The overall objective was implementation of a fully integrated and functional CORE laboratory. The "CORE laboratory" is a model of a fully integrated and functional, multifaceted, clinical laboratory. Delineation of the process is to enable clinical laboratory managers, in the government or civilian sectors, to make sound decisions about formulating and implementing the CORE laboratory concept. The defining and comprehensive decisions should be based on concept requirements, advantages, disadvantages, and employee core competency assessments. Operationally, the organizational change resulted in well-rounded, multidisciplinary, multiskilled laboratorians and instructors/mentors for the Phase II military medical laboratory technician (91K student) training program. As of this time, our laboratory is the only Department of the Army medical center that operates a fully integrated and functional CORE laboratory.

The Department of Pathology and Area Laboratory Services of Dwight David Elsenhower Army Medical Center (DDEAMC) has undergone a reengineering of its physical layout to create a better, more effective, clinical laboratory. Before full implementation of the CORE laboratory concept at our facility, the automated stat chemistry, hematology, and urinalysis sections were structured as three separate entities, staffed with respective supervisors and uniquely trained and highly skilled laboratorians who were specialists in their particular disciplines. For example, the hematology section was staffed with personnel knowledgeable and technically proficient in hematology only, and likewise for the automated stat chemistry and urinalysis sections. This form of organizational structure not only created sectional experts but also fostered great limitations in personnel utilization. In addition, it lacked the flexibility to cross-level staff during shortages, created divisiveness, and diminished crosstalk between peers concerning commonly noted problems and technical knowledge. Similarly, it increased the cost of doing business because of lack of consolidation of analytical platforms, which sometimes contributed to delays in analyzing emergency samples for critical patients. Typically, in other medical centers within the Department of the Army and probably in the Department of Defense medical centers, the areas that are colocated include portions of the chemistry subspecialty such as automated routine chemistry profile testing, immunoassay testing of hormones, therapeutic drug monitoring, blood gases/ osmolality/ionized calcium testing, urine screening for drugs of abuse, and urinalysis. The hematology component usually includes automated complete blood counts and coagulation analysis.1,2 Although their laboratorians might have been crosstrained, their utilization has been contrary to the CORE laboratory concept that is exhibited by DDEAMC. Our laboratory is designed around a CORE laboratory concept, in which high-volume automated routine chemistry, urinalysis, hematology, coagulation, and flow cytometry testing are colocated in a large open-bay laboratory. Our laboratorians are cross-trained and, as a result, they become generalists who are able to rotate through all of the workstations in the CORE laboratory.

Why CORE Laboratory?

Clinical laboratory medicine is becoming highly automated and costs necessitate more streamlined processes. This is especially true for federally financed Army medical center laboratories. Similarly, the force projection for the 21st century reveals that the most severe dilemma that faces military laboratory medicine is outsourcing. Except for military readiness issues, all other military laboratory medicine aspects could be outsourced to the civilian sectors. This outsourcing could be controlled effectively if military laboratorians fostered innovative ways of doing laboratory medicine business that are more costeffective and enhance productivity and efficiency. Another aspect of this equation is the dwindling enlisted military personnel workforce coupled with an aging civilian laboratorian population. Of equal importance is the civilian sector's mantra for the 21st century that alludes to the outsourcing issue, cost cutting, competitiveness, and the right to claim "center of excellence" status.2 A graphical representation of these concerns is illustrated in Figure 1.

Planning and Construction Phases

Discussions regarding this re-engineering began in earnest in early June 1998 and are just now coming to fruition. Several preconstruction meetings were held between management and the laboratory staff members. The premise behind these meetings was to get their collective input regarding the process and to solicit their expertise on the physical configuration of the laboratory, thus creating better workstations and a more cohesive workflow. The goal was to have the laboratorians participate in the decision-making process, which fosters claims of ownership of the concept that will influence their work environment.3 Serious consideration was given to ergonomics, platform placement, and workstation layout, to include specimen-receiving and specimen-processing workstations. Similar preconstruction meetings were held between management and the contracted construction company. The focus of these meetings was to discuss and set construction milestones and major objectives for each construction phase. Other major facets of preconstruction concerns were also discussed, and provisions for the following were addressed: (1) space options outside the pathology department to accommodate operations during renovations; (2) constraints for renovation (e.g., break room and restrooms); (3) other laboratories that recently underwent renovation/major construction; (4) a checklist to help organize planning and preparation; (5) working relationships and expectations (pathology, health care facility planners, contractors, and management); and (6) agendas for discussion for the follow-up, preconstruction, management meeting.