression. A few months later, I went to my supervisor’s office and he mentioned the furniture again. “Yes, we have been working on that”, I said. He said, “I don’t know how to pick out furniture. My wife usually picks out the furniture.” I smiled. He said, “We should have someone else pick it. I don’t want to pick it out. I wonder what the staff would like to have. We should let them have a say.” I said, “I agree. I thought that you might think the same way, so we already asked them to pick it out.” He said, “Well, we don’t just need chairs, the front desk is in bad shape too.” I said, “Yes, sir. I agree, that’s why we already asked the team to pick out chairs that would match the front desk.” He said, “We really need to order it.” Then, I said, “We have already placed the order in the Capital Equipment Replacement Program (CERP) system. (The CERP System is how we submit equipment for purchase through Military Treatment Facilities)”Well, sir, I have already sent you the link, I just need you to click “approve”. He then looked through his email messages, clicked the link, and just looked at me. “Well, what do you need me for?” he said. I said, “Look, sir, anyone can tell you something is wrong. That’s broken, the wrong test was ordered, that patient is dehydrated, that needs to be fixed, or that is the wrong result. That’s data. I could also say,”That toilet is overflowing, I guess I’ll call J&J." and leave it at that. But, instead, I’d rather take the extra steps and transform the data to knowledge which would allow you the opportunity to make the wise decision, like when you click the approve button. I’m supposed to be making your job easier. You should be happy that I’m here. If you’re not happy I’m here, I’m doing something wrong."

Anecdotally, I believe this thought-process mixed with civility and contextual intelligence can help us employ our technical skills, in the milieu of our environment, for the benefit of the health of our patients. There are plenty of examples of this:

A phlebotomist might notice that a patient has a certain cartoon character on her shirt and play a movie with that character on the television in the blood drawing room, or give her a sticker, to help calm the anxiety of her young patient. A medical attendant might ask the patient, who is getting evacuated if she would like to call her husband to tell him to meet them at the hospital. A Morgue assistant working on an autopsy might understand the implications of the reasons for the death and prepare the morgue to meets the specific needs of the Pathologist or Medical examiner. A pathologist might do a bit of research on the deceased Soldier so their conversation can provide a sense of closure to the bereaved spouse. A Medical Laboratory Technician (MLT) working in Hematology, while scanning the blood of an unsuspected patient, may find that they have contracted Malaria or AML (Acute Myeloid/Myelocytic Leukemia), confirm their findings, call the nursing staff with the critical results and notify the attending physician who will be relieved because he had no idea what was ailing his patient.

I will close with a real-life example: An MLT working in Chemistry ran a blood gas, and after repeating the test with a similar result realizes that the calculation produced by the analyzer was incompatible with life, called the nurse and asked for a new sample. Through this process, the nurse realized that the nursing assistant in training drew the blood from the arm that had the IV. After receiving the fresh blood sample, the results were within both normal and acceptable range. This good news story started with one fundamental thought- a decision!

If we all do our part, make not only simple decisions that are appropriate, but high-quality decisions, we’ll break free from the prison cell of indecision, help each other, serve our patients better and become a High-Reliability Organization as a result of our efforts.

Group photos of the Laboratory team of teams, at Blanchfield Army Community Hospital, Fort Campbell, Kentucky, in support of Breast Cancer awareness

Group photos of the Laboratory team of teams, at Blanchfield Army Community Hospital, Fort Campbell, Kentucky, in support of Breast Cancer awareness

Group photos of the Laboratory team of teams, at Blanchfield Army Community Hospital, Fort Campbell, Kentucky, in support of Domestic Violence Prevention

Group photos of the Laboratory team of teams, at Blanchfield Army Community Hospital, Fort Campbell, Kentucky, in support of Domestic Violence Prevention

References

2018 Army Medicine Campaign Plan

Scott, S. (2002). Fierce conversations: Achieving success at work & in life, one conversation at a time. New York, N.Y: Viking.

Lowery, L. (Not yet published). His-story: A spiritual inspirational memoir. My life in the Military and how when people tried to put periods into my life, and I had question marks, God inserted commas instead. Publisher TBD.

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