Behavior Analytic Approach to Evaluating Performance Variables in Laboratory Accessioning

Summary: Introduction: Organizational behavior management (OBM) is a subdiscipline of applied behavior analysis (ABA) that emphasizes the systematic evaluation and modification of environmental variables in the workplace to improve personnel performance, stimulate productivity, and foster organizational growth. OBM is uniquely positioned to provide a holistic, behavioral approach to process and quality improvement endeavors across various healthcare settings. Specimen accessioning is especially critical in the context of pathology laboratories. The integrity and quality of accessioning practices performed by laboratory personnel are imperative for ensuring patient safety while mitigating errors that disrupt downstream workflows and ultimately delay patient care. This study applies the principles of OBM to characterize performance barriers and assess the impact of environmental interventions on the performance of specimen accessioning in the anatomic pathology laboratory of a 244-bed hospital. Materials and Methods: The project was divided into an initial assessment, intervention period, and post-intervention assessment. The initial assessment comprised baseline analysis of accessioning specifications/requirements (spec/req) deficiencies and functional assessment of the accessioning process via the Performance Diagnostic Checklist - Human Services (PDC-HS) to identify performance barriers. The following domains were assessed with individual personnel: training/competency assessment; task clarification and prompting; resources, materials, and processes; and performance consequences, effort, and competing tasks. Interventions consisted of a laboratory-wide safety initiative, supervisory changes, updated job materials, and a revised training/competency assessment program. Post-intervention assessment entailed comprehensive analysis of spec/req deficiencies for a total of 12 months and follow-up administration of the PDC-HS to evaluate changes in the accessioning process and personnel perspectives. Results: Total spec/req deficiencies are plotted over 12 months with 2 phase change lines, denoted as Phase 1 and Phase 2, that account for the temporal proximity of interventions (Figure 1). Visual analysis demonstrates a linear reduction in spec/req deficiencies following Phase 1 with steady maintenance beyond Phase 2 (Figure 2). Overall, deficiencies decreased by 25% (337 baseline vs. 252 post-intervention). The PDC-HS highlighted multiple performance barriers at baseline, especially: 1. absence of formal training/competency assessment programs, 2. inaccurate and disorganized job materials, and 3. poor morale from predominant negative corrective feedback. Post-intervention PDC-HS results demonstrate substantial improvements in task engagement and morale, mainly attributed to addressing previously described barriers by retraining with a formalized curriculum/competency assessment, providing updated job resources, and increasing the ratio of positive-to-negative feedback. Conclusions: Stable reduction of reported deficiencies and significantly improved PDC-HS results provide quantitative and qualitative evidence that the applied interventions enhanced performance in specimen accessioning as intended. Although the results are promising, several limitations must be acknowledged. The PDC-HS is a comprehensive tool requiring synthesis of direct observations with personnel testimony, thereby introducing opportunities for bias and interference from confounding variables - such as private events (ex. motivation), staffing constraints, and turnover. Moreover, the spec/req deficiencies analyzed for this project are generated by laboratory personnel rather than automated systems, which underscores the necessity for ongoing monitoring to account for fluctuations in reporting. Even so, this project demonstrates a functional framework of the behavior analytic approach to evaluating dynamic performance variables in laboratories and beyond.