The planning, operation, and function of a clinical laboratory in a teaching hospital

Shortly after World War I, laboratories began to grow in number and complexity in the hospitals throughout the United States. Need dictated the funding and therefore, expansion of these laboratories. In general, very little overall planning was introduced into the development of these laboratories but rather empiricism and reaction to pressure dictated the day-to-day, week-by-week development. Since a great deal of the teaching at that time was done on a one-by-one basis with laboratory learners, and since much of the laboratory work was done by physicians and used directly upon the patient, there was very little need for considering the laboratory as a more global resource for the teaching institution. As the science of medicine advanced and as the diversity and complexity of laboratory occupations increased, it was necessary to place more stress upon careful planning and operation of the clinical laboratory in the teaching institution. The laboratory was approached not only as a training area in its own right but as an adjunct to the undergraduate and postgraduate medical education occurring in the teaching institution. It became paramount then to consider the detail planning necessary to bring about a structural and functional entity that could respond to these more global teaching needs. It was imperative that the laboratory itself respond to its role and responsibility in the tripartite function of a teaching institution -- research, education, and service. In any good planning environment, effort must be expended towards setting goals and objectives; analytical methods applied to making assumptions and establishing premises. Alternate means for achieving goals and objectives were developed. Energy was expended in making forecasts and projecting results. Alternate means were sorted out and choices were made. Implementation guidelines were designed and an evaluation and feedback mechanism was instituted. In more recent years, we have attempted to apply these steps in planning to the development of laboratories and to the installation of operational procedures which would allow the clinical laboratory to truly function as a teaching unit and as a vital resource for the total training program of the institution in which it is housed.