Multidisciplinary dimensions in clinical system management

Aramco Health Center is a private hospital which caters for patients from all walks of life. The institution is an also a teaching and referral hospital and provides a variety of services which include Cardiology, General medicine, surgery, Orthpaedic, Mental health, Rehabilitation, Emergency treatments and various forms of specialized treatments. Several types of Community health Services are also provided.

The health center has undergone a long and strategic redevelopment which has been targeted at the expansion of its key resources necessary for the hospital to fully meet the demand of resident of the surrounding suburbs. The health institution is equipped with about 300 beds that are sufficient to meet the demand of the community. The major departments that are targeted are Clinical Laboratory Science department, Sonography department and Dietetics department. However, the institution caters for both in and out patients. The Institution has an accreditation, certification and compliance from various bodies such as the JCIA, CAAB, CMS, NLRB, OSHA, CMS, JCAHO, ASCP, CAP, AABB, AIUM, ARDMS, JRCDMS, CAAHEP, SDMS, HCFA, ADA, CADE and CDR.

Background of the Manager

The manager who is to supervise the three departments; Clinical Laboratory Science department, Sonography department and Dietetics department is required to be both efficient and effective in his duties. The manager who is to run these departments possesses the following qualifications

Education:

The manager must have a bachelor degree in CLS and must be a holder of a MBA so as to bolster his or her managerial skills.

Experience:

The manager must have worked in a laboratory setting for a period of not less than 10 years.

The departments that the manager is mandated to supervise

The manager is to be responsible for three departments; Clinical Laboratory Science department, Sonography department and Dietetics department. These departments are all fundamental to the effectiveness of the health institution. The Clinical Laboratory Science department performs the necessary laboratory tests and employs a total of 140 employees. This includes the out patient phlebotomists as well. The Tomography department has about 30 employees and the dietetics department employs 12 specialists.

Purpose of this manual

This is a multidisciplinary manual drafted in order to guide new clinical managers whose responsibility and mandate falls within three clinical departments at the Aramco Health Center.It outlines various conditions that must be met by the different departments in regard to various accreditations, approvals and recognitions. It also spells out clearly the roles and the academic requirements that each and every staff at Aramco must fullfil.This manual is therefore aimed at streamlining the smooth running of the three departments at Aramco Health Center.The aim is to ensure that proper safety and working policies are followed in order to ensure that the level of service delivery at Aramco health Center is the best that can ever be achieved in the health care delivery.

Communication within the departments

The clinical communication must be carried out using both oral and written form. Therefore; the possession of such skills is a necessary part of being on the Clinical Laboratory Science department, Sonography department and Dietetics department teams. All the nurses must therefore be equipped with the necessary communication skills. The nurses and technicians on duty must therefore be able to actively participate in various forms of patient care, documentation of various charts and the noting of the outcome of various notes on the patients. There should however be proper communication among the departmental teams. All the team players are encouraged to participate in their duties fully and they must be engaged in multidisciplinary team activities such as meetings in order to express their opinions and also to comprehensively nature their skills.

In case of any outbreak of communicable diseases or accidental exposure, the incidents MUST be communicated to the CDC and the incidents communicated in the OSHA logs as required.

Clinical Laboratory Science department

Aramco Health Center Clinical Laboratory Science department is certified and recognized by the AABB as a full Immunohematology Reference Laboratory that provides pertinent information coupled with consultation on the identification of blood group antibodies, their grouping, and the preparation of components, therapy, testing and research on blood compatibility. This department employs a total of 140 employees which includes an in and out patient phlebotomist.

Leadership and Supervision

The laboratory must be headed by board-certified scientist whose designation could be a pathologist, a doctoral scientist, a physician. The head could also be derived from any relevant medical laboratory field such as clinical chemistry or microbiology. This is in accordance to Chapter one of the CAP Laboratory Accreditation Program Standards. The individual MUST be qualified to conduct supervisions and must be able to assume a variety of roles which include executing his or her professional duties while also performing consultative, administrative, educational, and scientific and various forms of organizational responsibilities. These roles must be executed in an effective and efficient manner and must be implemented according to the set CAP standards. In case of ineffective administration of the above roles by the chosen individual then the individual would be subject to expulsion from duty with a revocation of their laboratory accreditations.

Delegation Policy and Quality Control

The manager must ensure that a cumulative record of results from the various proficiency testing programs are kept and properly documented to be used a means of reviewing and evaluating the laboratory employees competence and to confirm if they fall within the CAP recommended limits

In order to ensure that quality service is provided and maintained in the laboratory, it is essential for the manager to ensure that daily and frequent surveillance of the various results are taken on different individuals. A recommendation should then be written in order to identify individuals who underperform in their duties.

Regulations

The Clinical laboratory science department must be compliant with the CLIA regulations and standards. The laboratory is also subject to regulation by the Centers for Medicare & Medicaid Services (CMS) subject to the rules laid down by the CLIA.

Testing regulations

The clinic laboratories are mandated by CLIA to perform all three categories of tests. These categories are waived tests, moderately complex tests and the high risk complexity tests. The waived tests are the tests that have very small chance of risk and error. This category is however exempt from almost all of the CLIA rules. This is subject to conducting test under this category in accordance to the strict compliance of all the instructions provided by the manufacturers of testing equipment.

The laboratories must be staffed with professionals who can perform moderate and high complexity testing. These professionals are the only ones allowed to perform and supervise the tests being carried out in the labs.

The laboratory must at all times adhere to the approved CLIA proficiency standards and programs which are necessary for providing an external evaluation used in gauging the accuracy of test results. The manager must ensure that the conducting of tests involving moderate and high complexity tests must be done when all systems and processes are in place so as to monitor the testing equipment and procedures' accuracy. This is to ensure that the overall qualities of every element of the laboratory are maintained at high standards.

The following guidelines MUST be followed by all the employees of this department subject to the OSHA regulations:

Hazard Communication:

The clinic is to fully comply with the OSHA standards of communication that are put in place in order to ensure that everyone in the department knows how to take care of all the hazardous chemicals in the laboratory. The standards are also put in place in order to help the employer and the employees of the health facility to adequately protect themselves from exposure to hazardous chemicals in the facility. Hazard Communication Program must be written and then implemented as per the OSHA requirements in the facility.

Blood borne Pathogens protection

All the employees must be protected from health hazards that results from exposure to various kinds of deadly and infections blood borne pathogens as required by the OSHA's Bloodborne Pathogens standard. It is the responsibility if the in-charge manager to ensure that the OSHA standards are adhered to. This is because of the inevitable risk that is associated with working in the laboratory. There must be a well written exposure plan in the laboratory at all times. It is also a MUST to ensure that all the clinical laboratory science staffs are well trained to handle any incidences that might be related to accidental exposure.

Exit Routes

The manager must ensure that the exit routes in the laboratory facility are easily accessible and are never obstructed at any time. This is in accordance to the strict requirements as outlined by OSHA.

Electrical Standards

The laboratory must be equipped with the necessary electrical hazard equipment. This requirement is one of the most fundamental requirements that must be met according to OSHA regulations. All the electrical fittings and systems must be done to comply with the strict requirements as outlined by OSHA.The laboratory must therefore be fitted with special wiring together with appropriately installed equipment.

Emergency Action Plan

As a strict requirement of OSHA, the clinical laboratory science department must comply to this standard that is used in describing all the appropriate actions that must be taken by the facility in order to ensure that there is proper safety in case of any accidents such as fire outbreak.

Fire Safety

As a strict requirement of OSHA, the facility must ensure that there is a proper Fire Prevention Plan that is necessary to avert any kind of loss of either life or property.

Medical and First Aid

All the employees who work in this department must have the necessary component of both medical and first-aid providers. This is in order to ensure that any emergency situation that arises can be met with the appropriate solution.

Personal Protective Equipment

Due to the high risk of infection that is associated with the samples in the laboratory, it is essential that the clinical laboratory department ensure that each operation in the department is thoroughly assessed in order to ensure that no employee handle potentially infectious samples without wearing the appropriate Personal Protective Equipment. It is therefore a MUST as it falls under one of the OSHA requirements.

Hepatitis B Vaccination

All the clinical staff is supposed to be vaccinated against Hepatitis B since it is a JCIA requirement. It has been proved that once an individual has completed the Hepatitis B course, he/she will definitely have a long lasting protection against individuals who are immune-competent; this means that booster doses will no longer be required. This may be so but it is highly recommended that testing on post-vaccination serological in carried out after the third vaccine dose in approximately 3 months.

All employees will are provided with a chance to undertake intra-dermal Hepatitis B vaccination. Failure of sero-conversion will also mean that the hospital will not allow an individuals participation in various procedures which are prone to exposure. The exposure prone procedures belong to a subset of the invasive procedures, and have derived their characteristics through a potential for direct contact between the health workers skin i.e. thumb or fingers; and sharp instruments which are used in surgery, sharp tissue (i.e teeth) in the body cavities or other body sites which have poor visualization or are confined such as the mouth.

Exposure to a blood-borne virus to the any employee is managed according to the set OSHA protocols. The manager should be contacted incase concerns about any particular procedure arise.

Confidentiality

• One should never disclose information about patients or any staff member to a third party over any form of communication channels.

• The staff member's records should be given same degree of confidentiality and care as patient records

• All clinical notes that are made about patients must be disposed in a proper manner after being shredded. This action must be performed in the respective departments in which the notes are taken. This action does not however be performed on clinical records.

• All the staff must be very careful when discussing or disclosing patients and their treatment regimes with their colleagues. Personal information must never be disclosed as this constitutes a serious violation of personal privacy.

• One must never include any identifying information regarding patients in their areas of assignments