Title: Laboratory automation in urban hospitals
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Permanent Link: http://ufdc.ufl.edu/UF00097800/00001
 Material Information
Title: Laboratory automation in urban hospitals an exploratory study of the effects of automation on the professional role of medical technologists
Physical Description: iv, 194 leaves : ; 28 cm.
Language: English
Creator: Hamer, Myron Philip, 1935-
Copyright Date: 1968
 Subjects
Subject: Medical technology -- Vocational guidance   ( lcsh )
Medical laboratories -- Automation   ( lcsh )
Sociology thesis Ph. D   ( lcsh )
Dissertations, Academic -- Sociology -- UF   ( lcsh )
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Thesis: Thesis - University of Florida.
Bibliography: Bibliography: leaves 181-191.
Additional Physical Form: Also available on World Wide Web
General Note: Manuscript copy.
General Note: Vita.
 Record Information
Bibliographic ID: UF00097800
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000559170
oclc - 13441618
notis - ACY4618

Full Text











LABORATORY AUTOMATION IN URBAN
HOSPITALS: AN EXPLORATORY STUDY
OF THE EFFECTS OF AUTOMATION
ON THE PROFESSIONAL ROLE OF
MEDICAL TECHNOLOGISTS






By
MYRON PHILIP HAMER











A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY









UNIVERSITY OF FLORIDA
1968
























UNIVERSITY OF FLORIDA
311262 08552 6506
ft'^*



^/"^ ^j.











ACKNOWLEDGMENTS


The author wishes to express appreciation to members of

his Committee; to Dr. Joseph S. Vandiver, his kind and understand-

ing Chairman; to Dr. Darrel J. Mase, Dean of the College of Health

Related Professions for his encouragement and assistance; to Mrs.

Elsie Evers for her valuable aid; to Miss Ruth Williams, Chairman

of the Medical Technology Curriculum, University of Florida, whose

concern for her beloved profession gave inspiration for the study;

to faculty members of the College of Health Related Professions, too

numerous to mention, without whose cooperation and help this work

could never have been completed; to a hurried, harried typist; and

lastly, but never least, to his beloved parents whose sacrifices and

early guidance made graduate education possible and desired.











TABLE OF CONTENTS


Page

ACKNOWLEDGMENTS. . . . . . . . . ... . . ii

LIST OF TABLES . . . . . . . . ... ... .iv

Chapter

I. INTRODUCTION. . . . . . . . . .. .

II. METHODOLOGY . .. . . . . . . . . 6

III. ROLE THEORY . . . . . . . . ... . . 21

IV. MEDICAL TECHNOLOGY--GENERAL DESCRIPTION . . ... 38

V. AUTOMATION . . . . . . . .... ..... .55

VI. SOCIOLOGICAL EFFECTS OF AUTOMATION. . . . .. 73

VII. ATTITUDES AND OTHER SOCIOPSYCHOLOGICAL TOPICS .... 118

VIII. PROFESSIONAL CONCERNS . . ... . ....... 136

IX. THE FUTURE OF MEDICAL TECHNOLOGY. . . . . .. 158

SUMMARY . . . . . . . . ... . . . . .178

BIBLIOGRAPHY . . . . . . . . ... . . . 181

APPENDIX . . . . . . . . . . . . . 192

BIOGRAPHICAL SKETCH. . . . . . . . . .. .... 194









LIST OF TABLES


NUMBER Page

1. FLORIDA HOSPITALS VISITED FOR INTERVIEWS BY LOCATION,
CONTROL, AND SIZE (NO. BEDS). . . . . . ... 10

2. NUMBER OF REGISTERED MEDICAL TECHNOLOGISTS, MT(ASCP),
BY STATES, SEPTEMBER, 1960 . . . . .... 51

3. MEDIAN SALARIES OF MT(ASCP)'S BY STATES . . .. 54

4. SUMMARY OF TRANSCRIBED INTERVIEW AND QUESTIONNAIRE
RESPONSES ON SELECTED TOPICS . .. .... 192










CHAPTER I

INTRODUCTION


Any meritorious study should have a reason for being under-

taken. The inspiration for this dissertation was found in the fall

of 1966 in a conversation between the investigator and Miss Ruth Wil-

liams (Chairman of the Medical Technology Curriculum of the University

of Florida). Because of the rapid spread of automated devices in the

clinical laboratory, Miss Williams wondered if a profession of medical

technology would still exist ten years in the future. "Why," she ques-

tioned, "would not a doctoral student in sociology be interested enough

in such an issue to study the changes that might occur, maybe write his

dissertation on them?"

This writer, who for some time had been considering the possi-

bility of investigating some aspects of the roles of health related

professionals, thereupon became intrigued by the challenge of discov-

ering the various ways in which technological changes can affect pro-

fessional roles. Here was a need expressed by a professional person,

an educator and leader in her field, for a sociologist to "do something"

about a topic of obvious practical importance to her profession. More-

over, to the sociologist hearing the appeal, the idea seemed to lend

itself to asking such sociological questions as "How does automation

affect professions?" "Does automation mean that fewer professional








personnel will be needed?" "Do professionals perceive automation as a

threat or as an opportunity?" "Do some professionals adapt to automa-

tion more readily than others?" It seemed that these and other ques-

tions might be explored and that an opportunity might be afforded to

test and refine extant theory.

To be sure, the investigator should perhaps have been warned at

that time by the admonition also proffered by Miss Williams, "You'll

find that almost no one in medical technology has written on this sub-

ject."

A search of the Index Medicus and the American Journal of Medi-

cal Technology confirmed that, indeed, virtually nothing has been written

by professionals in this field. Examination of the index of the American

Sociological Review suggested that sociologists have written little

enough either about automation or about medical technology, much less

about the effects of automation on medical technology.1

Continued search in periodicals, texts, and reference works

yielded very little explicit information. A footnote in a basic text-

book by Arnold Rose stated that "there are many studies of automation,

but few by sociologists."2 Economists and industrial engineers seem

to have made most of the contributions,3and they have concentrated


A search of the 1960 American Sociological Review index re-
vealed almost no studies sufficiently relevant to the effects of tech-
nological change on roles to be useful in this study.

2Arnold M. Rose, Sociology: The Study of Human Relations (2nd
ed. rev.; New York: Alfred A. Knopf, 1965), p. 433.

3lbid.








their efforts on determining the economic and labor displacement ef-

fects of automation on various industries.4 Cultural and social

changes in professions undergoing automation have been largely ne-

glected.5

Faced with a lack of materials, the investigator realized

that little aid for a dissertation would be forthcoming from published

sources. Since, nonetheless, the subject under consideration is both

important in itself and offers a challenge to sociological interpre-

tation, the decision was made to proceed with an exploratory study.

As has been stated, the major purpose of this dissertation is

to identify and.formulate hypotheses regarding changes in the role of

the medical technologists that accompany automatization of the clinical

laboratory. Additional aims include the identification of important

variables for later descriptive and analytical studies:

Many exploratory studies have the purpose of
formulating a problem for more precise inves-
tigation or of developing hypotheses. An ex-
ploratory study may, however, have other func-
tions: increasing the investigator's familiar-
ity with the phenomenon he wishes to investi-
gate in a subsequent, more highly structured,
study, or with the setting in which he plans
to carry out such a study; clarifying con-
cepts; establishing priorities for further


During the 1950's a running polemic occurred between labor
and management in the United States and in other countries concern-
ing the manpower effects of automation. Labor claimed, in general,
that automation displaces workers, management,that it creates dif-
ferent and often higher paying jobs.

Dr. Helga Roth,in a letter to the investigator dated March
22, 1967, reported that the Science Information Exchange of the
Smithsonian Institution had no knowledge of "...any studies on ef-
fects of automation on roles in various work settings."








research; gathering information about prac-
tical possibilities for carrying out research
in real-life settings; providing a census of
problems regarded as urgent by people work-
ing in a given field of social relations.6

All of these reasons apply to this investigation, since automation in

the hospital laboratory is, in its mass production aspects, so very

recent that the necessary time for comprehensive social and economic

evaluations has not yet elapsed. Moreover, the relatively under-

developed state of role theory has suggested the appropriateness of

an exploratory study:

The relative youth of social science and
the scarcity of social science research make
it inevitable that much of this research, for
a time to come, will be of a pioneering
character. Few well-trodden paths exist for
the investigator of social relations to follow;
theory is often either too general or too spe-
cific to provide clear guidance for empirical
research. In these circumstances, exploratory
research is necessary to obtain the experience
that will be helpful in formulating relevant
hypotheses for more definitive investigation.7

To be sure, even exploratory studies should be backed by a

thorough review of whatever pertinent literature is available. How-

ever, because of the extreme paucity of studies relating to the role

of the medical technologist and to the social effects of automation

on professions, a review of the literature can serve for the most part

only to define and discuss major concepts of "role" and "automation"

and to make specific their application in the context of this study.


Claire Selltiz, et al., Research Methods in Social Rela-
tions (rev.; New York: Holt, Rinehart, ard Winston, 1966), p. 51.

71bid., pp. 51-52.








Although some very preliminary hypotheses may be perceived in the

literature reviewed, most hypotheses to guide further research are

expected to emerge from this investigation itself.

In this dissertation, a departure from the usual practice

of entitling a distinct chapter, "Review of the Literature," seems

to be justified, principally because of the scantiness of sociologi-

cal literature concerning the effects of automation on health profes-

sions. This study, in fact, is a pioneering attempt to make a first

contribution to such a literature.

The investigator has found pertinent materials in economic

and industrial literature relating to automation, in the literature

of role theory, and in the professional literature of medicine and

medical technology. Rather than attempting to present such diverse

materials in one chapter devoted to the literature, the investigator

has found it more meaningful to consider the specific literature on

automation when discussing automation, the literature on role theory

in a chapter on role theory, and so on. In short, the contribution

of relevant previous writings will be most effectively presented

topically.












CHAPTER II


METHODOLOGY


The major method used in this study is the experience sur-

vey. As the name implies, this exploratory activity is undertaken

by interview and questionnaire techniques and serves to gather hy-

potheses and insights from those individuals most intimately involved

in the phenomena under investigation.

Probably only a small proportion of exist-
ing knowledge and experience is ever put into
written form. Many people, in the course of
their everyday experiences, are in a position
to observe the effects of alternative deci-
sions and actions with respect to problems of
human relations. The director of a settle-
ment house, and the group workers on his staff,
are likely to develop insights into the charac-
teristics of young delinquents and the proba-
ble effectiveness of various approaches to
them. The psychiatric social worker may ac-
quire sensitivity to the environmental condi-
tions that impede the adjustment of patients
released from a mental institution and, on
the other hand, to factors that support ad-
justment. Such specialists acquire, in the
routine of their work, a reservoir of ex-
perience that could be of tremendous value
in helping the social scientist to become
aware of the important influences operating
in any situation he may be called upon to
study. It is the purpose of an experience
survey to gather and synthesize such ex-
perience.l

The experience survey involves using selected samples (purposive

samples) of workers in the field. "...The respondents must be chosen


1Claire Selltiz, et al., Research Methods in Social Relations
(rev.; New York: Holt, Rinehart, and Winston, 1966), p. 55.







because of the likelihood that they will offer the contributions

sought."2

In an experience survey it is a waste of
time and effort to interview people who
have little competence, or little rele-
vant experience, or who lack ability to
communicate their experience.3

Moreover, it is neither necessary nor desirable to obtain a random

sample, since

the aim of the experience survey is to ob-
tain insight into the relationships between
variables rather than to get an accurate pic-
ture of current practices or a simple consen-
sus as to best practices. One is looking for
provocative ideas and useful insights, not for
the statistics of the profession.4

Nevertheless, obtaining the opinions of different kinds of people,

situated differently in the social structures involved, usually proves

productive of more insights.

In terms of the numbers of interviews and questionnaires that

are appropriate in an experience survey, there are few rigid guide-

lines to follow. All investigations, of course, have limits of time

and of financial resources. Ideally, however, the number of inter-

views and questionnaires that should be administered is determined

by the quantity and quality of insights forthcoming. In other

words, ideally, interviewing should continue as long as substan-

tially new insights and hypotheses are gained in sufficient numbers.


2bid.

31bid., pp. 55-56.

41bid., p. 55.

51bid., p. 56.







The Interviews

The major investigative medium for this study has been that of

the interview. As implied by the title of the dissertation, the main

interest has been in changes in the professional role of medical tech-

nologists in urban Florida hospitals. Therefore, interviews were ar-

ranged at a selected number of these institutions.

Although no attempt was made to obtain a random sample of hos-

pitals in Florida, efforts were made to assure that those chosen were

fairly representative of general hospitals in terms of such variables

as length of stay, legal control, size (number of beds), and type of

service. It was decided that personnel should be interviewed in small,

medium, and large general hospitals, although it seemed doubtful that

automation would have spread very far in the smaller institutions.

A broad geographical base (ideally, the entire United States)

was regarded as desirable, but limitations of time and travel funds

were paramount and precluded investigation in other than two major ur-

ban areas of the State of Florida: the Tampa Bay area and Dade County

(Greater Miami).

The pre-test of the interview schedule was accomplished at

the Shands Teaching Hospital, University of Florida, Gainesville

(a large hospital), at Alachua General Hospital, Gainesville (a

medium hospital), and at Suwannee County Hospital, Live Oak (a

small hospital).6


In the United States, small general hospitals are usually de-
fined as having less than 150 beds; medium general hospitals as having
150 to 374 beds; and large general hospitals as having 375 beds or more.
Conversation with Dr. John Champion, Chairman, Health and Hospital Ad-
ministration Curriculum, University of Florida, Gainesville, August 7,
1967.







The regular interviews were carried out at the following hos-

pitals (listed in order of visitation): Mound Park (St. Petersburg);

Tampa General; South Florida Baptist (Plant City); Baptist Hospital

of Miami; St. Francis Hospital (Miami Beach); Hialeah Hospital; Doc-

tor's Hospital (Coral Gables); Jackson Memorial Hospital (Miami);

Mt. Sinai Hospital (Miami Beach); Victoria Hospital (Miami); and the

Miami Heart Institute (Miami Beach).7

In Table 1 basic data for hospitals visited during the regular

interviews are presented.

As has already been mentioned, an investigator utilizing the

experience survey method should examine the viewpoints of several

different kinds of persons in a social system. In the planning of

this study it was felt that the opinions of the medical technologists

themselves should most certainly be sampled, as should those of the

two major components of their role set--clinical pathologists and

hospital administrators. However, because of unforeseen developments

at several hospitals, the investigator interviewed clinical chemists

and other types of clinical personnel. Nevertheless, the research


7The Miami Heart Institute, not a general hospital, became an
"unscheduled stop" since its new pathologist, Dr. Jerome Benson, is a
leading figure in automated laboratories.

8Throughout the interview period, a maximum flexibility was
maintained as to who was interviewed. Definite appointments had been
arranged with each hospital by telephone and letter to interview the
hospital administrator, the clinical pathologist, and, usually, the
chief medical technologist. Another technologist, recommended either
by the chief technologist or by the pathologist (or by both), was also
interviewed. In some instances, however, the pathologist or administra-
tor was called away the day the interview had been scheduled or the





10


TABLE 1

FLORIDA HOSPITALS VISITED FOR INTERVIEWS
BY LOCATION, CONTROL, AND SIZE (NO. BEDS)*


NAME


Baptist Hospital of
Miami

Doctor's Hospital


Hialeah Hospital


Jackson Memorial
Hospital

Miami Heart Institution


LOCATION


Miami


Coral Gables


Hialeah


Miami


Miami Beach


CONTROL


Baptist


private
(non-profit0

Seventh
Day Advent-
ist

County


private
(non-profit
specialty
hospital)


SIZE (NO. BEDS)


Medium (306)


Medium (213)


Medium (246)


Large


Small


(1,218)


(162)


Mound Park Hospital St. Petersburg City Large (649)


Mt. Sinai Hospital Miami Beach private Large (483)
of Greater Miami (non-profit)

South Florida Baptist Plant City Baptist Small (100)


Tampa General Hospital Tampa City Large (604)


Victoria Hospital Miami private Small (102)
(non-profit)


"Source: Hospital (Guide Issue Part 2): Journal of the
American Hospital Association, XLI,(August, 1967).

Mt. Sinai Hospital is actually, though not legally, a Jew-
ish sponsored institution.


1


---




11


design called for interviewing, at each hospital, the administrator,

the chief pathologist, the chief laboratory technologist, and a tech-

nologist of the staff (preferably an individual working in hematology

or in clinical chemistry).

It had early been decided that the interviews would be tape

recorded. The investigator reasoned that whatever the disadvantages

there might be in using a tape recorder (such as inhibiting the re-

spondents) they would be more than compensated by the capturing of

all that was said, including voice tones. Attempting to write down

each interview, even by shorthand, could never have succeeded as well

for such open-ended sessions, nor could the interviewer have been as

free to play his part, to interact as continuously, had he been forced

to write constantly. In any event, the use of a tape recorder pre-

sented virtually no problems.10 Topics covered in the interviews are

presented in Chapter VI.


technology staff was overwhelmed with extra work and literally had no
time to be interviewed. In such instances the investigator gladly took
the opportunity of talking with the chemist, the assistant hospital mana-
ger, or even a laboratory assistant, on the undoubtedly sound premise that
any interview was better than none. Actually, several of the most fruit-
ful interviews were obtained in this way.

Of course, facial expressions and gestures could only be re-
corded with a television camera.

100nly one interviewer, during the pre-test, refused to be re-
corded. Most seemed to forget all about the tape recorder and micro-
phone when the interview got underway, and only a very few betrayed
signs of nervousness, even at the start of the session. Just possibly
laboratory workers of all levels are more accustomed than the general
public to equipment and devices of all kinds. In any event, the inves-
tigator always presaged the interview with some remark "that the rea-
son I record these interviews is to save time."






Before commencing either pre-test or regular-run interviews,

the investigators had consulted several standard sources on social

science research methodology both to refresh his knowledge of inter-

viewingll and to gain new insights into the art and science of inter-

viewing.

One result of such consultations was the confirmation of the

investigator's opinion that unstructured interviews would be the most

appropriate major medium for dealing with the unexplored area of auto-

mation and its effects on role. Selltiz, et al., remark, for example,

that

another advantage of the interview is its
greater flexibility. In a questionnaire,
if the subject misinterprets a question or
records his response in a baffling manner,
there is usually little that can be done
to remedy the situation. In an interview
there is the possibility of repeating or re-
phrasing questions to make sure that they
are understood or of asking further questions
in order to clarify the meaning of a response.
Its flexibility makes the interview a far su-
perior technique for the exploration of areas
where there is little basis for knowing either
what questions to ask or how to formulate them.2

Similarly, the investigator's choice of the open-ended type of inter-

view finds support in the remark that "open-ended questions are called

for when the issue is complex, when the relevant dimensions are not known,

or when the interest of the research lies in the exploration of a

process...."3


llAs an undergraduate, the investigator conducted market research
interviews in Tampa and St. Petersburg, Florida, for the Psychological
Corporation of New York (through the Department of Psychology, University
of Tampa).

1Selltiz, p. 242. Italics the writer's.

131bid., p. 262.








In discussing methods for studying effects of technological

change, Urs Jaeggi comments, perhaps too optimistically, that "the

interview is regarded as the most valuable instrument of social re-

search. Nowadays, either alone or combined with others, it is the

commonest means of all."4l He is probably on safer ground in claim-

ing that "in research dealing with a given aspect of technological

change, interviews of various kinds will be appropriate... .115

Selltiz compares the interview technique with the question-

naire and discusses question content in terms of purpose (whether one

is looking for "facts"; beliefs about facts; feelings; standards of

action; present or past behavior; conscious reasons for beliefs, feel-

ings, policies, actions; present or past behavior; conscious reasons

for beliefs, feelings, policies or behavior). He also presents

types of interviews ("structured" and "less structured").16

Additional basic information concerning interviewing is pro-

vided by Goode and Hatt, who treat interviewing as a social process

and analyze the complex interaction between interviewer and inter-

viewee. They give advice (and examples) on how to establish and main-

tain rapport, how to carry the interview forward, how to use probe ques-

tions, how to record the interview, and how to bring it to a close.17


Urs Jaeggi, "New Forms of Technology: Methods for Studying
the Probable Effects," Automation: A Discussion of Research Methods, ed.
International Labour Organization (Geneva: International Labour Office,
1964), p. 138.

Ibid.

16Selltiz, Chapter 7, pp. 236-278.

17William J. Goode and Paul K. Hatt, Methods in Social Science
(New York: McGraw-Hill Book Company, Inc., 1952), Chapter 13, pp. 184-
208.








While seeking additional information and advice on effective

handling of interview problems, the investigator relied also on one

of the most up-to-date and extensive volumes dedicated to the inter-
18
view method. In almost overwhelming detail, this book offers in-

depth information on every phase and problem of interviewing and ex-

plains social and psychological dynamics of the interview process.

The investigator read carefully much of the presentation of general

theory of interviewing and made careful study of sections that deal

with the kind of open-ended, semi-structured interviews appropriate

for this dissertation. It is quite impossible to try to summarize

the rich offerings of this volume in the space that can reasonably

be allowed here for a discussion of interviewing. Yet the investiga-

tor time after time was enabled to perform more effectively because

of insights and advice gained from this volume.19

Many manuals and books written on interviewing have lists of


18Stephen A. Richardson, Barbara Snell Dohrenwend, and David
Klein, Interviewing: Its Forms and Functions (New York: Basic Books,
Inc., 1965).

19During the interviews, the investigator remembered the
statement that highly educated professionals will often simply vol-
unteer information without its being requested and will often pre-
fer to talk without guidance from the interviewer--in fact, may re-
sent direction. To the investigator's great satisfaction, this ob-
servation seemed to hold very well. On the average, the clinical
pathologists (by far the best educated group interviewed) did volun-
teer much of the information sought without being asked for it. Their
responses were usually more complete, more thoughtful, and reflected
consideration of more variables. In one instance, the pathologist be-
gan the interview by asking, "Do you mind if I just talk and give you
my ideas and feelings about automation? Then you can ask any questions
you like." In that and several other interviews, the pathologist ad-
dressed himself to, and, without probing, answered adequately all but
one or two questions on the interview schedule!








"do's and don't's" for the various phases of interviewing. Many of

these lists are similar, but the investigator read and studied sev-

eral in an attempt to avoid as many pitfalls in his interviewing ac-

tivities as possible. The following excerpts from an interviewing

manual are typical of general canons used in training interviewers

(who in this instance were to ask questions in connection with a

study of the sick role):

1. Presenting the Study

There are certain things you should tell all re-
spondents and there are certain general approaches
that we feel are preferable to others. . .Most
important in this regard is your general identi-
fication of the nature of the study. Identify
it as a study of how people feel about medical
matters and about their own experiences with
medical matters.

Avoid going into elaborate discussion of substan-
tive aspects of the questionnaire in this prelimi-
nary talk. Don't present yourself, or the study,
as advocates of a great deal of medical care, or
modern medicine, or anything in particular, but
simply as a group that feels the need for knowl-
edge about how people feel on these matters.
Present yourself, and the study, as neutral on
all debatable health questions, and above all
discourage any suspicion that we are trying to
"check up" on people's health practices accord-
ing to some preconceived schedule of "good"
health practices.

2. About Interviewing

All interviews are to be conducted face to face
with each respondent. Never interview anyone
over the phone.

The respondent should never be permitted to read
the questionnaire, or to fill it out himself.
The interviewer asks the questions and records
the person's answers. Never interview people in
,groups.








Try to avoid interviewing any person in the
presence of another. No substitutes or as-
sistants are allowed to do your work.

3. How to Interview

Your attitude at all times should be friendly,
conversational, and impartial. Take all opin-
ions in stride. Never show surprise at a per-
son's answer, nor reveal your own opinions.

Do not explain a question or elaborate upon
it unless so instructed. If the respondent
does not understand the question, repeat it
slowly with proper emphasis. Your survey
specifications suggest specific explanatory
probes.

Do not accept as final answers replies that
do not specifically answer the question. In
such cases, repeat the question, or tell the
respondent you're not quite sure what he means.

Avoid qualified answers ("Well, it depends")
by pressing for an opinion ("Well, taking
everything into consideration," or "on the
basis of the way things look now").

Never suggest a possible answer, nor help the
respondent to arrive at any particular answer.
Let him express his own opinions in his own
way.

4. Rules for Good Interviewing

The main task in interviewing is to take every
precaution to make sure you get a clear, com-
plete, and unambiguous statement of your re-
spondent's ideas. Before you can confidently
circle a pre-coded response, you must ask your-
self whether the respondent has given a com-
plete answer. Don't accept vague and unclear
answers here or in the open-ended questions.
Before you can leave an open-ended question and
go on to the next topic, you must ask yourself
the same questions.

Probing is important for both the pre-coded and
the open-ended question. While you do not have








to record the verbatim answer, you are still
responsible for all the probing (continued
neutral questioning) needed to get a satisfac-
tory answer to pre-coded questions. You'll
find, of course, that most pre-coded ques-
tions need less intensive probing than do the
open-ended questions, but they will often need
probing.

Most interviewers find the open-ended question
somewhat more difficult and therefore more chal-
lenging than the pre-coded question. On every
one of the open-ended questions, the general
goal is to find out exactly what the respondent
is thinking, both in relation to the general ob-
jectives of the survey and the specific purposes
of that question. Your objective is to draw the
person out, and to get him to express all of his
ideas before leaving that question and going on
to the next one. It is not enough simply to get
an answer from the respondent. Instead, you must
follow up what the respondent says, using probes
to get him to expand and clarify his answer, un-
til you are sure that you have the entire picture
of the way the respondent thinks about the ques-
tion.

Never suggest answers to your respondents. ALWAYS
use probes like:
How do you mean?
Can you give me an example?
What do you have in mind?
Why do you say that?
Could you explain a little?
Do you have any other things in mind?

Or you can repeat the respondent's own words
with a rising inflection, to suggest that you
are not sure of exactly what he means. DON'T
SUGGEST ANSWERS. The new interviewer may find
it hard not to suggest answers, for in normal
conversation we often do so without realizing
it. While one may think of interviewing as a
friendly conversation, it is a rather artificial
one. In most conversations it's quite common
for a person who is not certain what his partner
means by an expression to suggest the meaning.20


20Gerald Gordon, Role Theory and Illness: A Sociological
Perspective (New Haven, Conn.: College and University Press, 1966),
pp. 113-115.








This listing of rules and suggestions, as well as others like

it, proved helpful in guiding the investigator away from poor inter-

viewing practices.

Although in this study the interviews have constituted the

primary source of information concerning laboratory automation, a few

questionnaires were mailed to expert clinical pathologists throughout

the United States.21 The following questions were asked of the path-

ologists:

1. Since your laboratory has been substan-
tially automated, to what extent have your
MT (ASCP)-level workers been enabled to
perform more specialized procedures?

2. What human relations problems involving
medical technologists has automation brought
to your laboratory?

3. Do you employ a specialist to repair automated
equipment? If not, will you need such a per-
son in the future?

4. Will automation tend to require the workload
to be so scheduled as to fit the functioning
of the equipment, thereby leaving medical
technologists less leeway in scheduling their
work?

5. Has automated laboratory equipment required
teamwork on the part of laboratory workers?
If so, have yorASCP-level technologists needed
to play, to a greater degree, a supervisory
role?


21Development and use of automation in the clinical labora-
tory is so very recent that it is doubtful any experts exist. Cer-
tain pathologists, however, have automated their clinical laborato-
ries more extensively and for a longer period of time than others.
Some of these pathologists have experimented with automation, have
written about it, and have found solutions to problems created by it.
The investigator has succeeded in identifying some of these patholo-
gists through articles written by or about them, by obtaining their
names from pathologists interviewed, or by means of correspondence
with the Technicon Corporation of Chaucey, New York, the world's larg-
est manufacturer of automated laboratory equipment.








6. As laboratories become more automated, will
more men be attracted into medical technology?

7. As the efficiency and reliability of automated
machines increase, will the need for the clinical
pathologist to supervise technologists be reduced?

8. Has working with automated equipment meant less
personal satisfaction for your technologists than
manual methods have provided?

9. Have your technologists experienced boredom or
monotony working with the automated machines?

10. When they perform tests with automated equip-
ment, do medical technologists gain or lose any
prestige in the eyes of physicians, nurses, and
other hospital personnel?

11. Will automation in the laboratory mean that fewer
medical technologists will be needed?

12. Will the complexities of automation require more
detailed work rules and regulations in the labora-
tory?

13. How can the quality of work performance of the in-
dividual technologist be judged when work is done
on an automated machine?

14. As they enter an automated future, will medical
technologists become more professional? Will
they be less dependent on clinical pathologists
for solving laboratory problems?

15. Do the technologists who work primarily with the
automated equipment tend to regard themselves as
an elite group? Do others in the laboratory so
regard them?

16. Have you found it advisable to assign your better
technologists to the operation of your automated
machinery?

17. Can the autoanalyzer be successfully operated
by certified laboratory assistants or other
junior-college level people, if they work under
the supervision of a MT (ASCP)?







A number of the responses received to these questions have

proved helpful in interpreting the results of the interviews.. Re-

sponses from interviews and questionnaires have been used inter-

pretively rather than statistically; however, a table appears in the

Appendix that gives totals of types of responses for each topic.

In summary, this dissertation study has been carried out by

means of semi-structured, open-ended interviewing of professional

laboratory personnel. Often termed an experience survey, such inter-

views have constituted a most fruitful approach to an almost unex-

plored area of social science.











CHAPTER IIl


ROLE THEORY


The purposes of this chapter are (1) to describe the nature

and scope of role theory; (2) to define the term "role" and certain

related concepts; (3) to delineate a conceptual framework adequate

for attaining the objectives of this dissertation, and (4) to pre-

sent examples of concept usage.


The Nature and Scope of Role Theory

The term "role theory" is a misleading phrase since it in-

volves much more than role and includes very little theory. Role

theory seems rather to be composed of growing areas of social science

knowledge, often holding little more in common than usage of the word

role. On the positive side,

...there are a recognizable community of thought,
a voluminous and growing literature, a vigorous
research endeavor, and an application of the knowl-
edge in practical affairs. These developments in-
dicate that the study of role may well be on the
threshold of becoming an area of specialized in-
quiry in the behavioral sciences.l


IBruce J. Biddle and Edwin J. Thomas, Role Theory: Concepts
and Research (New York: John Wiley and Sons, Inc., 1966), p. vii. The
new, edited book will probably be considered a valuable addition to a
confused area of behavioral science. In the words of its authors, "One
of the principal tasks facing the role field is that of achieving some
coalescence of its efforts so as to crystallize its identity as a pro-
spective specialization in the behavioral sciences." Certainly this
writer is greatly indebted to the book for making more precise the
various usages of the term role, for reviewing the nature and scope







Yet whatever it may become, role theory at present is largely an in-

choate field of activity:

...The methods, knowledge, and theory in role
have not yet evolved into an articulate, de-
fined, and well-integrated discipline of study.
Despite the existence of a rich and wide-ranging
literature, the field has no text, no collection of
readings, and no comprehensive statement of its
concepts, theory, and knowledge.2

Historically, role theory has been traced to the writings of

James, Baldwin, Cooley, Dewey, Sumner, Maine, Simmel, Durkheim, Ross,

and others,3 but it was the contributions of Mead, Moreno, and Linton

in the 1930's that served to establish role in the social sciences.4

In this decade, a technical language evolved and systematic studies

were undertaken.

After World War II, role-related terms began to appear ex-

tensively in the titles of empirical studies. At present, role theory

is a new field of study, not widely recognized. Yet it does possess

"...an Identifiable domain of study, perspective, and language." It

has, moreover, "...a body of knowledge, some rudiments of theory,and


of role theory, and for presenting examples of writings on "such prob-
lems as the processes and phases of socialization, interdependences
among individuals, the characteristics and organization of social posi-
tions, processes of conformity and sanctioning, specialization of per-
formance and division of labor."
2bid.

Ibid., p. 5. The conceptual contribution of these writers
will be presented in the next section of this chapter.

4Martindale, for example, credits Mead with making role "...
the point of fusion for personality and social structure." Don Mar-
tindale, The Nature and Types of Sociological Theory. (Boston:
Houghton Mifflin Company, 1960), p. 359.








characteristic methods of inquiry"--its field is "...apparently noth-

ing more or less than complex, real-life behavior as it is displayed

in genuine on-going social situations."5 Its perspective is

a limited, social determinism that ascribes
much, but rarely all, of the variance of real-
life behavior to the operation of immediate or
past external influences. Such influences in-
clude the prescriptive framework of demands and
rules, the behavior of others as it facilitates
or hinders and rewards or punishes the person,
the positions of which the person is a member,
and the individual's own und standing of and
reactions to, these factors.

Role theory consists of a body of diverse knowledge in different fields.

It has not yet been

...reviewed, collated, organized, and evaluated.
The field of role consists of many hypotheses and
theories concerning particular aspects of its do-
main, but these propositions, like the knowledge
to which they relate, have yet to be reviewed and
integrated. And even if the propositions were
brought together in some organized form, they
would undoubtedly not constitute a single, mono-
lithic theory of the sort that the appellation
"role theory" implies, nor would they always be
distinguishable from other theoretical state-
ments in such disciplines as psychology, socio-
logy, and anthropology.7

It is the belief of Biddle and Thomas that role theory will neither

disappear soon nor "reign supreme" on the social science scene, but

rather will win recognition as a specialization by "further specifi-

cation of its domain of inquiry, by clarification and extension of


5bid., p. 17.

61bid., p. 18.

7lbid., p. 18.








its language, and by organization, review, and integration of its

knowledge and theory."8


Definitions of Role and Related Concepts.

The language of role theory poses particular problems, both

to readers and researchers, even though its terminology is, perhaps,

the only distinctive aspect of role theory:

The field of role is unique by virtue of its
commitment to this particular combination of
domain of study, perspective, language, knowl-
edge, theory, and research endeavor. But of
these single aspects of the field only the
language qualifies as distinctive, for all of
the other features are to varying degrees
shared also with other fields and disciplines.9

In role theory language, there are problems because "the ideal of one

concept clearly defined, with one verbal label has still to be at-

tained:

At present the language of role is a par-
tially articulate vocabulary that stands mid-
way in precision between the concepts of the
man in the street, who uses what the common
language just happens to offer as a terminol-
ogy, and the fully articulate, consensually
agreed-upon set of concepts of the mature
scientific discipline.10

The purpose of this section is briefly to review the major historical

contributions to the development of role vocabulary, and to examine

some of the variations in usage of role terms.


Ibid., pp. 18-19.

91bid., p. 18.


101bid., p. 13.







Thomas and Biddle have presented a sketch of the evolution of

"role" as term and concept. They cite Moreno's account of the origin

of the word:

"Role" originally a French word which pene-
trated into English is derived from the Latin
rotula (the little wheel, or round log, the
diminutive of rota-wheel). In antiquity it
was used, originally, only to designate a
round (wooden) roll on which sheets of parch-
ment were fastened so as to smoothly roll
("wheel") them around it since otherwise the
sheets would break or crumble. From this
came the word for an assemblage of such leaves
into a scroll or book-like composite. This was
used, subsequently, to mean any official vol-
ume of papers pertaining to law courts, as in
France, or to government, as for instance in
England: rolls of Parliament--the minutes or
proceedings. Whereas in Greece and also in
ancient Rome the parts in the theater were
written on the above-mentioned "rolls" and
read by the prompters to the actors (who tried
to memorize their part), this fixation of the
word appears to have been lost in the more il-
literate periods of the early and middle cen-
turies of the Dark Ages, for their public pres-
entation of church plays by laymen. Only
towards the sixteenth and seventeenth centuries,
with the emergence of the modern stage, the
parts of the theatrical characters are read from
"roles," paper fascicles. Whence each scenic
"part" becomes a role.l1

Although role had been a part of English (and other languages) for

years, it was not until the 1930's that the term was employed with

any kind of technical rigor. In particular, developments in usage of

the word have been attributed to Mead, Moreno, and Linton.

In his Mind, Self, and Society (1934), Mead used the concept

of "role taking" (taking the role of the other) and concepts such as


Ibid., p.6, citing J. L. Moreno (ed.), The Sociometry
Reader (Glencoe, Ill.: The Free Press, 1960), p. 80.







the "generalized other," the "self," the "I," and "audience." Moreno,

with his psychodrama and sociodrama, pioneered in the use of role play-

ing (by which he meant a method for learning to perform roles more

adequately). Linton advanced the classic distinction between status

(position) and role:

A status, as distinct from the individual
who may occupy it, is simply a collection of
rights and duties... A role represents the
dynamic aspect of a status. The individual
is socially assigned to a status and occupies
it with relation to other statuses. When he
puts the rights and duties which constitute
the status into effect, he is performing a
role. Role and status are quite inseparable,
and the distinction between them is of only
academic interest. There are no roles without
statuses or statuses without roles. Just as in
the case of status, the term role is used with
a double significance. Every individual has a
series of roles deriving from the various pat-
terns in which he participates and at the same
time a role, general, which represents the sum
total of these roles and determines what he
does for his society and what he can expect
from it.12

Although the 1930's saw the formal beginnings of role language de-

velopment, the years after World War II experienced the greatest

spread of role-related terms in the social sciences. Today, as

Biddle and Thomas point out,

...one finds role concepts in articles and
books in fields dealing with the professional
concerns of personal and social change, and
many workers in education, industry, and in-
terpersonal helping have adopted selected terms
from the vocabulary. Role concepts are not the
lingua franca of the behavioral sciences, but


12bid., p. 7, citing Ralph Linton, The Study of Man
(New York: Appleton-Century, 1936), pp. 113-114.








perhaps they presently come closer to this
universal language than any other vocabulary
of behavioral science.13

Even so, these authors hasten to point out that current role language

suffers from two basic difficulties, which are "a lack of denotative

clarity and incompleteness of the language."4 By the first fault is

meant that role terms have popular and technical meanings, that even

technical meanings are often not exact. A major practice that leads

to a failure of denotative clarity is the use of role metaphors; an

outstanding example is Erving Goffman's studied use of the drama-

turgical metaphor. In Biddle and Thomas' words,

Role enactment, role playing, role-playing
ability, role taking, coaching, altercasting,
front, realization, performance, actor, mask,
persona, psychodrama, sociodrama, part, pres-
entation of self, identity, as-if behavior--
these are some of the metaphorical concepts in-
spired mainly by a dramaturgical model of hu-
man behavior. (Although the metaphor of drama
has been most pervasive, there are also other
types of metaphor in role theory. Concepts
such as "self," "ego," "alter," "I," and "me"
appear to be mentalistically inspired, whereas
"position," "network and "relationship" imply
a structural mode.)15

In particular, the dramaturgical model is conducive to error:

The error which attends a thoroughgoing meta-
phorical conceptual scheme is that of a dis-
torted view of human behavior. The dramatur-
gical model, for instance, may easily go be-
yond the plausible implication that some be-
havior is intentionally engaged in to foster


Ibid., p. 8.

141bid., p. 9

151bid., p. 13.








given impressions and to achieve instrumental
objectives, generally, to the extreme view
that all human encounter is fraught with self-
interest, calculation, manipulation, deception,
guile, deceit, and suspicion.
The metaphorical concept has great heuristic
value, however, especially in the early stages
of scientific effort.16

The second basic difficulty, language incompleteness, is not dealt

with to any great length by these authors, who merely indicate its

existence in the following paragraph:

Despite the conceptual richness of the language,
there are phenomena logically belonging to role
theory that have yet to be identified and con-
ceptualized. We often apply the term "conformity"
to prescribed behavior that corresponds to that
which is prescribed, but sometimes the prescrip-
tions themselves correspond to, and are controlled
by, the prescribed behavior itself. What is the
latter process and what are we to call it? Some
prescriptions appear only in writing, some as ex-
pressed verbal demands, and others as subvocal
directives for oneself or others. In what ways
are these prescriptions similar and different,
and do they merit separate concepts and terms?
A sizable proportion of the continuous outpour-
ing of publications on role is devoted to the
identification and conceptualization of previously
unrecognized phenomena of role.17

Regardless of problems of language usage, Biddle and Thomas

do arrive at a,dozen terms which they feel are basic to the role

field. In a table they give common language meanings and selected

role theory meanings for these terms. This investigator has chosen

a certain number of these terms believed to be most relevant to the


16bid.

171bid., pp. 13-14.







aims of this dissertation and will present their role theory mean-

ings:

The word expectation, for example, has been defined by role

theorists as (1) a concept held about a behavior likely to be ex-

hibited by a person,(2) a standard held for the behavior of a person,

(3) an anticipation, (4) a norm, and (5) an attitude. Norm has meant

(1) a standard held for the behavior of a person or group, (2) a de-

scription of, or concept held about, a behavior pattern likely to be

exhibited by a person or group, (3) behavioral uniformity of actors,

and (4) role. Performance has meant overt activity (sometimes "role

behavior" or "goal-directed" behavior). Sanction has meant (1) be-

havior by an actor which rewards or punishes another,contingent upon

conformity by the other to norms or rules or (2) descriptions, con-

cepts, or anticipations of contingent rewards or punishments.

The basic concepts of position and role, also, have had va-

rious meanings assigned to them. Position (social position) may mean

(1) a designated location in the structure of a social system, (2)

a set of persons sharing common attributes or treated similarly by

others, or (3) a role. Role may designate (1) a behavioral repertoire

characteristic of a person or a position, (2) a set of standards, de-

scriptions, norms, or concepts held (by anyone) for the behavior of

a person or a position, or (3) a position. Status has been used to

mean (1) a position and (2) power, prestige, or wealth associated

with a social position. Role conflict for some writers has stood

(1) for inconsistent prescriptions (or other standards) held for a







person by himself or by one or more others, (2) for the attribution

of inconsistent prescriptions (or standards) to others, applicable

to one's self, or (3) for feelings of unease resulting from the ex-

istence or assumption of inconsistent prescriptions (or standards).18

The variety of meanings given by role theorists to these basic

concepts amply testifies to the linguistic confusion existing in the

field. For purposes of this dissertation, it is necessary that a

consistent set of meanings be utilized in discussing changes in the

role of medical technologists. The next section of this chapter will

present such a conceptual framework.19


Conceptual Framework for the Dissertation

The unknown aspects of the role of the medical technologist

(resulting largely from rapid technological change) create problems

in the selection of a consistent set of terms. When one needs a

role vocabulary to discuss that which is only partly described and

analyzed, the 'best' definitions of terms--the most useful ones--

are not readily apparent. The problem is made more acute by the


18Ibid., definitions selected and quoted from Table 3, pp.
10-12.

19No pretense is made at establishing a theoretical frame-
work for discussing technology-produced changes in professional
roles. Given the exploratory character of this investigation, such
an attempt would be a premature, indeed, a foolhardy, exercise.

For a comparison in the handling of the topic of role theory,
readers are referred to Chapter 1 of Gerald Gordon's Role Theory and
Illness: A Sociological Perspective. (Iew Haven, Connecticut: Col-
lege and University Press, 1966).







diffuse aims of the dissertation.20

In the judgment of this investigator, one sufficiently ade-

quate set of definitions is that offered by Gross, Mason, and McEachern

in their near-classic study of the role of the school superintendent.21

In addition to definitions, their observations concerning problems of

specificity in role research designs are helpful.

These authors point out that almost all role definitions and

theoretical endeavors involve social locations, behavior, and expec-

tations--in other words, that "...individuals: (1) in social locations,

(2) behave, (3) with reference to expectations."22 With this fact

in mind, they present the following definitions:

A position is the location of an actor or
class of actors in a system of social rela-
tionships.

A positional sector is an element of the
relational specification of a position, and
is specified by the relationship of a focal
position to a single counter position.

An expectation is an evaluative standard
applied to an incumbent of a position.

A role is a set of expectations applied
to an incumbent of a particular position.

20As stated earlier, this exploratory studlynot only endeavors
to ascertain changes in professional roles (narrowly defined), but also
seeks to learn more about hospital laboratory work settings and changes
in their social systems. Moreover, it delves into issues and problems
not always of specific sociological interest.

21Neal Gross, Ward S. Mason, and Alexander W. McEachern, Ex-
plorations in Role Analysis (New York: John Wiley and Sons, Inc., 1958).

22bid., pp. 17-18. Italics the authors'.








A role sector is a set of expectations ap-
plied to the relationship of a focal position
to a single counter position.

A right of an incumbent of a focal position
is an expectation applied to the incumbent of
a counter position.

An obligation of an incumbent of a focal po-
sition is an expectation applied to the incum-
bent of a focal position.

A role behavior is an actual performance of
an incumbent of a position which can be referred
to an expectation for an incumbent of that po-
sition.

A role attribute is an actual quality of an
incumbent of a position which can be referred
to an expectation for an incumbent of that po-
sition.

A role behavior sector is a set of actual
behaviors which can be referred to a set of
expectations for behaviors applicable to the
relationship of a focal position to a single
counter position.

A role attribute sector is a set of actual
attributes which can be referred to a set of
expectations for attributes applicable to the
relationship of a focal position to a single
counter position.

A sanction is a role behavior the primary
significance of which is gratificational-
deprivational.23

In discussing these concepts, the authors make clear that positions may

be focal or counter, ascribed or achieved.24 A focal position is simply

the one being studied, whereas counter positions are those to which the

focal position is related. Without doubt,


231bid., p. 67. Examples of usage of these terms in this disser-
tation are given in the final section of this chapter.
24learly the position of medical technologist is achieved.
Clearly, the position of medical technologist is achieved.







...a position cannot be completely described
until all other positions to which it is related
have been specified. Of course, a complete rela-
tional specification is a limiting case with
which it would be 'impossible to deal empirically.
For a given research problem it may be necessary
to take into account only a limited set of counter
positions.25

Thus, although the focal position of the medical technologist is cer-

tainly related to some dozen or more counter positions, this investi-

gator has emphasized for the most part changes in expectations among

the fully registered medical technologists and the major counter po-

sitions of clinical pathologist, hospital administrator, clinical

chemist, and a number of ill-defined positions such as laboratory

technicians, assistants, and aides. This emphasis pointedly does not

include positional sectors such as medical technologist/custodian or

medical technologist/equipment salesman. Nor does it probe technologist/

patient interaction.26

After defining role as a set of expectations, Gross, Mason, and

McEachern hasten to add that by expectations they mean what role de-

finers think the incumbent of a position should be or do (normatively),

rather than necessarily what the definers anticipate he will do:


251bid., p. 51.

2Relationships with patients have been tentatively assumed by
this investigator to diminish in frequency and intensity not primarily
because of the advent of automation but rather as a function of hospital
size. In small hospitals and clinics, the technologist may draw blood
(perhaps daily on the same patient) and then subject the sample to va-
rious test procedures (manually). In such a situation, the technologist
and patient come to know each other as persons, and their interaction
can have effects on health care results. In large hospitals specialists
phlebotomistss) draw the blood, and the laboratory technologist rarely
sees a patient. Patients may become just numbers and names. To be sure,
automation probably contributes to this depersonalization effect, as will
be discussed in the final chapter of this dissertation.







What will happen and what should happen in a
situation are quite different ideas. The
meaning of expectations is normative rather
than predictive. For the predictive sense
in which the term "expectation" is used, we
would suggest the more general and precise
term anticipation... .2

Moreover, these authors also distinguish dimensions of an expectation,

such as direction (negative and positive) and intensity. In addition,

expectations can specify behaviors and attributes, and they can relate

to different levels of generality (from general functions to microscopic
28
acts, for example).28

It will be noted, too, that the definition of role as expecta-

tions given in Explorations in Role Analysis advantageously leaves

open the question of who are the role definers. Thus, in this disser-

tation the investigative interest is in expectations for medical tech-

nologists held by clinical pathologists, hospital administrators, and

the medical technologists themselves.

In summary, the linguistic framework of Explorations in Role

Analysis is sufficiently consistent and flexible to provide a termi-

nology that allows fruitful discussion of the central issues of this

dissertation. Within this framework, much has been accomplished to-

ward investigating changes occurring in consensus and in division of

labor (among other role related issues).

In light of Gross, Mason, and McEachern's discussion and


2Ibid., p. 59.
28
28n this study questions are asked about behavior and at-
tributes primarily at the level of general functions and general per-
sonal qualities.







analysis of theoretical and linguistic problems inherent in role

analysis, this dissertation,in addition to examining some broader

questions, probes changes in the role of the medical technologist

primarily as that role is defined by clinical pathologists, hos-

pital administrators, and the technologists themselves. Expecta-

tions examined are mainly those composed by the following role sec-

tors: technologist/pathologist, technologist/auxiliary personnel,

technologist/administrator, and technologist/chemist. Change is ex-

amined primarily at the level of general functions; the scope of the

social system studied is clinical laboratories of general hospitals in

urban areas of the State of Florida.


Examples of Concept Usage

The final objective to be accomplished in this chapter is one

of making explicit usage of concepts adopted from Explorations in Role

Analysis. As listed and defined previously in this chapter, the terms

position, positional sector, expectation, role, role sector, right, ob-

ligation, role behavior, role attribute sector, and sanction can all

be applied to the analysis of any focal and counter positions. In

this dissertation the focal position, that of the ASCP-registered

technologist, is studied in relation to selected counter positions

(namely, those of pathologist, hospital administrator, technician, and

chemist).

If the terminology of Gross, Mason, and McEachern's opus

magnum is applied to the clinical laboratory, it is evident that the

major positional sectors are those of technologist/pathologist,







technologist/administrator, technologist/technician, and technologist/

chemist. To each positional sector there corresponds a role sector--a

set of normative expectations held, for example, by technologists for

pathologists, and by pathologists for technologists. Thus, technologists

may have the expectation that pathologists devote time to the solution

of unusual problems occasioned by new laboratory equipment. Similarly,

pathologists may expect technologists to bring to their attention un-

usual results or technical problems that could affect procedure results.

Or a chemist may expect a technologist to defer to his superior knowl-

edge (presumed or real) concerning techniques in clinical chemistry.

In other words, role sectors consist of rights and obligations. In

this study, those expectations held by medical technologists for path-

ologists are rights; those held by pathologists for medical technologists

are obligations.29

Behavior of a medical technologist in response to the expec-

tations in any role sector is designated as role behavior. Thus, a

technologist who asks a technician to repeat a procedure when results

seem dubious or equivocal is engaging in role behavior (in this case,

supervisory behavior). Likewise, the fact that a registered tech-

nologist can work calmly and efficiently in time of extreme medical

emergency is an example of the possession of a role attribute.

Technologists are expected to, and, indeed, must remain collected in

face of pressure, and stability must be one quality of the technolo-

gist's personality. Other necessary role attributes include manual


29By definition--the reverse would be true if the position of
clinical pathologist were the focal position.








deftness, scientific curiosity, and a rather high intelligence.

At some point of analysis it may be useful to consider role at-

tribute sectors and role behavior sectors. The educational level and

curriculum content of the ASCP-registered technologist, for example,

can be described as two of those expectations that compose the role

attribute sector of the technologist/pathologist positional sector.

Historically, pathologists created the position of medical technolo-

gist; pathologists, still the major employers of technologists, there-

fore remain the most important counter position incumbents (role de-

finers) for behavior and attributes of technologists.

The terms adopted from Explorations in Role Analysis have been

useful in discussing the role findings of this study; some,however,

have been more helpful than others. A few sections of the final three

chapters are devoted to discussions of role-related topics (such as

status) or of non-sociological, but important, professional concerns

(such as laboratory efficiency and quality control). In these latter

cases, the role terminology has not always been suitable or necessary

for their presentation.












CHAPTER IV

MEDICAL TECHNOLOGY--GENERAL DESCRIPTION


Although the main objective of this dissertation is not to

describe the field of medical technology as such, it is nevertheless

both necessary and proper to delineate this allied health profession.

Therefore, the origins and development of medical technology will be

reviewed briefly, and internal personnel variations of the field will

be examined.


Definition

Medical technology has been variously defined, but a citing

of the following two definitions will suffice. Fagelson prefers to

think of medical technology as "...that brand of medicine concerned

with the performance of the laboratory determinations and analyses

used in the diagnosis and treatment of disease and the maintenance of

health."' Or it is, to Heinemann, "...the application of principles

of natural, physical, and biological sciences to the performance of

laboratory procedures which aid in the diagnosis and treatment of

disease."2 Although the role of the medical technologist may be

changing in several aspects, its essence is still that of "fact-finder."


1Anna P. Fagelson, Opportunities in Medical Technology (New
York: Vocational Guidance Manuals, Inc., 1961), p. 22.

2R. Heinemann, "What is Medical Technology?" Hospital Progress,
XLIV (April, 1963), 98.







One medical technologist, for example, has described her role on

the medical team by means of an ingenious analogy:

Comparing us to the Perry Mason show might
be one way--the Doctors being Perry Masons;
the Nurses, the Della Streets; and the Medi-
cal Technologists, the Paul Drakes--out to
get the facts.3

In the simplest words, then, the medical technologist is a laboratory

worker who performs tests to ascertain facts upon which physicians may

make decisions as to diagnosis and treatment. The current role of the

medical technologist can be more fully understood by noting the origins

and evolution of medical technology, particularly in the American health

system.


History of Medical Technology

It is often difficult, if not impossible, to pinpoint the

"first" of anything. Like many other health professions, medical

technology has long roots in history. Fagelson, for instance, pre-

fers to trace medical technology to fourteenth-century Italy, where

a prominent physician of the University of Bologna, one Mondino, em-

ployed a young woman (Alessandra Giliani, d. 1326) as an assistant

to do many of the tasks now considered part of the role of the medi-
4
cal technologist. Undoubtedly through the centuries many such


3Mary Kay G. Moon, "The 3M's of Medical Technology," The
American Journal of Medical Technology, XXXI (September-October,
1965), 386. Italics the author's.

Fagelson, pp. 29-31. Whether or not Alessandra was indeed
the first medical technologist is of little consequence; she cer-
tainly was not the first member of a socially recognized calling. The







assistants have played parts of the role of medical technologists.

Similar forerunners can be perceived for almost any modern health

profession.5

It is a certainty, however, that medical technology began to

crystallize into a socially recognized role around the turn of the

century. In 1896 Johns Hopkins opened the first hospital clinical

laboratory; the first private laboratory was opened in New York the

following year, while the first chemistry laboratory had opened in

Minnesota in 1873.6 Other types of public health laboratories were

opened before the turn of the century in Louisiana, Rhode Island,

and Minnesota. By 1900 the census spoke vaguely of "100 technicians"

(all men) employed in the United States. By 1920 the census reported

1,500 men and 2,000 women, and Fagelson observes that "...this rapid

increase, particularly in the number of women technicians, perhaps


story, involving a romance and Alessandra's early death from a lab-
oratory infection, can, of course, serve as inspiration for young
medical technologists!

5The present writer for several years has had responsibili-
ties in directing the Introduction to Health Related Professions
course offered in the Health Center of the University of Florida.
Lectures given in the course are replete with examples of "early
physicians," "early physical therapists," or "early occupational
therapists." Interested readers should consult the authoritative
History of Medicine by Sigerist for information on the origins of
health professions.

Ibid., p. 31.

71bid.

Ibid. Not all of these were medical technicians; some were
dental technicians or were industrially employed.







reflects the true beginnings of laboratory medicine and employment

of medical laboratory workers in this country."9

Wars seem often to bring forth many technological and social

changes. Medicine and the related health fields appear to be par-

ticularly responsive to war-time changes, as new scientific tech-

niques and methods of providing health care are developed.10 In this

respect, World War I was no exception; it created a tremendous de-

mand for laboratories, and, of course, for people to work in them.

There were all too few trained technologists to meet the demands of

laboratories the U. S. Army wished to establish.11 The few tech-

nologists in existence at this time had in most cases received only

on-the-job training; no organization existed to set standards for

training or to register and certify technologists when trained.12

Even clinical pathology was not recognized as a medical specialty

until after World War I (the American Society of Clinical Patholo-

gists (ASCP) was established in 1922).13 By 1928 the need for com-

petent laboratory workers had become so overwhelming that the ASCF


91bid., p. 32.

10See footnote 5 above. Of course, almost every social in-
stitution and society itself can be vastly changed by war. The
technological and scientific advances which in modern times seem to
to be concomitants of war are obvious.

llFagelson, p. 32.

12bid.

131bid. Other writers say 1923, but the difference is not
essential.








decided to establish a Board of Registry of Medical Technologists.14

This body is responsible for examining and registering students of

medical technology that have met its educational requirements.15

Before a description of medical technology today is presented,

a note of sociological interpretation may be desirable. The field of

medical technology was created by clinical pathologists as a rational

response to their own growing body of knowledge and their time-

consuming role as specialists in medicine. At first, physicians per-

formed their own laboratory tests, but gradually certain physicians

began to specialize in performing tests and in developing new ones,

thus giving rise to the specialty of clinical pathology.6 These

specialists soon found that the volume of testing was becoming so

great that the training of laboratory assistants to perform most of

the testing was a necessity.17 The need for assistants who could and

would perform most tests routinely, yet accurately, led pathologists


14bid. Actually it was established as the Board of Registry
of Laboratory Technicians; the present name was assumed in 1936.

15The most common educational pattern for medical technolo-
gists (ASCP) is the 3 plus 1 plan: two years of general college edu-
cation, one year of college training in medical technology, and one
year of practicum (internship). The majority of MT(ASCP)'s,about
85 per cent, hold bachelor's degrees. The Registry is currently con-
sidering making the bachelor's degree mandatory for registration.
Conversation with Mrs. Janet Rodeheaver, Assistant Professor of Medi-
cal Technology, University of Florida, August 7, 1967.

6Ellen Anderson, "Medical Technology Today," The American
Journal of Medical Technology, XXXI (May-June, 1965), p. 159.

171bid.







to establish standards of training and performance and led to the

creation of the position of head of laboratory (or chief technologist),

a person with the function of supervising the day-to-day operation of

the laboratory.18 Such a delegation of tasks was not accomplished

without controversy:

There have been questions and dissenting
opinions voiced throughout the years by
clinical pathologists as to the wisdom
of extending so much technical knowledge
to those not qualified by a medical de-
gree. But the laboratory technicians
themselves have countered that point by
strict adherence to the Code of Ethics,
and by working toward better standards
of laboratory training.19

In 1932, with the encouragement of the nation's pathologists, medical

technologists founded their own professional organization, the American

Society of Clinical Laboratory Technicians, since 1936 called the Amer-

ican Society of Medical Technologists.20 Fagelson writes proudly,

It can be stated without reservation that
medical technology, though it began as lit-
tle more than scientific dishwashing, has
evolved into an exacting profession, a
necessity to modern medical science.21

Although this statement is essentially correct, some qualification and

reservations need to be advanced in appropriate parts of this chapter.


8Lavinia B. White, "Thirty-five Years of Medical Technology,"
The American Journal of Medical Technology, XXXI (July-August), p. 295.

191bid., pp. 295-296.

201bid., p. 297.

2Fagelson, p. 27.







Characteristics of the Field

The foregoing paragraphs have discussed medical technology

as if there existed a well-knit, homogeneous group of professional

people who, under the general direction of the clinical pathologist,

run myriads of tests and perform procedures in well-understood, set

patterns of activity. This characterization is, however, only partly

accurate. Medical technologists differ among themselves in a number

of ways, including areas of specialization, professional registration,

educational level, sex, geographic distribution, and salary levels.

They also differ because of a large variety of work settings. The

purpose of this section is to describe some of these differences.


Areas of Laboratory Endeavor

One of the most important things to know about a medical

technologist is the area of laboratory work in which he or she has

specialized. Although there are "generalists" in medical technology,

people who work in several areas, they are for the most part found

in small clinics and hospitals or in doctors' offices.22 In medical

technology, as in almost all scientific and professional fields that

face "knowledge explosions," more specialization is necessarily the

rule. Hence most medical technologists, though trained as generalists,

eventually become specialists by means of further training and/or by

choosing to work in one of the following specialized areas:


22Lura Street Jackson, The Medical Technologist (Cambridge,
Massachusetts: Bellman Publishing Company, 1958), pp. 89.







Hematology, Here are performed quantitative and
qualitative studies of blood cells, as in the mi-
croscopic examination of blood for the detection
of anemia or leukemia.

Serology and immunology, dealing with the de-
tection of antibodies in the blood plasma in
health and disease. Here diagnostic tests are
made for evidence of syphilis, undulant fever,
erythroblastosis, etc.

Urinalysis, the chemical and microscopic ex-
amination of urine. This is the oldest of labo-
ratory tests and one of the most commonly per-
formed. Diabetes, nephritis, etc., are detected
by this procedure.

Microbiology, the study of bacteria, viruses, fungi,
and parasites. The diagnosis of diphtheria, typhoid
fever, and tuberculosis dependsupon techniques of
microbiology.

Cytology, the examination of smears of body fluids
in diagnosis of cancer of the uterus, lung, and other
organs.

The blood bank, involving the storing and selection
of blood to match the strict requirements of the re-
cipient. Blood types and the Rh factor are deter-
mined in this division.

Physiologic chemistry, the study of the chemical
processes that take place in the body in health
and disease. By measuring accurately one or
another of the chemical substances present in the
blood or other body fluids, it is possible to
recognize the presence and sometimes determine the
nature of various diseases of the liver, kidneys,
joints, intestines, glands, etc.

Histology, which involves the preparation and
staining of thin tissue slices for microscopic
study and interpretation by the pathologists,
most important in the diagnosis of cancer.

Testing for allergies, poisons, and basal metabo-
lisms are among other miscellaneous procedures per-
formed in a hospital pathology laboratory by medical
technologists.23


231bid., pp. 9-11.


~I_







Specialty listings differ, and other authorities include the new field

of radioisotopes (nuclear medical technology) as a specialty.24 The

busiest areas of the clinical'laboratory--those handling the greatest

volume of work--are hematology and chemistry.25 This fact is important,

since these two areas, which together constitute a major and growing

part of laboratory work, are precisely the areas most subject to auto-
26
mation.2


Medical Technologists and Medical Technicians

Fortunately, the specialty areas in which medical technologists

work are easy to understand since they are based upon investigations of

specific parts of the human body or of its fluid and solid products.

Unfortunately, this clarity fades when one is trying to grasp the es-

sential composition of workers in the field itself. It is not dif-

ficult for an investigator arbitrarily to label as medical technolo-

gists only those college-educated persons registered by the Registry

of the American Society of Clinical Pathologists. Yet to do so would

be vastly to simplify an extremely complex employment situation and,

to a degree, to commit a sociological error.

The problem is partly semantic and reflects the confusion of

usage that abounds in medical circles, to say nothing of the public

at large:


24Fagelson, p.22. Fagelson would include serology and immu-
nology as a part of microbiology, along with bacteriology, mycology,
and parasitology.

251bid., p. 12.

26In fact, automation in the laboratory at the moment is vir-
tually synonymous with automation of hematology and chemistry proce-
dures, a situation to be discussed at length in Chapter V of this study.








Medical job titles are difficult to explain.
Often the same title describes different jobs.
Much depends on the type of laboratory one
works in, and the degree of specialization re-
quired. It is not surprising that in occupa-
tions that are relatively new, such as in the
medical laboratory field, occupational changes
take place and definitions of the sort of work
done by certain personnel change from year to
year and from place to place.27

This investigator has repeatedly seen in the literature of the labora-

tory field and has heard in conversation with those individuals con-

tacted for this study the terms medical technologist and medical tech-

nician used almost interchangeably, both terms referring to the "fully

trained" laboratory worker. As one writer points out, the MT(ASCP)

group strongly favors applying the term "medical technologist" to

themselves alone, having the phrase "medical technician" or "medical

laboratory technician" refer to either "...a scientific specialist

with advanced academic training or to a technician who has learned

to perform one or more medical tests through training on the job."28

It is conceded, nevertheless, that "...on the job the MT(ASCP) may be

called a laboratory technician or medical technician....",,29 Again,

the same MT(ASCP) writes that

Other laboratory workers, who have lesser
qualifications, and have not been certified
by the Registry, may be called laboratory
technicians or laboratory aides. Some highly
qualified laboratory assistants, with higher
degrees, may not be registered medical


27Jackson, p. 7.
28
28Ibid.

291bid.







technologists. They too are called tech-
nicians rather than technologists, since
they are not registered.3U

The essential point he-re is that medical technology is (if

defined as being composed of those laboratory workers sharing ap-

proximately the same tasks and level of technical preparation) a

category of workers, which,like nursing, is divided into "more pro-

fessional" and "less professional" strata. Regardless of what they

are called,31 the MT(ASCP)'s constitute somewhat less than one-tenth

of current medical laboratory staffs32 and hence can hardly be said

to be representative of laboratory "technicians" or "technologists"

generally. The distinction that the MT(ASCP)'s wish to draw by call-

ing themselves technologists and all others technicians3 is certainly


301bid. Italics mine.

31This investigator would be quite content to use the term med-
ical technologist to refer to MT(ASCP)'s alone, calling others between
the laboratory aide level and the MT(ASCP) level technicians, except
that the "technicians" would then include about 75 per cent of all labor-
atory workers, doing in many cases much the same work as the MT(ASCP)'s.

32T. C. Nation, "The Present Status of Medical Laboratory Per-
sonnel," The Journal of the South Carolina Medical Association, LXll
(October, 1966), 410.

330ne MT(ASCP) writes, "By definition, a technician is a per-
son who can perform tasks more or less mechanically, while a technolo-
gist is a person who understands what he is doing." Anderson, p. 161.
This seems to be the dictionary distinction, but then how logically
can MT(ASCP)'s call the many experienced, competent laboratory workers
"technicians"--especially those who, though not eligible for registry,
do understand what they are doing and may even have advanced degrees
in their area of specialty? Of course, the Registry does allow certain
of them to take examinations for registration, if they have obtained
graduate degrees.








a valid one when professionalism and assured quality of work are

at issue. As a group, the MT(ASCP)'s do exhibit more of the charac-

teristics of professionalism--are indeed the most nearly professional

of any other collectivity calling themselves technologists. It must

be reiterated, however, that many technologists, not ASCP-registered,

are still competent, even excellent technologists; not a few have

risen to administrative posts, such as chief technologist.

Since, however, the registered ASCP technologists do repre-

sent, as a group, the best trained, most proficient, and most pro-

fessional stratum of medical technology, this dissertation study is

focused primarily on the ASCP technologists. In other words, it is

the laboratory workers functioning at the ASCP level that are under

investigation, since this worker fully believes that the effects of

automation are similar for ASCP-registered technologists and those

technologists who, although unregistered, do virtually the same work.

This similarity of effects will be particularly true concerning

those who have approximately the same intellectual capacity and

theoretical training as the ASCP-registered technologist.


34There are several other organization that register tech-
nologists not eligible for registry with the ASCP because they have
not graduated from schools and curriculums approved by the medical
profession. Among these are the American Medical Technologists,
The International Registry of Independent Medical Technologists,
The Registry of Medical Technologists of the International Society
of Clinical Laboratory Technologists, and the National Council of
Medical Technology Schools. Technologists commercially trained
and registered by these organizations do not, in general, command
the status and salaries as do the MT(ASCP)'s nor will most large
health institutionsemploy them, or give them advancement if em-
ployed. Lab World, August, 1967, p. 865.







Geographic Distribution, Sex Ratio, and Salary Averages

For the purposes of this dissertation, there is no need to

present detailed information on the demographic and economic charac-

teristics of the ASCP technologists. A brief mention of basic facts,

however, will help the reader to have a better understanding of the

profession.

First of all, medical technology has traditionally been a

field for women. Even today, about 90 per cent of ASCP technologists

are women.3

The number of medical technologists has apparently been in-

creasing very rapidly in recent years. In 1957 the Registry of Medi-

cal Technologists listed 22,959 registered technologists in the na-
36
tion. In 1960, the total number rose to 27,189, apportioned among

the states as is shown in Table 2. A very recent study conducted

by the National Committee for Careers in Medical Technology reveals

that the MT(ASCP)'s are nationally now in excess of 30,000.7 Al-

though not all the technologists who received questionnaires in

the study responded, the following summary report issued by the Com-

mittee is well worth quoting at length:

Medical technology is a young profession--
with nearly three-fourths of its members hav-
ing less than 10 years of experience.


35Fagelson, p. 41.

6Jackson, p. 31.

37National Committee for Careers in Medical Technology, Medi-
cal Technologist-Pathologist: A Newsletter Relating to the Profession
of Medical Technology, Issue 36. Washington, D. C.: The Committee,
April, 1967, p. 4.







TABLE 2

NUMBER OF REGISTERED MEDICAL TECHNOLOGISTS,
MT(ASCP), BY STATES, SEPTEMBER, 1960*


STATE NO. STATE NO.


Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of
Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Lousiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska


34
411
222
197
2,085
600
353
88
139

688
440
150
1l1
1,414
606
362
560
668
654
114
384
535
1,461
946
295
778
189
280


New Hampshire
Nevada
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Canal Zone
Puerto Rico
Virgin Islands
Canada
Panama
Other Foreign


(U.S.)


101
42
554
141
1,257
497
119
1,504
399
416
1,494
68
173
125
496
1,742
126
49
597
709
224
958
55
22
190
3
170
9
185


*Adapted from Anna P. Fagelson, Opportunities in Medical Tech-
nology (New York: Vocational Guidance Manuals, Inc., 1961), p. 35.

The New York total is proportionately low, Miss Ruth Williams
suggests, because many commercial laboratories (particularly in New
York City) employ non-ASCP technologists. Recent legislation is de-
signed to improve this situation. Another factor that may explain the
relative lack of ASCP technologists is the absence (until very recently)
of any ASCP-approved school. Interview with Chairman, Medical Technology
Curriculum, J. Hillis Miller Health Center, University of Florida, Gaines-
ville, Florida, August 18, 1967.







Background data on more than 30,000
MT(ASCP)'s compiled through tabulation of
all questionnaires received in NCCMT's sur-
vey show:
Three-quarters of those responding are 39
years old or younger, and 42.7 per cent are
under 30. Of those with college degrees, more
than two-thirds graduated since 1955. As a
side note, 11.3 per cent are male.
Nearly 91 per cent have the equivalent of
four years of college--84 per cent with a
baccalaureate or higher degree, and another
6.9 per cent with three or more years of col-
lege but no degree--plus their year of medical
technology study. While many won their de-
grees in biological science or chemistry, medi-
cal technology was the major by a 2-1 ratio.
Of those responding, 65.2 per cent worked
in medical technology in 1966, with 57.4 per
cent employed 30 or more hours a week. An ad-
ditional 7.4 per cent were occasionally
employed in the field, while about 27.4 per
cent were not working or were employed as
teachers, doctors or in some other field.
The largest single group of those working
full-time was made up of those giving "staff
technologist" as their principal activity--
46 per cent. Chief medical technologists
were second with 23.1 per cent, followed by
18.9 per cent as section heads. Far down
are research technologists, 7.5 per cent;
teaching supervisors, 3.1, instructors, I
plus per cent.
Just about half do not supervise any other
workers in their laboratory, another fourth
(6 per cent) supervise I to 3 workers, 16.3
per cent have 3 to 10 workers under them,
while the remainder supervise more than 10
persons.
In which areas of the laboratory do most
medical technologists work? The majority
seemed to be divided between those special-
izing in just one area (usually chemistry)
and those rotating in four or more areas.
Among the areas specified for those on ro-
tation, chemistry again was top-runner, cited
by 67.8 per cent of those working 30 or more
hours a week, followed closely by hematology
(64.5 per cent).




53

Next were urinalysis (53.5 per cent),
serology (45.7 per cent), microbiology
(43.1 gr cent), blood bank (39.8 per
cent).

Table 3 shows salaries of ASCP technologists by state.




































38
Ibid.







TABLE 3


MEDIAN SALARIES OF MT(ASCP)'S BY STATE*


MEDIAN NUMBER OF MEDIAN -NUMBER OF
STATE SALARY RESPONDENTS STATE SALARY RESPONDENTS


Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of
Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri


$6,015
7,819
6,300
5,571
7,703
5,776
6,023
6,239

6,453
5,711
5,949
6,109
5,769
6,241
6,300
5,926
6,005
5,595
5,582
5,305
6,499
5,957
6,975
6,203
5,725
5,867


270
29
157
136
1,616
385
190
34

116
444
307
119
52
772
341
224
290
319
442
32
202
295
763
530
154
389


Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina

North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming


*Adapted from


National Committee for Careers in Medical Tech-


nology, Medical Technology: A Newsletter Relating to the Profession
of Medical Technology, Issue 36. Washington, D. C.: The Committee,
April, 1967, p. 4.


$5,659
5,706
7,287
5,467
6,128
6,349
6,300
5,614

5,524
5,990
6,043
6,262
5,603
6,136
5,516
6,099
5,550
5,705
6,004
5,759
5,700
6,321
5,717
6,507
6,049


84
187
35
46
275
67
652
278

59
752
256
212
643
40
83
76
312
950
79
36
282
316
113
498
25












CHAPTER V


AUTOMATION


Definitions


In order to present the findings of this study, it has been

necessary to describe the field of medical technology. To define au-

tomation and to examine briefly its history and variations are also

essential. In particular, the ways in which medical technology has

become automated must be outlined. The purpose of this chapter is to

set forth the nature of automation and to describe its penetration

into the work of the hospital laboratory.

The first question that arises is how to define automation.

Numerous accepted definitions and usages exist, many of them fairly

dissimilar. In fact,

The conceptual confusion surrounding the
word "automation" is such that it is used
to characterise technology as both an evo-
lutionary and a revolutionary process, to
describe the novelty of arrangements that
link one machine with another, and to de-
note the unusual capabilities of engineer-
ing forms, particularly those that improve
upon the contributions otherwise made by
labour. In brief, it is used to describe
almost every economic change that might
be contemplated, including changes in plant
layout, product design, job design and
methods for quality control. Because the
label has been applied so indiscriminately,
because we have not yet been able to fashion
a classification system appropriate for the
analysis of the myriad forms that technical








change is now assuming, and because we have
not yet developed theoretical models that can
allow in full for the consequences of these
varying engineering forms, there exists a feel-
ing that the subject has become a stalking-
horse for the pamphleteer or polemicist.l

The same authors have classified definitions of automation according

to the emphasis they give to certain variables. One group of defini-

tions emphasizes automation as an organizational revolution, which in-

volves

...novelties of production planning and
product design... The essential element
in automation is the rationalisation of the
entire production process. Each stage, from
raw materials to the final product, is care-
fully designed. The plant's organisational
chart must be redrawn to integrate purchas-
ing, production, quality control, distribu-
tion, and marketing activities. Even the
end-product may be redesigned to optimise the
use of production facilities.2

Examples of definitions of the organization type include that of John

Diebold:

It is no longer necessary to think in terms
of individual machines, or even in terms of
groups of machines; instead, for the first
time, it is practical to look at an entire
production or information handling process
as an integrated system and not a series of
individual steps.... Automation is more than
a series of new machines and more basic than
any hardware. It is a way of thinking as
much as a way of doing.3


Paul E. Sultan and Paul Prasow, "Automation: Some Classifica-
tion and Measurement Problems," Automation: A Discussion of Research
Methods, ed. International Labour Organization (Geneva: International
Labour Office, 1964), pp. 9-10. This writer is deeply indebted to this
paper for summation of definitions of automation and their usages in
research endeavors.

21bid., p. 12.

Congress of the United States, 86th Congress, Second Session:







Peter Drucker calls automation "...a concept of the organization of

work. It is therefore as applicable to the organization of distri-
,,4
bution or of clerical work as to that of industrial production."

Automation allows a flow of production, as the following defi-

nition notes:

...automation means continuous automatic
production, linking together more than one
already mechanized operation with the prod-
uct automatically transferred between two
or among several operations. Automation is
thus a way of work based upon the concept
of production as a continuous flow, rather
than processing by intermittent batches of
work.9

Other, more common, definitions of automation, however, are

based upon the "performance characteristics of the technology itself."6

In these concepts, automation means reproducing the sensory and mental

capacities of human beings by machines, replacing man's muscles with

handling devices, and his control and thought processes with computers.

The central idea is that mechanical or
chemical processes are directed, controlled
and corrected within limits automatically,


"Bringing Automation Up to Date," in New Views on Automation, Papers
submitted to the Subcommittee on Automation and Energy Resources, Joint
Economics Committee (Washington: Government Printing Office, 1960), pp.
83-84 and 91. Cited by Sultan and Prasow, p. 13.

Peter F. Drucker, "The Coming Labor Shortage," in America's
Next Twenty Years (New York: Harper and Row, 1957). Cited by Sultan
and Prasow, p. 13.

5Herbert R. Northrup, "Automation: Effects on Labor Force,
Skills, and Employment," in Annual Proceedings (1958) of the Industrial
Relations Research Association, pp. 35-36. Cited by Sultan and Prasow,
p. 14.

Sultan and Prasow, p. 14.







that is, without further human interven-
tion once the system is established.7

Or, more concisely, "Automation is the use of machines to run machines.

The heart of such automation is the computer, which serves as the in-

formation center, the brain center of a group of machines. The common

elements in these definitions of automation are the following:

a) the integration of production planning
to fuse purchasing, production and dis-
tribution activities, and in the tech-
nical sphere the linkage of one machine
activity to another;

b) the application of instrumentation tech-
niques that simulate human skills through
both open- and closed-loop control sys-
tems. Both input and output behavior are
closed-loop control systems. Both input
and output behavior are communicated to
control systems which in turn induce neces-
sary changes in the production process;

c) the integration of informational technology
involving market variables and process varia-
bles to influence production.9

Yet not even dividing definitions of automation into the two

categories just discussed will suffice to cover the complexities of

the situation. The question needs to be asked, "Can we assume that

automation is, in fact, simply 'advanced technology' or 'high-level

mechanization'?"


7John T. Dunlop (edited by), "Introduction: Problems and Pro-
tentials," in Automation and Technical Change (New York: Columbia Uni-
versity, The American Assembly), pp. 1-2. Cited in Sultan and Prasow,
p. 15.

Peter F. Drucker, Harper's Magazine. Cited in Sultan and
Prasow, p. 15.

Sultan and Prasow, p. 15.








Buckingham proposes that three distinctions be made between

mechanization, mass production and automation (which, he feels, have

evolved historically in that order).10 Sultan and Prasow state:

Mechanisation involved the use of machines
to perform work; mass production involved a
new technique for production organisation;
the third phase, is a technology based on
communication and control.



One might prefer to divide technical changes
into two major categories. The first indus-
trial revolution involved the development of
machines and natural sources of power. The
second revolution now upon us represents tech-
nical developments that make automatic produc-
tion and control feasible.11

They also point out, however, that automation may be a matter of the

degree of automation. Any automatic control mechanism involves auto-

mation, but automation may be called cybernation when computers are

involved.1

One group of researchers has proposed a "ladder of automatic

control" classification system, with each step of the ladder indicat-

ing increased complexity of the control system.1 On the other hand,

10
1Walter Buckingham, "Automation, Employment and Economic
Stability," in Automation and Society, ed. Howard Boone Jacobson and
Joseph S. Roucek (New York: Philosophica Library, 1959), p. 60.

llSultan and Prasow, p. 16-17.

12Ibid. "Cybernation" derives from Norbert Wiener's "cybernet-
ics"--the use of computers in technology.

13Criteria and Bases for a Study on the Extent of Automation in
American Industry, A Study Prepared by the Diebold Group, Inc., for the
Manpower Administration of the U. S. Department of Labor, Office of Man-
power, Automation and Training (January, 1964). Cited by Sultan and Pra-
sow, p. 18.







James Bright offers the "mechanization profile," which allows classi-

fication of work sites into seventeen stages of mechanization:

What is the operational significance of
the mechanisation profile? Bright has made
use of it to examine the flow of the work
process for particular products in various
industries. He emerged with the conclusion
that the term "automation" is indeed applied
loosely, for his analysis reveals sharply
different levels of technology for the same
product at varying stages of its manufac-
ture. Plants thought to be automated had
only "islands" of such automated activity.
What he defines as the "span" of mechanisa-
tion was frequently limited.14

Is there, then, any way out of the morass of conceptual confu-

sion surrounding automation? Probably not, if unanimity of definition

is the objective. Seemingly for a long time to come scholars in dif-

ferent disciplines and even within disciplines will disagree more than

they agree.15 Each investigator will have to choose arbitrarily a defi-

nition for automation that best suits his needs.

Although no definition this writer has found or devised is en-

tirely satisfactory, the following statement would seem to indicate

the essence of the concept of automation:

"Automation" is defined in various ways, but it
may be summarily defined as the accomplishment


14Sultan and Prasow, p. 19.

15The present writer attended a discussion session on the
"Social Impact of Automation" at the 1967 Meeting of the Southern
Sociological Society (Atlanta, Georgia, March 31). The session be-
gan well enough, but it soon became evident that no one was talking
about the same thing when he used the term"automation." Very little
light was shed on any social effects, but the air became warm as va-
rious pet definitions were proposed. The chairman was barely able to
steer the meeting back on a positive track before the session ended.







of a work task by an integrated power-driven
mechanism entirely without the direct appli-
cation of human energy, skill, intelligence,
or control.16

The beauty of the definition is, from the point of view of the so-

cial investigator, its ability to include as automation any simple

self-running, labor-saving device, as well as a computer-controlled

oil refinery. This definition is also consonant with Simon's re-

marks that

the automation of manufacturing processes is a
natural continuation and extension of the In-
dustrial Revolution. We have seen a steady in-
crease in the amount of machinery employed per
worker. In the earlier phases of mechanization,
the primary function of machinery was to replace
human energy with mechanized energy. To some
extent in all phases, and to a growing extent in
recent development, another goal has been to sub-
stitute mechanical for human sensing and control-
ling activities. Those who distinguish the newer
"automation" from the older "mechanization" stress
our growing ability to replace with machines simple
human perceiving, choosing, and manipulating
processes.17

It is probably the "perceiving" ability of modern automated

equipment that has led automation to be called "the awesome servant."18

During the last decade...developments in the
fields of electronics, communications, and
electric network analysis have made possible
the construction of a wide variety of self-
correcting and self-programming machines.


16Bernard Karsh, "The Meaning of Work in an Age of Automation,"
Current Economic Comment, III (August, 1957), 9.

7Herbert A. Simon, The Shape of Automation for Men and Manage-
ment (New York: Harper and Row, 1965), p. 33.
18
Juanita M. Kreps, Automation and Employment (New York: Holt,
Rinehart and Winston, Inc., 1964), p. 6.







These machines are capable of automatically
performing a sequence of logical operations,
similar in many ways to the mental processes
of human beings. ...
These recent developments have been of such
importance that they constitute the first
steps of what coming generations will look
upon as a second industrial revolution.19

In factautomation has even been defined as the Second Industrial Revo-
20
lution.2

Mann and Hoffman reflect much the same definition as that pre-

sented in the last few paragraphs. Their definition of automation is

similar to that of Karsh, recommended by this writer. Most importantly,

they conclude, as this writer has concluded, that the effects of automa-

tion, however it may be defined, cannot really be distinguished from

the effects of "advanced technology" generally. The analytic distinc-

tion can be made easily enough between that which is automatic and that

which is merely mechanized,21 but most work settings have intertwined

mixtures of both, so that sociological effects or changes of one cannot

be distinguished very readily or at all from those of the other or from

their combined influence. Mann and Hoffman are worth quoting at length

on this point:

Early in this exploratory study of some
of the intraorganizational effects brought
about by the introduction of automated tech-
nology it became evident to us that the term


19John Diebold, Automation: The Advent of the Automatic Factory
(Princeton, N. J.: D. Van Nostrand Company, Inc., 1952), p. 2.

20Magnus Pyke, Automation: Its Purpose and Future (New York:
Philosophica Library, 1957), p. 168.

21To restate the difference, a process or task is mechanized
when a machine or instrument replaces man's muscles; a process or task
is automated when a machine or instrument replaces man's immediate sen-
sory and mental functions--control and correction.







"automation!' had almost as many definitions
as authors writing about it. In the prolific
literature on the anticipated consequences of
the "Second Industrial Revolution" automation
had become the name given to every form of
technology introduced into American industry
in the last few years. From this array of
definitions we found it possible to define
automation conceptually as the application of
control devices of a feedback nature, such as
servomechanisms, to provide self-regulating
production processes. Whereas mechanization
replaced man's muscles in the transport of ma-
terials, automation has replaced man's senso-
ria in monitoring production processes and has
replaced his brain in certain regulatory decision-
making functions.
Although automation can be conceptually dis-
tinguished as a form of technological advance-
ment, in actual practice it is rarely, if ever,
introduced in isolation from other technologi-
cal changes. In the present study the introduc-
tion of automation was accompanied by other basic
production changes, including the redesign of the
power plant and the greater mechanization of cer-
tain aspects of the production process. Since
this mixture of automation with other forms of
technological advance will be the rule rather
than the exception, it probably will be impossible
to study automation in isolation from other forms
of technological change.22

This writer's examination of laboratory automation leads him to agree

that there is little point to engaging in somersaults trying to refine

definitions or to draw distinctions that are not empirically relevant.

One can conclude that indeed the word "auto-
mation" is employed loosely, and there seems
little advantage in distinguishing it from
advanced forms of technical change. ...Efforts
to confine its meaning or graduate its capaci-
ties in terms of the sophistication of the con-
trol mechanism serve a limited purpose.23


22Floyd C. Mann and Richard L. Hoffman, Automation and the
Worker: A Study of Social Change in Power Plants (New York: Henry Holt
and Company, 1960), pp. 191-192.
23Sutan and Prasow, 32.
Sultan and Prasow, p. 32.








John Dunlop has remarked that "...it is impossible to isolate the im-

pact of automation from other forms of mechanisation and technical

change."24 A more fruitful use of time is to examine the forms auto-

mation has taken in the hospital laboratory.


Automated Equipment in the Laboratory

In the modern hospital laboratory of today there is a somewhat

bewildering array of devices, instruments, and machines that may be

broadly described as "automatic." In both numbers and types of equip-

ment, the hospital laboratory has been undergoing a transformation.

The purpose of this section is to present a general classification sys-

tem to aid in the comprehension of this equipment. An effort will be

made to describe some of the devices which have seemingly created the

greatest changes in laboratory work relations and in health care.25

In the previous section, automation was defined and discussed

as it might apply to various work settings and industries. Only one

classification has been found of automation in the clinical laboratory,

that of Dr. F. W. Sunderman, Jr., Associate Professor and Director of

Pathology at the J. Hillis Miller Health Center, University of Florida,

Gainesville. In his schema automation is divided into three categories:

24
2Dunlop, p. 2. Cited in Sultan and Prasow, p. 32.

25To the technically minded, nothing will seem more fascinating
than the design and operation of these new machines. There exists a
growing technical literature about them; a study of the scientific and
technological principles underlying their existence is intriguing. This
investigator has made it a point to be taken on a guided lecture tour of
an "automated" laboratory. No detailed technical descriptions will be
offered here, however, since such descriptions would be beyond the scope
of this dissertation and would presume a far deeper knowledge of chemis-
try, physics, and laboratory technology than this writer can pretend to
possess.







1) Automation concerned with the acquisition
of analytical requests and samples, and con-
cerned with the storage and reporting of ana-
lytical results. In other words: "automation
of communications."

2) Automation which is concerned with labor-
saving devices to assist the technologist in
her conventional analytical tasks. In other
words, "automation of manipulations."

3) Automation which is concerned with the per-
formance of analyses without the manual partici-
pation of the technologist, and in which the
technologist serves only in a supervisory ca-
pacity. This type of automation may be'termed
"robot analysis."26

Automation of communications will be dependent largely on the

introduction of computers whereby data can be transmitted, stored, and

retrieved electronically. The main advantage will be in relieving the

overworked technologists from the now heavy burden of clerical work.
27
The computer will provide the blood collection team27 with a

printed tabulation of the blood samples each patient must have, "ar-

ranged systematically by nursing floor and hospital room number, in-

dicating the volumes of blood and types of preservative or anticoagu-

lant which are required."28 The computer can also prepare separate


2Unpublished materials given to investigator by Dr. Sunderman.

27In large hospitals, some technologists or certified assist-
ants may specialize as blood collectors (often called phlebotomists,
or humorously in the medical subculture, vampires!).
28
2Sunderman. The effects and future possibilities of automa-
tion of communications will be discussed at greater length in other
portions of this dissertation.







listings of the patients who need each type of blood or other tests;

the listings serve as the daily work sheets for the technologists.

For physicians, cumulative, permanent records (printouts) can be up-

dated daily for each patient.29

The oldest and perhaps most important (though less dramatic)

category is automation of manipulations. Examples include such labor-

saving devices as vortex mixers and mechanical mixers, automatic burets,

automatic recording spectrophotometers, and automatic balances. Sun-

derman points out that

in the long run, automation of manipulations
may prove of greatest value in assisting with
the analyses which are either extremely com-
plex, and thus defy robot analysis, or the
analyses which are infrequently performed, and
which therefore are impractical to undertake
completely by instrumental methods.30

Again, the labor-saving devices may not be as dramatic as the next cate-

gory to be discussed, but their cumulative effects of relieving monoto-

nous tasks, saving time, and increasing accuracy are quite important.

The automatic pipette, for example, is far more accurate, delivering

more precise amounts of liquids than manual pipetting; it is safer,

too, since chances of poisoning are virtually eliminated.31

The third category of automation in the laboratory is "robot

analysis." Overwhelmingly, the leading contender for public and pro-

fessional attention in this category are the multi-channel autoanalyzers,

291i.
I29bid.

301bid.

31Anna P. Fagelson, Opportunities in Medical Technology (New
York: Vocational Guidance Manuals, Inc., 1961), p. 12.








developed and manufactured by Technicon Instruments Corporation and now

being used by about eighty United States hospitals.32 Having been issued

in eight-, twelve-, and eighteen-channel models, the autoanalyzers to

many people have become virtually synonymous with laboratory automation.

Though inaccurate, this belief does reflect the growing importance of

autoanalyzers in the chemical laboratory. Each channel represents one

test, so that eight, ten, or twelve tests can be run simultaneously

from the same blood sample.

Product of inventive research physicians and
Technicon technologists, the autoanalyzers
perform many delicate and highly sophisticated
chemical and physical tasks in less time than
it takes to describe them. First, the 3-milliliter
blood sample (less than a teaspoonful) is cen-
trifuged to get rid of the cells; the analyzer works
with the serum that remains. The machine divides
the serum into twelve portions and sends them rac-
ing through the plastic tubes by power from roller
pumps.
Along the way, every sample is appropriately di-
luted and mixed with a specific reagent for each
of the twelve tests. The resulting rivulets are
variously colored, according to the reagent used
and the interaction between reagent and serum.
Near the output end, each sample drops into a
tube on the rim of a colorimeter that looks like a
twelve-spoke wheel. A powerful light flashes a
beam through the tubes, and photo-electric cells
measure the intensity of the transmitted light. A
computer converts these readings into values for
the pen to draw on the chart paper.33

The main function of the autoanalyzer is diagnostic screening and the

checking of the blood chemistries of patients whose conditions are

already known.34


32"Medicine," Time, October 28, 1966. p. 68.

33
Ibid.

34bid.







Another example of an instrument illustrating robot analysis

is a very valuable automatic device called the Coulter counter, used

in hematology. In many laboratories it is replacing the time-consuming

visual method of counting red and white cells with the microscope. This

counter, though expensive, can count to within 3 per cent accuracy and

can even measure size of red cells.35

Another promising new instrument is the robot chemist. Similar

to the autoanalyzer, the robot chemist has the advantage of being

"programmable." Whereas the autoanalyzer can use only one or two

methods for performing certain tests, the robot chemist can do a test

by adapting a variety of manual methods.36


Dynamics and Development of Automation

The third objective of this chapter is to present a brief his-

torical sketch of automation, giving attention to the causes of present-

day laboratory automation. In the previous section, which dealt with

definitions of automation, the position was taken that automation is a

part of an evolutionary development of technology. Automation may be a

distinct phase in industrial progress, but it is
nevertheless a part of the long continuum of man's
mechanization of his work. The economic and social
effects of the new technology should be viewed in
this perspective.37


35David Seligson, "Automation and Labor- Saaving Devices in
the Chemical Laboratory," Connecticut Medicine, XXV (July, 1961)
424.

Interview with Dr. John B. Miale, Director of Clinical Path-
ology, Jackson Memorial Hospital, Miami, Florida, June 16, 1967.

37Diebold, p. 6.




69
There is really nothing particularly recent about automation. One of

the earliest automated devices, still used today, was the pressure

cooker (a regulator) invented by Denis Papin in 1680.38 In 1784 Oliver

Evans built a fully automated flour mill near Philadelphia.39 In 1801

Joseph Marie Jacquard invented an automatic loom, 11,000 of which were

found in France alone by 1812.40 In fact, automation in some form has
41
always been present since the inception of the steam age.

In the hospital laboratory automation is not new either. There

have probably always been some kinds of automatic devices since the

42
beginnings of medical technology at the turn of the century.4 Some

early examples include "mixers" in serology, crude automatic pipetters

in the early 1930's, and, by World War II, the autotechnicon.43

World War II, in fact, gave a big boost to laboratory automa-

tion since military and civilian utilization of laboratory services

expanded far beyond the manual capabilities of "unreasonably small and

insufficiently staffed hospital laboratories."44 Ever since World War II


38R. H. Macmillan, Automation (Cambridge: Cambridge University
Press, 1956). Cited in Yale Brozen, Automation: The Impact of Technologi-
cal Change (Washington, D. C.: American Enterprise Institute for Public
Policy Research, 1963), p. 6.

3Diebold, p. 1.
401bid.
lIbid.

Ibid.
42
4Seligson, p. 423.

43Conversation with Miss Ruth Williams, Chairman, Department of
Medical Technology, University of Florida, August 18, 1967. The auto-
technicon moves tissues from one alcohol solution to another for drying.
Finally it dips the tissues into paraffin wax; advantageously it can be
programmed to let the tissues soak in various solutions the desired
length of time.

44Seligson, p. 423.







the demand for laboratory tests per patient has been soaring.45 It

in indeed fortunate that automatic machinery began its great boom

after the War. There is no doubt that hospital laboratories would

long since have collapsed under the weight of increased numbers of

procedures were it not for the automatic equipment now installed and

working. Fortunately, the time required to implement new discoveries

has been lessening:

It has been pointed out that a study of indus-
trial history shows that there has been a pro-
gressive reduction in the time-lag between the
date of an invention and the date when it is put
to practical use. Whereas at the end of the nine-
teenth century this time-lag was about twenty
years it is now only a few years. 7

A good example of this trend is the autoanalyzer, which, introduced in

1957, is now used in over eighty hospitals. Instead of two channels,

twelve-channel models are standard with an eighteen-channel machine now


451bid. Because, no doubt, of rising population, proportionate
increase in the very young and very old, rising socio-economic standards,
advances in medicine and in medical technology, and the resultant in-
creased appreciation of arddemand for medical services on the part of the
public.

46There is universal agreement on this point among laboratory
people of all kinds and levels with whom this investigator has talked.

Prolonged failure of the autoanalyzer(s) in a large automated
hospital means that most blood testing comes to a halt, since typically
only emergency blood tests can be handled manually at such a time. In-
terview with William G. Curtis, clinical chemist, Mt. Sinai Hospital,
Miami Beach, Florida, June 19, 1967.

47Frederick Pollock, The Economic and Social Consequences of
Automation (Oxford: Basil Blackwell, 1957), p. 66.

4Time, p. 68.






49
available. The rapid spread of the autoanalyzer, in spite of very

real problems (technical and social) involved in its use, illustrates

the dynamic force behind automation--the need to increase productivity

and, hopefully, reduce costs. As Diebold has remarked,

automation is, of course, a means for increasing
productivity, and, in fact, the increased pro-
ductivity obtainable through automation is pos-
sibly the single most important economic meaning
of automation.50

The steadily increasing testing load in almost all hospitals,51

the critical and apparently eternal shortage of technologists, and ris-

ing labor costs52 all contribute to the rush toward automation. Even

many small hospitals (where volume might be presumed to be too small)

have installed autoanalyzers.53 The reason is not hard to appreciate

when one considers that in an eight-hour day some autoanalyzers can

run 960 individual tests, an accomplishment that would take the average

technologist three weeks!54 By 1965 somewhere between 25 and 50 per cent

of laboratory workloads were performed by automatic instruments; possibly


49Herman M. Sturm, "Technological Developments and Their Effects
Upon Health Manpower," Monthly Labor Review, 'XC (Janua'ry,.'1967), 3.

50Diebold, p. 167.

51Said to be a 15 per cent or greater per annum increase in
many laboratories. Seligson, p. 424, and interview with Miale.

52Pyke, p. 160. Whether automation actually can save laboratory
money is debatable. Costs of quality control and more highly trained
personnel bring the claim of cost savings into question. Interview with
Miale.

53Seligson, p. 423.

54Sturm, p. 3.







75 per cent will be so handled by 1975.55 Mass routine tests that can

be performed for from twenty-five to thirty dollars on automated equip-

ment in about two hours would cost one hundred to two hundred dollars

manually and would take two days to perform.56 The motives of hospitals

to automate as they face the current crisis in health care demand

scarcely require further explanation.

In a later chapter, emerging patterns of laboratory automation

will be examined. The extent of laboratory automation today is inchoate,

difficult to measure, and imperfect in design and functioning.. Short-

comings and problems rampant in today's semi-automatic laboratories will

undoubtedly find solutions that will profoundly alter the technical and

architectural arrangements of the hospital laboratories of tomorrow.

The technological innovations will result in vastly different patterns

of social relationships on the part of all types and levels of laboratory

workers.










551bid. This is understandable when one considers hematology
and chemistry are by far the busiest areas of the laboratory and are
also the most subject to automation, dealing as they do with liquids.

Moreover, at many hospitals the routine blood testing and
urinalysis make up a large portion of the total procedures performed.
Seventy common tests at one Chicago hospital, for example, made up 85
per cent of the workload.

561bid., p. 2.












CHAPTER VI

SOCIOLOGICAL EFFECTS OF AUTOMATION


To determine scientifically the effects of any innovation is

a most complex undertaking. As scientists in all disciplines know,

causes are usually multiple, effects varied, and changes frequently

impossible or extremely difficult to attribute to any single cause.

The problem of ascertaining what effects automation has and

will produce on the professional role of medical technologists, even

in an exploratory rather than a definitive sense, is consequently com-

plex. Review of several bodies of literature reveals clues as to

changes in industries and the professions that automation may bring,

but such changes may not necessarily be expected to occur in the clin-

ical laboratory. Additional data gained through interviews and question-

naires have served to pinpoint changes that have occurred or may be im-

minent with the advent of laboratory automation. In any final sense,

however, the ultimate effects of automation will also be determined

by social and economic changes in hospitals, in the health system, and

in society as a whole.

Thus, to say that any one change of role and function in the

laboratory is caused by automation alone is virtually impossible. Many

changes may be the results of increases of hospital size, or incre-

ments in scientific knowledge, or in political and economic pressures.








This exploratory study endeavors only to identify those effects that

most logically and rationally seem to be caused primarily by automa-

tion. All other social changes in laboratories, regardless of cause,

fall beyond the scope and methodology of this study and are therefore

not considered here.

Changes and problems related to automation and dealt with in

this dissertation can be divided, conveniently, if somewhat arbitrarily,

into three categories of topics--the sociological, the sociopsycholog-

ical, and the professional.1 The purpose of Chapter VI is to present

findings from literature reviewed on certain sociological topics and

to discuss such findings with reference to the interviews and question-

naires. Covered in this chapter are the topics of sex composition;

status (prestige); functions (division of labor); frequency and mean-

ing of interactions; stratification; and bureaucracy.


Sex Composition

Obviously, a knowledge of the "sex ratio" of any profession or

group of workers is vital for understanding many of its characteristics,

its behavior, and its status among and relations with other groups and

society at large. The fact that approximately 90 per cent of MT(ASCP)'s

are women has many implications for the status of the profession and for

its relations with the predominantly male counter-positions of clinical

pathologists and hospital administrators.

Corwin and Taves' observations on nursing are relevant to


In the previous chapter on role, it was noted that no at-
tempt was made to limit investigation to matters of role as strictly
defined, but rather that a number of role-related issues would also
be probed.








medical technology. In their view, nursing's "minority character"

is given additional emphasis by its feminine composition, which "...

leaves an inescapable stamp on'it. ...Throughout its history, the

status of nursing has reflected the status of women in general--

nurses' subordinate role among medical personnel corresponds with that

of women in American society."2

If nursing, like public school teaching, traditionally has had

female composition as a cardinal role attribute, medical technology

has probably only to a slightly lesser degree been similarly character-

ized. Medical technology has been and is primarily a woman's field, but

the entrance of men into the field seems to be accelerating.3


Robert G. Corwin and Marvin J. Taves, "Nursing and Other Health
Professions," Handbook of Medical Sociology, eds. Howard E. Freeman, Sol
Levine, and Leo G. Reeder (Englewood Cliffs, N. J.: Prentice-Hall, Inc.,
1963), p. 188. Nursing and medical technology are similar in some re-
spects but quite different in others. Using caution, the investigator
has gleaned a number of sociological insights from the Corwin and Taves
chapter.

3The investigator has not yet found statistical information to
confirm the trend; however, pathologists and technologists with whom he
has talked seem certain that the percentage of male MT(ASCP)'s is at
least slowly increasing. Of the at least 10 per cent who are men, many
of them began their laboratory training in the armed services. Lura
Street Jackson, The Medical Technologist (Cambridge, Mass.: Bellman Pub-
lishing Company, 1958), p. 11.

Certainly, in the last several years, a fairly large number of
male students have made inquiry about the University of Florida medical
technology program.

It is worth commenting, too, that fully 50 per cent of the inter-
views with technologists conducted by the investigator in Florida hos-
pitals were with men. The percentage of male interviewees was even higher
if one were to include a number who labelled themselves biochemists. Al-
though on the surface this percentage seems to be good evidence of a







It was decided to ask one question during the interviews (and

on the questionnaire) concerning the effects automation might have on

the recruitment of men into medical technology. The question was "Do

you think more men will be attracted into medical technology as labor-

atories become more automated?" One answer invariably was offered by

all respondents, regardless of sex, position, or length of service.

The universal opinion was held that low wages are the primary reason

that so few men have entered the profession (or remained in it). This

response was worded in various ways, but always the conviction was ab-

solute. Most respondents conceded, however, that men "naturally like"


growing male presence in medical technology, it must be remembered (1)
that the interviewees did not compose a random sample of Florida tech-
nologists; (2) that approximately one-half of the technologists inter-
viewed were chief technologists (administrators) and hence more likely
to be men, and (3) that a large portion of the hospitals visited were
in Tampa and Miami where male Cuban refugee physicians, dentists, and
chemists have been eagerly employed as medical technologists (techni-
cians) by local hospitals when they have not been eligible for Florida
licensure as physicians and dentists. Several of the pathologists in-
terviewed were Spanish-speaking. In fact, Spanish seems to have be-
come the de facto language in almost all departments of several South
Florida hospitals.

4Fagelson offers low wages, scant recognition, and a feminine
image as prime reasons so few men become MT(ASCP)'s. Anna P. Fagelson,
Opportunities in Medical Technology (New York: Vocational Guidance Man-
uals, Inc., 1961), p. 42.

Perhaps social scientists, too, would offer the feminine image
of medical technology as an additional deterrent; oddly enough, also,
the relatively low wages of medical technologists might be attributed
in part to the overwhelmingly feminine composition of the field. A
vicious circle effect may be operating.

Nevertheless, some hospitals follow a policy of hiring males
whenever possible--probably because men tend to have more stable work
records (do not marry, become pregnant, and cease employment). One







mechanical devices and enjoy operating and repairing machinery ("get

less flustered") or that they have more innate talents along mechanical

lines. Most thought that automation will interest and attract men, if

the remuneration problem is solved.

Feminine composition seems to be a well-established role at-

tribute of medical technologists in all role sectors considered in

this study, and remarks were made among women technologists to indicate

resistance to entrance of men into the profession. A number of neg-

ative remarks are noteworthy.

One thought, advanced by both men and women and by pathologists

and technologists alike, is that, although men technologists are better

at coping with mechanical problems, women are more able to stay with

the routine operating of the machines.


example of such a hospital is Mt. Sinai, where salaries are fairly high.
Interview with Mr. William Curtis, clinical chemist, Mt. Sinai Hospital,
Miami Beach, Florida, June 19, 1967.

5This is the phrasing of the interviewees. Social scientists,
of course, assume that these may be culturally developed, rather than
innate, traits.

The standard cultural rationalization was offered by many in-
terviewees (by both men and women and by pathologists, administrators,
and technologists) that men must have higher wages since they have
families to support.

interview with a biochemist June 6, 1967. Similar views were
expressed by others, including a young technician. In an interview on
May 18, 1967, she expressed the opinion that "men won't be interested
in automation. Men need a higher position (supervisory). They need
to provide for their families, not run machines, which women can do."
In an interview on June 6, 1967, a chief technician remarked that "men
will get bored just running the machines in hematology." Many of these
remarks were stated in a tone that indicated distinct hostility to the
idea of male technologists. The investigator doubts, though, that a
majority of female technologists necessarily feel reluctance to accept
men into the laboratories.







On the positive side, a number of pathologists expressed

fervent hope that more men will become medical technologists. One

thought that many pathologists would welcome men technologists since

they can become good supervisors ("females take directions from them
8
better").

In summary, it is sufficient to state that most administrators,

pathologists, and technologists feel that laboratory automation will

in itself attract men into medical technology, and that men have a

valuable contribution to play in the automated laboratory. Yet almost

universally, low wages are perceived to be the major deterrent to male

entrance into the field. Hence, no positive hypotheses should be

formulated as to changes in sex composition because of automation per

se. Yet men may be more actively recruited, since it is possibly true

that American culture typically develops more mechanical talent in men

than in women.

Moreover, if large automated laboratories require more trouble-

shooters and supervisors among MT(ASCP)'s, men, offered increased salary

incentives, may enter the field in great numbers, breaking the vicious-

circle effect that seems operative at present.


Automation and Status

Status, in the sense of prestige, or ranking, among professions,


Interviewed May 18, 1967. This pathologist held the opinion
that a well-rounded male technologist is a very great asset (working
with machinery, repairing). He did think, however, that such males
"give less to little, tiny details," at times tend to be arrogant, and
in some cases manifest certain feminine behavior traits.








is of increasing concern among the recently emerging allied health

professions.9 This investigator is not aware of any empirically de-

rived hierarchies into which the health professions have been ranked.

Almost certainly, however, the lay public accords the greatest amount

of prestige to members of the older and better known professions:

denistry, optometry, nursing, and, in particular, medicine. Hospital

personnel also probably accord higher esteem to physicians and nurses

than to most other hospital workers. The purpose of this section is

to develop hypotheses concerning the possible effects automation may

have on the status (whatever that exact status may be) of medical tech-

nologists. Since laboratory automation is still in its early stages,

the only sources of information are comparative examples from other

professions and the opinions and feelings of administrators, patholo-

gists, and medical technologists themselves.

For the purposes of this section, a good starting point is

again the Corwin and Taves analysis of nursing. In regard to the

status of nursing, they observe that

the status of nursing is best understood
in terms of its humanitarian, bureaucratic,
and professional role conceptions.
From its origin early in the eleventh cen-
tury, nursing inherited the drudgery con-
nected with sick care, first performed by
women in monasteries as a religious duty and
later in tax-supported institutions for meager
pay. Yet even then, the nurse had a claim to
social prestige. An altruistic motive was at-
tributed to her--she worked "in a sacred aura"


9Corwin and Taves, pp. 188-189.







which gave her a kind of moral superiority,
for to be in a position to help others is a
mark of superiority. This service ideology,
the traditional basis of nurses' respectabil-
ity, remains central to the nursing image;
it has elevated nursing from a servile occu-
pation to a position of prestige by reinforc-
ing an altruistic image of the vocation.10

Medical technology does share in the "service ideology," the "altruis-

tic image" of nursing and gains prestige thereby. Yet it is likely

that medical technologists benefit relatively little from the "moral

superiority" that nurses are accorded by the general public. The rea-

son is that most members of the public have almost no idea as to what

medical technologists are or do. A very frequent complaint made when

this investigator interviewed technologists was that "nobody knows

what we do anyway, and half the patients in the hospital think we are

nurses." Those patients who do distinguish medical technologists as

separate professionals remember them in terms of "those people who

stick needles into us and draw blood."'1

In addition to an altruistic image, nurses acquire status from

another circumstance:


101bid.

lRecurrent remarks made by Miss Ruth Williams in lectures on
medical technology to HRP 201 classes at the University of Florida,
1964-67.

The point that needs to be made here is that medical technolo-
gists perform a "hidden service," the real nature of which is unknown
to the average patient. Beyond vague notions of "urinalysis" and "blood
testing," the majority of patients have little conception of what a
clinical laboratory is, much less an understanding of the many proce-
dures performed in one. The same cannot be said, of course, for








The nurse's present identity has been
fashioned by still another feature of a former
era: nurses early achieved relatively autonomous
status as private practitioners. By the turn of
the century the majority of graduate nurses were
in private practice. The nurse's hours were long
and she was at the convenience of the family which
employed her, but in the absence of the physician,
she was held responsible for the patient's well-
being. Over a period of time this authority has
been altered by the conditions which increased
the demand for nurses in the early part of the
century--specialization and increased admissions
to hospitals brought about a variety of social
changes. Currently, only about 15 per cent of
registered nurses are in private practice. Hos-
pitals and related institutions are the prime
users of nursing services, employing nearly two-
thirds of the 460,000 professional nurses in
this country. The nurse has become an institu-
tional employee.
Like other ancillary professionals working in
hospitals, the nurse's autonomy has receded be-
fore the organization of large modern hospitals.
It has been charged that the nurse is in fact
neither a professional nor a ministering angel,
but rather an administrator and a technician, a
member of an organized bureaucracy whose work--
which includes all things not done by other


physicians, nurses, and a myriad of other counter positions in the
hospital, the incumbents of which do have a more developed and ac-
curate concept of the medical technologist. Jackson, p. 8.

Interestingly, out-patients at several large general hos-
pitals the investigator has visited do actually go to the laboratory
for blood and other tests and are able to witness technologists at
work. Understanding of scientific principles aside, lower class
Americans may be better off in knowledge of clinical laboratories
than better educated middle and upper class Americans.

Nevertheless, medical technology is not at all a well-known
profession. As Fagelson comments, "The image of the medical tech-
nologist grows ever stronger in the medical picture. And yet medi-
cal technology is perhaps the least heralded of all the allied medi-
cal professions. Both the nature of the work and the relative new-
ness of the field have contributed to the relegation of the medical
laboratory to obscurity where it remained until quite recently, away
from the eyes and ears of the patient and the public." Fagelson,
p. 26.








people--is directed by persons outside the pro-
fession, namely doctors and hospital administra-
tors.12

Medical technology, of course, totally lacks the added aura of private

practice.

Whatever the exact location of medical technology in a pres-

tige hierarchy, its status, like its sex composition, will possibly be

affected by automation mainly through intervening variables. The

literature reviewed concerning effects of automation, not written by

sociologists, very seldom deals with changes in status in professions

undergoing automation.

Responses in the interviews and questionnaires were positive,

negative, and neutral; they came from incumbents of the focal position

and counter positions alike. Some pathologists, administrators, and

technologists were of the opinion that the status of medical tech-

nologists (as determined by perceptions of the general public and medi-

cal personnel, considered separately) would increase, while others

thought it would decline or not be affected.

Medical technologists indicated overwhelmingly that they feel

the public has little awareness or appreciation of their profession.

One biochemist observed that medical technology has a rather low
13
status:3 a technologist said dejectedly, "I hope public opinion will

rise."'' Whatever their opinion of the current status of medical


12Corwin and Taves, pp. 188-189.

131nterviewed June 6, 1967.

14Interviewed May 18, 1967.







technology, the majority of technologists expressed the belief that

automation will not affect that status (since the hospital laboratory

and medical technology are unknown anyway).

There were, however, a number of both positive and negative

comments. One young technician thought that status would fall rapidly

"if the machines take over" and technologists become "machine opera-

tors," but she also believed that some medical technologists would

gain prestige should they become supervisors and that hospital workers

might view medical technology more favorably after automation.15

A positive response on the part of a biochemist was as follows:

"People will come to have more respect for medical technologists when

they come to appreciate the complexity of machines and the fact that

with automation more knowledge is needed."l6 One technologist said

there would be more prestige when medical technologists begin working

with expensive equipment.17

Very few hospital administrators seemed to think that automa-

tion will have no effect on the status of medical technology. One said

that "the status of medical technologists will fall, as far as on-

lookers are concerned, if the personal goes out of it."'8 Yet one

administrator felt that the drama associated with automation will in-

crease the prestige of medical technologists.19


151nterviewed May 18, 1967.
16Interviewed June 12, 1967.

17Interviewed June 14, 1967.
181nterviewed June 14, 1967.

19Interviewed May, 1967.







Although several pathologists thought that the status of

medical technologists would be little affected by automation, the

great majority of those responding (interviews and questionnaires)

believed that the technologists would definitely gain status. 'One

pathologist interestingly remarked that the CLA's (certified laboratory

assistants) will gain the most prestige, since they will be operating
20
the machines.2

Somewhat in contradiction, another pathologist thought that

ASCP technologists would lose prestige if they did nothing but operate

automatedequipment, but that they will retain their prestige or en-

hance it if they perform more specialized tests or become supervisors.21

The views of clinical pathologists, medical technologists, and

hospital administrators, by no means unanimous, in regard to possible

effects of automation on status merit interpretation. In the first

place, the question concerning status did not specify for the respon-

dent, nor did it suggest to him, how or why automation might affect

status. Initially, the respondent was allowed to imagine any causal

connection that he wished. If the respondent seemed to perceive no

connection whatsoever, the interviewer asked if prestige would be low-

ered or heightened should the medical technologistsbecome, as it were,


20Interviewed June 21, 1967. Actually, who can and should
operate the autoanalyzer and other pieces of equipment is a contro-
versial question.

21nterviewed May 18, 1967. The two opinions are not really
contradictory since CLA's, who have lower status, would probably gain
in prestige should they become the main operators of the glamorous
new machines, whereas the MT(ASCP)'s, capable of much more intricate
scientific endeavors, might well lose prestige by "merely" pushing
buttons (especially if this were virtually all they did).








machine operators or monitors, rather than skilled "artisans."22 In

all probability, most respondents did not perceive too clearly this

possible effect. In fact, responses to the status question were gen-

erally vague and unconvincing.

To many respondents the status question may have seemed un-

real, and though they answered it, their "yes and no" answers seem to

indicate that they had given the matter little thought and had for the

most part not experienced or perceived status changes during the few

brief years in which laboratories have been automating.

The most widely held opinions were either that there would be

no change in status or that there would be a rise in status. The judg-

ment of the investigator is that a hypothesis should be advanced in

favor of a rise in the status (prestige ranking) of the ASCP technolo-

gist as determined by the general public, patients, and hospital per-

sonnel. The reasons for this judgment need explanation.

One reason is the somewhat fallacious basis of the "no change"

position. The no-change answer was usually offered in conjunction with

the statement that "no one knows what medical technologists do in hos-

pital laboratories." Essentially this statement is correct in regards

to patients and the general public. If public and patients do not

know that medical technologists exist, they can hardly be said to hold

them in any sort of esteem, low or high. At the least, medical tech-

nologists would share the status of nurses with whom they are so

22
It was this well-known effect of industrialization (skilled
artisan reduced in status to an assembly line worker) that prompted
the inclusion of the status question.








ubiquitously confused.

It may well be, however, that medical technologists are not

now as "hidden" as they assume.23 Unquestionably, a large percentage

of the public either does not know what a laboratory technologist is

or does indeed think that all women in white dresses and shoes are

nurses. The American public is, nevertheless, one of the more highly

educated and health conscious publics in the world. American high

schools have "health careers days" for their students. Above all,

some hospital laboratories and other clinical laboratories are'increas-

ingly featured by press and other news media precisely because of the

drama of the autoanalyzer and the growing controversy in Congress and

the press over quality of laboratory work and the need for more govern-
24
mental regulation. Therefore, a heightened public recognition of

medical technology and automation in the laboratory is occurring. The

prestige that Americans award scientific and technological achievements

may well "rub off" on the medical technologists who help design and

operate the ever more complex automated equipment.

If the ASCP technologists are able to adjust positively to the

proximate age of laboratory automation, the contribution their efforts

can make to health care will, in all likelihood, create for them much


230bviously, the extent to which medical technology is or is
not recognized as an area of health care specialization is a matter
to be determined by empirical research.

24The Time article of October 28, 1966, which describes the
autoanalyzer, is an example of how knowledge of the laboratory is being
disseminated.







more publicity and prestige than they have ever before enjoyed. Prob-

ably, too, assumption by ASCP technologists of the functions of ad-

ministrator and attainment of a more fully professional existence may

very well provide more prestige for the profession than may be lost

when and if the ASCP technologist largely ceases to be a skilled bench

worker.25

Finally, the status of the MT(ASCP) will be indirectly elevated

by automation if automation leads to (1) higher education and performance

levels for technologists; (2) higher wages as a result of greater edu-

cation, and, possibly, professional militancy, and (3) more men tech-

nologists (attracted by higher wages and other factors) who can relieve

the profession of its feminine minority status. These three factors

are interacting and interdependent in their effect on the status of

the medical technology profession.


Automation and Changes in Functions

For purposes of this study, role has been defined as a set of


25The fully registered technologists may not gain status, how-
ever, if he or she becomes merely a machine operator. As Karsh remarks,
"It [the machine] may depend for its continued operation on a workman
who checks dials, and gauges, makes decisions, and bears the responsi-
bility. But the machine is likely to be far more spectacular than the
workman and the machine gets the bulk of the credit. The worker's
pride is very nearly pointless unless it is upheld by the esteem of the
community. Thus specialized work that is insulated from recognition by
the worker's significant community--those whose opinions of him mean
the most to him--violates the sentiments of "craftsmanship." Bernard
Karsh, "The Meaning of Work in an Age of Automation," Current Economic
Comment, III (August, 1957), 7.

The autoanalyzer, of course, is just such a machine.







expectations applied to the incumbent of a position. In the two pre-

ceding sections of this chapter, changes in expectations for the attri-

bute of sex and the role-related problem of status were discussed. This

section presents findings and discussions of possible changes in ex-

pectations for several general functions of medical technologists. All

of the functions of the ASCP technologists working in hospitals are not

discussed here, nor have the many detailed acts which compose much of

the content of their role been enumerated. The intent, rather, has been

to gather insights and information as to likely changes in expectations

for the focal position by its incumbents and by incumbents of its two

major counter positions.

It should be pointed out that, regardless of expectations, auto-

mation by definition creates changes in the actual behavior of the in-

cumbents of the focal position.26 Automation (in simplest terms) means

that a device or machine accomplishes partially or completely the work

that a human has previously done. Automated laboratory equipment pro-

vides, in varying degrees, energy, skill, intelligence, and control for

the performance of procedures. Of course, the degree of automation must

be recognized, since laboratory automation is only in its beginning

states. As automation advances, each new task or activity that is

26
2As noted in a previous chapter, role is often defined as actual
behavior, but the investigator prefers, for this study, to define it as
expectations for behaviors or attributes. Although cases of complete cor-
respondence between expected behaviors and actual behaviors are probably
few, in most instances the two may be assumed to be closely correlated.
The advantage of defining role as expectation lies in the basic assump-
tion of role theory that expectations mainly determine behavior, i.e.,
individuals enact roles (fulfill expectations). However, the concession
should probably be made that widespread changes in actual behavior may
alter expectations. Congruence of actual behavior with expected behavior
and the possibility for role conflict and modes for its resolution would
seem to be more easily conceptualized by defining role as expectations.







automated reduces the former role content of the medical technologist

as "performer of tests." Thus, the role of the medical technologist,

whether defined as expectations or as actual behavior, is necessarily

altered.27

Certain alternative functions seem likely to become part of the

role of the ASCP technologist. If machinery and devices are to handle

the actual performance of procedures, for example, will the ASCP tech-

nologist become a machine operator? Will she (he) become more of a

specialist, concentrating all efforts toward mastering the many new

esoteric manual tests in one area of laboratory testing? Will automated

machinery be operated by personnel of lesser training than the ASCP tech-

nologist (under his or her supervision)? Will automation advance so ma-

terially in all areas of laboratory activity that the present skills

of the ASCP technologist will become redundant? Who will provide main-

tenance and repair for the complicated, expensive new equipment?

In regard to these questions, relevant literature was examined;

questions were then asked in interviews of pathologists, technologists,

and hospital administrators.

One topic investigated is the possibility that automation will

free the technologist to do other, more specialized, tasks. This pos-

sibility is occasionally mentioned in professional literature. A per-

tinent example is an article entitled "Laboratory Automation Has Freed


27The last chapter and summary offer predictions of likely de-
velopments in laboratory and hospital automation in the next few
decades and of effects on the profession of medical technology.







28
the Technologist,28 which optimistically announces that

technologists are free to specialize when
machines take over the routine tests. ...Ma-
chines do not replace technologists. Rather
they allow him to do more experiments and take
over the routine laboratory work so that the
technologist is free to do more specialized
procedures.29


2Diane Spencer, "Laboratory Automation Has Freed the Technolo-
gist," Hospital Management, C(September, 1965), 73-80.

Similarly, Lab World states that automation "...frees technical
staff for new and important tasks and more difficult patient problems."
Lab World, VIII (August, 1967), 615.

Sturm writes that "the utilization of automated equipment and
semi-skilled laboratory assistants will free highly trained technical
staff for more advanced, complex tasks involving difficult patient care
problems." Herman M. Sturm, "Technological Developments and Their Ef-
fects Upon Health Manpower," Monthly Labor Review, XC (January, 1967), 3.

29Spencer, p. 73. It is important to reiterate at this point
that the ASCP technologist is trained as a "generalist." A pathologist
writes, "Our own registered medical technologists have been trained in
a wide variety of subjects. Their education includes not only chemistry
but hematology, microbiology, radioactive isotopes, serology, and other
related subjects. They can perform many procedures at night, on holi-
days, and on week-ends. ...They can shift from one peak load to another,
substituting vacations, or when illness weakens one department or another.
In the majority of our hospitals, the main workload is performed by the
generalists trained in our approved schools of medical technology by
pathologists. This generalist, though experienced in wide areas, is best
qualified to meet routine needs and to know when situations arise which
require the director's attention." George J. Carroll, "The Clinical
Laboratory: A Challenge for the Future." Southern Medical Journal, LVIII
(January, 1965), 91. Dr. Carroll also recommends, however, that many
technologists study to become specialists rather than generalists.

It is worth commenting at this point, too, that whereas automa-
tion may make specialization possible, greater knowledge and a deluge
of new procedures make it necessary. For example, one pathologist
thought that though it may be desirable to give future ASCP technologists
a taste of all areas in their training, the "generalist" is sure to dis-
appear. Interviewed June 21, 1967.

Still another pathologist thought the MT(ASCP)'s will have to
become specialists, while some laboratory assistants might continue as
"generalists." Interviewed June 19, 1967.







Theoretically, if machines can be self-regulating or under

direct control of laboratory assistants, the ASCP-level technologists

would then be free to perform other tests which either cannot be au-

tomated or occur too infrequently to warrant automating.

Opinion seems quite divided among respondents, the majority

holding to the position that lesser-trained personnel will not be able

to cope with automation. The most outspoken of pathologists in the ma-

jority group holds the unequivocal view that automatic equipment re-

quires the very best, most highly trained, ASCP technologists for its

proper utilization. He sees little current or future need for persons

of less than ASCP-level training, and feels that the intricacies and

problems of present automated equipment require a knowledge of the prin-

ciples of chemistry and physics (perhaps at the master's level) that

militates against employment of sub-baccalaureate personnel.30

The same pathologist claims that in the Miami area almost all

pathologists have informed him they want only ASCP technologists to

work with their automated equipment. When technicians have been al-

lowed to run the machines, the pathologists report too frequent oc-

currence of erroneous results--"They've been burned," as he phrased

it.31

Many technologists, technicians, and chemists interviewed

also took either an outright negative stand on the possibilities of

technologists performing more specialized tests or were non-committal,


30lnterviewed June 16, 1967.

311bid.







unable to perceive any "time-saving" qualities of automated equip-

ment. Virtually all emphasized the time-consuming challenge of keep-

ing the machines operating correctly and the new mass of clerical work

that has accompanied automation.

Although most responses were negative (in all groups interviewed),

a number of interviewees did believe that automation will allow tech-

nologists to become more specialized. For example, one registered tech-

nologist with sixteen years' experience, thoughtthat automation has al-

ready brought about more specialization at her hospital.32

With such a divergence of opinion, interpretation is necessary

in order to suggest hypotheses worthy of later operationalizing and

testing. This investigator suggests that with the question of "special-

ization," as with several other questions concerning functions, re-

sponses differ because of the irregular progress of automation and the

degree to which the interviewees are responding to current or to fu-

ture laboratory technology. The assumption that role changes are

caused by (or at least are correlated with) automation and technologi-

cal innovation implies that such changes vary in extent with the de-

gree of technological change.


32lnterviewed June 5, 1967.

The mixed response pattern of the interviews was also evident
in replies on the questionnaires, in which the negative viewpoint is
slightly predominant. An eminent pathologist in North Carolina re-
ports "very little" specialization; an equally eminent pathologist in
Alabama reports having witnessed specialization to a large degree.
Both of these authorities have national reputations in laboratory auto-
mation. Their opposing viewpoints may be caused in part by different
institutional work patterns and policies, as well as by different de-
grees of automation.

A Florida pathologist was able to estimate a 40 per cent







To advance hypotheses on the basis of the short-term tech-

nological changes that have occurred or will occur in the next few

years serves a useful, but limited, purpose. The experience, for

instance, of most pathologists, technologists, and administrators

up to the present time apparently leads them to conclude that automa-

tion requires full employment of the best technologists' talents

available, with little extra time for creative research or performance

of specialized, unautomated tests.33 The present investigator con-

curs in this judgment, but would advance the hypothesis that in a

long-run sense (ten to fifteen years) the technological characteristics

of hospital laboratories will afford some MT(ASCO)'s opportunities

for specializing in unautomated tests, for creating new test proce-

dures, and for conducting research. It is probably true, however,

that even more opportunities will be offered by a more basic shift in

the functions of medical technologists--opportunities for adminis-

trative activities.

Another topic examined in the literature, the interviews, and

the questionnaires is the possibility that the registered ASCP tech-

nologist. may, in the automated laboratory, become primarily a group

or team leader, an administrator, a coordinator, an "executive." To


increase in specialized tests, but one in Atlanta, Georgia, reported
that "with automation the work load has increased, so that there is
very little time for more specialized procedures."

33The crystallization of negative opinion on this matter among
pathologists and technologists alike is demonstrated by the conclusion
of a recent national workshop that less trained, inexperienced person-
nel cannot be successfully employed in automated laboratories. Thomas
K. Kinney and Robert S. Melvill, Automation in Clinical Laboratories:
The Present State and Future Uses of Automation. Proceedings of a Work-
shop Conference (1967), p. 808.








be sure, many experienced ASCP technologists (and many technicians)

have always functioned in supervisory posts as chief technologists,

heads of services, or shift supervisors.. Nevertheless, the basic

core role activity of the profession has always been that of "per-

former of tests." The question is to what extent will the registered

technologist cease to be a manual benchworker and become an adminis-

trator.34

Such a change has already occurred in the role of the registered

nurse, with implications for the prestige (status) of nursing.35

The degree to which medical technologists will become super-

visors logically depends on patterns of division of labor in automated


34Related questions need to be asked in regard to accompanying
changes in role attributes--will different personality characteristics
and educational accomplishments be necessary for ASCP-technologists to be-
come administrators.

35Corwin and Taves, p. 189. Interestingly, the change in the
role of the registered nurse has been brought about not by automation
but by increased specialization and hospital size; such a major shift
in the role of the medical technologist also will probably occur be-
cause of increases in specialization and in the size of hospitals, as
well as a result of laboratory automation.

It is interesting to speculate, too, that the sex composition
of nursing will not change as rapidly as that of medical technology,
since although administration may attract males into both professions,
automation and mechanization (attractive to men) will probably not oc-
cur as rapidly, or to the same extent, in nursing as it will in medi-
cal technology.

In addition, medical technology, increasingly removed from di-
rect patient care, will probably more readily lose its feminine image.
The unhappy (incongruous) situation of the male nurse in American so-
ciety is apparently not as acute for male technologists. Most people
seem to see nothing unmanly in being a skilled laboratory worker or
administrator.








laboratories and the degree automation attains in laboratories.36

It is apparent, then, that the hypotheses just advanced in the pre-

vious section on "specialization" are equally relevant to "adminis-

tration."

The responses given by interviewees (pathologists, technolo-

gists, and administrators) were about equally divided into negative

and positive positions. Reasons advanced for each position were va-

ried.

In general, respondents who thought ASCP technologists'would

become supervisors did so because they believe most automated equip-

ment can be operated by personnel with less than ASCP-level training.

Those who took the negative viewpoint generally stated that employment

of ASCP technologists is necessary for successful operation of auto-

mated equipment and/or that they only employ ASCP technologists.

The investigator's position is that ASCP technologists will

not enter administration in numbers much greater than they already have

in a short-run period of time (five to ten years). Again, however, the

investigator believes that in ten to fifteen years technological change

will indicate that the most viable role for the registered technologist

will be that of administrator and supervisor.

Just as in reality registered nurses no longer nurse, most


361f ASCP-level training is necessary to operate and monitor
automatic machinery, then not many more ASCP technologists, proportion-
ately, may become administrators than currently are such. If, however,
laboratory equipment becomes fully automatic (involving computers and
servomechanisms) and does not require ASCP-level operators), then ad-
ministration and procedure specialization may become major components
of the role of the registered technologist. The assumption, again, is
that the technological configuration will, empirically, be the major
determinant of role content.




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