member spotlight
high-level PCR work and next-generation
sequencing—to other testing areas. It also
tests for high-consequence agents and
performs PFGE (moving toward whole
genome sequencing) on clinical and
food samples associated with foodborne
disease investigations.
Tuberculosis (TB): In addition to classical
TB culture, this unit is implementing
next-generation sequencing for more
rapid test turn-around and more timely
detection of antibiotic resistance. “I love
what they’re doing here,” said Whitmar.
Virology: The virology unit specializes in
classical serology, an expertise that is no
longer available in many laboratories. It
tests for a wide assortment of respiratory
pathogens, the rabies virus and vector-
borne pathogens, such as Zika virus.
Immunology: “This is a unit that really
works in high gear,” said Whitmar,
performing the laboratory’s single-highest
volume work: sexual transmitted disease
testing. Altogether, the unit tests over
100,000 specimens/year, with a large
proportion coming from the St. Louis area,
where gonorrhea incidence is among
the highest in the country. The unit is
increasingly turning to automation to
accommodate the high-volume testing.
Chemistry: The Chemistry Unit
performs childhood blood lead testing
and follow-up testing on environmental
samples from households with positive
clinical results. It tests private well
water and food samples for chemical
contamination. And it performs method
development and testing for the chemical
arm of the Laboratory Response Network.
PublicHealthLabs
@APHL
Breath Alcohol: Located in Poplar Bluff,
this program enforces administrative
rules and regulations for testing breath,
blood and other matrices for alcohol and/
or drugs; certifies alcohol and drug testing
devices and methods; approves training
courses; provides expert court testimony;
and conducts breath testing research
that has been published in peer-reviewed
forensic journals.
Success
Microbiology: Home to an “outstanding”
reference section, the Microbiology
Unit also maintains an expertise
in parasitology and makes all the
laboratory’s testing media. “Matt Renner,”
said Whitmar, “is a media wizard. He
makes the best anywhere, and the QC
validates it.”
Environmental Bacteriology: The biggest
chunk of this unit’s work is public water
testing, comprising 70,000 to 80,000
samples/year. The 17025 ISO-accredited
laboratory is a member of the Food
Emergency Response Network, and was
recognized by the US Food and Drug
Administration for its superlative work
helping to resolve a recurring foodborne
disease outbreak in St. Louis (ultimately
traced to Salmonella Oranienburg on
eggshells).
“We have always wanted to know how we
can make our lab better,” said Whitmar.
Thus, when staff member Laura Naught
began investigating ways to quantitatively
measure laboratory performance using
the prestigious Baldrige Business Model,
her efforts were welcomed. Staff from
the Baldrige Performance Excellence
Program assessed the laboratory and
trained several laboratorians to conduct
standardized interviews with a random
assortment of colleagues from all areas
of the laboratory. “We confirmed that
we were a high-functioning group, but
had opportunities for improvement,”
said Whitmar. Under Naught’s direction,
six workgroups were established as
part of the laboratory’s Systematically
Collaborating for Overall Performance
Excellence (SCOPE) initiative, and staff
continue to rotate into and out of the
workgroups. Said Whitmar, “We consider
the work of SCOPE the combined effort
of the staff. It is the fruit of their ideas
and effort.”
Among the SCOPE changes were staff
appreciation days, a “much more usable”
strategic plan and a greater focus on
customer and employee satisfaction.
“SCOPE has been our biggest success
story, without a doubt,” said Whitmar.
“I am elated that we are this good as
an organization.” The next steps are
to showcase the laboratory’s excellence
by attaining a state or national
performance award and to increase
excellence even further.
APHL.org
Challenges
• Retaining staff. Although the
laboratory’s employees are
“outstanding, qualified staff,” two key
factors lead many to leave after about
two years on the job: location and pay.
The laboratory’s home base, Jefferson
City, is a small town of 40,000 people,
without the attractions of “a big glitzy
city.” And Missouri state government
salaries are the lowest in the country.
“Our staff are highly motivated
and love public health and love the
laboratory. But we can’t pay them
enough.”
• Electronic test ordering and reporting
(ETOR) with the state health agency.
Although the laboratory is prepared
to implement ETOR with its parent
agency, the Missouri Department of
Health, the department is as yet unable
to receive electronic test reports. “We
can’t move forward if the Department
of Health can’t move forward with us.”
Goals
• Further integrate the Baldrige Business
Model into the laboratory’s quality
improvement program.
• Create a new personnel class—
laboratory support technician—within
state government. Once in place,
current “office support” staff in the
Central Services and Post-analytical
Reporting Units will switch to the
new class, which comes with a
higher pay scale and more varied
set of duties, including specimen
accessioning and other basic
laboratory tasks. “We can bump their
pay a little bit and give them a more
enriching employment experience.”
• Continue to implement ETOR with
major clinical partners. The laboratory
is piloting NBS ETOR with two big
hospital systems, together responsible
for 14,000 births/year.
• Continue to expand next-generation
sequencing.
• Work with the departmental billing
unit to institute online billing for
laboratory services.
• Implement a laboratory director
succession plan in the coming year. n
Spring 2018 LAB MATTERS
33