Pathology and Laboratory Medicine Management:

Curriculum and Competencies

Laboratory Management is the integration and coordination of organizational resources to provide
quality laboratory services as efficiently and effectively as possible. Success requires a vast array of
skills founded on sound principles of management science.

Leadership: General Principles

Leadership and management models

Competency: Medical Knowledge
- Describe Management Theory
- Differentiate between leadership and management
- 1. Tasks and tools of management
- 1.1 Organizing daily operations
- 1.2 Directing personnel
- 1.3 Controlling performance
- 1.4 Time management
- 2 The role and responsibilities of the Medical Laboratory Director
- 2.1. CLIA requirements
- 2. 1.1 Standard: Laboratory director qualifications
- 2. 1.2 Standard: Laboratory director responsibilities
- 2.2. CAP and The Joint Commission Standard
- 2. 3 Critical leadership and management skills
- 3. Emotional intelligence of leadership

Planning

Competency: Systems-Based Practice
- List the basic elements of the strategic processes
- Develop a business plan, including operations, marketing and sales
- 1. Strengths, Weaknesses, Opportunities, Threats (SWOT analysis)
- 2. Scenario planning
- 3. Disaster Planning

Communication

Competency: Interpersonal and Communication Skills
- Create an effective presentation and conduct a management meeting.
- 1. Interpersonal communication tools and strategies. Effective Communications
- 2. Presentation skills
- 3. Meeting management
- Recognize the role of continuing education activities in the practice of Pathology
- 1. The Pathologist as educator
- 1.1. Staff continuing education
- 1.2. Tumor Board and other medical staff functions
- Analyze public relations as it relates to the practice of pathology
- 1. Dealing with the media
- 2. Advocacy
- 2. 1 Lobbying
- 2. 2 Political Action Committee
- 2. 2.1 College of American Pathologists (PathPAC)
- Describe business development activities as they relate to the practice of pathology
- 1. Laboratory outreach management
- 1.1. Marketing
- 1.1.1. Market analysis and planning
- 1.1.2. Advertising and promotions
- 1.2. Sales
- 1.2.1. Basics of selling your services
- 1.2.2. Client services
- 2. Logistics and communications
- 2.1. Specimen pickup
- 2.2. Result reporting
- 3. Research activities
- 3.1. Principles of research
- 3.2. Grant applications and administration
- 3.3. Funding agencies and entities
- 3.3.1. Government
- 3.3.2. Institutional
- 3.3.3. Industry

Personnel Management

Organizational structure

Competency: Systems-Based Practice
- Identify the most common forms of clinical laboratory and pathology practice organizational structures.
- Recognize the different forms of professional practice Laboratory models (academic medical center, community hospital-based and independent)
- Describe Pathology group practice arrangements

Personal Career Development

Competency: Systems-Based Practice
- Identify the essential elements of professional employment and career development
- 1. Preparation for the job/fellowship market (or, How to find a job, keep it and what is expected of the newly graduated pathologist in practice?)
- 1.1. Preparing your CV/resume
- 1.2. Networking
- 1.3. Interviewing skills, presentation and etiquette
- 1.4. Understanding the job market characteristics
- 1.5. Being a member of a pathology group or academic practice
- Describe the importance of maintaining good Medical Staff relations
- 1. Being a member, in good standing, of the medical staff of a hospital
- 2. Medical staff committee participation
- Analyze the role of the pathologist/pathology group from the hospital administrator’s perspective
- 1. Hospital Relations

Principles of Human Resource Management

Competency: Systems Based Practice
- List relevant labor laws
- 1. Fair Labor Standards Act
- 1.1. Exempt and non-exempt employees
- 2. Affirmative action, discrimination, sexual harassment
- 3. Americans With Disabilities Act
- 4. Family Medical Leave Act
- 5. Collective bargaining agreements and labor unions
- Describe the different job classifications and job descriptions
- 1. Training and certification of medical laboratory science professionals
- 2. Competency assessment
- 3. Work force trends
- 4. Managing the technical workforce

Recruiting, Interviewing, Hiring

Competency: Interpersonal and Communication Skills
- Conduct an interview for a new employee
- List the principles of compensation and benefits management

Performance Evaluations

Competency: Interpersonal and Communication Skills
- Recognize the importance of a performance appraisal as a motivational tool
- Conduct a performance appraisal
- Recognize the importance of setting performance expectations
- Describe progressive discipline and its documentation as an effective communications tool
- 1. Performance evaluation
- 2. Counseling
- 3. Progressive discipline
- 4. Conflict resolution and dismissal
- List employee retention strategies
- Evaluate the role of teamwork and consensus building

Operations

Laboratory operations management

Competency: Medical Knowledge
- Create a test menu
- Design a program for test evaluation and validation
- List the essential elements of choosing and monitoring reference laboratories
- 1. Use of reference laboratories
- 2. Request for Proposal process
- 3. Monitoring performance
- Apply workforce staffing models
- 1. Complex-based standards and job responsibilities
- Analyze workflow management
- 1. Specimen management
- 2. Instrument maintenance
- 3. Automation (task-targeted, sub-total, total laboratory automation)
- 4. Bar code and RFID technologies
- 5. Laboratory design and facilities management

Quality control principles

Competency: Practice-Based Learning and Improvement
- Analyze QC data for a common laboratory procedure
- Interpret QC data for a common laboratory procedure
- 1. Levey-Jennings plots, Westgard Rules

Quality assurance and quality improvement

Competency: Practice-Based Learning and Improvement
- Participate in a quality improvement activity
- 1. General principles
- 2. CAP Q-Probes
- Process improvement and industrial engineering principles
- 1. LEAN
- 1.1 What is a LEAN laboratory?
- 2. Six Sigma

Service standards and standard operating procedures (“The Procedure Manual”)

Competency: Practice-based Learning and Improvement
- Prepare a laboratory SOP for a test procedure or process
- Prepare a laboratory report
- 1. Report format (in the LIS, HIS, web portal and EMRs)
- 2. Utilization management
- Identify productivity measures
- 1. Benchmarking (internally and externally) metrics
- Describe managing physician office laboratories (POL)
- Define POC, Waived and Provider Performed testing
- 1. Proficiency and competency requirements

Laboratory Equipment

Competency: Medical Knowledge
- Demonstrate a new instrument evaluation
- Prepare a justification for its acquisition
- 1. Technology assessment
- 2. Equipment acquisition
- 3. Financial justification process for purchase, lease and reagent rental agreements

Supply chain management

- Vendor and supplier relationships
- Inventory management
- Group Purchasing Organizations (GPO)

Proficiency testing

Competency: Medical Knowledge
- Demonstrate ability to review external proficiency surveys
- Respond to identified problems or questions
- 1. CAP Proficiency Test Surveys and others
- 2. Anatomic pathology PT

Financial Management

Budget preparation

Competency: Medical Knowledge
- Identify basic elements of preparing a budget for pathology and laboratory services
- Describe the role of a budget in planning, managing and controlling operations

Basic accounting and financial reporting

Competency: Medical Knowledge
- List the general elements of an income statement and balance sheet
- Interpret an income statement and balance sheet
- 1. Financial statements and variance analysis
- 2. Auditing
- 3. Cash flow analysis
- 4. The Revenue Cycle

Sources of pathology and laboratory revenue

Competency: Medical Knowledge
- Identify the general forms of reimbursements for pathology and laboratory services
- 1. Insurance and Medicare
- 2. Forms of reimbursement
- 3. Medicare and Medicaid
- 3.1 Overview of CMS
- 3.2 Part A services and the DRG (in-patient)
- 3.3 Part B services (out-patient and out-reach)
- 3.3.1 Technical Component (TC)
- 3.3.2 Clinical Laboratory Fee Schedule
- 3.4 Professional Component (PC)
- 3.4.1 RBRVS
- 3.4.2 Physician Fee Schedule
- 4. Part C (Medicare Advantage) and Part D
- 5. Medicaid and federal and state funding

Categories of laboratory expenses

Competency: Medical Knowledge
- List the necessary elements of test cost accounting
- Cost account a common laboratory procedure
- 1. Test cost accounting and price setting
- 2. Total cost, fixed cost, variable cost, average cost and marginal test cost analysis.

Coding, billing and collections

Competency: Medical Knowledge
- Assign correct CPT codes for common Pathology and Laboratory Medicine procedures
- 1. Current Procedure Terminology (CPT)
- 2. Diagnosis coding (SNOMED, ICD-9/10)
- 3. Client billing, third party billing
- 3.1 Contracted billing services arrangements
- 4. Accounts Receivable (days outstanding), Bad debt, billing benchmarks
- 5. Pension funds, insurance and tax planning

Informatics

Statistics

Competency: Practice Based Learning
- Given tests results linked to appropriate clinical data, calculatesensitivity, specificity, ROC curve, positive predictive value, negative predictive value, and likelihood ratio at any given result threshold
- 1. Basic parametric and non-parametric descriptive statistics
- 2. Predictive values, likelihood ratios and ROC curves
- 3. Regression analysis

Management of IT systems

Competency: Practice-Based Learning and Improvement
- Productively engaging with and supporting IT managers purchase, build and maintain major IT systems in the laboratory and hospital
- 1. Vendor relationships, contracting
- 2. Security (HIPPA)

Transactional databases, data warehouses

Competency: Practice-Based Learning and Improvement
- Evaluate the role of transactional databases and data warehouses in the everyday practice of pathology
- 1. Retrieval of database information
- 2. Tumor registries
- 3. Biorepository data bank

Laboratory information systems (LIS)

Competency: Practice-Based Learning and Improvement
- Describe Laboratory Information Systems and their use in daily practice
- 1. Functionalities
- 2. Integration (interfaces) with other systems (HIS, EMR)
- 3. HL7 basics and LOINC
- 4. Selection process

Integrated patient centered support

Competency: Practice-Based Learning and Improvement
- Describe Integrated patient centered support
- Evaluate all elements involved in Integrated Patient Centered Support
- 1. Electronic health record (EHR)
- 2. Electronic medical record (EMR)
- 3. Internet resources and linkages

Public health reporting

Competency: Systems Based Practice
- List state reporting laws
- Describe the laboratory’s role regarding reportable diseases

Personal computing

Competency: Practice-Based Learning and Improvement
- Analyze scientific and financial data using a spreadsheet program
- Describe scientific and financial data presented using a spreadsheet program
- 1. Word processing, spreadsheets, presentations, scheduling, and other productivity tools
- Pathology: an information specialty
- Identify different features of laboratory reports that affect physician comprehension and behavior
- 1. Reporting
- 2. Consultations
- 3. Education

Digital imaging

- Describe the role of digital imaging in Pathology
- Analyze the processes involved in preparing digital images and their use
- 1. Slide scanning, viewing, image storage
- 2. Remote microscopy
- 3. Image analysis

Compliance

Competency: Practice based learning and Improvement
- List the basic elements of the model compliance plan
- 1. Model Compliance Plans for Clinical Laboratories
- 2. Privacy (HIPAA)
- 3. Laboratory certification and accreditation
- 3.1 CLIA certification
- 3.1.1. The Clinical Laboratory Improvement Amendments
- 3.2 Analytical complexity (Waived, Medium, High)
- 3.3 CAP, COLA, JCAHO accreditation

Facility Safety

Competency: Medical Knowledge
- Describe the basic elements of the laboratory safety program
- 1. OSHA regulations
- 2. Laboratory safety plans
- 2.1. Chemical hazards, MSDS
- 2.1.1 MSDS Frequently Asked Questions
- 2.2. Radiation safety
- 2.3. Biological hazards and Universal precautions
- 2.4. Electrical safety
- Recognize the importance of Patient safety
- 1. Patient safety principles
- 2. Laboratory errors management

Biomedical ethics and Institutional Review Board requirements

Competency: Medical Knowledge
- List the steps involved in obtaining Institutional Review Board (IRB) approval for clinical research studies
- 1. The Common Rule
- 2. Informed consent and study patient protections
- 3. Conflicts of interest

Laboratory accreditation and inspections

Competency: Practice-Based Learning and Improvement
- Perform a CAP self-inspection or mock inspection or participate in a CAP inspection of another facility as a Team member
- 1. AABB for blood banks
- 2. ISO 15189
- 2. 1 College of American Pathologist ISO 15189 Accreditation FAQs
- Perform a mock tracer survey of a blood transfusion, starting at the order to transfuse and following through the laboratory and back up to the floor. (For information on how to perform a tracer, please see http://www.jointcommission.org/tracer_methodology_101)

Quality Systems, Regulatory Compliance and Safety

Competency: Medical Knowledge
- Describe the laboratory testing process
- 1. The laboratory testing process (pre-analytic, analytic and post-analytic work)
- 2. The quality system plan and structure
- 3. CLSI Quality Systems Plan
- 3. 1 What is the Clinical and Laboratory Standards Institute?
- 3. 2 What is the CLSI QSP?

Public health reporting

Competency: Systems Based Practice
- List state reporting laws
- Describe the laboratory’s role regarding reportable diseases

Legal Affairs: contracts and negotiations

Competency: Medical Knowledge
- List the basic elements of a contract
- Demonstrate the ability to negotiate a contract employment
- 1. Essential elements of a contract
- 2. Employment contracts
- 3. Hospital contracts with pathology groups
- 4. Managed care contracts
- 5. Negotiation techniques and strategies

Risk Management

Competency: Medical Knowledge
- Identify the elements of a risk management program
- Demonstrate the ability to effectively manage an incident
- 1. Medical Malpractice and professional negligence
- 2. Personal liability and malpractice insurance
- 3. Vicarious liability of the pathologist and medical laboratory director
- 4. Occurrence reporting
- 5. The process of litigation
- 5.1 Notice, discovery, and trial
- 5.2 Legal counsel
- 5.3 Material and expert witnesses
- 5.4 Document maintenance

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