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No matter what your job position or title, YOU are President and Chief Executive Officer of "Me Incorporated", the single most exciting company in the world. We are in the midst of a great revolution, summarized in the "Delta Table of Revolutions". Part one of this table looks at macro trends--trends affecting our economy and society. Part two examines the revolution taking place within health care. Part three looks at the revolution taking place within laboratory medicine. To survive and thrive in the 21st century, Me Inc. must adopt the best practices of any highly successful company. Me Inc. must develop its core competencies--transferable skills that you can take with you from one organization to another. There are 10 core competencies of Me Inc. These are over and above the essential technical, scientific, and/or medical knowledge and skills that you have. The core competencies you require minus the core competencies you possess equal your skills gap. The key to success for Me Inc. is to close the skills gap. This must be undertaken in a carefully planned way. You must form a clear, concise, and, above all, written plan with specific, realistic, and measurable goals.

The natural progression of automation in the clinical laboratory next will lead to robotic devices to perform many of the manual tasks still remaining. To date, most efforts of laboratory automation have been directed at the analytic phase. New targets for automation will be at the preanalytic and postanalytic phases where many of the bottlenecks in specimen flow now occur in highly repetitive manual tasks. Laboratory professionals will have a unique opportunity to incorporate new concepts of robotics in their facilities to improve error rates and to use massive laboratory databases to improve medical and public health services.

CLIA '88 regulations require that laboratories evaluate and assure the competency of all personnel who perform laboratory tests. The study objective was to determine the interpretation of, compliance with, and implementation of these regulations by laboratories. Interviews were conducted with a stratified nonrandom sample of 20 laboratories including hospital, blood bank, commercial reference, physician office, group practice, and independent laboratories from 12 selected states. Information was collected about the history and development of their competency assessment programs and activities, their definition of competent staff, the interrelationship of competency assessment with performance appraisals, cost, benefits, and the assessment methods and tools used. Competence of laboratory personnel is a complex issue reflecting the dynamics and environment of each unique laboratory setting. This research found no consistent method of competency assessment implementation. This report provides a summary of methods and approaches. Learning what other laboratories are doing will assist managers in developing meaningful and cost-effective competency assessment programs. Documenting all competency assessment activities is important; it serves as a personnel performance management tool and satisfies inspectors. Used in the spirit of continuous quality improvement, the competency assessment program may point to ways of improving processes, personnel, and performance.

Managing human resources in this era of precipitous change poses one of the most difficult challenges and opportunities for leaders in the clinical laboratory. Shifts in health systems integration, cost control, patient-focused managed care, and provider changes have led to trends which fundamentally alter the way in which clinical laboratory services are organized, provided, and funded. To be successful change agents, laboratory managers must understand the cycle of human resource development and how people adopt change. They must embrace a systems thinking perspective and develop strategic leadership skills to share a vision of what the laboratory of the future will be. These new, advanced human resource management skills can be acquired through a variety of formal and informal learning experience.

Medical technologists and their coworkers serve as a critical link in the delivery of health care, yet their performance typically is appraised in a traditional way, causing stress for both managers and workers. Drawing on Total Quality Management concepts, this article proposes a framework for appraising performance in a clinical laboratory context and shows how it can be used to address the problems that managers face in providing constructive appraisals to laboratory personnel.

Significant changes are occurring in the organization and delivery of clinical laboratory services. Many laboratorians are concerned that these changes will adversely affect the quality of these services as well as their own careers. The purpose of this paper is to review the changes occurring in health care and to discuss their impact on laboratory and other health-care services. It will present the concept of the postmodern laboratory and the skills and skill mix of personnel needed by the new organizational paradigm.

This is the second part of a two-part article on finding and hiring the best employees for your organization. Part I discussed costs of poor hiring, benefits of good hiring, elements of an effective hiring process, the job description, hiring from within versus outside the organization, the job application, résumé screening, telephone screening, and salary considerations. Part II will discuss the selection interview, legal issues in hiring, and the orientation process.

This article describes the benefits of good hiring and the costs of poor hiring in a health-care environment. The elements of an effective hiring process are delineated and discussed, including job descriptions; position specifications; the advantages and disadvantages of hiring from within or outside of the organization; and job application, résumé, and telephone screening. Part II will focus on compensation considerations; the selection interview; legal issues in hiring; letting candidates know the results; and orientation of new employees. Keys for success in each of these areas are provided. An outline of the steps in a selection interview as well as specific do's and don'ts in interviewing are provided. The point is made that the selection of a new employee is one of the most important processes in the effective management of any health-care organization. Yet, it is often done in haste, with a sense of urgency and with insufficient attention to the demands of the job, the specific nature of the organization, and the less tangible but critical aspects of the applicants.

Total quality management and continuous quality improvement are important tools for survival in today's turbulent economy. The George Washington University Medical Center (GWUMC) has initiated institution-wide training in total quality improvement. The FOCUS-PDCA process is one specific instrument used at GWUMC to pursue the goal of total quality. The FOCUS-PDCA acronym stands for: Find a process to improve; Organize a team that knows the process; Clarify current knowledge of the process; Understand the causes of process variation; Select the process improvement; and then Plan, Do, Check, Act. The FOCUS-PDCA process was used to solve a real-world problem in the Central Laboratory of GWUMC. Dramatic improvement in the success rate of phlebotomists resulted, and the percent of "unable to draw" events decreased from more than 5% to less than 1%.

Selecting well-qualified employees has become increasingly difficult for employers. Legal complaints citing discrimination and negligent hiring have made interviewers and organizations more vulnerable than ever. Also, predicted declines in the skill levels of employees will continue to make it difficult for interviewers to select applicants who best match job requirements. These difficulties can be traced to a variety of traps that often lead to poor hiring decisions. The authors describe the traps interviewers face and highlight actions that can be taken by interviewers to avoid these traps and to improve the effectiveness of their interviewing and employee selection decisions.

The law of defamation and the risks involved in issuing employment references are discussed. A hypothetical scenario is used to illustrate the legal standards governing the tort of defamation and to apply those standards to employment references. Practical suggestions for a "controlled reference" policy are provided, with the objective of allowing for responsible exchange of employment information and avoiding a defamation lawsuit.

In February 1991, CLMA's National Affairs Committee (NAC) developed a proposed position statement on mandatory HIV/HBV testing of health-care workers. The proposed statement was submitted to the 24-member National Affairs Reactor Panel and, based on their input, appropriate revisions were made. In May 1991, CLMA surveyed the full membership, and, as a result, the following position was adopted. Ninety-six percent of the members responding agreed with principles 1, 2, and 3; 88% agreed with 4, 5, and 6. NAC members include Royal A. Crystal, Chair; Linda D. Bielitzki, J.D., Vice Chair; Michael G. Bissell, M.D., Ph.D.; Earl C. Buck; Michael A. Maffetone, D. A.; Timothy Murray; Laurence J. Peterson; Marianne C. Watters; and Martha A. Feichter, National Affairs Analyst.

Performance appraisals have recently become the focus of legal scrutiny. Because the appraisal process may lead to salary adjustments, promotions, opportunities for development, discipline, or even termination, issues such as fairness and discrimination are raised. This paper discusses specific constitutional and statutory laws that prohibit discrimination in performance appraisals. In addition, specific rulings from select court cases illuminate key legal defense factors in performance appraisal. Questions are posed to help identify weaknesses in a laboratory's performance appraisal system.

Service quality is the great differentiator of the 1990s. It means understanding and consistently meeting customer requirements. A lack of complaints is a poor indicator of customer satisfaction. Reliability is the most important factor affecting your customers' perception of quality. This article outlines a do-it-yourself process for creating and enhancing a quality culture in a clinical laboratory. This process requires understanding the nature and importance of quality; adopting quality goals and performance measurements; asking for customer input; rewarding satisfactory performance; creating self-managed teams that aim for continuous improvement; and encouraging unrelenting service directed at delighting customers. In a competitive marketplace, quality is the great differentiator that pays impressive dividends.