What led you to your current position at the Joint Commission?
In 2020, as an Army reservist, I was deployed by the military to what’s called U.S. CENTCOM — what most of us think of as the Middle East. I was put in charge of every laboratory in all of the Middle East, from Egypt all the way up to Israel and Jordan, which included a couple combat areas as well. All told, I managed 40 laboratories in 20 different countries for the Army, Air Force and Navy.
It was also a very good time from a professional conference perspective because conferences went virtual. That meant being in the Middle East didn’t stop me from speaking at the American Society for Clinical Laboratory Science (ASCLS) or the Clinical Laboratory Management Association (CLMA) conferences. I also had the opportunity to do a webinar series on laboratory management.
If you look at an MBA or MHA degree, nobody with those is ever going to focus on laboratory medicine. They might focus on hospitals in general, but not the lab. There were so many lessons that I wish I had learned before becoming a lab director that would have made me more effective and better at what I was doing. And so, managing these 40 laboratories across the Middle East, I had this audience of soldiers who were trying to manage labs, oftentimes for the first time in their lives — and they were missing all this key knowledge.
How has your experience directing laboratories for the military informed your role in a civilian environment?
Working in both military and civilian environments reminds me of what is possible. In the civilian sector, the lab is one of the most heavily regulated parts of a hospital in the U.S.. But in the military, especially in an overseas environment, a lot of times you have to do what’s necessary and there isn’t a regulatory body in the traditional sense. Basically, it’s “here are the rules, try to conform to them as best you can, but if combat operations say that you can’t, then deviate from that and do what you have to do to save lives.
Experiencing that approach affords me a unique outlook when I go into highly regimented, “this is the way we’ve always done it” civilian laboratories.
For example, I’ve been to facilities that only allow four-year med techs (MTs) to work in their laboratory. But with 15,000 lab techs leaving our field every year, staffing is a major issue. Every school in the country combined only produces 4,850 lab techs per year and only 1,400 of those are four-year degree MTs. So, when labs put themselves in the narrow box of “only four-year med techs can work in this laboratory,” good luck continuing to offer those services to your patients. You’re going to run out of staff.
So how do you convince people who have never tried different approaches? I can give them insights and say, “I realize you’ve always done it this way, but there is so much more outside of the narrow confines if you’re willing to explore your options.” Breaking some of those assumptions often starts with a simple conversation, and I feel like my military experience allows me to broach those topics.
What do you like most about working in a laboratory?
How is the Joint Commission survey unique and in what ways do you strive to provide value to the laboratories you visit?
When I come into a survey, I put a lot of forethought into the agenda, as do my peers. The thing is, that agenda isn’t set in stone. There are several things that I have to do during a survey, but I don’t actually care what order they get done in. It’s very fluid and very much a conversation with the organization. Asking questions such as, “What do you need? What’s going to work best for you? How do we work around the patient care that you’ve got going and the staffing that you’re dealing with?”
Some of the core pieces: There is going to be an HR component where we look at the competency files and the education files of your staff members. We’re going to look at patient tracers. For myself, I ask for the organization to provide several diagnoses that I know will lead to good questions, and follow patients throughout the two year survey that meet that specific criteria.
I also want to know: Are you doing something different and novel that I can learn from? Are you doing something where maybe you’re using an outdated resource and we should revisit that reference you’re using for that particular policy and procedure? And so whenever I see things out of the ordinary, that’s when my curiosity is peaked. That’s why I ask questions, not in an effort to “get” anybody, but in an effort to learn and exchange information.
Beyond that, the lab tour is always important. I try to connect to the staff. I close my tablet and go into the laboratory, and I just let laboratorians ask me questions for 30 minutes. When I was being inspected I would’ve killed for that opportunity. During that conversation I don’t take notes. I just answer questions. Occasionally I have to go find resources to answer their questions and I’ll bring that back to the staff.
Are there any direct messages you want to give to your laboratory peers about the accreditation process?
At The Joint Commission, we do a lot of patient tracers. When I was on the receiving end of Joint Commission surveys, there’s always this temptation to not trust the survey process. The surveyor tells you to grab a random selection of tracers that meet the criteria. But as a director, I always pre-screened every one of those before I handed them to a surveyor. Please don’t do that. And I say that as somebody who did it my entire career.
For example, I was on a survey for a rather large organization where a patient had a hemoglobin at 4.6. They gave an emergency release unit of blood and the patient’s hemoglobin went up to 14. Obviously there was a problem. When we dove into it we discovered a chemistry tube that was rejected for saline contamination. We now know that the saline contamination reduced the hemoglobin of the CBC tube which led to an unnecessary transfusion.
I’m not there to get you. I’m actually more there to learn from you as well as teach. And whether you get two findings or 20 findings, you’re going to get accredited. Our goal isn’t to cause you problems or heartache. Our goal is for patient care to be better, which is the same goal you have.
Additionally, remember that I’m here to work with you. The more things that you shield or that you obscure, the less effective I’m going to be in my job and the less betterment we can give to your patients. I want to help you engage with your C-suite and with your nursing teams and to come together to improve patient care.
Be open and honest and tell me about the challenges because you’re not alone. Staffing is a challenge across the country. Regulatory compliance being seen as a cost center by your hospital, not getting the resources that you need — you’re not alone; it’s happening everywhere. I’ve seen solutions at other hospitals that can help you as well, so talk to me about those challenges because that’s the only way I’ll know how to gear my survey or gear the education so your facility is best positioned when I’m gone.
What’s the value of a Joint Commission accreditation for laboratories?
Michael Veri
Michael Veri, MLS (ASCP), MS, is a laboratory surveyor with The Joint Commission. He previously served the United States military overseas as the laboratory advisor to more than 40 labs in over 20 countries. Michael has been a laboratory surveyor with The Joint Commission since 2021.
Michael has a Bachelor of Science in Biochemistry from the University of Louisville and a Master of Science in chemistry from the University of South Florida. He is currently working toward his MBA at Indiana University’s Kelley School of Business.
Michael’s personal hobbies include chess, Brazilian jiu jitsu and spending time outdoors with his wife and children.