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Laboratory automation in urban hospitals

Material Information

Title:
Laboratory automation in urban hospitals an exploratory study of the effects of automation on the professional role of medical technologists
Creator:
Hamer, Myron Philip, 1935-
Copyright Date:
1968
Language:
English
Physical Description:
iv, 194 leaves : ; 28 cm.

Subjects

Subjects / Keywords:
Biomedical technology ( jstor )
Health professions ( jstor )
Hospital administration ( jstor )
Hospitals ( jstor )
Machinery ( jstor )
Medical equipment ( jstor )
Medical technology ( jstor )
Physicians ( jstor )
Production automation ( jstor )
Technology ( jstor )
Dissertations, Academic -- Sociology -- UF ( lcsh )
Medical laboratories -- Automation ( lcsh )
Medical technology -- Vocational guidance ( lcsh )
Sociology thesis Ph. D ( lcsh )
City of Miami ( local )
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.

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University of Florida
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University of Florida
Rights Management:
Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
022050466 ( alephbibnum )
13441618 ( oclc )
ACY4618 ( notis )

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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.




Full Text
114
deliberate structuring (in response to automation), status is lent
to a sub-group of workers, a well-knit team, that, through training
and work experience, may well develop a sub-culture molded to the needs
of automated laboratories.
Predictions may be made that the formation of an elite group
creates morale problems among manual workers who are not chosen for
automation: they may feel that their skills are devalued and their
status reduced. Equally, however, the existence of an elite group may
well be instrumental in providing a channel of upward mobility for
younger technologists, who will then be willing to undergo the extra
training necessary for work with automated equipment.
The extent to which these developments will occur in other hos
pitals of fairly similar characteristics is, of course, a matter for
empirical determination. Their apparent occurrence at one large hos-
80
pital is, however, suggestive.
Worthy of note, also, is the chief pathologist's belief that
automation will end stratification in the clinical laboratory based
on skill and educational levels. In his view, only ASCP technologists
go
wln the literature is found a report by Walker that in the ac
counting and sales division of one firm where automated machinery was
introduced, a similar "social polarizing" occurred: "The greater number
of key punch operators and other machine groups increased the number of
employees who were associated more with the mechanical processing of
data than with the data itself. Because of the obvious distinguishing
characteristics of the machine jobs as against the accounting jobs and
because promotion is probably more feasible within rather than between
the groups, there is an increasing possibility of a rather severe schism
between these two groups within the Accounting Division." Walker did
not, however, intimate greater prestige for the "automation people."
Charles R. Walker, Modern Technology and Civilization: An Introduction
to Human Problems in the Machine Age (New York: McGraw-H¡11 Book Company,
Inc., 1962), pp. 306-307.


190
Rodriguez, Manuel Antonio, Chief Laboratory Technologist, St. Francis
Hospital, Miami Beach, Florida, June 13, 1967.
Rywlin, Arkadri Michael, pathologist, Mt. Sinai Hospital, Miami Beach,
Florida, June 19, 1967-
Sayet, Maxwell Martin, pathologist, Doctor's Hospital, Coral Gables,
Florida, June 15, 1967.
Sunderman, William F., Jr., Associate Professor of Pathology and Di
rector of Clinical Laboratories, Shands Teaching Hospital and
Clinics, J. Hillis Miller Health Center, University of Florida,
Gainesville, Florida, May, 1967- Date unavailable.
Taylor, Caral Ann, medical technician, Alachua General Hospital, Gaines
ville, Florida, May 18, 1967.
Trimble, Robert Earl, Administrator, Hialeah Hospital, Hialeah, Florida,
June 14, 1967.
Vincont, Nanette Ruth, medical technologist, Mound Park Hospital, St.
Petersburg, Florida, June 5> 1967-
Williams, Ruth, Chairman, Medical Technology Curriculum, J. Hillis Miller
Health Center, University of Florida, Gainesville, Florida, August
18, 1967.
Wolfe, Sandra, medical technologist, Shands Teaching Hospital and
Clinics, J. Hillis Miller Health Center, University of Florida,
Gainesville, Florida, May, 1967. Date notavailable.
Other Sources
Brownhill, Lydia. "The Hospital's Responsibilities in Medical Tech
nology Education." Keynote speech delivered at the Fourth Sympo
sium on Medical Technology Education, held at Southeastern Massa
chusetts Technological Institute, North Dartmouth, Massachusetts,
November 18, 1966.
Casey, Albert E., pathologist, Birmingham Baptist Hospital, Birming
ham, Alabama. Questionnaire returned to investigator, July, 1967-
Clague, Ewan. "The Impact of Technology Upon Manpower." Unpublished
summary of remarks at the Sixteenth Annual Conference of the Greater
Chamber of Commerce, Philadelphia, Pennsylvania, January 10, 1963.
Evans, Luther H. and Arnstein, George E. (eds.). Automation and the
Challenge to Education. V/ashington, D. C., National Education As
sociation, 1962. Proceeding of a symposium held in V/ashington,
D. C., January, 1962.


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
19oS


156
then, only if ASCP technologists did nothing but run machines (a most
unlikely eventuality). A very few interviewees believed that automa
tion would have little or no effect. The overwhelming majority of
administrators, technologists, and pathologists thought that beyond
any doubt automation will tend to raise salaries of MT(ASCP)'s. The
reason most often cited was the need for more education and specialized
training. Some said that the existence of a relatively few technolo
gists trained in automation in a period of rapid expansion of labora
tory services will force up salaries of the few so trained. Hospitals
will be very dependent on the automated machinery that only these rela
tively few technologists will be trained to operate.
As mentioned in a previous chapter, men are discouraged from
entering laboratory employment by the low wages offered. Nevertheless,
the increasing entry of men into the field may have the effect of rais-
48
ing salaries more rapidly. It should be noted, also, that militancy
(including unionism) is generally on the rise among hospital workers,
a militancy that entry of more men into the hospital work force may
be expected to augment.^ One pathologist claimed that wages will
have to rise to keep pace with increments in wages paid in other health
, 50
professions.
ko
H And, of course, the rising salaries will attract more men,
produce a circular, spiraling effect.
^One pathologist, stated quite bluntly that only unionism will
enable technologists to command higher salaries. Interviewed June 19,
1967.
50
Interviewed June 7> 1967-


97
5Q
workers or leaders. A different type of person may be needed." ^ A
biochemist pointed out that "very few managers are good scientists,
40
and few scientists are good managers." An administrator remarked,
"medical technologists will need to become supervisors, yet many are
41
not human-relations minded and would make poor supervisors."
This investigator believes, also, that at least many, if not
a majority, of registered technologists, would have difficulty in ef
fectively functioning as supervisors. It may be that role attributes
for medical technologists will undergo rapid change if automation
creates for them a supervisory roie.
Still another function of medical technologists may undergo
change with the spread of automation in the laboratory. Machinery and
equipment of all kinds must necessarily be maintained and repaired.
As far as maintenance is concerned, the manual devices in clinical
laboratories have always been the responsibility of the technicians
and technologists who work with them. One topic, that of "maintenance
function," was included in interviews and questionnaires in order to
formulate hypotheses as to the possible expansion or contraction of
this aspect of the role of medical technologists.
One of the most obvious facts encountered by the investigator
at all hospitals visited is that as far as repair and maintenance are
39
J^\nterviewed May, 1967
^Interviewed June 6, 1967-
^Interviewed May 25, 1967-


146
Management, in defending automation, consistently points to
the new jobs--and better jobsthat it creates. Labor, however, has
not been so sanguine over automation's effects in many industries.
That automation, in specific instances, causes unemployment, retrain
ing problems, and general social dislocation can scarcely be gainsaid.
Yet for most industries the case for unemployment effects seems to be
largely unsubstantiated. Remarks of the U. S. Commissioner of Labor
Statistics (U. S. Department of Labor) are worth presenting at length:
The overstatement is that not all technological
job changes in our economy eventuate in the actual
unemployment of individual workers. The BLS [Bu
reau of Labor Statistics] has made a number of au
tomation studies over the past few years, studies
which describe the methods and the effects of in
troducing new technology into a factory or an of
fice. In practically every case, layoffs were in
significant or even non-existent, while transfers
and retraining opened up many new job opportunities.
In a survey of the introduction of electronic com
puters into twenty offices, it was found that, in a
total of 2,800 previously existing jobs, 1,500 were
unchanged, 600 new jobs were created in those same
offices and 700 jobs were eliminated. However, only
400 employees were dropped from the payroll,, prac
tically all of them by means of attrition--mostly
turnover and retirement. A total of about 900
workers were either reassigned, transferred or re
trained, many of the latter for higher-grade jobs.
While this is only one small example, it is fairly
typical of the experience in other firms and in
dustries. In many cases, firms introducing new
machinery and new methods find that their total
work force is increased, even though considerable
numbers of jobs are eliminated. Of course, this
larger work force, with their automated equip
ment, produces a much larger output than previously.
In summary, a considerable amount of technological
displacement can take place within an industry or


This dissertation was prepared under the direction of the
chairman of the candidate's supervisory committee and has been ap
proved by a 11 members of that committee. It was submitted to the
Dean of the College of Arts and Sciences and to the Graduate Coun
cil, and was approved as partial fulfillment of the requirements
for the degree of Doctor of Philosophy.
March, 1968
Dean, Col leg
Dean, Graduate School
Supervisory Committee:


52
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-^ 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, 1
plus per cent.
Just about half do not supervise any other
workers in their laboratory, another fourth
£6 per cent) supervise 1 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).


10
TABLE 1
FLORIDA HOSPITALS VISITED FOR INTERVIEWS
BY LOCATION, CONTROL, AND SIZE (NO. BEDS)*
NAME
LOCATION
CONTROL
SIZE (NO. BEDS)
Baptist Hospital of
Miami
Miami
Baptist
Mediurn
(306)
Doctor's Hospital
Coral Gables
private
(non-profit)
Mediurn
(213)
Hialeah Hospital
Hialeah
Seventh
Day Advent-
i st
Mediurn
(246)
Jackson Memorial
Hospital
Mi ami
County
Large
(1,218)
Miami Heart Institution
Miami Beach
private
(non-profit
specialty
hospital)
Smal 1
(162)
Mound Park Hospital
St. Petersburg
City
Large
(649)
Mt. Sinai Hospital
of Greater Mi ami
Miami Beach
private
(non-profit)
Large
(483)
South Florida Baptist
Plant City
Baptist
Smal 1
(100)
Tampa General Hospital
Tampa
City
Large
(604)
Victoria Hospital
Mi ami
private
(non-profit)
Smal 1
(102)
JU /
''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.


CHAPTER IV
MEDICAL TECHNOLOGYGENERAL 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.
Defi nition
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
2
disease." Although the role of the medical technologist may be
changing in several aspects, its essence is still that of "fact-finder."
Vnna P. Fagelson, Opportunities in Medical Technology (New
York: Vocational Guidance Manuals, Inc., 1961), p. 22.
^R. Heinemann, "What is Medical Technology?" Hospital Progress.
XL I V (Apri1, 1963), 98.
38


187
Smith, Harvey L. "Contingencies of Professional Differentiation,"
American Journal of Sociology,LXII I (January,1958), 410-14.
Snyder, John I., Jr. "The American Factory and Automation," Saturday
Review. XXXVI I 1 (January 22, 1955), 16-17-
Solow, Robert M. "Where the Jobs Goand Where They Come From',' Think,
XXXIII (May-June, 1967), 2-7-
Spencer, Diane. "Laboratory Automation Has Freed the Technologist,"
Hospital Management, C (September, 19&5), 73-80.
Sturgeon, Phillip and McQuiston, Dorothy T. '.'The Status of Routine
Blood Typing with the Autoanalyzer," American Journal of Clinical
Pathology, XU II, (Hay, 1954), 454-463-
Sturm, Herman M. "Technological Developments and Their Effects Upon
Health Manpower," Monthly Labor Review, XC (January, 1967), 1-9-
Tatum, Julian Rundel 1. "Changing Roles of Professional Personnel in
the Field of Medical Care," Nursing Outlook, I (January, 1953),
694-96.
Treudley, Mary Bosworth, "The Concept of Role in Social Work," American
Sociological Review, IX (December, 1944), 665-670.
Trumbull, Marlin L. "Curriculum Development in Schools of Medical
Technology," The American Journal of Medical Technology, XXVIII
(September-October, 1962), 262-270.
Tustin, Arnold. "Feedback," Scientific American,CLXXXVII (September,
1952), 48.
Ulan, Martin S. "The Role of the Administrator in the Growth and
Development of the Laboratory," The American Journal of Medical
Technology, XXVII (January-February, 1961), 35-37-
Wheeler, E. T. "Reconciling Automation and Humanism in the Hospital
of the Future," Hospitais, XXXVII (November 1, 1963), 51-54.
White, Lavinia B. "Thirty-five Years of Medical Technology," The
American Journal of Medical Technology, XXXI (July-August, 1965),
295-299-


102
specialized technicians (phlebotomists) draw blood on the wards,^
with the result that laboratory technologists and nurses do not inter-
LO
act with any significant degree of frequency.
The interviews did, however, shed some light on changes in the
major pathologist/technologist positional sector. The possibility of
change in the frequency of interaction between pathologist and regis
tered technologist emerged in a number of interviews. Most noteworthy
was the viewpoint that, in the short-run, automation has greatly in
creased the interaction. A closer relationship has resulted, since
the greater scientific knowledge of the pathologist has been essential
in the installation, evaluation, and "debugging" of the automated ma
chinery. In the long run, however, most of the same respondents felt
that interaction will be much less frequent once the initial problems
of automation are solved.
47
One pathologist lamented the lack of "social perception"
on the part of many phlebotomists, who, he felt, often lack a good
"bedside manner." Interviewed June 5, 1967-
le investigator did perceive, nevertheless, some indica
tions that friction exists between nurses and technologists. One
possible source of difficulty, pointed out by a biochemist, is the
fact that nurses must conform parts of their scheduling to that of
the laboratory. Interviewed June 6, 1967-
Indeed, the investigator has heard and read complaints that
too often the "tail wags the dog," that the entire hospital program
of patient care is too often limited and hemmed in by the scheduling
needs of the laboratory. Thus, an undiagnosed patient known to this
investigator spent two expensive week-end days in the hospital wait
ing for certain laboratory procedures to be performed on Monday at
3:00 p. m.
In regard to laboratory personnel, one technologist remarked
confidently, "we have always run our own show--the others must con
form to us." Interviewed June 6, 1967.


130
In concluding, she claimed that both manual and automated pro
cedures can become boring to the technologist, even though automated
equipment does eliminate much routine. She summarized her feelings
quite emotionally:
I don't like it, don't care for it. You're
losing a lotthe machines take over (which
is what all the ignorant people see). You
need to have some personal relationship, es
pecially in work like medicine. Oh, I'm in
it for the love of medicine, not just a job.
I'd work even if I didn't have to. I wouldn't
come in just to set up the machines. I want
to know about patientscorrelation of tests.
Even as a supervisor, the meaning would be
gone. A doctor should still be able to order
what he wants and not have to have all tests.
Tests should confirm a doctor's diagnosis.33
33
-^Because of high costs of tests, medical schools have tradi
tionally taught physicians to order only those necessary to diagnose,
or "confirm diagnosis." A newer view (made possible by automation) is
that tests should aid in the diagnosisparticularly through computer
analysis of multiple correlations. W. H. Kerns, "'Casey's Profiles'
Expand Di agiostic Role," The Modern Hospital CV1 I I (April, 1967) 124.
This emerging view is far from universal acceptance among phy
sicians, as several pathologists have admitted to this investigator.
One physician writes the following warning: "The learned professions
and in fact all the professions run the risk of peculiar disaster from
automation in the form of electronic computers. There can be no argu
ment against the conception that in the legal profession computers may
perform services highly valuable in any major legal procedure. In law
the influence of precedent in the preponderance of cases is notable.
The danger point arrives if computers may be allowed to express opin
ions or to pronounce judgment. Human considerations so pervade legal
action that, when a computer thrusts forth its own "guilty," much that
is admirable to law becomes doomed. If the computer's "guilty" deter
mines guilt as later pronounced by the judge, then that judge is in
need of an even blacker gown than the one he now wears."
This physician also remarks, "Long the physician has steeled
himself against his laboratories being permitted to di ctte diagnoses.
In a sense a computer is a laboratory, and if that particular labora
tory thrusts forth the edict 'operate,' then the medical profession
has come upon woeful days." Carey P. McCord,"Preserving the Individual
in an Age of Automation," Journal of Occupational Medicine VI October,
1964), 400-401.


142
The investigator rather expected to encounter similar improve
ments in the clinical laboratory as automation progresses, and he asked
specifically as to changes in safety, housekeeping, and pleasantness
of physical surroundings.
For the most part, however, respondents in all three interview
categories reported little or no change in the safety and pleasantness
of clinical laboratories. Moreover, not a few felt that automation has
had a deleterious effect. Comments and reasoning of several respondents
on these matters are worth considering.
A chief technologist thought automated laboratories will be
safer because of less contact with chemicals and bacteria, whereas the
environment will have to be air-conditioned because of the automated
13
equipment. A biochemist pointed out that automation has meant more
plastics and less glassware (hence less breakage and chance of cuts).
Another chief technologist was able to estimate the automated labora
tory as being "a little bit safer--about 10 per cent." ^
Pathologists and administrators, generally, and some other
laboratory personnel, believed either that automation would have little
or no effect on laboratory safety and pleasantness or that conditions
1 3
Interviewed May, 1967
Air-conditioning is absolutely required in rooms where such heat-
producing equipment as digital computers are located and is desirable with
virtually all laboratory equipment because it dehumidifies.
'^Interviewed June 12, 1967.
'Interviewed June 13, 1967-


149
1. Automation replaces workers in some func
tions. (Thus, technologists may no longer
perform many tasks manually, but they may
become specialists in certain seldom per
formed tests, may become laboratory admin
istrators, may become maintenance and re
pair specialists, or may become researchers.)
(See Chapter VI, Changes in Functions.)
2. Automation is not "complete." (For several
decades laboratory automation will not be
comprehensive; many steps in procedures are
not, and often cannot be automatized; vast
gaps remain in the laboratory as an auto
mated system.) (See Chapter IX.) 1
3. Automation is not "perfected." (Hence, it will
require the attentions of at least ASCP-level
personnel to be properly utilized). (See the
first section of this chapter.)
4. The population of the United States is rising.
(Automation will only help to meet the crisis
in health personnel to care for a larger popu-
1 at i on'.)
5. Socioeconomic levels are rising. (A better
educated, more affluent populace will demand
increasing medical services, including, of
course, a greater number of laboratory de
terminations per patient.)
6. Political and social changes are making pos
sible a system of government medical care pay
ments for the elderly, and, quite possibly
in the near future, for many children. (The
very old and very young are, of course, the
segments of the population that consume a
large proportion of medical services.)
7. Partially because automation has made more
laboratory determinations economically pos
sible per patient, physicians are requesting
procedures to a much greater degree. (Lab
oratory testing is coming to be used for
screening and for diagnosis, rather than just
for the confirming of diagnosis). (See next
chapter.)


32
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 obiigat I on 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 attr? bute 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 attr? bute 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. A focal position is simply
the one being studied, whereas counter positions are those to which the
focal position is related. Without doubt,
bid., p. 67. Examples of usage of these terms in this disser
tation are given in the final section of this chapter.
24
Clearly, the position of medical technologist is achieved.


105
Aside from the possibility of "better relations," a very
large number of pathologists, medical technologists, and administra
tors interviewed saw little or no difference in relationships and
expectations in the major positional sector. Following probing by
the investigator, however, a significant number did think that with
automation pathologists (and other physicians) would order more tests
and would expect greater accuracy, quicker results, and fewer "break
downs" or failure to complete work.^9 Alternatively, it was thought
that pathologists could afford to engage in more general rather than
specific (immediate) supervisory behavior.
Still other interviewees believed that changes will be in
evitable in the relationship between technologists and pathologists,
but that such changes will not occur primarily because of automation.
This investigator readily agrees that automation is not likely to be
the only factor causing alterations in the typical interaction pat
terns of the major position sector. He does feel, though, that, along
with other factors, automation may well be instrumental in pushing
medical technologists into more "equal i tari an" interaction with path-
ologists.
This change in relationships is parallel to and consonant
59
A number of pathologists and technologists pointed out, how
ever, that many physicians mistrust automatic testing and demand cor
roboration of results by means of manual tests. One pathologist be
lieves that this mistrust may be caused by fear of new procedures, but
it is also generated by the, as yet, unevaluated performance of many
automated devices. Interviewed June 19 1967
Another pathologist lamented the failure of manufacturers to
evaluate adequately their own equipment and also the lack of time for
pathologists to "write up" and publish their own evaluations. Inter
viewed June 21, 1967


CHAPTER I I I
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.'
Bruce 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
21


163
were included in a multitest battery depend
ing upon the geographic, ethnic and environmental
factors which establish specific disease risk
at any particular test center.
The ultimate shape that multitesting will take,
then, is unclear. Certain features, however, al
ready are obvious. It is economically possible
to deliver a number of test results for very little
more cost than was formerly involved in producing
the result of a single determination. This statement
is realistic only if one assumes the existence of
some sort of electronic data-processing equipment
programmed to accept and distribute the multiple
results. Second, it has been demonstrated that
gratuitous testing does yield surprising and use
ful results, even when it is carried out in par
allel with care by highly competent physicians
utilizing more traditional approaches. In other
words, if a number of gratuitous test results are
abnormal, these may be judged by the patient's
physician to be significant and perhaps even alter
his diagnosis.
The actual chemical testing is done without ex
penditure of much professional time. Consequently,
those in the health care professions who seek methods
to broaden the distribution of health care have un
derstandably been eager to apply screening studies
more widely. Medicine being for the most part now
adays hospital-based, the hospital administrator
is thus faced with decisions concerning selection
of expensive and complex items of chemical analytical
hardware and must in addition recognize that this new
endeavor will inevitably put pressure on existing
systems which use manual processing of laboratory re
ports and bring on the specter of expensive data-
processing requirements. Without doubt, these de
velopments appear inexorable. It is only unfor
tunate that the field has moved so quickly that
proper validation of test batteries has not yet
been completed and that even chemical methodologies
have not been standardized.
The approach to multichannel testing at Missouri
has evolved through the need to remain responsive
to changing chemical methodologies and also the
likelihood that our test battery would change its
make-up. Two additional considerations shaped
our system: the existence of computer processing
capability within the institution, and consider
able reservation concerning the accuracy and


177
some years of further education and struggle will be necessary be
fore medical technologists attain the semi-autonomous position of
25
nurses. p
^The calls for professionalism on the part of technologists
and the apparent determination on the part of many pathologists to
maintain their control over the clinical laboratory seemingly consti
tute a largely hidden power struggle. Another such struggle seems to
be occurring between pathologists and other laboratory scientists.
The investigator does not wish to express partiality in this issue
(although he confesses to personal bias as to how and by whom clinical
laboratories should be operated).
Interested readers may wish to consult the following articles:
Ruth Hovde, "The Dynamics of Education in Medical Technology," The
American Journal of Medical Technology, XXIX (March-Apri1, 1963), 61-75;
George J. Carroll, The Clinical Laboratory: A Challenge for the Future,
Southern Medical Journal, LVi 1 I (January, 1965), 90-95; Leonor Haley,
"Status or Status Quo," The American Journal of Medical Technology,
XXXII (January-February,1966), 28-32.


35
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,


64
John Dunlop has remarked that "...it is impossible to isolate the im
pact of automation from other forms of mechanisation and technical
change." 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
bewi1 dering 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.^
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
Dunlop, p. 2. Cited in Sultan
25,
'To
than the desi
growing techn
technological
investigator
an "automated
offered here,
of this disse
try, physics,
possess.
the technically minded, nothing will seem more fascinating
gn and operation of these new machines. There exists a
ical literature about them; a study of the scientific and
principles underlying their existence is intriguing. This
has made it a point to be taken on a guided lecture tour of
" laboratory. No detailed technical descriptions v/i 11 be
however, since such descriptions would be beyond the scope
rtation and would presume a far deeper knowledge of chemis"
and laboratory technology than this writer can pretend to


127
A pathologist in Central Florida stated that there is no frus
tration on the part of medical technologists, no feeling of "loss of
control." He felt that most technologists realize that automation ac
tually places them in better control, enables them to produce more ac
curate results, and will free them from routine tests so that more
stimulating manual procedures can be performed. "Automation will give
technologists opportunity for growth by getting routine tests off their
backs. Only the exceptional medical technologist misses doing the test
by hand.
One pathologist pointed out that there is little boredom in v
the laboratory since it is the least interesting, the most monotonous
work that is automated. He feels, moreover, that the most interesting
work (perhaps 40 to 50 per cent of laboratory work) will never become
24
automated.
Another pathologist noted no frustration or feelings of lack
of control among technologists. On the positive side he reported hav
ing heard several technologists using endearing terms and names for
^Interviewed June 7> 1967-
24
Interviewed June 15, 1967. This interviewee is pathologist
to a number of South Florida hospitals, which, collectively, account
for a considerable percentage of procedures performed in the area.
The pathologist must have meant that 40 to 50 per cent of ex
isting kinds of procedures will never be automated, since, by volume
of tests, some laboratories have already reached 75 to 80 per cent
performed by automated equipment. In this investigator's opinion, how
ever, much more than 50 per cent of all kinds of tests will become au
tomated (a matter to be further discussed in the last chapter of this
dissertation).


36
technologyst/admin!strator, 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
29
are obiigations.
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
^By defi nition--the reverse would be true if the position of
clinical pathologist were the focal position.


131
I don't think automation should take over!^
The chief technician of a large general hospital, a woman of
some thirteen years of laboratory experience, took an ambivalent po
sition on automation. Some of her comments are the following:
1 can't get interested in any particular [auto
mated procedure]--just mechanical. 1 miss the
patient contact in a large number of cases. It's
a mass production, but the machine doesn't run
us. We're not as tired with automation--less eye
strain.35
A biochemist at a large private hospital reported no feelings
of "loss of control" over work with automation and an increase in his
own interest in his work. He noted with evident relief that automa
tion permits laboratory workers to "sit, relax, and drink coffee,"
while they watch the machines. Previously the technologist had to
stand and "stay with it" constantly.^
At another large general hospital, the chief technologist, a
lady of some twenty-four years of laboratory experience, offered in
teresting comments on automation:
The only bad thing is the loss of feeling the
medical technologist once had--it has to be re
placed by other satisfactions... At first 1
felt the machine was running me, then later when
I learned its ways, then I felt in control of the
machine. ...You have to change with the times. '
Although this interviee's general attitude seemed negative,
she became enthusiastic in enumerating some of the "good points" of
automation:
^Interviewed June 16, 1967
35
Interviewed June 7, 1967-
^Interviewed June 12, 1967
37
"Interviewed June 16, 1967-


72
75 per cent will be so handled by 1975-^ 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
56
manually and would take two days to perform. 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.
^-*1 bi d. 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.
56
Ibid., p. 2.


88
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-
A /*
cumbents of the focal position. 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
As 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 possiblity for role conflict and modes for its resolution would
seem to be more easily conceptualized by defining role as expectations.


91
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
30
militates against employment of sub-baccalaureate personnel.
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 resu1ts--"They1ve been burned," as he phrased
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,
^1nterviewed June 16, 1967-
31
I bid.


27
perhaps they presently come closer to this
universal language than any other vocabulary
of behavioral science.^3
Even so, these authors hasten to point out that current role language
suffers from two basic difficulties, which are "a lack of denotative
14
clarity and incompleteness of the language." 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 mental istically inspired, whereas
"position," "network," and "relationship" imply
a structural mode.)^
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
^1 bi d .. p. 8.
^1 bid., p. 9 .
^1 bi d., p. 13.


106
with the possible shift of the registered technologists' function
from performers of tests to administrators and supervisors of labora
tories. It is correlated, also, with shifts in the role attributes
of sex, education, and stratification of skills; it accompanies almost
by definition, shifts in the role functions of clinical pathologists.
A more equalitarian relationship implies changes among ASCP
technologists toward professionalism. Medical technologists (like
nurses, physical therapists, occupational therapists, and others)
are apparently in the process of becoming more professional. Corwin
and Taves are worth quoting on this point:
Professionalization, it should be observed,
usually is somewhat militant in character, a
difficult position for many women to take
overtly. The militant aspects include efforts
to overcome lay control (represented by hospital
administration) and to reduce subordination to
physicians, which creates nurse-doctor conflicts.
At present, a militant minority of near-professional personnel is
evident, but the great mass of registered technologists (much less
laboratory technicians) do not appear to possess sufficient post
baccalaureate education, independence in acquiring and applying knowl
edge, a body of theory, and self-direction to be considered profes
sionals. ^ Yet, if the registered technologist accepts a bureaucratic
^Corwin and Taves, p. 192.
^Nowhere is this more clearly exemplified than in the obvious
dependence of technologists on pathologists; it seemed to the investi
gator during his interview tour that pathologists (with very notable
exceptions among technologists) are the laboratory personnel who are
currently making the most professional responses to automation.


117
majority reported that, as a result of automation, little increase in
86
bureaucratic rules has been experienced or is expected. Some re
spondents did feel that the future will bring more "work rules."
In the investigator's judgment, a tentative hypothesis should
be proposed that the bureaucratic aspects of laboratories will not be
greatly augmented by automation. Not only is majority opinion strongly
against the possibility, but it appears to the investigator, also, that
those holding the minority position were really saying that new (dif-
O
ferent) rules and regulations wi11 be necessary.7 Moreover, a sig
nificant percentage of respondents suggested that the effect of auto
mation will be to decrease work regulations.
On the whole, the issue of possible effects of automation on
the bureaucratic aspects of the laboratories was difficult to communi
cate during interviews. In general, only the better educated among
the interviewees seemed able to perceive any possible causal relation
ship.
The investigator concludes that laboratories are already very
bureaucratic work structures in which automation (particularly when
fully developed) may well serve in many cases to free technologists
from the need for minute regulations to control behavior.
Of
ODExplicit recognition is given here to the probability that
increases in regulations usually result from increases in such variables
as hospital size and laboratory work force. The interest, however, has
been to ascertain whether automation may also contribute to bureaucrati
zation.
0~j
'Certainly, it is very much one thing to say that new rules are
needed and another to declare that (necessarily) more rules (or more de
tailed rules) are needed. A number of respondents did say, however, that
to obtain adequate results with automation rules will have to be followed
more closely.


67
developed and manufactured by Technicon Instruments Corporation and now
being used by about eighty United States hospitals.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
perforin many delicate and highly sophisticated
chemical and physical tasks in less time than
it takes to describe them. First, the 3-mi 11 i 1iter
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.3**
^"Medicine," Time, October 28, 1966. p. 68.
3Sbid.


123
It is this type of decision with known criteria
that can be built most readily into machine
programs.9
Since important functions and even positions may be altered or even
abolished in this case, workers feared (quite realistically) the loss
of title and status. The positions usually abolished served
...as terminal points for the average employee
who rises to these positions through sheer en
durance within the system. Occasionally these
positions also serve as a proving ground for
managerial aspirants.
In this study the elimination of these status
positions and the further restriction of the areas
of employee decision-making fell as a severe blow
on status position occupants. Long service em
ployees were stripped of many of their responsi
bilities at a time when the right and ability to
make such decisions was the principal reward of the
job.10
Walker comments strongly on the lessened "autonomy" employees enjoyed
over "work-pacing":
The new more highly integrated work process al
lowed less autonomy in setting a work pace for
both individual employees and more work groups.
Work could not be held over from one day to the
next. Each group had to process a specific num
ber of accounts every day or perform specific
operations. Deadlines themselves became more
important, regardless of how the job had been
going, or how the personnel and equipment were
performing. Absences and tardiness became in
creasingly important because of their detrimental
Q
-'Charles R. Walker, Modern Technology and Civilization: An
Introduction to Human Problems in the Machine Age (New York: McGraw-
Hill Book Company, Inc., 1962), p. 303.
1lbid.. p. 306.


126
Less physical fatigue was present, but there was more mental fatigue
20
and tension, thought to be caused by increased responsibility.
Obviously, the foregoing examples of findings are only meant
to be suggestive of possible sociopsychological effects of automation
on medical technologists. The remainder of this chapter will be de
voted to presentation and discussion of the reactions of interviewees
and questionnaire respondents. Persons responding differed greatly in
the completeness and value of their comments. Not all are worthy of
quoting at length, or even noting. A few offered responses sufficiently
valuable for total reproduction. Comments of pathologists will be con-
si dered f i rst.
One pathologist reported no frustration, boredom, or monotony
among his medical technologists working with automated equipment; in
fact, he thought automation had been a real challenge to them. At
present, he feels his technologists have a distinct feeling of personal
accomplishment, but also feared that such a feeling would no longer ob-
2 1
tain-if the machines become perfected.
Another pathologist thought that his medical technologists like
the new equipment, that they do not find the work monotonous, "as one
22
would expect."
degrees of automation, in different kinds and sizes of work settings,
from respondents who differ in such variables as sex, age, intelli
gence, education, length of service, and position held.
20
Charles R. Walker, Toward the Automatic Factory (New Haven,
Conn.: Yale University Press, 1957). Findings cited and summarized by
U. S. Department of Labor, Background Information on Impact of Automa
tion and Technological Change on Employment and Unemployment (Washington,
D. C., September, 1961), p. 22.
o 1
Interviewed June 12, 1967-
^1nterviewed June 13, 1967-


k3
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 profess i onalism--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.
3^There are several other organization that register tech
nologists not eligible for registry with the ASCP because they have
not graduated from schools and currculums 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 Ml'(ASCP)'s nor will most large
health institutionsemploy them, or give them advancement if em
ployed. Lab World, August, 197, P- 865.


18
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
21
the United States. 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. V/i 11 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 yoirASCP-1evel technologists needed
to play, to a greater degree, a supervisory
role?
21
Development 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.


100
be able to handle all but major breakdowns.
A few respondents offered the specific hypothesis that regis
tered technologists will oversee maintenance and serve as "first-line"
repairmen, but that factory-trained specialists will attend to major
45
breakdowns. This viewpoint, in the investigator's opinion, will be
demonstrated to be correct.^
Although ASCP technologists are currently meeting the challenge
of breakdowns (with assistance from pathologists), the ever-increasing
complexity and numbers of automated devices, as well as the current
steady increase in hospital size, will probably mean that specialized
repairmen will be employed either by the hospital (perhaps servicing
repairs. In response to the questionnaire, "Do you employ a special
ist to repair automated equipment? If not, will you need such a per
son in the future? A Georgia pathologist remarked: "No. The path
ologist, because of adequate training, is generally able to repair
equipment." This statement is certainly most unusual. As another
pathologist points out, "Automation can free the pathologist from
technical concerns, although some pathologists like to tinker." Inter
viewed June 21, I967.
Moreover, there is little in the training of pathologists (phy
sicians) that would give them superior expertise in electronic repairr
work.
^An analysis offered by a Florida pathologist interviewed
June 5, 1967. One administrator commented that "we need factory-
trained representatives; medical technologists should not do major re
pairs." Interviewed June 5, 1967- Another administrator also saw ASCP
technologists as "first-line" repairmen, making adjustments in the man
ner of radio operators in the military services. Interviewed May 25,
1967.
46The day of the "biomedical engineer" would, nevertheless,
seem to be arriving. His role may not include repair and maintenance
of the most intricate machinery, but he may be expected to care for the
majority of devices throughout the hospital.


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
9
al 1 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.^ 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 inverview was better than none. Actually, several of the most fruit
ful interviews were obtained in this way.
o
Of course, facial expressions and gestures could only be re
corded with a television camera.
^Only 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 tfie 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 1 record these interviews is to save time."


98
concerned, laboratories are passing through an acute transitional
period in role definitions. No one seems at all certain as to the
best maintenance system for the new automated equipment, nor pre-
h"?
cisely "who should repair what."
The prevailing pattern at present seems to be that, when a
complicated automatic piece of equipment is purchased, the factory
offers without charge (or at minimal cost) a course in operating and
maintenance of the machine involved to whomever the. hospital desig
nates. As a rule, head technologists or "those mechanically in
clined" receive the training. These people then become responsible
for keeping the machinery in running order. In a surprising number
of hospitals, however, the policy is to train all personnel to run and
operate the automated equipment. Although the same hospitals admitted
that some technologists (mostly men) were better at the automated
equipment and other (mostly women) were better at manual procedures,
the utilization of all personnel to operate and care for the machinery
seemed to stem from the fear, seldom fully expressed (by pathologists
and administrators), that if only certain personnel become proficient
with the machines, a monopoly of skills will afford them unusual power
in bargaining for wages and working conditions. This fear may well be
realistic since, as was mentioned in a previous chapter, laboratory
I O
This confusion is thorouohly understandable if one considers
the new, almost raw quality of much of the automated equipment. A de
vice, often costing thousands of dollars is rushed from invention to
factory to laboratory without adequate evaluation of its technical
problems and weaknesses, much less its scientific capabilities. Be
fore anyone has had time to master and "debug" the device, a new and
presumably improved model has appeared. The situation has become so
bad that one pathologist called for government control over quality
of automated equipment. Interviewed June 19, 1967-


93
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. 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(ASC0)'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."
33
The 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.


103
It is worthwhile to note some of the interview comments on
these points. Among technologists, for example, one stated that
"at first the pathologist intervened to assure quality control, but
now we work more independently, unless trouble comes1.1^ Another re
marked, "Automation has made a closer relationship between the auto
matic section and the pathologist--more communication--but this is
because things are new.""^
A pathologist reported that at his large hospital one patholo
gist had had to work "very closely" with the automation team.^* In
regard to the future, however, another pathologist feels that the
pathologist will not need to have such direct, constant control, but
that nevertheless automation will make actual control and problem
analysis easier. Pathologists will spend less time supervising labora
tories (will interact with technologists less frequently) but may be
more effective.*^
Aside from frequency of interaction, most respondents seemed
to feel that automation has already meant, and will continue to mean,
a "better relationship" between pathologists and technologists. The
meaning of this statement is clear: the major bone of contention be
tween pathologists and technologists is accuracy of test results.
In a later chapter, evidence will be offered for the
^Interviewed June 6, 1967-
^Interviewed June 16, 1967.
51
Interviewed June 16, 1967
52
Interviewed June 7, 1967.


169
and results in an appropriate medical fash
ion permits more rapid and critical evalua
tion by the physician of all the test results,
thus eliminating the possibility of his miss
ing, disregarding or not noticing vital test
results. These are hazards which occur when
laboratory results are attached in the con
ventional, shingled method. The printed, at
tractive format saves the doctor time and ef
fort as he notes the results of all the tests
and evaluates their significance. No longer
can differences in place, technologist section
of laboratory or time of test performance lead
to chaotic, irrelevant, and nonchronological
entry into the clinical record.
10. It is often claimed that automated or computer
ized technics only transfer to other personnel
many of the acts which they claim to eliminate.
The 1080 DAS [Data Acquisition System] does
not shift to ward personnel clerical duties
which formerly may have been performed by labora
tory personnel. On the contrary, use of the tab
ulation card requisition by ward personnel has
materially simplified test ordering because of
the reduction in the variety and number of forms
and the ability to order groups of multiple tests
by a single stroke rather than having to identify
each separate procedure. Transferring the doc
tor's orders from the "laboratory order form" to
the preprinted requisition speeds up the order
ing process and reduces the possibility of er
ror.
11. The rental of the system is equivalent to the
cost of one medical technologist. This ex
penditure can be justified by the increased
productivity of the laboratory that results from
the installation of the system.
12. The receipt of an 8 1/2 by 11 inch single pa
tient report form replaces the conventional
method of receiving large numbers of individual
small report forms which are attached singly and
manually into the chart. The single sheet is
placed into the chart while that of the previous
day is removed and discarded. The alternating
use of color coded report forms each week auto
matically apprises the ward nurse of the start of


39
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-
k
cal technologist. Undoubtedly through the centuries many such
3
Mary Kay G. Moon, "The 3M1s of Medical Technology," The
American Journal of Medical Technology, XXXI (September-October,
1965), 386. Italics the author's.
4
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


107
role (supervising and administering automatic laboratories) and if
males become predominant in numbers and influences, greater profes
sionalism and independence from clinical pathology could result.
The question of professionalism was a difficult, indeed a
delicate, one for the investigator to handle as he interviewed either
pathologists or technologists. The stated norms of registered medical
technologists call for service and subordination to the pathologists
who created them. To state a desire to evade or replace these norma
tive relationships would hardly be easy for incumbents of focal or
counter position. The investigator believes that both technologists
and pathologists are strongly divided among themselves as to the cor
rectness and need for further professionalization of and more inde
pendence for medical technologists.
In reference to possible changes in relationships, a number
of comments and viewpoints are worth examining. Among pathologists,
the most positive comments were heard from one who stated that "in
time the medical technologist will attain a professional standing
at least as high as nurses.This pathologist feels that medical
"a.
technologists will come up the scale by their own efforts. He
believes, too, that pathologists will want largely to abandon their
^Although the investigator often observed resistance to
change or a desire for change in relationships among the various in-
viewees, he also noted a distinct inclination not to talk about it"
on the part of many. in fact, he suspects that many a there-will-
be-no-change reply was motivated by a desire to evade a sensitive
issue.
^Interviewed May 18, 1967*


95
laboratories and the degree automation attains in laboratories.^
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
3^lf 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.


77
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-
'This 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 13, 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.


180
toward greater professionalism of medical technologists. Quite ten
tatively, the hypothesis was advanced that automation will not increase
the bureaucratic aspects of laboratories.
Although a few (usually older) technologists seemed either to
dislike automation or to feel ambivalent concerning it, the majority
of technologists interviewed reacted favorably. Aside from such so
ciological or sociopsychological topics, hypotheses are offered that
automation will improve laboratory accuracy, will not lessen the cur
rent demand for technologists, and will tend to raise salaries in the
profession.


120
responsibilities of workers, it may also in
crease monotony, downgrade skills, and reduce
workers' feelings of importance. Automation
increases the optimum economic size of indus
trial plants and transfers much of the control
of production from men to machines. Conse
quently, workers find it harder to identify
themselves with the objects of production and
to find satisfaction in their work.^
He also notes that automation creates greater emotional hazards for
workers, such as isolation from other workers (hence lonesomeness and
3
boredom).3
Another writer states that automation may be perceived as a
threat (and may be a threat) to employment by many workers, including
professionals:
Automation may threaten to deprive wage
earners and salaried employees not only of
a particular job but it may perhaps even
render certain professional skills redundant
and undermine the social status of many people
employed in industry. Only a privileged mi-
nority--supervisors and maintenance men--can
feel that their jobs are safe.**
Jacobson reported that automobile workers interviewed in one
study "felt that they were losing control over work pacing in the way
the job was done" and that workers had to pay more attention to the
work they were doing.J The workers also
2
Walter Buckingham, Automation: Its Impact on Business and
People (New York: Harper and Brothers, Publishers, 1961) p. 174.
3Ibid., p. 95.
^Frederick Pollock, The Economic and Social Consequences of
Automation (Oxford: Basil Blackwell, 1957)> PP- 40-41.
^Eugene Jacobson, "The Impact of Technology and Automation on
the V/orker: Some Effects of Automation on Industrial and Clerical Workers,'
Industrial Medicine and Surgery, XXXII (June, 1963) 216.


3
their efforts on determining the economic and labor displacement ef
fects of automation on various industries.^ Cultural and social
changes in professions undergoing automation have been largely ne
glected. ^
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 1ater 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."


147
in a particular firm without any direct unem
ployment resulting from the change.^5
The function of this section is not, of course, to survey the vast
literature on employment effects of automation in the many kinds of
work settings found in industry, or to categorize even the health
fields (concerning which data are, in any event, scant). The intent
here is to hypothesize as to what may happen to the numbers of ASCP-
level technologists employed in hospital laboratories following auto
mation.
Three logical possibilities exist: the numbers of technolo
gists employed will (1) increase, (2) decrease, (3) remain approxi
mately the same. In the early stages of this study, the investigator
frankly thought he might discover a profession on the brink of extinc
tion. Numerous persons exclaimed, "Why study the effects of automa
tion on the role of medical technologists? Obviously, they will not
have a role to playthe machines will perform all the tests."
All analyses in the literature, however, ruled out the possi
bility of fewer technologists, much less did they foresee the demise
of the profession. Nor did any predictions occur that the numbers of
technologists would remain constant. The weight of opinion seemed to
be that technologists will increase.
As interviewing progressed, it became increasingly obvious that
25
Ewan Clague, "The Impact of Technology Upon Manpower," Unpub
lished summary of remarks at the Sixteenth Annual Conference of the
Greater Chamber of Commerce, Philadelphia, Pennsylvania, January 10,
1963.
26
For a summary of labor's viewpoint, see Automation's Unkept
Promi se, a booklet (Publication Number 47) issued by the AFL-CIO. Wash
ington, D. C.: Industrial Union Department,- AFL-CIO, 1962.


54
TABLE 3
MEDIAN SALARIES OF MT(ASCP)'S BY STATE*
STATE
MEDIAN
SALARY
NUMBER OF
RESPONDENTS
STATE
MEDIAN
SALARY
NUMBER OF
RESPONDENTS
A1abama
$6,015
270
Montana
$5,659
84
Alaska
7,819
29
Nebraska
5,706
187
Ari zona
6,300
157
Nevada
7,287
35
Arkansas
5,571
136
New Hamps hi re
5,467
46
California
7,703
1,616
New Jersey
6,128
275
Colorado
5,776
385
New Mexico
6,349
67
Connecticut
6,023
190
New York
6,300
652
Delaware
6,239
34
North Carol ina
5,614
278
District of
Columbia
6,453
116
North Dakota
5,524
59
Florida
5,7H
444
Ohio
5,990
752
Georgia
5,949
307
Oklahoma
6,043
256
Hawaii
6,109
119
0 regon
6,262
212
1 daho
5,769
52
Pennsy1vania
5,603
643
1 11inois
6,241
772
Rhode Island
6,136
40
1 ndiana
6,300
341
South Carolina
5,516
83
1 owa
5,926
224
South Dakota
6,099
76
Kansas
6,005
290
Tennessee
5,550
312
Kentucky
5,595
319
Texas
5,705
950
Lou is i ana
5,582
442
Utah
6,004
79
Mai ne
5,305
32
Vermont
5,759
36
Maryland
6,499
202
Vi rginia
5,700
282
Massachusetts
5,957
295
Washington
6,321
316
Mi chigan
6,975
763
West Vi rginia
5,717
113
Minnesota
6,203
530
Wisconsin
6,507
498
Mississippi
5,725
154
Wyoming
6,049
25
Missouri
5,867
389
"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,
Apri1, 1967, P- 4.


189
Delgado, Rene, biochemist, Baptist Hospital of Miami, Miami, Florida,
June 7, 1967.
Dickinson, Jack E., biochemist, Tampa General Hospital, Tampa, Florida,
June 6, 1967.
Evans, Ira C., pathologist, Mound Park Hospital, St. Petersburg, Florida,
June 5, 1967.
Gillotte, J. P., pathologist, South Florida Baptist Hospital, Plant
City, Florida, June 7, 1967.
Irarragorri, Luis, Assistant to Chief Technician, Hialeah Hospital,
Hialeah, Florida, June 14, 1967-
Jeffus, Benny H., Chief Technologist, Baptist Hospital of Miami,
Miami, Florida, June 12, 1967-
Johnson, Lois B., Administrator, Suwannee County General Hospital,
Live Oak, Florida, May 29, 1967.
Klein, Robert Edward, pathologist, Alachua General Hospital, Gainesville,
Florida, May 18, I967.
Mason, Adele L., Chief Technologist, Jackson Memorial Hospital, Miami,
Florida,June 16, 1967 -
Miale, John B., Director, Clinical Pathology, Jackson Memorial Hospital,
Miami, Florida, June 16, 1967
Olsen, Herluf V., (former) Director, Shands Teaching Hospital and Clinics,
J. Hillis Miller Health Center, University of Florida, May, 1967-
Date not available.
Ortez, Rosario, Head, Hematology Department, Doctor's Hospital, Coral
Gables, Florida, June 15, 1967.
Perez, Carmen, Chief Technician, Tampa General Hospital, Tampa, Florida
June 6, 1967.
Placzek, Richard Steven, Assistant Director, Mound Park Hospital, St.
Petersburg, Florida, June 5, 1967-
Rodeheaver, Janet, Assistant Professor of Medical Technology, J. Hillis
Miller Health Center, University of Florida, Gainesville, Florida,
August 7, 1967.
Riemer, William Edward, pathologist, Baptist Hospital of Miami, Florida,
June 12, 1967.


101
automated equipment throughout the hospital) or maintained in regional
offices by manufacturers. Some technologists (particularly males)
may specialize in the repairing of equipment, but there is seemingly
little in the education and personality of most technologists to prompt
them into such a specialized function.
Frequency and Meaning of Interactions
Few intimations are given in non-sociological literature re
viewed as to the effects of laboratory automation on the frequency and
meaning of interaction between incumbents of the focal position (medi
cal technologists) and incumbents of major counter positions (patholo
gists, administrators, hospital physicians, and nurses). Nor were the
results from interviews much more encouraging. On questions relating
to "interaction," i.e., the relationships between incumbents, the in
vestigator experienced more difficulty in phrasing the inquiry and in
eliciting responses than on any other topic. Apparently most respond
ents (and probably most people generally) see social relationships as
fixed, "given," and not subject to extended change, even though there
is seemingly little difficulty in perceiving changes in technological
patterns. Whatever the case, the investigator did not feel overly suc
cessful in a majority of interviews in handling this question.
The problem was further heightened by the fact that there is
apparently little interaction (in hospitals of any size) between tech
nologists and nurses, or between technologists and administrators. In
large hospitals, an administrator has contact only with the patholo
gists, or more rarely, with the chief technologist. Similarly,


153
37
medical technologists," he said.
A pathologist believed that more registered technologists
,o
will be needed, since machinery needs supervision. Another pathol
ogist saw no lessening of demand for ASCP-technologists, since "we
39
ar in a deficit," A third pathologist said that "fears of unem-
ployment are probably groundless."
Only a handful of respondents felt that automation will de
crease the need for ASCP-level technologists. These persons did not
appear to be very sure of their opinions and seemed definitely to be
referring to the distant future. A biochemist thought automation
41
might require fewer, but better prepared, technologists. A techni
can stated, "1 have always been concerned about that--worned about
my jobbut they said there wouldn't be less." She did, however,
foresee that possibly fewer registered technologists in the long run
would be used to direct personnel of lesser training.^
^Interviewed May, 1967-
oO
^Interviewed June 16, 1967- Increasingly, fewer technolo
gists (proportionate to volume of procedures) may be needed, however
since servomechanisms (es
peci
ally computers)
39
1nterviewed June
13,
1967.
40
Interviewed May
18,
1967.
1nterviewed June
12,
1967-
42
Interviewed May
18,
1967.
43
Ibid.


167
In recent years, the introduction of auto
mated and semi automated testing devices which
can perform repetitive tasks mechanically has
presented the first evidence that industrial
technics can be adapted to the medical labora
tory with substantial advantage. But this has
not been an entirely unmixed blessing.
While these instruments can produce more test
results, in less time, more cheaply, using less
manpower of lesser technical training and operat
ing in smaller spaces, the number of measurements
has risen so precipitously that it threatens to
inundate clinical pathologists and physicians.
Procurement of large numbers of specimens and the
clerical procedures necessary to prepare them for
testing by automation pose significant problems
in maintaining proper identification of the speci
men, of the patient, and of the test desired.
The accuracy of calculations and the correctness
of the final test results are put in question be
cause of the enormous amount of necessary clerical
effort which still is carried out slowly and in
efficiently. As a consequence, an imbalance in
laboratory operations has developed, the automa
tion of instrumentation not being matched by a
similar increase in automation of information
handling. This imbalance threatens to cancel
or diminish the advantages accruing from the
technological advances in instrumentation.
The resolution of these problems, therefore,
requires additional technical support, precedent
for which already has been established in in
dustry and research, namely, the introduction
into the clinical laboratory of data processing
and of the computer.
Early steps in this evolution consisted of
manually keypunching all demologic patient data,
types of tests, and test results and preparing
reports using accounting machines. These pioneer
ing attempts finally culminated in the creation of
a cybernetic laboratory in which all automatic and
semiautomatic test instruments could be coupled
to automatic data acquisition systems for computer
processing of test results and quality control data.
Through such a link, all steps of the test path from
patient specimen and test identification through
test performance to entering a test result in the
patient's medical record can be monitored, controlled,
and performed by a computer.'3
13
I bid.. p. 108.


121
...felt some confusion about skill requirements
for the new job, but felt, nevertheless, they
were on a higher skilled job. (This is related
to the fact that the new equipment was complex.)
The worker tended to feel a greater sense of
responsibility. (This is related to the fact
that the new equipment was more expensive and
mistakes more costly.)b
The-same study reported no differences in fatigue between the old and
the new (automated) job; fewer opportunities for social interaction;
interaction in smaller groups; and less identification with a particular
work group. In the new plant, relationships with supervisors were felt
to be more formal. Most automobile workers were satisfied with their
new situation, but they chose to make the change on their own volition.^
Jacobson also reports on a questionnaire study of insurance com
pany workers' reactions to the introduction of an IBM 650 machine:
1. A third of the employees reported it had
a marked effect on their job.
2. Two per cent were promoted, 4 per cent were
transferred, and 27 per cent said they kept
the same job but that the work was noticeably
changed.
3. Half said the effect of the change-over made
no difference to them; 40 per cent like it,
and only 6 per cent reported dislike.
4. About one-third reported the change-over was
quite disrupting, while the rest said it was
only slightly or not at all disrupting.
When employees were asked to anticipate the ef
fect of the computer on their jobs in the next
year or two, the following findings emerged:
^1 bid.
^1 bid.


80
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.^
Medi-cal 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.
In addition to an altruistic image, nurses acquire status from
another circumstance:
1 01 b i d .
^Recurrent 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


61
of a work task by an integrated power-driven
mechanism entirely without the direct appli
cation of human energy, skill, intelligence,
or control.^
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.^ 7
It is probably the "perceiving" ability of modern automated
1 ft
equipment that has led automation to be called "the awesome servant."
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.
1 A
DBernard Karsh, "The Meaning of Work in an Age of Automation,"
Current Economic Comment, III (August, 1957), 9.
^Herbert 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.


19
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)?


151
against in discussing the doctrine of compara
tive advantage. When we foresee fewer employees
in factory and office, we mean fewer per unit of
capital equipment. It does not follow that there
will be fewer in total. To predict the occupa
tional profile that will result, we must look more
closely at the prospective rates of automation in
different occupations.30
Sturm wri tes:
The sharp growth in demand for clinical laboratory
tests that has occurred in recent years is expected
to continue and perhaps accelerate. Labor-saving
effects of automated equipment will therefore only
partially offset the expanding demand for medical
technologists.31
Lab World estimates that in the decade 1965-1975 medical laboratory per
sonnel will constitute the "...second fastest-growing occupational group
on
in the health field--following x-ray techniciansIn the same period,
the magazine estimates a 60 per cent increase over the current 100,000
will be needed.33 Lab World explains that in spite of automation the
need for more tests and more kinds of tests has prevented any lessening
of the already acute shortage of medical technologists.
Jackson laments the fact that
today in the U. S. there is a drastic shortage
of medical technologists. New hospitals,
3lbid., p. 35.
O 1
3 Herman M Sturm, "Technological Developments and Their Effects
Upon Health Manpower," Monthly Labor Review. XC (January, 1967), 3
^Lab World, VIII (August, 1967), 865.
34
Ibid. In relation to the shortage, Charles Kimball stated that
at least twice the estimated 60,000 technologists in existence in 1963
could have been employed in that year. Charles Kimball, "Changing De
mands of Science and Technology," American Journal of Medical Tech
nology XXXI (May-June, 1965), p. 209.


12
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
viewing^ 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. ^
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
,,1 3
process.....
As 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).
12
Selltiz, p. 2*(2. Italics the writer's.
13lbid.. p. 262.


CHAPTER VI I
ATTITUDES AND OTHER SOCIOPSYCHOLOGICAL TOPICS
Attitudes, which have been defined as "enduring systems of pos
itive or negative evaluations, emotional feelings, and pro or con ac
tion tendencies with respect to social objects,"^ are among the most
important variables determining human behavior. Accordingly, quite
early in the planning stage of this dissertation study, it was decided
to investigate the attitudes of medical technologists toward laboratory
automation. Encountering uniformity of attitudes among incumbents of
the focal position was not anticipated nor was the intention to ascer
tain exactly the percentages of technologists in Florida in favor of or
opposed to automation. Rather, the objective was to identify patterns
of responses upon which to formulate hypotheses.
An attempt was made also to probe the problems of monotony,
fatigue, and boredom, as well as to determine feelings of personal
David Krech, Richard S. Crutchfield, and Egerton L. Ballachey,
Individual in Society: A Textbook of Social Psychology (New York: McGraw-
Hill Book Company, 1962), p. 139-
Berelson and Steiner state that opinions, attitudes, and beliefs
"...do not have fixed meanings in the literature, but in general they
refer to a person's preference for one or another side of a controver
sial matter in the public domain--a political issue, a religious idea, a
moral position, an aesthetic taste, a certain practice (such as how to
rear children)!1 Bernard Berelson and Gary A. Steiner, Human Behavior:
An Inventory of Scientific Findings (New York: Harcourt, Brace and
World, Inc., 1964), p. 557.
118


122
1. About 40 per cent anticipated the computer
would continue to have some influence on
them, but about the same number did not be
lieve it would affect their jobs.
2. Both high and low seniority employees were
more apprehensive of the change, than those
in the middle, apparently because indivi
duals in these first two groups felt the
change would work to their disadvantage.
3. The more able employees were more likely to
welcome the change than the less able.
4. Women, in this particular situation, seemed
to welcome the change more than-men.
5. A regular positive relationship was found
between economic class and readiness to
change.
From these data, it seems clear that employees were re
acting not so much to the fact or to the prospect of
change itself as to their perception of the effects of
the change on their own welfare.
In another study, Walker reported that introduction of automation into
an accounting and sales division of an industry led to an acceleration
of the level of formalization, further rationalization in the organiza
tion of work, and the substitution of rules and regulations for indi
vidual decision-making:
Programming itself is a large step in this direc
tion. Decisions formerly left to individual em
ployees to handle within the spirit of a general
statement of policy are programmed into the machine.
Ibid., p. 217* Jacobson apparently means that of the one-
third whose jobs were markedly affected by the IBM 650, 2 per cent
were promoted, 4 per cent were transferred, etc.
In the second group of findings (concerning anticipations),
Jacobson seems to mean in I tern 5 that the higher the wage level the
greater the willingness to change.


17
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 1ike:
How do you mean?
Can you give me an example?
V/hat 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
^Gerald Gordon
Perspective (New Haven,
pp. 113-115-
, Role Theory and Illness: A Sociological
Conn.: College and University Press, 1966),


135
this study, although, of course, no data have been accumulated that
indicate how many technologists have left the field because of au
tomat i on.
In any event, there seems to be little more present in most
cases of negative reaction than a strong nostalgia for old ways. In
one interview resentment over inability to fulfill internalized role
expectations was observed. In virtually every negative case, however,
recognition of the worth and benefits of automation was expressed.
Since this exploratory interview study was designed to gain
clues as to attitudes rather than to ascertain their direction and ex
tent, no definitive statement can be made regarding the extent of posi
tive or negative attitudes, monotony, or boredom among technologists
in Florida or in the United States generally. Further studies may well
benefit, however, from the tentative hypothesis suggested by this in
vestigation that in general medical technologists are reacting posi
tively to laboratory automation and concurrent changes in their pro-
LO
fessional role. As one pathologist expressed it "only the excep
tional medical technologist misses doing the tests by hand."^
¡.Q
As an aside, the investigator suggests that, psychologically,
the medical technology profession is in an enviable position in re
gards to technological change. A portion of the next chapter en
deavors to establish the probability that in ten to fifteen years
laboratory automation will become almost total. Yet even then, and
certainly until then, much laboratory work will continue to be manual.
Hence most medical technologists in the field today can afford the
luxury (as some industrial workers cannot) of choosing to learn auto
mation skills or to remain manual craftsmen for the rest of their work
ing days. Moreover, schools of medical technology have time to adopt
"automation currculums" to promote appropriate socialization for an
automated future.
ntervi ewed June 6, 1967-


68
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 cel Is.^
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.
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.^^
35
David Seligson, "Automation and Labor-Saving Devices in
the Chemical Laboratory," Connecticut Medicine, XXV (July, 1961)
424.
O £
Interview with Dr. John B. Male, Director of Clinical Path
ology, Jackson Memorial Hospital, Miami, Florida, June 16, 1967.
37
Diebold, p. 6.


37
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.


176
need of hospitals to help underwrite rising
deficits on patient care by imposing high,
non-competitive laboratory charges, thus rais
ing the ceiling below which others might prof
itably compete. In this situation many of the
traditional private laboratories organized and
controlled by pathologists have successfully
contracted in recent years to provide all de
terminations for many small hospitals in their
areas.
The newer type of entrepreneurial laboratory,
however, poses a much more fundamental question:
To what extent is laboratory medicine to be sub
ject to professional control and motivated by
professional requirements? Also to what extent
are pathologists and medical technologists to
become salaried employees of corporate subsid-
i ari es? ^
Possible changes in control and financing of the clinical laboratory
are not within the scope of this dissertation. Should laboratories
become, however, the province of corporate enterprise, medical tech
nologists are still likely to experience the same changes in func
tions and role attributes already predicted earlier in this study.
Implicit throughot this study is the investigator's be
lief that automation, in concert with other factors, will push the
ASCP-level technologists into a more independent, professional role
than they have ever before known. Such a new status will not have
24
been won with ease. The day of the hand-maiden may be over, but
23
National Committee for Careers in Medical Technology and the
U. S. Department of Health, Education, and Welfare, Public Health Ser
vice, National Center for Chronic Diseases Control, Manpower for the
Medical Laboratory: Resource Book. Produced for a National Conference
on Education and Career Development (held at the University of Maryland
Center of Adult Education, College Park, Maryland, October 11-13 1967-)
o Ll #
c As claimed by technologists Ruth Hovde, "The Dynamics of Edu
cation in Medical Technology," The American Journal of Medical Technology,
XXIX (March-Apri 1, 1963), 63.


87
more publicity and prest i. ge 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
oc
worker. .
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
^The 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. Ml (August, 1957) 7-
The autoanalyzer, of course, is just such a machine.


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 Hiss Ruth Wil
liams (Ciiai rman 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
1


9
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. S inai 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
o
and other types of clinical personnel. Nevertheless, the research
7The Mi ami Heart Institute, not a general hospital, became an
"unscheduled stop" since its new pathologist, Dr. Jerome Benson, is a
leading figure in automated laboratories.
o
Throughout 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 awsy the day the interview had been scheduled or the


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, I960 51
3. MEDIAN SALARIES OF MT(ASCP)'S BY STATES 54
4. SUMMARY OF TRANSCRIBED INTERVIEW AND QUESTIONNAIRE
RESPONSES ON SELECTED TOPICS i 192
iv


The Modern Hospital,
"Daily Test Reports Are Help to Physicians,"
(April, 1967), 112-113.
Detweller, L. F. "Automation in the Hospital," Canadian Hospital.
XL I (May, 1964), 54-5-
Drucker, Peter. "Education in the New Technology," Think, XXVI I I
(June, 1962), 3-5.
Ett^nan, S. L. "Advances in Clinical Chemistry Instrumentation," The
American Journal of Medical Technology, XXXI (September-October,
1965), 377-383.
Fishbein, I. L.. "Automation and Individual Responsibility," Journal
of the Florida Medical Association, LI (June, 1964), 373-4.
Foster, John T. "How to Analyze Laboratory Efficiency," Modern Hos
pital CVII (July, 1966), 102-8.
Haley, Leonor. "Status or Status Quo," The American Journal of Medi
cal Technology, XXXII (January-February, 1966), 28-32.
Heinemann, R. "What is Medical Technology?" Hospital Progress, XLIV
(April, 1963), 96-8.
Hospital (Guide Issue Part 2): Journal of the American Hospital
Associat 1 on, XU (August, 1967) -
Hovde, Ruth. "The Dynamics of Education in Medical Technology," The
American Journal of Medical Technology, XXIX (March-Apri1, 1963),
61-75.
Hoyt, Robert S. and Pribor, Hugo C. "Quality Control Saves More Than
It Costs," The Modern Hospital, CV (April, 1967), 114-21.
Hutton, Auldon F. "Advantageous Use of a Mechanical Petri Dish Ro
tator," The American Journal of Medical Technology, XXVII (Sep-
tember-October), 1962), 257"9-
Jacobson, Eugene. "The Impact of Technology and Automation on the
Worker: Some Effects of Automation on Industrial and Clerical
Workers," Industrial Medicine and Surgery, XXXII (June, 1963),
216-226.
Karsh, Bernard. "The Meaning of Work in an Age of Automation,"Cur
rent Economic Comment, III (August, 1957), 3-13-
Kerns, W. H. "'Casey's Profiles,"'
1967), 123-126.
The Modern Hospital, CVII I (Apri1,


74
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.' 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 Compos ition
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.


26
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. V/hen 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
f rom it.12
Although the 1930's saw the formal beginnings of role language de
velopment, the years after V/orld 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
1 2
Ibid., p. 7, citing Ralph Linton, The Study of Man
(New York: Appleton-Century, 1936), pp. 113-11^.


20
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.


75
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--
nurses1 subordinate role among medical personnel corresponds with that
o
of women in American society."
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.^
2
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.
3
"The 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


108
supervisory functions in order to devote more time to interpreting
tests, consulting with other physicians, and visiting wards in order
to spend more time with patients. To a much less extent will path
ologists want to be directly involved in running the laboratory or
in delving into autopsies and tissues.^
The same pathologist cautioned, however, that his viewpoint
is by no means universal among pathologists, although it appears to
be a growing one. In particular, many older pathologists (and es
pecially tissue pathologists) disagree with the proposed changes
66
just outlined.
A South Florida pathologist believed that automation can free
the pathologist from technical concerns to become more of a consultant
and diagnostician; the MT(ASCP) can assume more of the management of
the laboratory and quality control.^7
Other technologists, chemists, and administrators voiced the
above prediction to one degree or another. A chief technologist felt
that the registered technologist may become more of an administrator
o
to relieve the pathologist. A biochemist remarked that over the
last few years an increasing number of technical decisions are being
made by technologists, while the pathologist is increasingly assuming
65lbid. 66lbid.
^Interviewed June 21, 1967. He also recognized the current
role controversy with the remark that "there is as much confusion in
the role of the pathologist as there is in the role of the MT(ASCP).
It's like nursing. Where does nursing end and medicine begin?"
68
Interviewed May, 1967.


}kO
However wondrous the current generation of automated devices
may appear to be, it must be recognized (l) that they are only the
"model A'S and T's" of a dynamic new industry, (2) that most of the
machinery is only partially automated, and (3) that all too many of
them are marketed without adequate factory testing.^
That mechanical inventions of value are almost always im
proved upon is incontrovertible. The point is too obvious to belabor,
yet it is apparently being overlooked by some laboratory workers and
pathologists who have seemingly arrived at premature negative judg
ments regarding laboratory automation. It is, of course, unquestionable
that current devices are all too filled with "bugs"--imperfections in
design and functioning, which are creating endless headaches for the
staff that operate them. Such problems militate against acceptable
levels of accuracy. Although improvements in equipment will undoubtedly
continue to be forthcoming, present imperfections and crudities must
be taken into account and dealt with to assure accuracy.
The second factor affecting accuracy in clinical testing is the
lack of complete automation. In particular, most current automated in
struments have no built-in quality controls or are not "watched," are
not monitored, by computers or other servomechanisms. Hence, unless
quality controls are applied by ever-observant technologists, there is
little reason to hope that results will be consistently accurate.
10
One pathologist calls the marketing of poorly tested laboratory
equipment a national scandal. He feels that confidence of physicians in
automation has been undermined by this situation. Interviewed June 19,
1967.


132
Thank heavens for automation! When I think
of the overtime ten years ago. You can only
work so long, so hard, then accuracy falls.
,..They talk about the monotony of operating
an autoanalyzer--it doesn't even begin to re
late to the monotony that the technologist fejt
who was clicking off cell counts hour after
hour after hour. I would rather sacrifice
knowing patients and patients' names and get
off on time!38
The chief medical technologist at a general hospital (twenty-
five years' experience) reported no sense of "loss of control," since
with automation technologists "... have to figure out much and many
things. It gives them a sense ofwell, they're a part of things,
39
too. She was, however, somewhat nostalgic about the pre-automation
1aboratory:
1 kind of enjoyed the manual ways 1 think
automation is very important--we couldn't
do 40,000 [procedures] a month without it,
but it was more personal before.^
She stated that she missed, in particular, the taking of blood, the
consideration of test results, and knowing who the patient is. "Now
there are blood collectors," she said. "1'm one of the rare ones,
41
the old-fashioned type."
One technologist demonstrated extreme ambivalence toward
automation. She admitted that machines do take away much of the
381 bid.
39
Interviewed June 6, 1967-
40
Ibid.
41
Possibly, but this technologist is not alone in her feelings.


58
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 technology1 or 'high-level
mechanization'?"
^John 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.
g
Peter F. Drucker, Harper's Magazine. Cited in Sultan and
Prasow, p. 15.
9
Sultan and Prasow, p. 15.


22
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 wel1-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, but it was the contributions of Mead, Moreno, and Linton
in the 1930's that served to establish role in the social sciences.**
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."
21 bid.
3
Ibid., p. 5- The conceptual contribution of these writers
will be presented in the next section of this chapter.
**Marti ndale, for example, credits Mead with making role "...
the point of fusion for personality and social structure." Don Mar
ti ndal e The _Nature_arid_Ty£es_jgf_oc[oJo^i_ca_[_Theo£y.. (Boston:
Houghton Mifflin Company, I960), p. 359.


7
because of the likelihood that they will offer the contributions
2
sought
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
Morover, 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
' 1 r 1 hts, not for
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."*
21 b i d.
3Ibid., pp. 55-56.
*Mbid.. P. 55.
5J_bj_d., p. 56.


193
TABLE ^--Continued
QUESTIONS RESPONSES
YES
NO
CONDITIONAL
Will automation decrease the absolute
numbers of MT(ASCP)'s?
3
26
1
Will automation tend to raise the wage
level of MT(ASCP)1s?
13
8
1
Will automation better working condi
tions (physical) of the clinical labor
atory?
10
10
1
Including significant responses on interview pre-test and
regular-run schedu1es. "Don't know," and unclear responses not in
cluded.


168
When automation of communications is wedded to automated
laboratory testing devices, an automated system which has distinct
advantages is created. After only eight months of operation, the
following features and benefits were noted by the Youngstown labora
tory:
1. It maintains and safeguards the identity of
the specimen from phlebotomy to preparation
of the "patient summary report" for the medi
cal record.
2. It reduces the large number of manual proce
dures and handling necessary to prepare the
specimen for automated testing--such as writ
ing name and number on test tube, running clots,
pouring plasma into another vessel--and elimi
nates cumbersome, time-consuming, repetitive
writing of specimen number or name on tubes
in laboratory accession logs and work sheets.
3. It permits the random insertion of the specimen
into an automatic turntable transport for
determinations.
4. It permits repeat tests and dilution of specimens
too high to read.
5. It links within the computer the identity of the
patient and the specimen to the test to be per
formed and prepares the final results.
6. It offers enhanced accuracy, precision and quality
control of actual test performance. The computer
automatically corrects for instrument drift and
specimen interaction.
7. It prepares an appropriate interim ward report
during the day which reduces inquiries to the
laboratory by physicians and ward personnel.
8. It prepares a daily updated "patient summary re
port" on a single sheet which permits chronological
review of all test results for an entire week.
9. The clustering of clinically relevant procedures


44
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 wel1-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.^ 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:
^^Lura Street Jackson, The Medical Technologist (Cambridge,
Massachusetts: Bellman Publishing Company, 1958), pp. 89-


154
In response to the questionnaire item, "Will automation in
the laboratory mean that fewer medical technologists will be needed?"
one pathologist wrote, "No at the present time--probably yes in the
future."^ Another answered "No. Automation merely keeps abreast
of increased volume of work.."^5
In light of interview and questionnaire responses and the in
vestigator's own reasonings (listed previously), the hypothesis of
fered on the issue of numbers employed is that many more ASCP-
technologists w¡11 be required in the next few decades. Only in later
stages of laboratory automation may the numbers of MT(ASCP)'s be ex
pected to stabilize.
Automation and Wages
The effects that automation may have on the wage levels of
ASCP technologists working in hospitals is, in any strict sense, a
matter for determination by economists. This investigator has made
no attempt to employ the unfamiliar research techniques of the
economist to measure such effects. Rather, he has only asked patholo
gists, hospital administrators, and technologists what in their opinion
will happen to wage levels as automation in the laboratory becomes in
creasingly a reality. The beliefs of interviewees on this issue, re
gardless of their accuracy, are in themselves of behavioral importance,
since one may well expect a relationship between such beliefs and at
titudes toward laboratory automation. Technologists could scarcely
^Questionnaire completed by an Atlanta, Georgia, pathologist.
45
Questionnaire completed by a Coral Gables, Florida, pathologist.


129
confirmed by technologists themselves. There was, however, a sizeable
number of technologists and other laboratory workers who were nega
tive in their responses to automation. Other technologists were dis
tinctly ambivalent. Some comments of these individuals are worth not
ing or quoting at length.
A young technician in a North Florida hospital held a generally
negative view of laboratory automation. She affirmed its value in re
lieving monotonous, repetitive tasks and in eliminating much human er
ror, but she thought that there is no need for automation in all labora
tory areas. Some of her comments are the following:
I don't like the robot chemists that do every
thing... Anyone could run the machines with a
little training... With the machine, ambition
is irrelevant--it1s impossible to be more ac
curate... The machine begins to think for you,
and much patient contact is lost.30
When asked whether the automated equipment might replace technolgists,
she replied, "1 have always been concerned about that--worried about my
job--but they said there wouldn't be less."^
At another point during the interview, she made these remarks:
"I would feel that the machine would be taking control... 1 would not
be using my training if 1 were running a machine."^
The same technician said that automation of communications
(especially computers) would decrease personal contact with nurses.
30
31
32
Interviewed
Ibid.
Ibid.
May
18,
1967.


188
Interviews
Benson, Jerome, pathologist, Miami Heart Institute, Miami Beach, Flor-
ida, June 21, 1967-
Bowden, Wallace L., technician, Suwannee County General Hospital, Live
Oak, Florida, May 29, 1987-
Cash, Philip G., Laboratory Supervisor, Mound Park Hospital, St. Peters
burg, Florida, June 5 1967-
Calderin, Victor 0., pathologist, St. Francis Hospital, Miami Beach,
Florida, June 13, 1967.
Chadwick, Richard E., Laboratory Supervisor, Doctor's Hospital, Coral
Gables, Florida, June 15, 1967.
Champion, John, Chairman, Health and Hospital Administration Curriculum
J. Hillis Miller Health Center, University of Florida, Gainesville,
Florida, August 7, 1967.
Cheney, Douglas Raymond, technician, Suwannee County General Hospital,
Live Oak, Florida, May 29, 1967-
Coffey, Anne Veronica, Administrator, St. Francis Hospital, Miami Beach
Florida, June 13, 1967-
Coniglio, Adelinda, Chief Medical Technologist, Tampa General Hospital,
Tampa, Florida, June 6, 1967-
Corbin, Donna Lee, medical technologist, Jackson Memorial Hospital,
Miami, Florida, June 16, 1967.
Conroy, John Prentiss, Administrator, Alachua General Hospital, Gaines
ville, Florida, May 18, 1967-
Coolidge, Verna H., Chief Medical Technician, Alachua General Hospital,
Gainesville, Florida, May 18, 1967-
Crist, Earl Richard, Chief Coordinator and Chief Technologist, Shands
Teaching Hospital and Clinics, J. Hillis Miller Health Center,
University of Florida, May, 1967- Date not available.
Curtis, William G., clinical chemist, Mt. Sinai Hospital, Miami Beach,
Florida, June 19> 1967.
Davidson, Bert, Administrator, South Florida Baptist Hospital, Plant
City, Florida, June 7> 1967-


47
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.1"10
It is conceded, nevertheless, that "...on the job the MT(ASCP) may be
29
called a laboratory technician or medical technician...." 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 1aboratory assistants, with higher
degrees, may not be registered medical
^Jackson,
28...,
Ibid.
P. 7-
29
Ibid.


161
transformation already exist, and both improvements and new inven
tions may surely be expected.
Obstacles that will retard automation are, of course, not to
be ignored. Low testing volume in some hospitals will make expensive
types of automated devices uneconomical, but laboratory testing in
the future may be handled by large regional centers serving many hos
pitals. Hence even tests "seldom performed" in one hospital alone may
be economically automated in such centers. Overnight mail service will
mean that concentration of testing in large centers will be even more
feasible.
Costs of equipment and of maintenance are currently quite
high, but greater sales volume and mass production may in the near fu
ture be expected to result in a rapid reduction of costs.
There is no need for, nor is there any evidence with which to
depict, in more than general terms, a time schedule for the penetra
tion of automation into the clinical laboratory. Many variables will
help determine such a schedule. But, as Magraw has remarked, "...auto
mation has progressed so rapidly since World War II that even the most
optimistic guesses of the time required to reach certain goals have
been grossly in error.
Much more precise in their contours are the technological
configurations emerging in the clinical laboratory. A recognizable
^Richard M. Magraw, Ferment in Medicine: A Study of the Es
sence of Medical Practice and of Its New Dilemmas (Philadelphia: W.
B. Saunders Company, 1966), p. 214.


CHAPTER I I
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.^
The experience survey involves using selected samples (purposive
samples) of workers in the field. "...The respondents must be chosen
^Claire Selltiz, et al.. Research Methods in Social Relations
(rev.; New York: Holt, Rinehart, and Winston, 1966), p. 55-
6


175
A recent national conference summarized its views on labora
tory automation in the following manner:
Sophistication of test procedures, demand for
services, and automation of routine repetitive
laboratory tasks are mutually reinforcing. With
current demand patterns, some two dozen proce
dures account for 80 per cent to 90 per cent of
the workload in most laboratories. They are
amenable to automation, which in turn vastly
increases laboratory capacity and productivity
and lowers unit cost. Automation of laboratory
procedures can greatly enhance quality and qual
ity control; it can enlarge the service area from
locality to metropolis, region or state; it can
reduce patient costs to a range of one-fifth to
one-tenth of those for conventional procedures,
depending on volume. Current experience indi
cates that laboratory volume is expanding at the
rate of 15 per cent per year, roughly a five-year
doubling time. The economies of scale made pos
sible by automation provide a powerful incentive
toward centralization of laboratory facilities
for the bulk of patient tests, and radical de
partures from traditional laboratory practice
and staffing. As in many other fields, automa
tion will place a rising premium on the highest
laboratory skills, and may render many of the
lesser ones redundant.
Potentially, the entry of large venture into
the medical laboratory, increasingly through con
glomerate corporations otherwise unrelated to health
care, may be the most significant present trend from
the point of view of the laboratory-related pro
fessions. Such corporations are likely to have a
strong competitive position. Lacking effective
new initiatives by the professions, the field man may
become dominated within a decade or so by highly
centralized, automated laboratories operated as
industrial subsidiaries.
In a new form, this is merely an extension of
a trend toward private control of laboratories,
though until now control has been exercised chiefly
by pathologists and hospitals. Automation en
courages this trend by reducing unit costs on high
volume and enhancing the profit potential of large
investments. A contributing factor has been the


86
ubiquitously confused.
It may well be, however, that medical technologists are not
now as "hidden" as they assume.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-
I
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-
2h
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
230bv iously, 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 T ime article of October 28, 1966, which describes the
autoanalyzer, is an example of how knowledge of the laboratory is being
disseminated.


BIBLIOGRAPHY
Books
AFL--CI0, Industrial Union Department. Automation's Unkept Promise.
Washington, D. C., 1962.
Allen, Francis R. Technology and Social Change. New York: Appleton-
Century-Crofts, Inc., 1957-
Berelson, Bernard and Steiner, Gary A. Human Behavior: An Inventory
of Scientific Findings. New York: Harcourt, Brace and World, Inc.,
1964.
Biddle, Bruce J. and Thomas, Edwin J. (eds.). Role Theory: Concepts
and Research. New York: John Wiley and Sons, 1966.
Bredemeier, Harry C. and Stephenson, Richard M. The Analysis of So
cial Systems. New York: Holt, Rinehart and Winston, Inc., 1962.
Bright, James R. Automation and Management. Boston: Harvard Univer
sity Graduate S.chool of Business Administration, 1958.
Brozen, Yale. Automation: The Impact of Technological Change. Wash
ington, D. C.: American Enterprise Institute for Public Policy Re
search, 1963.
Buckingham, Walter. Automation: Its Impact on Business and People.
New York: Harper and Brothers, Publishers, 1961.
Coser, Lewis A. and Rosenberg, Bernard (eds.). Sociological Theory:
A Book of Readings. 2d ed. New York: The Macmillan Company, 1964.
Diebold, John. Automation: The Advent of the Automatic Factory. Princ
ton, N. J.: D. Van Nostrand Company, Inc., 1952.
Dunlop, John T. Automation and Technological Change. Englewood Cliffs
N. J.: Prentice-Hall, Inc., 1962.
Einzig, Paul. The Economic Conseguences of Automation. New York: W. W
Norton and Company, Inc., 1957
Fagelson, Anna P. Opportunities in Medical Technology. New York: Vo
cational Guidance Manuals, Inc., 1961.
181


BIOGRAPHICAL SKETCH
Myron Philip Hamer was born December 29, 1935, at Tampa., Flor
ida, where in June of 1954 he was graduated from H. B. Plant High School
In August of 1958, he received the degree of Bachelor of Arts cum 1aude
from the University of Tampa, and pursued additional work at the Univer
sity of Houston, the University of South Florida, and Mexico City Col
lege. From 1980 to 1962 he taught in secondary schools in Tampa, as wel
as in the evening division of the University of Tampa.
During most of 1962 and 1963 he worked as a graduate and teach
ing assistant in the Department of Foreign Languages of the University
of Florida and received the Master of Arts in Teaching degree (Spanish)
in August of 1963- Since January of 1964 Myron Philip Harner has been
enrolled in the Department of Sociology, University of Florida, com
pleting work leading to the degree of Doctor of Philosophy. From
August of 1964 through August of 1966 he served as graduate assistant
to the Dean of the College of Health Related Professions, University
of Florida; from September of 1966 until October of 1967 he worked as
Assistant in Administration to the Dean of the same College. On De
cember 1, 1967, he became Director of Health Occupations Education
at Santa Fe Junior College in Gainesville, Florida.
Myron Philip Hamer is a member of the Southern Sociological
Association, the American Sociological Association, the Association of
Schools of Allied Health Professions, Alpha Kappa Delta, and Tau Kappa
EpsiIon.
194


66
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.^9
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 elimi nated.^
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,
29i
30
bid.
1 bid.
^Anna P. Fagelson, Opportunities in Medical Technology (New
York: Vocational Guidance Manuals, Inc., 1961), p. 12.


92
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, thought that automation has al
ready brought about more specialization at her hospital.
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.
^interviewed 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


46
Specialty listings differ, and other authorities include the new field
of radioisotopes (nuclear medical technology) as a specialty.^ The
busiest areas of the clinical'laboratorythose handling the greatest
volume of work--are hematology and chemistry.^5 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.
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:
24
Fagelson, p.22. Fagelson would include serology and immu
nology as a part of microbiology, along with bacteriology, mycology,
and parasitology.
25lbid.. p. 12.
2.G
In 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.


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
19oS

trc-
UNIVERSITY OF FLORIDA
3 1262 08552 6506

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 1
I I. METHODOLOGY 6
III. ROLE THEORY 21
IV. MEDICAL TECHNOLOGYGENERAL DESCRI PTION 38
V. AUTOMATION 55
VI. SOCIOLOGICAL EFFECTS OF AUTOMATION 73
VII. ATTITUDES AND OTHER SOCIOPSYCHOLOG I CAL TOPICS 118
VIII. PROFESSIONAL CONCERNS 136
IX. THE FUTURE OF MEDICAL TECHNOLOGY 158
SUMMARY 178
BIBLIOGRAPHY 18 1
APPENDIX 19 2
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, I960 51
3. MEDIAN SALARIES OF MT(ASCP)'S BY STATES 54
4. SUMMARY OF TRANSCRIBED INTERVIEW AND QUESTIONNAIRE
RESPONSES ON SELECTED TOPICS i 192
iv

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 Hiss Ruth Wil
liams (Ciiai rman 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
1

2
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.^
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,
2
but few by sociologists." Economists and industrial engineers seem
to have made most of the contributions,^and 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.
2
Arnold M. Rose, Sociology: The Study of Human Relations (2nd
ed. rev.; New York: Alfred A. Knopf, 1965), p. 433.
31 b i d .

3
their efforts on determining the economic and labor displacement ef
fects of automation on various industries.^ Cultural and social
changes in professions undergoing automation have been largely ne
glected. ^
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 1ater 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."

if
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.^
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 o*
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.^
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, arid Winston, 1966), p. 51-
7 Ibid., pp. 51-52.

5
Although some very preliminary hypotheses may be perceived i ri 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
topi cally.

CHAPTER I I
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.^
The experience survey involves using selected samples (purposive
samples) of workers in the field. "...The respondents must be chosen
^Claire Selltiz, et al.. Research Methods in Social Relations
(rev.; New York: Holt, Rinehart, and Winston, 1966), p. 55-
6

7
because of the likelihood that they will offer the contributions
2
sought
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
Morover, 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
' 1 r 1 hts, not for
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."*
21 b i d.
3Ibid., pp. 55-56.
*Mbid.. P. 55.
5J_bj_d., p. 56.

8
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 Mi ami).
The pre-test of the interview schedule was accomplished at
the Shands Teaching Hospital, University of Florida, Gainesville
(a large hospital), at Alachua Genera! Hospital, Gainesville (a
medium hospital), and at Suwannee County Hospital, Live Oak (a
smal1 hospital)
^ln the United States, small general hospitals are usually de
fined as having less than 150 beds; medium general hospitals as having
150 to 11h 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-

9
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. S inai 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
o
and other types of clinical personnel. Nevertheless, the research
7The Mi ami Heart Institute, not a general hospital, became an
"unscheduled stop" since its new pathologist, Dr. Jerome Benson, is a
leading figure in automated laboratories.
o
Throughout 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 awsy 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
LOCATION
CONTROL
SIZE (NO. BEDS)
Baptist Hospital of
Miami
Miami
Baptist
Mediurn
(306)
Doctor's Hospital
Coral Gables
private
(non-profit)
Mediurn
(213)
Hialeah Hospital
Hialeah
Seventh
Day Advent-
i st
Mediurn
(246)
Jackson Memorial
Hospital
Mi ami
County
Large
(1,218)
Miami Heart Institution
Miami Beach
private
(non-profit
specialty
hospital)
Smal 1
(162)
Mound Park Hospital
St. Petersburg
City
Large
(649)
Mt. Sinai Hospital
of Greater Mi ami
Miami Beach
private
(non-profit)
Large
(483)
South Florida Baptist
Plant City
Baptist
Smal 1
(100)
Tampa General Hospital
Tampa
City
Large
(604)
Victoria Hospital
Mi ami
private
(non-profit)
Smal 1
(102)
JU /
''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.

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
9
al 1 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.^ 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 inverview was better than none. Actually, several of the most fruit
ful interviews were obtained in this way.
o
Of course, facial expressions and gestures could only be re
corded with a television camera.
^Only 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 tfie 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 1 record these interviews is to save time."

12
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
viewing^ 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. ^
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
,,1 3
process.....
As 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).
12
Selltiz, p. 2*(2. Italics the writer's.
13lbid.. p. 262.

13
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."^ 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...
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").^
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
1 7
tions, how to record the interview, and how to bring it to a close. '
14
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.
15... ,
Ibid.
l6Selltiz, Chapter 7, PP- 236-278.
'^William J. Goode and Paul K. Hatt, Methods in Social Science
(New York: McGraw-Hill Book Company, Inc., 1952), Chapter 13, pp. 184-
208.

14
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
19
of insights and advice gained from this volume.
Many manuals and books written on interviewing have lists of
1 ft
loStephen A. Richardson, Barbara Snell Dohrenwend, and David
Klein, Interviewing: Its Forms and Functions (New York: Basic Books,
Inc., 1965).
19
During 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 i ntervi ewer--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!

15
"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.

16
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 ansv/er.
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

17
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 1ike:
How do you mean?
Can you give me an example?
V/hat 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
^Gerald Gordon
Perspective (New Haven,
pp. 113-115-
, Role Theory and Illness: A Sociological
Conn.: College and University Press, 1966),

18
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
21
the United States. 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. V/i 11 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 yoirASCP-1evel technologists needed
to play, to a greater degree, a supervisory
role?
21
Development 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.

19
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)?

20
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 I I I
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.'
Bruce 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
21

22
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 wel1-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, but it was the contributions of Mead, Moreno, and Linton
in the 1930's that served to establish role in the social sciences.**
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."
21 bid.
3
Ibid., p. 5- The conceptual contribution of these writers
will be presented in the next section of this chapter.
**Marti ndale, for example, credits Mead with making role "...
the point of fusion for personality and social structure." Don Mar
ti ndal e The _Nature_arid_Ty£es_jgf_oc[oJo^i_ca_[_Theo£y.. (Boston:
Houghton Mifflin Company, I960), p. 359.

23
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."' 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 understanding 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
5lbid., p. 17.
6Ibid.. p. 18.
71bid.. p. 18.

24
its language, and by organization, review, and integration of its
g
knowledge and theory."
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.^
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.^
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.
8
9
10
Ibid.,
pp.
18-19
1 bid.,
P-
18.
Ibid.,
P-
13.

25
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
rotu1 a (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 Pariiament--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.^
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, 111.: The Free Press, I960), p. 80.

26
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. V/hen 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
f rom it.12
Although the 1930's saw the formal beginnings of role language de
velopment, the years after V/orld 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
1 2
Ibid., p. 7, citing Ralph Linton, The Study of Man
(New York: Appleton-Century, 1936), pp. 113-11^.

27
perhaps they presently come closer to this
universal language than any other vocabulary
of behavioral science.^3
Even so, these authors hasten to point out that current role language
suffers from two basic difficulties, which are "a lack of denotative
14
clarity and incompleteness of the language." 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 mental istically inspired, whereas
"position," "network," and "relationship" imply
a structural mode.)^
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
^1 bi d .. p. 8.
^1 bid., p. 9 .
^1 bi d., p. 13.

28
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.^
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 arid 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 roleJ7
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
16
Ibid.
^ 7j bid., pp. 13-14.

29
aims of this dissertation and will present their role theory mean-
i ngs:
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 (l) 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. Posit?on (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 (l) a position and (2) power, prestige, or wealth associated
with a social position. Role conf1ict for some writers has stood
(1) for inconsistent prescriptions (or other standards) held for a

30
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-
18
istence or assumption of inconsistent prescriptions (or standards).
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.
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
18
Ibid., definitions selected and quoted from Table 3, PP-
10-12.
19
JNo 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 ('lew Haven, Connecticut: Col
lege and University Press, 1966).

31
diffuse aims of the dissertation.^
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.^
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 "... i ndi vi dual s: (1) i n soci al locations..
(2) behave, (3) with reference to expectations-11 With this fact
in mind, they present the following definitions:
A pos i ti on is the location of an actor or
class of actors in a system of social rela-
tionships.
A pos? t?onal 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.
90
As stated earlier, this exploratory study not 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.
21
Neal Gross, V/ard S. Mason, and Alexander W. McEachern, Ex
plorations in Role Analysis (New York: John Wiley and Sons, Inc., 1358)
bid., pp. 17-18.
Italics the authors 1.

32
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 obiigat I on 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 attr? bute 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 attr? bute 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. A focal position is simply
the one being studied, whereas counter positions are those to which the
focal position is related. Without doubt,
bid., p. 67. Examples of usage of these terms in this disser
tation are given in the final section of this chapter.
24
Clearly, the position of medical technologist is achieved.

33
...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
posit ions.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/
'2(
patient interaction.
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:
Ibid. p. 51 .
2.G
Relationships 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
(phlebotomists) 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.

3*+
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
acts, for example).^
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
Anal vsis 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
27ibi_d., p. 59.
28
In this study questions are asked about behavior and at
tributes primarily at the level of general functions and general per
sonal qualities.

35
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,

36
technologyst/admin!strator, 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
29
are obiigations.
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
^By defi nition--the reverse would be true if the position of
clinical pathologist were the focal position.

37
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 TECHNOLOGYGENERAL 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.
Defi nition
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
2
disease." Although the role of the medical technologist may be
changing in several aspects, its essence is still that of "fact-finder."
Vnna P. Fagelson, Opportunities in Medical Technology (New
York: Vocational Guidance Manuals, Inc., 1961), p. 22.
^R. Heinemann, "What is Medical Technology?" Hospital Progress.
XL I V (Apri1, 1963), 98.
38

39
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-
k
cal technologist. Undoubtedly through the centuries many such
3
Mary Kay G. Moon, "The 3M1s of Medical Technology," The
American Journal of Medical Technology, XXXI (September-October,
1965), 386. Italics the author's.
4
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

40
assistants have played parts of the role of medical technologists.
Similar forerunners can be perceived for almost any modern health
profession
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- Other types of public health laboratories were
opened before the turn of the century in Louisiana, Rhode Island,
7
and Minnesota. By 1900 the census spoke vaguely of "100 technicians"
o
(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 technologists1.
^The 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.
6ibid., p. 31.
7Ibid.
g
Ibid. Not all of these were medical technicians; some were
dental technicians or were industrially employed.

41
reflects the true beginnings of laboratory medicine and employment
of medical laboratory workers in this country.
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.'*^ In this
respect, World War I was no exception; it created a trememdous 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.^ 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
1 ?
training or to register and certify technologists when trained.
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).'3 By 1928 the need for com
petent laboratory workers had become so overwhelming that the ASCP
9lbid.. p. 32.
^See 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.
^Fagelson, p. 32.
1 3
J\bid. Other writers say 1923, but the difference is not
essential.

42
decided to establish a Board of Registry of Medical Technologists.
This body is responsible for examining and registering students of
medical technology that have met its educational requirements.^
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.^ 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.^ The need for assistants who could and
would perform most tests routinely, yet accurately, led pathologists
^1bid. Actually it was established as the Board of Registry
of Laboratory Technicians; the present name was assumed in 1936.
^The 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)1s,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-
'^Ellen Anderson, "Medical Technology Today," The Amarican
Journal of Medical Technology, XXXI (May-June, 1965), p. 159.
17
Ibid.

43
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
18
the laboratory. 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
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. 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.
Lavinia B. White, "Thirty-five Years of Medical Technology/1
The American Journal of Medical Technology, XXXI (July-August), p. 295-
i9lbid., pp. 295-296.
20lbid.. p. 297.
21
Fagelson, p. 21.

44
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 wel1-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.^ 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:
^^Lura Street Jackson, The Medical Technologist (Cambridge,
Massachusetts: Bellman Publishing Company, 1958), pp. 89-

45
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.^3
bid., pp. 9~11

46
Specialty listings differ, and other authorities include the new field
of radioisotopes (nuclear medical technology) as a specialty.^ The
busiest areas of the clinical'laboratorythose handling the greatest
volume of work--are hematology and chemistry.^5 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.
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:
24
Fagelson, p.22. Fagelson would include serology and immu
nology as a part of microbiology, along with bacteriology, mycology,
and parasitology.
25lbid.. p. 12.
2.G
In 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.

47
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.1"10
It is conceded, nevertheless, that "...on the job the MT(ASCP) may be
29
called a laboratory technician or medical technician...." 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 1aboratory assistants, with higher
degrees, may not be registered medical
^Jackson,
28...,
Ibid.
P. 7-
29
Ibid.

48
technologists. They too are called tech
nicians rather than technologists. sinee
they are not reqistered.30
The essential point here 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,^ the MT(ASCP)'s constitute somewhat less than one-tenth
of current medical laboratory staffs^ 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-
33
ing themselves technologists and all others technicians is certainly
3^1 bid. Italics mine.
31
J This 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.
^T. C. Nation, "The Present Status of Medical Laboratory Per
sonnel," The Journal of the South Carolina Medical Association, LX11
(October, 1966), 410.
^One 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.

k3
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 profess i onalism--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.
3^There are several other organization that register tech
nologists not eligible for registry with the ASCP because they have
not graduated from schools and currculums 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 Ml'(ASCP)'s nor will most large
health institutionsemploy them, or give them advancement if em
ployed. Lab World, August, 197, P- 865.

50
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
a re women."
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-
tion. In I960, 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 30,000.37 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.
^Fagelson, p. 41.
^Jackson, p. 31
37N
ational 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,
Apri1, 1967, p. 4.

51
TABLE 2
NUMBER OF REGISTERED MEDICAL TECHNOLOGISTS,
MT(ASCP), BY STATES, SEPTEMBER, I960*
STATE
NO.
STATE
NO.
Alaska
34
New Hampshire
101
Alabama
411
Nevada
42
Arizona
222
New Jersey
554
Arkansas
197
New Mexico
141
California
2,085
New York
1,257
Colorado
600
North Carol ina
497
Connecticut
353
North Dakota
119
Delaware
88
Ohio
1,504
District of
139
Oklahorna
399
Columbia
0 regon
416
F lori da
688
Pennsy1vania
1,494
Georgia
440
Rhode Island
68
Hawaii
150
South Carolina
173
I daho
111
South Dakota
125
111 i nois
1,414
Tennessee
496
1ndiana
6 06
Texas
1,742
1 owa
362
Utah
126
Kansas
560
Vermont
49
Kentucky
668
Vi rginia
597
Lousiana
654
Washington
709
Mai ne
114
West Virginia
224
Maryland
384
Wi sconsin
958
Massachusetts 535
Wyoming
55
Mi chigan
1,461
Canal Zone
22
Minnesota
946
Puerto Rico
190
Mississippi
295
Vi rgi n 1 slands (U .S .)
3
Missouri
778
Canada
170
Montana
189
Panama
9
Nebraska
280
Other Foreign
185
ic
Adapted from Anna P.
Faqelson, Opportunities in Medical
Tech-
noloqy (New
York: Vocational
Guidance Manuals, Inc., 1961), p. 35-
The
New York total i s
proportionately low, Miss Ruth Wi1
1 i ams
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-

52
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-^ 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, 1
plus per cent.
Just about half do not supervise any other
workers in their laboratory, another fourth
£6 per cent) supervise 1 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 Pgr cent), blood bank (39-8 per
cent).
Table 3 shows salaries of ASCP technologists by state.
38
Ibid.

54
TABLE 3
MEDIAN SALARIES OF MT(ASCP)'S BY STATE*
STATE
MEDIAN
SALARY
NUMBER OF
RESPONDENTS
STATE
MEDIAN
SALARY
NUMBER OF
RESPONDENTS
A1abama
$6,015
270
Montana
$5,659
84
Alaska
7,819
29
Nebraska
5,706
187
Ari zona
6,300
157
Nevada
7,287
35
Arkansas
5,571
136
New Hamps hi re
5,467
46
California
7,703
1,616
New Jersey
6,128
275
Colorado
5,776
385
New Mexico
6,349
67
Connecticut
6,023
190
New York
6,300
652
Delaware
6,239
34
North Carol ina
5,614
278
District of
Columbia
6,453
116
North Dakota
5,524
59
Florida
5,7H
444
Ohio
5,990
752
Georgia
5,949
307
Oklahoma
6,043
256
Hawaii
6,109
119
0 regon
6,262
212
1 daho
5,769
52
Pennsy1vania
5,603
643
1 11inois
6,241
772
Rhode Island
6,136
40
1 ndiana
6,300
341
South Carolina
5,516
83
1 owa
5,926
224
South Dakota
6,099
76
Kansas
6,005
290
Tennessee
5,550
312
Kentucky
5,595
319
Texas
5,705
950
Lou is i ana
5,582
442
Utah
6,004
79
Mai ne
5,305
32
Vermont
5,759
36
Maryland
6,499
202
Vi rginia
5,700
282
Massachusetts
5,957
295
Washington
6,321
316
Mi chigan
6,975
763
West Vi rginia
5,717
113
Minnesota
6,203
530
Wisconsin
6,507
498
Mississippi
5,725
154
Wyoming
6,049
25
Missouri
5,867
389
"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,
Apri1, 1967, P- 4.

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
55

56
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.'
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
Di ebold:
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.
2lbid., p. 12.
^Congress of the U.nited States, 86th Congress, Second Session:

57
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.^
Other, more common, definitions of automation, however, are
based upon the "performance characteristics of the technology itself.
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, I960), pp.
83-84 and 91. Cited by Sultan and Prasow, p. 13.
4
Peter F. Drucker, "The Coming Labor Shortage," in America1s
Next Twenty Years (New York: Harper and Row, 1957). Cited by Sultan
and Prasow, p. 13-
^Herbert 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.

58
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 technology1 or 'high-level
mechanization'?"
^John 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.
g
Peter F. Drucker, Harper's Magazine. Cited in Sultan and
Prasow, p. 15.
9
Sultan and Prasow, p. 15.

59
Buckingham proposes that three distinctions be made between
mechanization, mass production and automation (which, he feels, have
evolved historically in that order).'0 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.'*
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
One group of researchers has proposed a "ladder of automatic
control" classification system, with each step of the ladder indicat-
1 3
ing increased complexity of the control system. On the other hand,
Walter 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.
'*Sultan and Prasow, p. 16-17-
1 2
Ibid. "Cybernation" derives from Norbert Wiener's "cybernet-
ics"--the use of computers in technology.
1 3
Criteria 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.

60
James Bright offers the "mechanization profile," which allows classi
fication of work sites into seventeen stages of mechanisation:
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.^
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. ^ 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
'^Sultan end Prasow, p. 19.
''The present writer attended a discussion session on the
"Social Impact of Automation" at the 19&7 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.

61
of a work task by an integrated power-driven
mechanism entirely without the direct appli
cation of human energy, skill, intelligence,
or control.^
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.^ 7
It is probably the "perceiving" ability of modern automated
1 ft
equipment that has led automation to be called "the awesome servant."
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.
1 A
DBernard Karsh, "The Meaning of Work in an Age of Automation,"
Current Economic Comment, III (August, 1957), 9.
^Herbert 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.

62
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.'9
In fact,automation has even been defined as the Second Industrial Revo-
*
, - 20
1ution.
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
21
which is merely mechanized, 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
19
JJohn Diebo1d, Automation: The Advent of the Automatic Factory
(Princeton, N. J.: D. Van Nostrand Company, Inc., 1952), p. 2.
20
Magnus Pyke, Automation: Its Purpose and Future (New York:
Philosophica Library, 1957), P- 168.
21
To 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.

63
"automation!1 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-regu1 ating
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. 3
^Floyd c. Mann and Richard L. Hoffman, Automation and the
Worker: A Study of Social Change in Power Plants (New York: Henry Holt
and Company, I960), pp. 191-192.
23
Sultan and Prasow, p. 32.

64
John Dunlop has remarked that "...it is impossible to isolate the im
pact of automation from other forms of mechanisation and technical
change." 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
bewi1 dering 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.^
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
Dunlop, p. 2. Cited in Sultan
25,
'To
than the desi
growing techn
technological
investigator
an "automated
offered here,
of this disse
try, physics,
possess.
the technically minded, nothing will seem more fascinating
gn and operation of these new machines. There exists a
ical literature about them; a study of the scientific and
principles underlying their existence is intriguing. This
has made it a point to be taken on a guided lecture tour of
" laboratory. No detailed technical descriptions v/i 11 be
however, since such descriptions would be beyond the scope
rtation and would presume a far deeper knowledge of chemis"
and laboratory technology than this writer can pretend to

65
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 team 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-
28
lant which are required." The computer can also prepare separate
26
Unpublished materials given to investigator by Dr. Sunderman
In large hospitals, some technologists or certified assist
ants may specialize as blood collectors (often called ph1ebotomists,
or humorously in the medical subculture, vampires'.).
28
Sunderman. The effects and future possibilities of automa
tion of communications will be discussed at greater length in other
portions of this dissertation.

66
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.^9
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 elimi nated.^
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,
29i
30
bid.
1 bid.
^Anna P. Fagelson, Opportunities in Medical Technology (New
York: Vocational Guidance Manuals, Inc., 1961), p. 12.

67
developed and manufactured by Technicon Instruments Corporation and now
being used by about eighty United States hospitals.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
perforin many delicate and highly sophisticated
chemical and physical tasks in less time than
it takes to describe them. First, the 3-mi 11 i 1iter
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.3**
^"Medicine," Time, October 28, 1966. p. 68.
3Sbid.

68
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 cel Is.^
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.
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.^^
35
David Seligson, "Automation and Labor-Saving Devices in
the Chemical Laboratory," Connecticut Medicine, XXV (July, 1961)
424.
O £
Interview with Dr. John B. Male, Director of Clinical Path
ology, Jackson Memorial Hospital, Miami, Florida, June 16, 1967.
37
Diebold, 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.^ |n 1784 Oliver
Evans built a fully automated flour mill near Philadelphia. ^ In 1801
Joseph Marie Jacquard invented an automatic loom, 11,000 of which were
foynd in France alone by 1812.^ 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
12
beginnings of medical technology at the turn of the century. Some
early examples include "mixers" in serology, crude automatic pipetters
4-2
in the early 1930's, and, by World War II, the autotechnicon. J
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
44
insufficiently staffed hospital laboratories." Ever since World War
OQ
JOR. H. Macmillan, Automation (Cambridge: Cambridge University
Press, 1956). Cited in Yale Brozen, Automation: The Impact of Technologi
cal Chanqe (V/ashi nqton.
Policy Research, 1963),
D. C.: American Enterprise Institute for Public
p. 6.
^Diebold, p. 1

40lbid.
411 bid.
Seligson, p. 423.
4*2
^Conversation 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.
44
Seligson, p. 423.

70
the demand for laboratory tests per patient has been soaring. ^ 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
46
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
48
1957 is now used in over eighty hospitals. Instead of two channels,
twelve-channel models are standard with an eighteen-channel machine now
^51 bid. 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 and demand for medical services on the part of the
public.
46
There 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.
^Frederick Pollock, The Economic and Social Consequences of
Automation (Oxford: Basil Blackwell, 1957) P- 66.
**^T i me, p. 68.

71
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,^'
the critical and apparently eternal shortage of technologists, and ris
ing labor costs-^ all contribute to the rush toward automation. Even
many small hospitals (where volume might be presumed to be too small)
C 9
have installed autoanalyzers. J 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. By 1965 somewhere between 25 and 50 per cent
of laboratory workloads were performed by automatic instruments; possibly
49
^Herman M. Sturm, "Technological Developments and Their Effects
Upon Health Manpower," Monthly Labor Review XC (January, 1967) 3-
5Diebold, p. I67.
^Said to be a 15 per cent or greater per annum increase in
many laboratories. Seligson, p. 424, and interview with Miale.
5^Pyke, 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
Mi ale.
-^Seligson, p. 423.
54
Sturm, p. 3.

72
75 per cent will be so handled by 1975-^ 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
56
manually and would take two days to perform. 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.
^-*1 bi d. 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.
56
Ibid., 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.
73

74
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.' 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 Compos ition
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.

75
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--
nurses1 subordinate role among medical personnel corresponds with that
o
of women in American society."
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.^
2
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.
3
"The 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

76
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-
4
solute. Most respondents conceded, however, that men "naturally like"
growing male presence in medical technology, it must be remembered (l)
that the interviewees did not compose a random sample of Florida tech
nologists; (2) that approximately one-half of the technologists inter
viewed viere 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.
^Fagelson 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. k2.
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 poss i bl e-'-probably because men tend to have more stable work
records (do not marry, become pregnant, and cease employment). One

77
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-
'This 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 13, 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.

78
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,
g
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.

79
is of increasing concern among the recently emerging allied health
9
professions. 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"
9
Corwin and Taves,
pp. 188-189.

80
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.^
Medi-cal 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.
In addition to an altruistic image, nurses acquire status from
another circumstance:
1 01 b i d .
^Recurrent 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

81
Ths 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--spec¡al ization 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.

82
people--!s 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: a technologist said dejectedly, "I hope public opinion will
14
rise." Whatever their opinion of the current status of medical
'^Corwin and Taves, pp. 188-189.
I ^
'Interviewed June 6, 1967
^Interviewed May 18, 1967.

83
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.^
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."'^ One technologist said
there would be more prestige when medical technologists begin working
with expens i ve equipment.^
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-
1 O
lookers are concerned, if the personal goes out of it." Yet one
administrator felt that the drama associated with automation will in
crease the prestige of medical technologists.^
nterviewed May 18, 1967
^1nterviewed June 12, 1967-
1 7
'Interviewed June 14, 1967-
1 O
Interviewed June 14, 1967.
19
Interviewed May, 1967-

84
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) wi11 gain the most prestige, since they will be operating
the machines.^
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-
O 1
hance it if they perform more specialized tests or become supervisors.
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 techno 1ogistsbecome, as it were,
20
Interviewed June 21, 19&7- Actually, who can and should
operate the autoanalyzer and other pieces of equipment is a contro
versial question.
21
Interviewed 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).

85
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.

86
ubiquitously confused.
It may well be, however, that medical technologists are not
now as "hidden" as they assume.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-
I
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-
2h
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
230bv iously, 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 T ime article of October 28, 1966, which describes the
autoanalyzer, is an example of how knowledge of the laboratory is being
disseminated.

87
more publicity and prest i. ge 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
oc
worker. .
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
^The 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. Ml (August, 1957) 7-
The autoanalyzer, of course, is just such a machine.

88
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-
A /*
cumbents of the focal position. 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
As 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 possiblity for role conflict and modes for its resolution would
seem to be more easily conceptualized by defining role as expectations.

89
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.
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? W¡11 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.

90
28
the Technologist," 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.^9
Diane Spencer, "Laboratory Automation Has Freed the Technolo
gist ," _Ho££]_ta2 .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-
29
Spencer, 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. LVII I
(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 poss i ble, 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.

91
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
30
militates against employment of sub-baccalaureate personnel.
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 resu1ts--"They1ve been burned," as he phrased
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,
^1nterviewed June 16, 1967-
31
I bid.

92
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, thought that automation has al
ready brought about more specialization at her hospital.
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.
^interviewed 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

93
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. 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(ASC0)'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."
33
The 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.

94
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-
34
trator.
Such a change has already occurred in the role of the registered
Or
nurse, with implications for the prestige (status) of nursing. 3
The degree to which medical technologists will become super
visors logically depends on patterns of division of labor in automated
^Related questions need to be asked in regard to accompanying
changes in role attributes--wi11 different personality characteristics
and educational accomplishments be necessary for ASCP-technologists to be
come administrators.?
^Corwin 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.

95
laboratories and the degree automation attains in laboratories.^
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
3^lf 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.

96
registered technologists will, in the investigator's opinion, no
longer routinely perform manual tests. Rather, they will be the in
dividuals who will coordinate lesser-trained personnel and automated
machinery in the performance of tests. The basic role function of the
medical technologist as seeker of facts upon which medical diagnosis
and care are based will not change, but the medical technologist will
obtain the facts as leader of a team of laboratory workers.^7
Such a major shift will present medical technologists with
both opportunities and problems. Though many of the old manual skills
may become redundant, knowledge of the scientific principles underly
ing them will be even more necessary. The medical technologists of
the future will need to be more knowledgeable as physical scientists
than ever before (more chemists and physicists rather than biologists).^
As administrators, however, the technologists w¡11 also need
talents and training in management and interpersonal relations. With
out doubt, many individuals do combine manual dexterity and scientific
ability with social skills, but a number of respondents foresaw problems
if the average MT(ASCP) is asked to become a supervisor.
A chief technologist remarked, for example, that "now many
medical technologists are not social-minded would not make good team
57
-''Again, the technological configurations, which will largely
be causal in effecting this major role shift, are described in the last
chapter of this dissertation.
,0
A point upon which there is universal agreement in the liter
ature and among respondents.

97
5Q
workers or leaders. A different type of person may be needed." ^ A
biochemist pointed out that "very few managers are good scientists,
40
and few scientists are good managers." An administrator remarked,
"medical technologists will need to become supervisors, yet many are
41
not human-relations minded and would make poor supervisors."
This investigator believes, also, that at least many, if not
a majority, of registered technologists, would have difficulty in ef
fectively functioning as supervisors. It may be that role attributes
for medical technologists will undergo rapid change if automation
creates for them a supervisory roie.
Still another function of medical technologists may undergo
change with the spread of automation in the laboratory. Machinery and
equipment of all kinds must necessarily be maintained and repaired.
As far as maintenance is concerned, the manual devices in clinical
laboratories have always been the responsibility of the technicians
and technologists who work with them. One topic, that of "maintenance
function," was included in interviews and questionnaires in order to
formulate hypotheses as to the possible expansion or contraction of
this aspect of the role of medical technologists.
One of the most obvious facts encountered by the investigator
at all hospitals visited is that as far as repair and maintenance are
39
J^\nterviewed May, 1967
^Interviewed June 6, 1967-
^Interviewed May 25, 1967-

98
concerned, laboratories are passing through an acute transitional
period in role definitions. No one seems at all certain as to the
best maintenance system for the new automated equipment, nor pre-
h"?
cisely "who should repair what."
The prevailing pattern at present seems to be that, when a
complicated automatic piece of equipment is purchased, the factory
offers without charge (or at minimal cost) a course in operating and
maintenance of the machine involved to whomever the. hospital desig
nates. As a rule, head technologists or "those mechanically in
clined" receive the training. These people then become responsible
for keeping the machinery in running order. In a surprising number
of hospitals, however, the policy is to train all personnel to run and
operate the automated equipment. Although the same hospitals admitted
that some technologists (mostly men) were better at the automated
equipment and other (mostly women) were better at manual procedures,
the utilization of all personnel to operate and care for the machinery
seemed to stem from the fear, seldom fully expressed (by pathologists
and administrators), that if only certain personnel become proficient
with the machines, a monopoly of skills will afford them unusual power
in bargaining for wages and working conditions. This fear may well be
realistic since, as was mentioned in a previous chapter, laboratory
I O
This confusion is thorouohly understandable if one considers
the new, almost raw quality of much of the automated equipment. A de
vice, often costing thousands of dollars is rushed from invention to
factory to laboratory without adequate evaluation of its technical
problems and weaknesses, much less its scientific capabilities. Be
fore anyone has had time to master and "debug" the device, a new and
presumably improved model has appeared. The situation has become so
bad that one pathologist called for government control over quality
of automated equipment. Interviewed June 19, 1967-

99
automation is irreversible, and a hospital would be almost paralyzed
should its team of automatic equipment workers leave or strike. Thus,
development of expertise (specialization) may be perceived by hospital
management as a possible threat, although the need for efficiency would
also seem to indicate that employees should be encouraged to concen
trate on tasks that fit their abilities and interests.
It is likely that as hospitals become larger, as manufacturers
develop systems for handling repairs locally, and as the pool of per
sonnel trained in automation increases, that medical technologists will
be encouraged to specialize either in automation or in manual proce-
, ^3
dures.
Mention should be made of the fact that repair and maintenance
are not being handled by ASCP technologists alone; biochemists, tech
nicians, and other laboratory personnel are also involved. Neverthe
less, the majority of respondents held the view that the ASCP tech
nologist can successfully actas "troubleshooter" and director of
routine maintenance for the automated equipment.
A sizeable minority of interviewees, however, thought that in
the future a "specialist" (described variously as a repairman or
"biomedical engineer") will be needed to handle repairs.^ A sig
nificant majority, nevertheless, agreed that ASCP technologists would
43
^This belief was advanced by a number of respondents, but was
particularly well expressed by one pathologist (interviewed June 19,
1967) who believes almost all ASCP technologists will have to be spe
cialists. They will, in fact, probably be forced to choose, at the be
ginning of their training period, a career either in automation or in
manual procedures.
^A most atypical view was that the pathologist should perform

100
be able to handle all but major breakdowns.
A few respondents offered the specific hypothesis that regis
tered technologists will oversee maintenance and serve as "first-line"
repairmen, but that factory-trained specialists will attend to major
45
breakdowns. This viewpoint, in the investigator's opinion, will be
demonstrated to be correct.^
Although ASCP technologists are currently meeting the challenge
of breakdowns (with assistance from pathologists), the ever-increasing
complexity and numbers of automated devices, as well as the current
steady increase in hospital size, will probably mean that specialized
repairmen will be employed either by the hospital (perhaps servicing
repairs. In response to the questionnaire, "Do you employ a special
ist to repair automated equipment? If not, will you need such a per
son in the future? A Georgia pathologist remarked: "No. The path
ologist, because of adequate training, is generally able to repair
equipment." This statement is certainly most unusual. As another
pathologist points out, "Automation can free the pathologist from
technical concerns, although some pathologists like to tinker." Inter
viewed June 21, I967.
Moreover, there is little in the training of pathologists (phy
sicians) that would give them superior expertise in electronic repairr
work.
^An analysis offered by a Florida pathologist interviewed
June 5, 1967. One administrator commented that "we need factory-
trained representatives; medical technologists should not do major re
pairs." Interviewed June 5, 1967- Another administrator also saw ASCP
technologists as "first-line" repairmen, making adjustments in the man
ner of radio operators in the military services. Interviewed May 25,
1967.
46The day of the "biomedical engineer" would, nevertheless,
seem to be arriving. His role may not include repair and maintenance
of the most intricate machinery, but he may be expected to care for the
majority of devices throughout the hospital.

101
automated equipment throughout the hospital) or maintained in regional
offices by manufacturers. Some technologists (particularly males)
may specialize in the repairing of equipment, but there is seemingly
little in the education and personality of most technologists to prompt
them into such a specialized function.
Frequency and Meaning of Interactions
Few intimations are given in non-sociological literature re
viewed as to the effects of laboratory automation on the frequency and
meaning of interaction between incumbents of the focal position (medi
cal technologists) and incumbents of major counter positions (patholo
gists, administrators, hospital physicians, and nurses). Nor were the
results from interviews much more encouraging. On questions relating
to "interaction," i.e., the relationships between incumbents, the in
vestigator experienced more difficulty in phrasing the inquiry and in
eliciting responses than on any other topic. Apparently most respond
ents (and probably most people generally) see social relationships as
fixed, "given," and not subject to extended change, even though there
is seemingly little difficulty in perceiving changes in technological
patterns. Whatever the case, the investigator did not feel overly suc
cessful in a majority of interviews in handling this question.
The problem was further heightened by the fact that there is
apparently little interaction (in hospitals of any size) between tech
nologists and nurses, or between technologists and administrators. In
large hospitals, an administrator has contact only with the patholo
gists, or more rarely, with the chief technologist. Similarly,

102
specialized technicians (phlebotomists) draw blood on the wards,^
with the result that laboratory technologists and nurses do not inter-
LO
act with any significant degree of frequency.
The interviews did, however, shed some light on changes in the
major pathologist/technologist positional sector. The possibility of
change in the frequency of interaction between pathologist and regis
tered technologist emerged in a number of interviews. Most noteworthy
was the viewpoint that, in the short-run, automation has greatly in
creased the interaction. A closer relationship has resulted, since
the greater scientific knowledge of the pathologist has been essential
in the installation, evaluation, and "debugging" of the automated ma
chinery. In the long run, however, most of the same respondents felt
that interaction will be much less frequent once the initial problems
of automation are solved.
47
One pathologist lamented the lack of "social perception"
on the part of many phlebotomists, who, he felt, often lack a good
"bedside manner." Interviewed June 5, 1967-
le investigator did perceive, nevertheless, some indica
tions that friction exists between nurses and technologists. One
possible source of difficulty, pointed out by a biochemist, is the
fact that nurses must conform parts of their scheduling to that of
the laboratory. Interviewed June 6, 1967-
Indeed, the investigator has heard and read complaints that
too often the "tail wags the dog," that the entire hospital program
of patient care is too often limited and hemmed in by the scheduling
needs of the laboratory. Thus, an undiagnosed patient known to this
investigator spent two expensive week-end days in the hospital wait
ing for certain laboratory procedures to be performed on Monday at
3:00 p. m.
In regard to laboratory personnel, one technologist remarked
confidently, "we have always run our own show--the others must con
form to us." Interviewed June 6, 1967.

103
It is worthwhile to note some of the interview comments on
these points. Among technologists, for example, one stated that
"at first the pathologist intervened to assure quality control, but
now we work more independently, unless trouble comes1.1^ Another re
marked, "Automation has made a closer relationship between the auto
matic section and the pathologist--more communication--but this is
because things are new.""^
A pathologist reported that at his large hospital one patholo
gist had had to work "very closely" with the automation team.^* In
regard to the future, however, another pathologist feels that the
pathologist will not need to have such direct, constant control, but
that nevertheless automation will make actual control and problem
analysis easier. Pathologists will spend less time supervising labora
tories (will interact with technologists less frequently) but may be
more effective.*^
Aside from frequency of interaction, most respondents seemed
to feel that automation has already meant, and will continue to mean,
a "better relationship" between pathologists and technologists. The
meaning of this statement is clear: the major bone of contention be
tween pathologists and technologists is accuracy of test results.
In a later chapter, evidence will be offered for the
^Interviewed June 6, 1967-
^Interviewed June 16, 1967.
51
Interviewed June 16, 1967
52
Interviewed June 7, 1967.

104
incontrovertible fact that automatic devices, when operated correctly,
produce more accurate (more reliable) results than do technologists.53
Thus, the "better relationship" results from heightened accuracy: the
pathologist's expectations for accuracy are more steadily met. Failures,
fault finding, sanctions, and re-doing of tests are all lessened.
A number of comments on this point were interesting. A pathol
ogist pointed out the existence of more "built-in accuracy."5^ Another
noticed better relationships between medical technologists and physi
cians because of "less human error" and "fewer problems brought to the
attention of the pathologist."'*' A chief technologist claims that au
tomation, when applied with tight controls, has cut down errors, leav
ing a "closer standard deviation" so that the "pathologist is pleased.
A laboratory supervisor made an important point by stating that
"now the medical technologistscan feel more confident of accuracy and
reliability when they have to defend their results.A biochemist
has observed more mutual respect between medical technologists and their
rO
pathologists following automation.'*

53
This is not to imply that technologists are usualy inac
curate: the accuracy of the ASCP technologist is justly renowned.
54
J Interviewed June 7 1967*
'"interviewed June 15, 1967.
^^Interviewed June 12, 1967-
^Interviewed June 15, 1967- This is a significant factor in
the improved relationship between the medical technologist and the path
ologist (and physicians generally). Pathologists and other physicians
are very quick to "come back" on the technologist who sends in a report
that seems unlikely or unexpected in light of known facts or appearance
of a patient. The technologist must defend her results and/or perform
the procedure again.
rO
' interviewed June 6, 1967-
* *§

105
Aside from the possibility of "better relations," a very
large number of pathologists, medical technologists, and administra
tors interviewed saw little or no difference in relationships and
expectations in the major positional sector. Following probing by
the investigator, however, a significant number did think that with
automation pathologists (and other physicians) would order more tests
and would expect greater accuracy, quicker results, and fewer "break
downs" or failure to complete work.^9 Alternatively, it was thought
that pathologists could afford to engage in more general rather than
specific (immediate) supervisory behavior.
Still other interviewees believed that changes will be in
evitable in the relationship between technologists and pathologists,
but that such changes will not occur primarily because of automation.
This investigator readily agrees that automation is not likely to be
the only factor causing alterations in the typical interaction pat
terns of the major position sector. He does feel, though, that, along
with other factors, automation may well be instrumental in pushing
medical technologists into more "equal i tari an" interaction with path-
ologists.
This change in relationships is parallel to and consonant
59
A number of pathologists and technologists pointed out, how
ever, that many physicians mistrust automatic testing and demand cor
roboration of results by means of manual tests. One pathologist be
lieves that this mistrust may be caused by fear of new procedures, but
it is also generated by the, as yet, unevaluated performance of many
automated devices. Interviewed June 19 1967
Another pathologist lamented the failure of manufacturers to
evaluate adequately their own equipment and also the lack of time for
pathologists to "write up" and publish their own evaluations. Inter
viewed June 21, 1967

106
with the possible shift of the registered technologists' function
from performers of tests to administrators and supervisors of labora
tories. It is correlated, also, with shifts in the role attributes
of sex, education, and stratification of skills; it accompanies almost
by definition, shifts in the role functions of clinical pathologists.
A more equalitarian relationship implies changes among ASCP
technologists toward professionalism. Medical technologists (like
nurses, physical therapists, occupational therapists, and others)
are apparently in the process of becoming more professional. Corwin
and Taves are worth quoting on this point:
Professionalization, it should be observed,
usually is somewhat militant in character, a
difficult position for many women to take
overtly. The militant aspects include efforts
to overcome lay control (represented by hospital
administration) and to reduce subordination to
physicians, which creates nurse-doctor conflicts.
At present, a militant minority of near-professional personnel is
evident, but the great mass of registered technologists (much less
laboratory technicians) do not appear to possess sufficient post
baccalaureate education, independence in acquiring and applying knowl
edge, a body of theory, and self-direction to be considered profes
sionals. ^ Yet, if the registered technologist accepts a bureaucratic
^Corwin and Taves, p. 192.
^Nowhere is this more clearly exemplified than in the obvious
dependence of technologists on pathologists; it seemed to the investi
gator during his interview tour that pathologists (with very notable
exceptions among technologists) are the laboratory personnel who are
currently making the most professional responses to automation.

107
role (supervising and administering automatic laboratories) and if
males become predominant in numbers and influences, greater profes
sionalism and independence from clinical pathology could result.
The question of professionalism was a difficult, indeed a
delicate, one for the investigator to handle as he interviewed either
pathologists or technologists. The stated norms of registered medical
technologists call for service and subordination to the pathologists
who created them. To state a desire to evade or replace these norma
tive relationships would hardly be easy for incumbents of focal or
counter position. The investigator believes that both technologists
and pathologists are strongly divided among themselves as to the cor
rectness and need for further professionalization of and more inde
pendence for medical technologists.
In reference to possible changes in relationships, a number
of comments and viewpoints are worth examining. Among pathologists,
the most positive comments were heard from one who stated that "in
time the medical technologist will attain a professional standing
at least as high as nurses.This pathologist feels that medical
"a.
technologists will come up the scale by their own efforts. He
believes, too, that pathologists will want largely to abandon their
^Although the investigator often observed resistance to
change or a desire for change in relationships among the various in-
viewees, he also noted a distinct inclination not to talk about it"
on the part of many. in fact, he suspects that many a there-will-
be-no-change reply was motivated by a desire to evade a sensitive
issue.
^Interviewed May 18, 1967*

108
supervisory functions in order to devote more time to interpreting
tests, consulting with other physicians, and visiting wards in order
to spend more time with patients. To a much less extent will path
ologists want to be directly involved in running the laboratory or
in delving into autopsies and tissues.^
The same pathologist cautioned, however, that his viewpoint
is by no means universal among pathologists, although it appears to
be a growing one. In particular, many older pathologists (and es
pecially tissue pathologists) disagree with the proposed changes
66
just outlined.
A South Florida pathologist believed that automation can free
the pathologist from technical concerns to become more of a consultant
and diagnostician; the MT(ASCP) can assume more of the management of
the laboratory and quality control.^7
Other technologists, chemists, and administrators voiced the
above prediction to one degree or another. A chief technologist felt
that the registered technologist may become more of an administrator
o
to relieve the pathologist. A biochemist remarked that over the
last few years an increasing number of technical decisions are being
made by technologists, while the pathologist is increasingly assuming
65lbid. 66lbid.
^Interviewed June 21, 1967. He also recognized the current
role controversy with the remark that "there is as much confusion in
the role of the pathologist as there is in the role of the MT(ASCP).
It's like nursing. Where does nursing end and medicine begin?"
68
Interviewed May, 1967.

109
a consulting role to other physicians and is becoming less of a lab-
69
oratory scientist. Another chief technologist claims that patho
logists do not "get too involved" as long as the machines function
well and quality control is adequate.^ A chief technician stated
with pride that "doctors now know that medical technologists are de
gree people who do. know what they're doing. They [the doctors] now
accept us for what we are."^ An administrator thought that the ASCP
technologists will become chiefs over the laboratory services and will
even interpret results, contact physicians to explain abnormal .results
"only the fully-trained technologist can relate to physicians intelli
gently."^
Although some of the foregoing comments are almost glowing in
their prediction of a more independent, professional future for medi
cal technologists, a number of negative opinions were also voiced dur
ing the interviews. One item on the questionnaire attempted to as
certain from the pathologists queried whether automation, especially
in the future, would be likely to reduce the need for pathologist su
pervision of technologists. Most replies were negative, but since
the sample was purposive (highly selected), rather than random, no
conclusion need be drawn as to how typical the negative response is
among pathologists generally.
69
Interviewed June 6, 1967-
^Interviewed June 6, 1967-
^Interviewed June 6, 1967-
72
Interviewed May, 1967-

110
In conclusion, the investigator advances a tentative hypothe
sis that automation will, with other factors, contribute to the fur
ther professionalization of medical technologists. The technical re
quirements of automated equipment are so involved as to necessitate
specialization and professionalization.
The MT(ASCP) would seem to be the most logical group of labora
tory workers to become proficient with such equipment. Persons of
lesser training may in the future conceivably operate the machinery
under supervision, but apparently are not prepared educationally to
70
cope with today's problem-ridden laboratory. J
Clinical pathologists, biochemists, and other laboratory workers
at the master's and doctor's level do have the requisite abilities to
dominate the incipient era of laboratory automation, but most of them
are already committed to distinct career patterns(i.e., as physicians
or laboratory researchers) which are more remunerative than that fol
lowed by most registered technologists. In addition, as one patholo
gist stated, research-oriented biochemists, physicians, and electronic
engineers at either the master's or the doctoral levels are far too few
in numbers and in far too great demand to play more than a supportive
role in automated laboratories.^
Registered technologists, however, are not thereby assured of
a more professional standing in the laboratory. Professionalism will
be hard-won, involving distinct efforts on the part of medical
73
As has been pointed out, a national consensus is emerging on
this point, one which is amply supported by an overwhelming majority
of interviewees in this study.
74
Interviewed June 21, 1967-

ni
technologists in acquiring new skills and knowledge. A transition
era, painful for many, appears to have begun. Before medical tech
nologists achieve a higher degree of professionalism, they will probably
have to experience the shifts in functions and role attributes previously
discussed, as well as undergo the necessary changes in educational prepa
ration to be dealt with in the last chapter of this report.
Automation and Stratification
The purpose of this section is to record an unsought, unexpected
insight into possible effects of automation on stratification and sub
group formation in the clinical laboratory. For whatever reasons, other
possible effects had been chosen as topics of investigation:; there were
no questions regarding stratification within the laboratory included
on the interview schedule or on the questionnaire.
Since this Section is based solely on interviews at one hospital,
it is not the intention of the investigator to give undue emphasis to
the situation found there. Yet the nature of the hospital recommends
that at least recognition be giveiof its laboratory personnel's re
marks. The hospital involved is one of Florida's very largest hospitals,,
located in Florida's largest metropolitan area.
Visited June 16, 1967 The very size of this hospital (its
large numbers of technologists, immense laboratory work volume, high
degree of stratification and bureaucratization) endow it with unusual
importance for this study. Since degree of automation is for obvious
economic reasons very highly correlated with a large volume of labora
tory procedures, large hospitals have, in most cases, experienced more
automation than have medium or small hospitals. The trend nationally,
moreover, is for all sizes of hospitals to grow rapidly. Future lab
oratory testing may be concentrated in enormous regional medical cen
ters, which will serve surrounding hospitals. Thus, this hospital's
size and the patterns of effects found there justify unusual scrutiny.

112
In the clinical laboratory of this institution, a policy of
dividing the work force into an automated section and a manual section
is followed, with detailed work rules and hierarchies (work classifica
tions) for each.^
The chief pathologist of this large hospital provided the in
vestigator with one of the most enlightening interviews of the study.^
No one in any interview evinced more concern with the possibilities
and limitations of automation in the clinical laboratory. Probably his
conviction that successful automation requires the efforts of the very
best technologists led him to structure his personnel into those who
work with the machines and those who continue to function manually.
The results of this structuring, in his view, are very clear.
The "automation people" are considered throughout the laboratory and
hospital as an elite group (and indeed, the very best technologists
were chosen). Consciously created, the automation team is composed
of members who think of themselves as constituting an elite very much
^ Previous mention was made of the large number of hospitals
that prevent the specialization found by requiring technologists to
rotate from manual to automatic work. The most probable reason, it
seems to this investigator, for a "non-speci al i zat i or1)1 pol i cy in small
and medium hospitals, where dependence on automation has developed,
is to prevent work stoppages in the event that a handful of automa
tion workers become ill, resign, or, possibly, strike.
However valid their reasons, the hospitals that follow a "non
specialization" policy would seem to reduce their efficiency and create
frustration among many laboratory workers. Most interviewees held the
opinion that "some technologists are good at automation and some are
not." In the investigator's thinking, such artificial prevention of
specialization cannot be maintained as the degree and complexity of
laboratory automation increase.
77
Interviewed June 16, 1967-

113
aware of the unusual prestige they enjoy. The pathologist admits
that the team was given the name of "special chemistry section" to
avoid jealousy on the part of manual workers. Increasing the pres
tige of the automation team is their frequent contact with a staff
pathologist assigned to work with them (especially during the diffi
cult initial period of automation).
In a quite separate interview, the medical technologist who
heads the automated team, expressed to the interviewer her belief that
morale in her area is extremely high, with all personnel eager to learn
and assume responsibility. She informed the. investigator that, although
they are not paid higher wages, her workers were always willing to stay
overtime, whereas the "manual people" do not like to do so. She re
marked, also, that the automated worker enjoys "being involved in the
whole process of tests. Sometimes they get clannish and want to gang
up on others'P
A third interviewee at the hospital was the chief technologist,
who has served twenty-four years in medical technology. She pointed
out that all new technologists are hired first into the manual sec
tion:
Then we hire into the automatic section
must be good teamworkers, have certain per
sonal characteristics, get along well with
people, be challenged by the machines, need
to be dedicated and conscientious. Many well-
trained medical technologists do not adapt. 79
It seems clear at this hospital that role attributes are being
redefined by pathologists and technologists alike. As a result of
7O
Interviewed June 16, 1967-
79
Interviewed June 16, 1967.

114
deliberate structuring (in response to automation), status is lent
to a sub-group of workers, a well-knit team, that, through training
and work experience, may well develop a sub-culture molded to the needs
of automated laboratories.
Predictions may be made that the formation of an elite group
creates morale problems among manual workers who are not chosen for
automation: they may feel that their skills are devalued and their
status reduced. Equally, however, the existence of an elite group may
well be instrumental in providing a channel of upward mobility for
younger technologists, who will then be willing to undergo the extra
training necessary for work with automated equipment.
The extent to which these developments will occur in other hos
pitals of fairly similar characteristics is, of course, a matter for
empirical determination. Their apparent occurrence at one large hos-
80
pital is, however, suggestive.
Worthy of note, also, is the chief pathologist's belief that
automation will end stratification in the clinical laboratory based
on skill and educational levels. In his view, only ASCP technologists
go
wln the literature is found a report by Walker that in the ac
counting and sales division of one firm where automated machinery was
introduced, a similar "social polarizing" occurred: "The greater number
of key punch operators and other machine groups increased the number of
employees who were associated more with the mechanical processing of
data than with the data itself. Because of the obvious distinguishing
characteristics of the machine jobs as against the accounting jobs and
because promotion is probably more feasible within rather than between
the groups, there is an increasing possibility of a rather severe schism
between these two groups within the Accounting Division." Walker did
not, however, intimate greater prestige for the "automation people."
Charles R. Walker, Modern Technology and Civilization: An Introduction
to Human Problems in the Machine Age (New York: McGraw-H¡11 Book Company,
Inc., 1962), pp. 306-307.

115
should be needed ("we don't need helpers"). In his words,
At first the idea was to use people at lower
skill levels, but with automation, the lower
level jobs won't exist. The lay person ex
pects that automation will do tests more
cheaply and with half-skilled people.
The pathologist expressed his disagreement with the popular view by
terminating his training program for laboratory assistants.
The investigator agrees that in the next few years (up to ten
years in the future) there may be an overwhelming need for ASCP-level
personnel in automated laboratories, but, as discussed in the previous
section "Automation and Functions," he also believes long-run changes
devices (their perfecting and the introduction of com-
again make possible employment of less educated person-
in automated
puters) wi11
, 82
Automation and Bureaucracy
In their introduction to readings on the subject, Coser and
Rosenburg state that "bureaucracy may be defined as that type of hier
archical organization which is designed rationally to coordinate the
81
Interview with chief pathologist. The emerging national
consensus on this point has already been mentioned.
82
Enough evidence exists to lead the investigator to conclude
that personnel of lesser training than that of the registered tech
nologist may be in demand even in the immediate future. Automation
in the laboratory is very incomplete, since data handling is still per
formed in most laboratories by traditional clerical methods. Until
the computer is effectively tied in with automated equipment to form
an automated system, many assistants will probably be needed to cope
with the enormous volume of clerical detail produced by the current
use of automated equipment.

116
work of many individuals in the pursuit of large scale administrative
O o
tasks." 3 Long ago Max Weber brought attention to rules, laws, and ad
ministrative regulations as prime characteristics of bureaucratic or-
. +. 84
gam zat i on.
In hospital laboratories of any size, a bureaucratic structure
exists to coordinate efforts of the various skill and specialization
levels of workers. Detailed rules are needed to regulate the work life
Or
of the clinical laboratory. p
Early in the planning of this study, a decision was made to in
vestigate the possibility that automation would increase rules and regu
lations and, generally, heighten bureaucratic aspects of the laboratory.
Virtually unmentioned in the literature, the topic of automation and
regulations was included in both interviews and questionnaires in several
kinds of questions.
Although the opinions of pathologists, technologists, and ad
ministrators were not unanimous on this issue, the overwhelming
Oo
'Lewi s A. Coser and Bernard Rosenberg (eds.), Soci olog i cal
Theory: A Book of Readings (2nd ed.; New York: The Macmillan Company,
1964), p. 463-
P4
Max Weber, "Characteristics of Bureaucracy." From Max Weber:
Essays in Sociology, eds. H. H. Gerth and C. Wright Mills (Oxford,
England: Oxford University Press, 1964), p. 196. Cited in Coser and
Rosenberg, p. 465.
8S
"Tor some description and discussion of stratification and
regulations in the laboratory, see Cornelia Van Benthem, "Laboratory
Administration: The Role of the Chief Technologist," The American
Journal of Medical Technology, XXVII (January-February, 1961), 43-47;
Martin S. Ulan, "The Role of the Administrator in the Growth and De
velopment of the Laboratory," The American Journal of Medical Technology,
XXVII (January-February, 1961), 35~37; Donald E. Brown, "Laboratory Ad
ministration: The Role of the Pathologist," The American Journal of
Medical Technology, XXVII (January-February, 1961), 38-41.

117
majority reported that, as a result of automation, little increase in
86
bureaucratic rules has been experienced or is expected. Some re
spondents did feel that the future will bring more "work rules."
In the investigator's judgment, a tentative hypothesis should
be proposed that the bureaucratic aspects of laboratories will not be
greatly augmented by automation. Not only is majority opinion strongly
against the possibility, but it appears to the investigator, also, that
those holding the minority position were really saying that new (dif-
O
ferent) rules and regulations wi11 be necessary.7 Moreover, a sig
nificant percentage of respondents suggested that the effect of auto
mation will be to decrease work regulations.
On the whole, the issue of possible effects of automation on
the bureaucratic aspects of the laboratories was difficult to communi
cate during interviews. In general, only the better educated among
the interviewees seemed able to perceive any possible causal relation
ship.
The investigator concludes that laboratories are already very
bureaucratic work structures in which automation (particularly when
fully developed) may well serve in many cases to free technologists
from the need for minute regulations to control behavior.
Of
ODExplicit recognition is given here to the probability that
increases in regulations usually result from increases in such variables
as hospital size and laboratory work force. The interest, however, has
been to ascertain whether automation may also contribute to bureaucrati
zation.
0~j
'Certainly, it is very much one thing to say that new rules are
needed and another to declare that (necessarily) more rules (or more de
tailed rules) are needed. A number of respondents did say, however, that
to obtain adequate results with automation rules will have to be followed
more closely.

CHAPTER VI I
ATTITUDES AND OTHER SOCIOPSYCHOLOGICAL TOPICS
Attitudes, which have been defined as "enduring systems of pos
itive or negative evaluations, emotional feelings, and pro or con ac
tion tendencies with respect to social objects,"^ are among the most
important variables determining human behavior. Accordingly, quite
early in the planning stage of this dissertation study, it was decided
to investigate the attitudes of medical technologists toward laboratory
automation. Encountering uniformity of attitudes among incumbents of
the focal position was not anticipated nor was the intention to ascer
tain exactly the percentages of technologists in Florida in favor of or
opposed to automation. Rather, the objective was to identify patterns
of responses upon which to formulate hypotheses.
An attempt was made also to probe the problems of monotony,
fatigue, and boredom, as well as to determine feelings of personal
David Krech, Richard S. Crutchfield, and Egerton L. Ballachey,
Individual in Society: A Textbook of Social Psychology (New York: McGraw-
Hill Book Company, 1962), p. 139-
Berelson and Steiner state that opinions, attitudes, and beliefs
"...do not have fixed meanings in the literature, but in general they
refer to a person's preference for one or another side of a controver
sial matter in the public domain--a political issue, a religious idea, a
moral position, an aesthetic taste, a certain practice (such as how to
rear children)!1 Bernard Berelson and Gary A. Steiner, Human Behavior:
An Inventory of Scientific Findings (New York: Harcourt, Brace and
World, Inc., 1964), p. 557.
118

119
accomplishment. For instance, do medical technologists experience
the "depersonalization" so often alleged to accompany industrializa
tion and automation?
In general, administrators apparently have very little first
hand knowledge of the laboratory. They depend for their information
concerning laboratory problems on communication with pathologists and
chief technologists. It seems evident that administrators, who rarely
interact with technologists, are in the least advantageous position to
observe expressions of the feelings and attitudes in the laboratory.
Clinical pathologists, more frequently in contact with the
workers in their laboratories, were almost always able to offer an
opinion as to the feelings of technologists. The technologists them
selves, of course, were best able by far to express their own reactions
to automation. This chapter affords a forum for their observations.
The plan of presentation calls for examination of literature
relating to attitudes and other sociopsychological effects of automa
tion, to be followed by the responses of administrators, pathologists,
and medical technologists.
Although studies of attitudes of professionals to automation
seem to be virtually nonexistent, a limited number of comments can be
found in the varied writings of physicians, psychologists, economists,
and others. Their writings reflect both negative and positive senti
ment .
Buckingham states that
While automation reduces working hours, improves
working conditions in many ways, and increases

120
responsibilities of workers, it may also in
crease monotony, downgrade skills, and reduce
workers' feelings of importance. Automation
increases the optimum economic size of indus
trial plants and transfers much of the control
of production from men to machines. Conse
quently, workers find it harder to identify
themselves with the objects of production and
to find satisfaction in their work.^
He also notes that automation creates greater emotional hazards for
workers, such as isolation from other workers (hence lonesomeness and
3
boredom).3
Another writer states that automation may be perceived as a
threat (and may be a threat) to employment by many workers, including
professionals:
Automation may threaten to deprive wage
earners and salaried employees not only of
a particular job but it may perhaps even
render certain professional skills redundant
and undermine the social status of many people
employed in industry. Only a privileged mi-
nority--supervisors and maintenance men--can
feel that their jobs are safe.**
Jacobson reported that automobile workers interviewed in one
study "felt that they were losing control over work pacing in the way
the job was done" and that workers had to pay more attention to the
work they were doing.J The workers also
2
Walter Buckingham, Automation: Its Impact on Business and
People (New York: Harper and Brothers, Publishers, 1961) p. 174.
3Ibid., p. 95.
^Frederick Pollock, The Economic and Social Consequences of
Automation (Oxford: Basil Blackwell, 1957)> PP- 40-41.
^Eugene Jacobson, "The Impact of Technology and Automation on
the V/orker: Some Effects of Automation on Industrial and Clerical Workers,'
Industrial Medicine and Surgery, XXXII (June, 1963) 216.

121
...felt some confusion about skill requirements
for the new job, but felt, nevertheless, they
were on a higher skilled job. (This is related
to the fact that the new equipment was complex.)
The worker tended to feel a greater sense of
responsibility. (This is related to the fact
that the new equipment was more expensive and
mistakes more costly.)b
The-same study reported no differences in fatigue between the old and
the new (automated) job; fewer opportunities for social interaction;
interaction in smaller groups; and less identification with a particular
work group. In the new plant, relationships with supervisors were felt
to be more formal. Most automobile workers were satisfied with their
new situation, but they chose to make the change on their own volition.^
Jacobson also reports on a questionnaire study of insurance com
pany workers' reactions to the introduction of an IBM 650 machine:
1. A third of the employees reported it had
a marked effect on their job.
2. Two per cent were promoted, 4 per cent were
transferred, and 27 per cent said they kept
the same job but that the work was noticeably
changed.
3. Half said the effect of the change-over made
no difference to them; 40 per cent like it,
and only 6 per cent reported dislike.
4. About one-third reported the change-over was
quite disrupting, while the rest said it was
only slightly or not at all disrupting.
When employees were asked to anticipate the ef
fect of the computer on their jobs in the next
year or two, the following findings emerged:
^1 bid.
^1 bid.

122
1. About 40 per cent anticipated the computer
would continue to have some influence on
them, but about the same number did not be
lieve it would affect their jobs.
2. Both high and low seniority employees were
more apprehensive of the change, than those
in the middle, apparently because indivi
duals in these first two groups felt the
change would work to their disadvantage.
3. The more able employees were more likely to
welcome the change than the less able.
4. Women, in this particular situation, seemed
to welcome the change more than-men.
5. A regular positive relationship was found
between economic class and readiness to
change.
From these data, it seems clear that employees were re
acting not so much to the fact or to the prospect of
change itself as to their perception of the effects of
the change on their own welfare.
In another study, Walker reported that introduction of automation into
an accounting and sales division of an industry led to an acceleration
of the level of formalization, further rationalization in the organiza
tion of work, and the substitution of rules and regulations for indi
vidual decision-making:
Programming itself is a large step in this direc
tion. Decisions formerly left to individual em
ployees to handle within the spirit of a general
statement of policy are programmed into the machine.
Ibid., p. 217* Jacobson apparently means that of the one-
third whose jobs were markedly affected by the IBM 650, 2 per cent
were promoted, 4 per cent were transferred, etc.
In the second group of findings (concerning anticipations),
Jacobson seems to mean in I tern 5 that the higher the wage level the
greater the willingness to change.

123
It is this type of decision with known criteria
that can be built most readily into machine
programs.9
Since important functions and even positions may be altered or even
abolished in this case, workers feared (quite realistically) the loss
of title and status. The positions usually abolished served
...as terminal points for the average employee
who rises to these positions through sheer en
durance within the system. Occasionally these
positions also serve as a proving ground for
managerial aspirants.
In this study the elimination of these status
positions and the further restriction of the areas
of employee decision-making fell as a severe blow
on status position occupants. Long service em
ployees were stripped of many of their responsi
bilities at a time when the right and ability to
make such decisions was the principal reward of the
job.10
Walker comments strongly on the lessened "autonomy" employees enjoyed
over "work-pacing":
The new more highly integrated work process al
lowed less autonomy in setting a work pace for
both individual employees and more work groups.
Work could not be held over from one day to the
next. Each group had to process a specific num
ber of accounts every day or perform specific
operations. Deadlines themselves became more
important, regardless of how the job had been
going, or how the personnel and equipment were
performing. Absences and tardiness became in
creasingly important because of their detrimental
Q
-'Charles R. Walker, Modern Technology and Civilization: An
Introduction to Human Problems in the Machine Age (New York: McGraw-
Hill Book Company, Inc., 1962), p. 303.
1lbid.. p. 306.

124
effect on the group's ability to complete their
portion of the job.^
The result was a greater need for coordination of all phases of the
1 2
accounting operation. Authority and responsibility tended to move
to a higher level to assure a "more efficient coordination."^
The effect of automation on individuals was varied:
For many individuals this was a period of
growth; for others a period of failure and
disillusionment. The change severely tested
marginal employees and supervisors while at
the same time giving more experienced and able
personnel the chance of their life to develop
and to demonstrate their work potentials.^
There is little need to cite writings on the ill effects of
15
industrialization on workers, since the much lamented horrors of the
assembly line are too well known to require much comment. Kimball,
for example, mentions the dark possibility that, "repetitive jobs, a
total unimaginative existence, can induce frustration, alcoholism,
mental disorder."^ Other writers, nevertheless, do not take such a
dim view of the probable effects of automation and industrialization.
Simon remarks that
1 2
A situation remarkably similar to the one that appears to
be emerging in the. clinical laboratory, where registered technologists
may have to serve mainly as "coordinators" (a major shift in role func
tions discussed in the previous chapter).
I3lbid.. p. 307-
14xL, p. 307.
^And perhaps over-emphasized.
^Charles Kimball, "Changing Demands of Science and Technology
American Journal of Medical Technology, XXXI (May-June, 1965), 212.

125
automation does not mean "dehumanizing" work.
On the contrary, in most actual instances of
recent automation jobs were made, on the whole,
more pleasant and interesting, as judged by the
employees themselves, than they had been before.
In particular, automation may move more and more
in the direction of eliminating the machine-
paced assembly line task and the repetitive
clerical task. It appears generally to reduce
the "work-pushing," "man-driving," and "expedit
ing" aspects of first-line supervision.'7
In similar vein he states that
we must be cautious, then, in inferring, because
managerial work will be more highly programmed in
the future than it has been in the past--as it al
most certainly will--that it will thereby be less
satisfying or less creative.18
Pollock is probably correct in concluding that current information is
too scanty to make any judgments as to sociopsychological effects:
In conclusion, it may be said that the available
evidence is insufficient to balance the pros and
cons of the effects of automation on the workers.
Nor is it possible to pass any final judgment on
the question as to whether the workers in an au
tomatic plant or office who improve their position
as a result of the introduction of automation ob
tain any real satisfaction from their new work.19
1 n
tinguished
any event, immediate effects need in many cases to be dis-
from long-range effects. At one plant (a seamless pipe
mill) worker morale dropped during the first year following automation
because of "bugs in production" which had to be corrected. Yet, after
an incentive plan was introduced, morale and production turned upward.
^Herbert A. Simon, The Shape of Automation for Men and Manage
ment (New York: Harper and Row, 1965), p. 35-
l8|bid., p. 97.
^Pollock, p. 212. In the investigator's view, also, there is
absolutely no reason to expect uniform reactions to different kinds and

126
Less physical fatigue was present, but there was more mental fatigue
20
and tension, thought to be caused by increased responsibility.
Obviously, the foregoing examples of findings are only meant
to be suggestive of possible sociopsychological effects of automation
on medical technologists. The remainder of this chapter will be de
voted to presentation and discussion of the reactions of interviewees
and questionnaire respondents. Persons responding differed greatly in
the completeness and value of their comments. Not all are worthy of
quoting at length, or even noting. A few offered responses sufficiently
valuable for total reproduction. Comments of pathologists will be con-
si dered f i rst.
One pathologist reported no frustration, boredom, or monotony
among his medical technologists working with automated equipment; in
fact, he thought automation had been a real challenge to them. At
present, he feels his technologists have a distinct feeling of personal
accomplishment, but also feared that such a feeling would no longer ob-
2 1
tain-if the machines become perfected.
Another pathologist thought that his medical technologists like
the new equipment, that they do not find the work monotonous, "as one
22
would expect."
degrees of automation, in different kinds and sizes of work settings,
from respondents who differ in such variables as sex, age, intelli
gence, education, length of service, and position held.
20
Charles R. Walker, Toward the Automatic Factory (New Haven,
Conn.: Yale University Press, 1957). Findings cited and summarized by
U. S. Department of Labor, Background Information on Impact of Automa
tion and Technological Change on Employment and Unemployment (Washington,
D. C., September, 1961), p. 22.
o 1
Interviewed June 12, 1967-
^1nterviewed June 13, 1967-

127
A pathologist in Central Florida stated that there is no frus
tration on the part of medical technologists, no feeling of "loss of
control." He felt that most technologists realize that automation ac
tually places them in better control, enables them to produce more ac
curate results, and will free them from routine tests so that more
stimulating manual procedures can be performed. "Automation will give
technologists opportunity for growth by getting routine tests off their
backs. Only the exceptional medical technologist misses doing the test
by hand.
One pathologist pointed out that there is little boredom in v
the laboratory since it is the least interesting, the most monotonous
work that is automated. He feels, moreover, that the most interesting
work (perhaps 40 to 50 per cent of laboratory work) will never become
24
automated.
Another pathologist noted no frustration or feelings of lack
of control among technologists. On the positive side he reported hav
ing heard several technologists using endearing terms and names for
^Interviewed June 7> 1967-
24
Interviewed June 15, 1967. This interviewee is pathologist
to a number of South Florida hospitals, which, collectively, account
for a considerable percentage of procedures performed in the area.
The pathologist must have meant that 40 to 50 per cent of ex
isting kinds of procedures will never be automated, since, by volume
of tests, some laboratories have already reached 75 to 80 per cent
performed by automated equipment. In this investigator's opinion, how
ever, much more than 50 per cent of all kinds of tests will become au
tomated (a matter to be further discussed in the last chapter of this
dissertation).

128
the machines. He feels technologists are proud of their equipment
25
and do receive personal satisfaction from its use.
One pathologist reported, interestingly, that the lower level
laboratory workers especially like automation and that they gain
great prestige from operating automatic devices. Registered technolo-
gists, however, may, he feels, become bored with automation.
At one of Florida's largest hospitals, the pathologist believes
that his ASCP-level personnel take real pride when.they obtain accurate
answers from the machines, because doing so is a real challenge. Au
tomation in his view is actually relieving much of the tedium and monot-
27
ony in the clinical laboratory.
Pathologists who completed questionnaire forms also overwhelm
ingly reported little or no frustration, boredom, or general unhappi
ness among their technologists. One did believe that some complaints
28
of "fatigue" indicated boredom. Another answered "sometimes" and
a third "no more than with manual methods.
The nearly unanimous opinion among pathologists that automa
tion does not bring adverse psychological reactions was generally
25
Interviewed June 19, 1967. Similarly, a laboratory super
visor remarked of one of his technologists that "she has a big smile
on her face when she can conquer the machine." Interviewed June 15,
1967.
26
Interviewed June 16, 1967-
^Interviewed June 16, 1967.
oO
A Florida pathologist.
29
A Southern pathologist noted for his work with automation,
and the third a South Florida pathologist.

129
confirmed by technologists themselves. There was, however, a sizeable
number of technologists and other laboratory workers who were nega
tive in their responses to automation. Other technologists were dis
tinctly ambivalent. Some comments of these individuals are worth not
ing or quoting at length.
A young technician in a North Florida hospital held a generally
negative view of laboratory automation. She affirmed its value in re
lieving monotonous, repetitive tasks and in eliminating much human er
ror, but she thought that there is no need for automation in all labora
tory areas. Some of her comments are the following:
I don't like the robot chemists that do every
thing... Anyone could run the machines with a
little training... With the machine, ambition
is irrelevant--it1s impossible to be more ac
curate... The machine begins to think for you,
and much patient contact is lost.30
When asked whether the automated equipment might replace technolgists,
she replied, "1 have always been concerned about that--worried about my
job--but they said there wouldn't be less."^
At another point during the interview, she made these remarks:
"I would feel that the machine would be taking control... 1 would not
be using my training if 1 were running a machine."^
The same technician said that automation of communications
(especially computers) would decrease personal contact with nurses.
30
31
32
Interviewed
Ibid.
Ibid.
May
18,
1967.

130
In concluding, she claimed that both manual and automated pro
cedures can become boring to the technologist, even though automated
equipment does eliminate much routine. She summarized her feelings
quite emotionally:
I don't like it, don't care for it. You're
losing a lotthe machines take over (which
is what all the ignorant people see). You
need to have some personal relationship, es
pecially in work like medicine. Oh, I'm in
it for the love of medicine, not just a job.
I'd work even if I didn't have to. I wouldn't
come in just to set up the machines. I want
to know about patientscorrelation of tests.
Even as a supervisor, the meaning would be
gone. A doctor should still be able to order
what he wants and not have to have all tests.
Tests should confirm a doctor's diagnosis.33
33
-^Because of high costs of tests, medical schools have tradi
tionally taught physicians to order only those necessary to diagnose,
or "confirm diagnosis." A newer view (made possible by automation) is
that tests should aid in the diagnosisparticularly through computer
analysis of multiple correlations. W. H. Kerns, "'Casey's Profiles'
Expand Di agiostic Role," The Modern Hospital CV1 I I (April, 1967) 124.
This emerging view is far from universal acceptance among phy
sicians, as several pathologists have admitted to this investigator.
One physician writes the following warning: "The learned professions
and in fact all the professions run the risk of peculiar disaster from
automation in the form of electronic computers. There can be no argu
ment against the conception that in the legal profession computers may
perform services highly valuable in any major legal procedure. In law
the influence of precedent in the preponderance of cases is notable.
The danger point arrives if computers may be allowed to express opin
ions or to pronounce judgment. Human considerations so pervade legal
action that, when a computer thrusts forth its own "guilty," much that
is admirable to law becomes doomed. If the computer's "guilty" deter
mines guilt as later pronounced by the judge, then that judge is in
need of an even blacker gown than the one he now wears."
This physician also remarks, "Long the physician has steeled
himself against his laboratories being permitted to di ctte diagnoses.
In a sense a computer is a laboratory, and if that particular labora
tory thrusts forth the edict 'operate,' then the medical profession
has come upon woeful days." Carey P. McCord,"Preserving the Individual
in an Age of Automation," Journal of Occupational Medicine VI October,
1964), 400-401.

131
I don't think automation should take over!^
The chief technician of a large general hospital, a woman of
some thirteen years of laboratory experience, took an ambivalent po
sition on automation. Some of her comments are the following:
1 can't get interested in any particular [auto
mated procedure]--just mechanical. 1 miss the
patient contact in a large number of cases. It's
a mass production, but the machine doesn't run
us. We're not as tired with automation--less eye
strain.35
A biochemist at a large private hospital reported no feelings
of "loss of control" over work with automation and an increase in his
own interest in his work. He noted with evident relief that automa
tion permits laboratory workers to "sit, relax, and drink coffee,"
while they watch the machines. Previously the technologist had to
stand and "stay with it" constantly.^
At another large general hospital, the chief technologist, a
lady of some twenty-four years of laboratory experience, offered in
teresting comments on automation:
The only bad thing is the loss of feeling the
medical technologist once had--it has to be re
placed by other satisfactions... At first 1
felt the machine was running me, then later when
I learned its ways, then I felt in control of the
machine. ...You have to change with the times. '
Although this interviee's general attitude seemed negative,
she became enthusiastic in enumerating some of the "good points" of
automation:
^Interviewed June 16, 1967
35
Interviewed June 7, 1967-
^Interviewed June 12, 1967
37
"Interviewed June 16, 1967-

132
Thank heavens for automation! When I think
of the overtime ten years ago. You can only
work so long, so hard, then accuracy falls.
,..They talk about the monotony of operating
an autoanalyzer--it doesn't even begin to re
late to the monotony that the technologist fejt
who was clicking off cell counts hour after
hour after hour. I would rather sacrifice
knowing patients and patients' names and get
off on time!38
The chief medical technologist at a general hospital (twenty-
five years' experience) reported no sense of "loss of control," since
with automation technologists "... have to figure out much and many
things. It gives them a sense ofwell, they're a part of things,
39
too. She was, however, somewhat nostalgic about the pre-automation
1aboratory:
1 kind of enjoyed the manual ways 1 think
automation is very important--we couldn't
do 40,000 [procedures] a month without it,
but it was more personal before.^
She stated that she missed, in particular, the taking of blood, the
consideration of test results, and knowing who the patient is. "Now
there are blood collectors," she said. "1'm one of the rare ones,
41
the old-fashioned type."
One technologist demonstrated extreme ambivalence toward
automation. She admitted that machines do take away much of the
381 bid.
39
Interviewed June 6, 1967-
40
Ibid.
41
Possibly, but this technologist is not alone in her feelings.

routine, monotonous work and that "we still retain some control, and
we decide what to call the results. I'm very grateful for the ma-
42
chines... ." Yet she also made the following remarks:
I hate the machines--! hate instruments of
all kinds. ...I don't think a woman's place
is with machines. This is only my own per
sonal opinion, because 1 hate them. But I
don't think a woman should have to do that--
we're the blood drawers and the--you know.
Far more representative of the majority view, however, were
the comments of another medical technologist who had sixteen years of
experience. She reported no feeling of loss of control over her work
because of automation. Even at the end of a very busy day, using au
tomation, there is still, for her, a real sense of personal accomplish
ment. Moreover, she stated that she still has the same personal feel
ing for the patient. Automation has apparently not removed interest
from her work:
You never know what the machine is going to
do--it's interesting just trying to keep up,
keep control with the machine. You're always
asking it, "What are you going to do today?"^
Although by its very nature the work is routine, she does not find it
monotonous. When asked for her total impression and feelings concern
ing laboratory automation, she replied,
I think it's a tremendous boon to the profes
sion. Human error is reduced to a minimum.
42,
bid.
43i
44
bid.
Interviewed June 5, 1967-

134
With hand procedures you tire. You start
off fresh in the morning, but by 3:00 o'clock
in the afternoon you're tired and have to be
careful not to pick up errors.45
In spite of some negative and some ambivalent responses, the
majority of interviewees seem not unhappy over the advent of laboratory
automation. This investigator has the distinct impression that most
medical technologists are "adjusting well" to changes in their pro
fessional role.
That some technologists should react negatively is not sur
prising. It is worthwhile to speculate on the causes of such reac
tions. In the first place, negative reactions were never found on
the part of male laboratory workers.^ Unhappiness was found largely
among "old guard" women technologists who missed the "good old days."^
This group of women have apparently internalized many of the values
and attitudes associated with skilled craftsmen--especially those re
garding accuracy and quality of work. The justified pride of regis
tered technologists in this manual competency can, understandably, be
undermined by automation. Nevertheless, "depersonalization" effect
apparently has not reached major proportions among interviewees in
45
Ibid.
^That is, dislike of automation and automated machinery.
Many men criticized specific inadequacies of present machinery but
heartily approved of their presence. Most expressed definite in
terest and enjoyment in working with them.
47
'This generalization was reached and stated independently
by a chief laboratory technologist, interviewed June 13 1967 and
by a biochemist, interviewed June 6, 1967. The latter said, "Often
the good old line medical technologists cannot adjust to automation."

135
this study, although, of course, no data have been accumulated that
indicate how many technologists have left the field because of au
tomat i on.
In any event, there seems to be little more present in most
cases of negative reaction than a strong nostalgia for old ways. In
one interview resentment over inability to fulfill internalized role
expectations was observed. In virtually every negative case, however,
recognition of the worth and benefits of automation was expressed.
Since this exploratory interview study was designed to gain
clues as to attitudes rather than to ascertain their direction and ex
tent, no definitive statement can be made regarding the extent of posi
tive or negative attitudes, monotony, or boredom among technologists
in Florida or in the United States generally. Further studies may well
benefit, however, from the tentative hypothesis suggested by this in
vestigation that in general medical technologists are reacting posi
tively to laboratory automation and concurrent changes in their pro-
LO
fessional role. As one pathologist expressed it "only the excep
tional medical technologist misses doing the tests by hand."^
¡.Q
As an aside, the investigator suggests that, psychologically,
the medical technology profession is in an enviable position in re
gards to technological change. A portion of the next chapter en
deavors to establish the probability that in ten to fifteen years
laboratory automation will become almost total. Yet even then, and
certainly until then, much laboratory work will continue to be manual.
Hence most medical technologists in the field today can afford the
luxury (as some industrial workers cannot) of choosing to learn auto
mation skills or to remain manual craftsmen for the rest of their work
ing days. Moreover, schools of medical technology have time to adopt
"automation currculums" to promote appropriate socialization for an
automated future.
ntervi ewed June 6, 1967-

CHAPTER VI I I
PROFESSIONAL CONCERNS
The purpose of this chapter is to discuss four issues, or
topics, included in the interview schedules and thought to be of
professional (and to a lesser extent, sociological) interest. The
professional topics are (1) accuracy of automated equipment, (2) safety
and working conditions in laboratories that automate, (3) changes in
numbers of technologists employed as laboratories automate, and (4)
changes in salaries following automation.
Accuracy of Automated Equipment
Though not of sociological concern per se, accuracy of automated
procedures (especially as compared with manual methods) was included in
the interview schedule. This issue, which is of obvious professional
importance, served to establish rapport early in the interviews before
the conversation turned to more behavioral matters. Moreover, accuracy
of testing devices is of more than chance interest in determining the
extent to which laboratory automation increases. The extent to which,
and the speed with which, automation progresses are prime variables af
fecting sociological change in the clinical laboratory.
Most interviewees agree that results from automated equipment
are more accurate than results from manual testing. Pathologists,
136

137
medical technologists, and hospital administrators seem convinced
that automation in the laboratory signifies greater accuracy. The
importance of accuracy to patient care scarcely requires comment.
Consequently, the interesting remarks that can and should be
made concerning accuracy do not center about whether automated equip
ment can produce more accurate results,^ but rather about problems in
assuring such accuracy. Although it is far beyond the scope of this
dissertation (and beyond the competence of this writer) to discuss the
technical problems of quality control for the many types of automatic .
laboratory equipment, a necessity is felt to report some of the opinions
and statements of interviewees concerning the problem of accuracy.
One of the major motives for automating, along with those of
cost reduction and greater productivity, is greater uniformity and
standardization of products. Machinery, of course, is immune to
psychological causes of inaccurate performance, such as fatigue, bore
dom, and emotional upsets. In Chapter VII note was taken of fatigue
and monotony as possible causes of mistakes in laboratory procedures.
^The statement should be that automated equipment is more ac
curate when properly maintained and used. Probably because of misuse
and imperfections in design, a few pathologists have taken an opposite
viewpoint. For example, one prominent Florida pathologist holds that
present automated devices cannot match fully trained ASCP technolo
gists for accuracy.
Yet Sturgeon reports that the autoanalyzer in one laboratory
agreed with manual results: "Strictly objective readings give complete
agreement with manual results in 97 per cent of the tests,1' Phillip
Sturgeon and Dorothy T. McQuiston, "The Status of Routine Blood Typing
with the Autoanalyzer," American Journal of Clinical Pathology, XU I I
(May, 1965), 461.

138
At one large hospital the chief pathologist cited a national
study which demonstrated the wide variance of results among technolo
gists, since "there is always.a human bias, especially with a skilled
medical technologist, since the skilled technologist expects to repro
duce well." Machinery, in his view, has more "objectivity" and is
standardized at each step of a procedure. "Automation is especially
valuable, not because it saves money only, but because it eliminates
* ,,2
bias.
Diane Spencer points out that "many tests now accurately done
by machines had never been done satisfactorily by conventional methods.
Important recent advances in automated laboratory equipment have occurred
More precise equipment and a greater degree of
automation have grown together since improved
precision minimizes instrument errors while in
creased automation lessens the risk of operator
error. Newer instruments also reduce the amount
of handl-ing steps for many specimens, thereby
eliminating opportunities for error that accompany
each step.1*
The results of automated equipment thus may be expected to be more pre
cise (reliable) and more accurate (valid).^
2
Interviewed June 16, 1967
3
"Laboratory Automation has Freed the Technologist," Hospital
Management, C (September, 1965), 73.
L
Robert S. Hoyt and Hugo C. Pribor, "Quality Control Saves More
Than it Costs," The Modern Hospital, CV(April, 1967), 11^.
^The following paragraph from the Hoyt and Pribor article is of
interest: "Isn't statistical quality control just a policing program?
Don't laboratory technicians resent it? No. In fact, we have found it
has a net positive effect on laboratory morale because it gives the
people a target. And in the last analysis, worker morale is perhaps the
single most significant factor in maintaining a high test quality level."
Ibid., p. 116.

139
In essence, automation "improves accuracy because it eliminates
human error."Data are more reproducible."^
One laboratory supervisor made the point that medical technolo
gists (with automation) can feel more confident of accuracy and relia-
8
bility when they have to defend their results. An administrator empha
sized his belief that automation has greatly improved accuracy, es-
Q
pecially in the small hospital.
Although there seems little doubt about the ability of automated
laboratory equipment to "out-perform" technologists as far as speed and
accuracy are concerned, one caveat should be added in the strongest pos
sible terms.
Automated laboratory equipment, like any other equipment, must
be properly maintained and properly operated if it is to produce ac
curate results. Because of what might be termed the primitive nature
of current automated equipment, any laboratory that simply purchases,
plugs in, and uses such equipment is running very grave risks. The
problem has several aspects.
^Remark of pathologist interviewed May 18, 1967
^Remark of pathologist interviewed June 19, 1967-
g
Interviewed June 15, 1967.
As mentioned in a previous chapter, having to defend their re
sults is a major irritant to medical technologists in their relation
ship with physicians. Physicians are prone not to accept unusual or
"or unlikely" results on their face value, since they know full well
that laboratory work is not by any means always without error. Hence
physicians frequently question the work of technologists and often de
mand that procedures be repeated.
The fact that results of automated procedures are also questioned
indicates that many physicians are not convinced that automated equipment
is entirely dependable.
,
^Interviewed May 25, 1967-

}kO
However wondrous the current generation of automated devices
may appear to be, it must be recognized (l) that they are only the
"model A'S and T's" of a dynamic new industry, (2) that most of the
machinery is only partially automated, and (3) that all too many of
them are marketed without adequate factory testing.^
That mechanical inventions of value are almost always im
proved upon is incontrovertible. The point is too obvious to belabor,
yet it is apparently being overlooked by some laboratory workers and
pathologists who have seemingly arrived at premature negative judg
ments regarding laboratory automation. It is, of course, unquestionable
that current devices are all too filled with "bugs"--imperfections in
design and functioning, which are creating endless headaches for the
staff that operate them. Such problems militate against acceptable
levels of accuracy. Although improvements in equipment will undoubtedly
continue to be forthcoming, present imperfections and crudities must
be taken into account and dealt with to assure accuracy.
The second factor affecting accuracy in clinical testing is the
lack of complete automation. In particular, most current automated in
struments have no built-in quality controls or are not "watched," are
not monitored, by computers or other servomechanisms. Hence, unless
quality controls are applied by ever-observant technologists, there is
little reason to hope that results will be consistently accurate.
10
One pathologist calls the marketing of poorly tested laboratory
equipment a national scandal. He feels that confidence of physicians in
automation has been undermined by this situation. Interviewed June 19,
1967.

\h\
Since complete automation is a number of years, perhaps several
decades away, a systematic program of quality control is essential.
Quality control is neither cheap nor easy, but without it predictions
of more volume, heightened accuracy, and reduced costs through automa
tion are meaningless.'' Without accuracy, automated equipment can only
v.
be deemed a threat to patient care. If properly maintained and operated,
however, automated instruments give distinct promise of economic and
scientific benefits.
Safety and Working Conditions
Prompted by mention in the literature of improved safety and
other working conditions in automated factories, the investigator thought
it worthwhile to inquire into changes in safety and in general "pleasant
ness" of physical surroundings following laboratory automation. That
automation usually improves working conditions in factories is well known.
Steel workers are no longer directly involved with moving incandescent
ingots; chemical plant employees are separated from direct contact with
acids. In general, there are ..."greatly improved working conditions,
1 2
including greater safety and easier housekeeping."
''There apparently is a tendency for many hospitals to buy ma
chines and simply turn them on under the direction of technician-level
personnel. That such proceedings are fallacious has now been given
national recognition. Proper automation requires more highly skilled
people and coordinated teamwork. See Thomas D. Kinney and Robert S.
Mel vi 11,. Automation in Clinical Laboratories: The Present State and
Future Uses of Automation. Proceedings of a Workshop Conference, 1967-
1 2
George B. Baldwin and George P. Schultz, "A New Dimension to
Old Problems," Monthly Labor Review, LXXVII I (February, 1955). P* 165-

142
The investigator rather expected to encounter similar improve
ments in the clinical laboratory as automation progresses, and he asked
specifically as to changes in safety, housekeeping, and pleasantness
of physical surroundings.
For the most part, however, respondents in all three interview
categories reported little or no change in the safety and pleasantness
of clinical laboratories. Moreover, not a few felt that automation has
had a deleterious effect. Comments and reasoning of several respondents
on these matters are worth considering.
A chief technologist thought automated laboratories will be
safer because of less contact with chemicals and bacteria, whereas the
environment will have to be air-conditioned because of the automated
13
equipment. A biochemist pointed out that automation has meant more
plastics and less glassware (hence less breakage and chance of cuts).
Another chief technologist was able to estimate the automated labora
tory as being "a little bit safer--about 10 per cent." ^
Pathologists and administrators, generally, and some other
laboratory personnel, believed either that automation would have little
or no effect on laboratory safety and pleasantness or that conditions
1 3
Interviewed May, 1967
Air-conditioning is absolutely required in rooms where such heat-
producing equipment as digital computers are located and is desirable with
virtually all laboratory equipment because it dehumidifies.
'^Interviewed June 12, 1967.
'Interviewed June 13, 1967-

143
would somewhat improve. One pathologist gave "less spillage and break-
J
age" as reasons for greater safety; another foresaw "superior phy
sical surroundings" and "less glassware."^
Nevertheless, a significant number of interviewees states that
automation may bring deterioration in levels of safety and pleasant
ness. An administrator felt that automation would surely bring new
1 O
safety hazards of its own. A pathologist was of the opinion that ma
jor problems have occurred, since automated equipment is being installed
19
in laboratories designed for manual work. ^
In other words, new architectural designs are needed to realize
any potential for greater safety and pleasantness.^ In many cases, the
laboratory may be worse off thanbefore automation. A technologist said,
21
"The lab looks like a machine shop--more messy." A biochemist claimed
that laboratory conditions may be generally better but that problems
22
arise when automated equipment is placed in manual laboratories.
The investigator has seen, firsthand, the vexing problems of
automated equipment installed in manual laboratories. In some, auto
analyzers hang over too-smal1 benches and protrude into aisles. Labo
ratory space, so often insufficient to handle manual work, is totally
16
17
18
19
20
21
22
Interviewed May
Interviewed June
Interviewed June
Interviewed June
Ibid.
Interviewed June
Interviewed June
18,
7,
14,
16,
6,
6,
1967.
1967.
1967.
1967.
1967.
1967.

144
unable to accommodate much of the new automated equipment. Hence,
the use of automation in laboratories designed for manual procedures
may reduce both safety and pleasantness, since, obviously, overcrowd
ing and awkward placing of equipment lead to neither.
As laboratories are redesigned for automation, however, it is
most reasonable to hypothesize that laboratories will become at least
somewhat safer and more pleasant. This will probably be so because
(l) whatever new hazards automated equipment involves will be overcome
in later models, (2) fewer possibilities will occur for breakage (less
"handling"), and (3) air-conditioning and better spacing for efficiency
23
will be mandatory.
Worth emphasizing, however, is the probability that no pro
found changes need be expected in safety or pleasantness of the labora
tory because of automation per se. The clinical laboratory has, for
decades, already constituted a safe work environment. Major problems
of accidents (breakage, spillings, infections, burns, and whatever) have
long been basically solved. There is simply no room for the accident-
prone, the careless, or the clumsy workman in the laboratory. High
standards of safety and appropriate architectural planning are the keys
to safety and pleasantness in manual and in automated laboratories.
Either kind of laboratory can be safe or dangerous, pleasant or annoying.
^At the Miami Heart Institute, Mr. John T. Thomas, MT(ASCP),
is demonstrating his professionalism and versatility by designing
laboratories to suit automated equipment. His blueprints and specifi
cations are fascinating, and what will probably be Florida's first
automation-age laboratory was probably constructed at the time of this
writing. The investigator regrets not having been able to meet Mr.
Thomas during his visit to the Institute.

145
Changes in Numbers of Technologists Employed
The specter of unemployment is one of the more typical associa
tions made concerning automation. That automation should awaken such
fear among workers and students of technological change is quite un
derstandable and not totally unfounded. The core meaning of automa
tion is, after all, replacement of human muscle power, intelligence, and
sensory functionings, wholly or in part, with the accomplishment of
work tasks by mechanical devices. Common sense indicates that men are
replaced once they are no longer needed. Nor is common sense entirely
wrong; automation in many industrial situations may create unemployment.
The "great employment controversy" has raged for several decades
and, indeed, is not yet resolved:
Some say that automation will create more jobs
while others claim that hundreds of thousands
of unskilled and semi-skilled jobs in factories,
railroads, and mines have been eliminated. In
a sense, both positions are correct. By its
very nature, automation eliminates certain types
of jobs, causing displacement. At the same time,
new jobs are created in industries utilizing au
tomation, and additional jobs are created in the
industries manufacturing this specialized equip
ment. Displacement, however, is not the same as
unemployment. There are countless examples of
technologic improvements displacing workers. The
history of technology is but a continuum of ma- ,
chines taking over work performed by human beings.
^Daniel H. Kruger, "Automation and Manpower," Journal of the
American Dietetic Association, XU I I (September, 1963), 199-200. Somers
et aj_., remark, "Indeed ... it is the separation of gains and losses and
gainers and losers that contributes to the controversy over technology's
employment effects. Employers benefit from cost effects and consumers
from price effects, but workers may lose their jobs." Gerald G. Somers,
Edward L. Cushman, and Nat Weinburg (eds.), Adjusting to Technological
Change (New York: Harper and Row, Publishers, 1963), p. 207.

146
Management, in defending automation, consistently points to
the new jobs--and better jobsthat it creates. Labor, however, has
not been so sanguine over automation's effects in many industries.
That automation, in specific instances, causes unemployment, retrain
ing problems, and general social dislocation can scarcely be gainsaid.
Yet for most industries the case for unemployment effects seems to be
largely unsubstantiated. Remarks of the U. S. Commissioner of Labor
Statistics (U. S. Department of Labor) are worth presenting at length:
The overstatement is that not all technological
job changes in our economy eventuate in the actual
unemployment of individual workers. The BLS [Bu
reau of Labor Statistics] has made a number of au
tomation studies over the past few years, studies
which describe the methods and the effects of in
troducing new technology into a factory or an of
fice. In practically every case, layoffs were in
significant or even non-existent, while transfers
and retraining opened up many new job opportunities.
In a survey of the introduction of electronic com
puters into twenty offices, it was found that, in a
total of 2,800 previously existing jobs, 1,500 were
unchanged, 600 new jobs were created in those same
offices and 700 jobs were eliminated. However, only
400 employees were dropped from the payroll,, prac
tically all of them by means of attrition--mostly
turnover and retirement. A total of about 900
workers were either reassigned, transferred or re
trained, many of the latter for higher-grade jobs.
While this is only one small example, it is fairly
typical of the experience in other firms and in
dustries. In many cases, firms introducing new
machinery and new methods find that their total
work force is increased, even though considerable
numbers of jobs are eliminated. Of course, this
larger work force, with their automated equip
ment, produces a much larger output than previously.
In summary, a considerable amount of technological
displacement can take place within an industry or

147
in a particular firm without any direct unem
ployment resulting from the change.^5
The function of this section is not, of course, to survey the vast
literature on employment effects of automation in the many kinds of
work settings found in industry, or to categorize even the health
fields (concerning which data are, in any event, scant). The intent
here is to hypothesize as to what may happen to the numbers of ASCP-
level technologists employed in hospital laboratories following auto
mation.
Three logical possibilities exist: the numbers of technolo
gists employed will (1) increase, (2) decrease, (3) remain approxi
mately the same. In the early stages of this study, the investigator
frankly thought he might discover a profession on the brink of extinc
tion. Numerous persons exclaimed, "Why study the effects of automa
tion on the role of medical technologists? Obviously, they will not
have a role to playthe machines will perform all the tests."
All analyses in the literature, however, ruled out the possi
bility of fewer technologists, much less did they foresee the demise
of the profession. Nor did any predictions occur that the numbers of
technologists would remain constant. The weight of opinion seemed to
be that technologists will increase.
As interviewing progressed, it became increasingly obvious that
25
Ewan Clague, "The Impact of Technology Upon Manpower," Unpub
lished summary of remarks at the Sixteenth Annual Conference of the
Greater Chamber of Commerce, Philadelphia, Pennsylvania, January 10,
1963.
26
For a summary of labor's viewpoint, see Automation's Unkept
Promi se, a booklet (Publication Number 47) issued by the AFL-CIO. Wash
ington, D. C.: Industrial Union Department,- AFL-CIO, 1962.

148
very few hospital administrators, pathologists, laboratory supervi
sors, biochemists, or technologists were expecting anything less than,
at least, a moderate increment in numbers of technologists.
The investigator is of the opinion, also, that medical tech
nologists must increase their numbers markedly in the next few decades,
that only as laboratory automation develops into a total system and at
tains "maturity" will a declining demand for ASCP-level technologists
effect a stabilization in their numbers.^ The remainder of this sec
tion is devoted to a discussion of this issue and a presentation of
pertinent literature and noteworthy interviews and questionnaire re
sults.
The dynamics of the situation are best understood by consider
ing automation's "replacement effect" in conjunction with other factors.
Automation, by definition, does take over the functions of human workers,
yet the advent of automated laboratory equipment will seemingly not mean
a reduction in ASCP-level technologists. Within the next ten years, at
least, such technologists may be in greater demand than at the present
because of the following constellation of interdependent reasons:
27
In Chapter VI, the investigator presented the hypothesis that
ASCP-technologists will be needed until several decades have elapsed, at
which time lesser-trained personnel would be able to operate the improved,
more fully automated generation of equipment. Simon states, "Most auto
mation calls for increased technical skills for maintenance in the early
stages; but the farther automation proceeds, the less those who govern
the automated system need to know about the details of its mechanism.
The driver of a I960 automobile needs to know less about what is under
the hood than the driver of a 1910 automobile. The user of a I960 com
puter needs to know less about computer designs and operation than the
user of a 1950 computer. The manager of a highly automated 1985 fac
tory will need to know less about how things are actually produced,
physically, in that factory than the manager of a i960 factory." Herbert
A. Simon, The Shape of Automation for Men and Management (New York: Harper
and Row, 1965), p. 48.

149
1. Automation replaces workers in some func
tions. (Thus, technologists may no longer
perform many tasks manually, but they may
become specialists in certain seldom per
formed tests, may become laboratory admin
istrators, may become maintenance and re
pair specialists, or may become researchers.)
(See Chapter VI, Changes in Functions.)
2. Automation is not "complete." (For several
decades laboratory automation will not be
comprehensive; many steps in procedures are
not, and often cannot be automatized; vast
gaps remain in the laboratory as an auto
mated system.) (See Chapter IX.) 1
3. Automation is not "perfected." (Hence, it will
require the attentions of at least ASCP-level
personnel to be properly utilized). (See the
first section of this chapter.)
4. The population of the United States is rising.
(Automation will only help to meet the crisis
in health personnel to care for a larger popu-
1 at i on'.)
5. Socioeconomic levels are rising. (A better
educated, more affluent populace will demand
increasing medical services, including, of
course, a greater number of laboratory de
terminations per patient.)
6. Political and social changes are making pos
sible a system of government medical care pay
ments for the elderly, and, quite possibly
in the near future, for many children. (The
very old and very young are, of course, the
segments of the population that consume a
large proportion of medical services.)
7. Partially because automation has made more
laboratory determinations economically pos
sible per patient, physicians are requesting
procedures to a much greater degree. (Lab
oratory testing is coming to be used for
screening and for diagnosis, rather than just
for the confirming of diagnosis). (See next
chapter.)

150
8. Number of kinds of laboratory procedures is in
creasing, including many seldom-performed tests
not economical to automate.
9. Increasing demands are being felt for ASCP
technologists to work in research projects
and in invention of new procedures and appar
atus .
10.Manual methods must still be used when equipment
fails. (Only largest medical centers can af
ford substitute devices.)
The reasons listed above are suggested by the investigator in
support of the hypothesis that in the next few decades many more ASCP
*
technologists will be utilized.
In medical and hospital literature statements were found to
lend credence to the above reasons. Kruger remarks,
The employment problem occurs because all auto
mation does not have the same employment effects.
Some installations require more labor than others.
In a strong growth industry, a rising demand for
products may more than offset the labor-saving ef
fects of automated equipment.^8
Simon illustrates the effect of growth of demand with an example:
Now, let us suppose that a specific technological
development permits the automation of psychiatry
itself, so that one psychiatrist can do the work
formerly done by ten. It is not at all clear
whether a 90 per cent reduction in price of psy
chiatric services would increase the demand for
those services by a factor of more or less than
ten. But if the demand increased by a factor of
more than ten, the proportion of persons employed
in psychiatry would actually increase.29
Or, again,
Now we must not commit the error I warned
28
Kruger, p. 200. Italics added.
^Simon, p. 36.

151
against in discussing the doctrine of compara
tive advantage. When we foresee fewer employees
in factory and office, we mean fewer per unit of
capital equipment. It does not follow that there
will be fewer in total. To predict the occupa
tional profile that will result, we must look more
closely at the prospective rates of automation in
different occupations.30
Sturm wri tes:
The sharp growth in demand for clinical laboratory
tests that has occurred in recent years is expected
to continue and perhaps accelerate. Labor-saving
effects of automated equipment will therefore only
partially offset the expanding demand for medical
technologists.31
Lab World estimates that in the decade 1965-1975 medical laboratory per
sonnel will constitute the "...second fastest-growing occupational group
on
in the health field--following x-ray techniciansIn the same period,
the magazine estimates a 60 per cent increase over the current 100,000
will be needed.33 Lab World explains that in spite of automation the
need for more tests and more kinds of tests has prevented any lessening
of the already acute shortage of medical technologists.
Jackson laments the fact that
today in the U. S. there is a drastic shortage
of medical technologists. New hospitals,
3lbid., p. 35.
O 1
3 Herman M Sturm, "Technological Developments and Their Effects
Upon Health Manpower," Monthly Labor Review. XC (January, 1967), 3
^Lab World, VIII (August, 1967), 865.
34
Ibid. In relation to the shortage, Charles Kimball stated that
at least twice the estimated 60,000 technologists in existence in 1963
could have been employed in that year. Charles Kimball, "Changing De
mands of Science and Technology," American Journal of Medical Tech
nology XXXI (May-June, 1965), p. 209.

152
new pathology laboratories, the increased
reliance on laboratory findings in diagnosis
and therapy, and the more widespread use of
medical facilities by all segments of the pop
ulation all add up to a need for more quali
fied medical technologists.35
Although written ten years ago, Jackson's words could scarcely be more
appropriate to today's scene. The investigator can only concur with
the current belief that "despite continued expansion of automation in
the clinical laboratory, the demand for laboratory personnel is ex
pected to increase rapidly during the next ten years.
Only in a projection of time of fifteen to twenty years from
now would the investigator suggest (for reasons explained previously
in this section) that the demand for fully-registered technologists
may stabi1ize.
The responses on interviews and questionnaires were almost
entirely in support of the view that automation will not reduce the
need for medical technologists. Hence only a few striking or nega
tive responses will be presented.
A hospital administrator noted no immediate diminution in
numbers of medical technologists because of the big "backlog" in
demand; at some future time a few technologists may have to move
to new job locations, he estimated, perhaps to work in large group
practice medical offices. "Automation shouldn't be threatening to
^Lura Street Jackson, The Medical Technologist (Cambridge,
Massachusetts: Bellman Printing Company, 1958), p. 865.
3^*Lab World, p. 865 .

153
37
medical technologists," he said.
A pathologist believed that more registered technologists
,o
will be needed, since machinery needs supervision. Another pathol
ogist saw no lessening of demand for ASCP-technologists, since "we
39
ar in a deficit," A third pathologist said that "fears of unem-
ployment are probably groundless."
Only a handful of respondents felt that automation will de
crease the need for ASCP-level technologists. These persons did not
appear to be very sure of their opinions and seemed definitely to be
referring to the distant future. A biochemist thought automation
41
might require fewer, but better prepared, technologists. A techni
can stated, "1 have always been concerned about that--worned about
my jobbut they said there wouldn't be less." She did, however,
foresee that possibly fewer registered technologists in the long run
would be used to direct personnel of lesser training.^
^Interviewed May, 1967-
oO
^Interviewed June 16, 1967- Increasingly, fewer technolo
gists (proportionate to volume of procedures) may be needed, however
since servomechanisms (es
peci
ally computers)
39
1nterviewed June
13,
1967.
40
Interviewed May
18,
1967.
1nterviewed June
12,
1967-
42
Interviewed May
18,
1967.
43
Ibid.

154
In response to the questionnaire item, "Will automation in
the laboratory mean that fewer medical technologists will be needed?"
one pathologist wrote, "No at the present time--probably yes in the
future."^ Another answered "No. Automation merely keeps abreast
of increased volume of work.."^5
In light of interview and questionnaire responses and the in
vestigator's own reasonings (listed previously), the hypothesis of
fered on the issue of numbers employed is that many more ASCP-
technologists w¡11 be required in the next few decades. Only in later
stages of laboratory automation may the numbers of MT(ASCP)'s be ex
pected to stabilize.
Automation and Wages
The effects that automation may have on the wage levels of
ASCP technologists working in hospitals is, in any strict sense, a
matter for determination by economists. This investigator has made
no attempt to employ the unfamiliar research techniques of the
economist to measure such effects. Rather, he has only asked patholo
gists, hospital administrators, and technologists what in their opinion
will happen to wage levels as automation in the laboratory becomes in
creasingly a reality. The beliefs of interviewees on this issue, re
gardless of their accuracy, are in themselves of behavioral importance,
since one may well expect a relationship between such beliefs and at
titudes toward laboratory automation. Technologists could scarcely
^Questionnaire completed by an Atlanta, Georgia, pathologist.
45
Questionnaire completed by a Coral Gables, Florida, pathologist.

155
be expected to look with favor upon technological innovations that
they believe will either "put them out of business" or reduce their
incomes.
In the preceding section, the hypothesis was formulated that
there will be an increasing demand for technologists following auto
mation. This section will serve to formulate and elaborate the hy
pothesis that laboratory automation will contribute toward the ele
vation of the salaries of ASCP-level technologists. By no means, how
ever, is the claim made that automation will be the sole causal factor
in any such elevation.
There is little need unduly to belabor the well-known fact that
technological innovations (including automation) consistently work to
raise general living standards. Automation increases productivity
and "the main long-run effect of increasing productivity is to increase
real wages--a conclusion that is historically true and analytically
demonstrable." Solow points out that wage earners benefit economi
cally from automation more than do investors.^ Thus, with the excep
tion of the minority of workers displaced by automation in some in
dustries, workers tend to benefit through higher wages and salaries.
As far as medical technology is concerned, only two re
spondents suggested that automation might tend to lower salaries, and,
^Simon, p. 22.
^Robert M. Solow, "Where the Jobs Goand Where They Come
From." Think. XXXI1 I (May-June, 1967), p. 3-

156
then, only if ASCP technologists did nothing but run machines (a most
unlikely eventuality). A very few interviewees believed that automa
tion would have little or no effect. The overwhelming majority of
administrators, technologists, and pathologists thought that beyond
any doubt automation will tend to raise salaries of MT(ASCP)'s. The
reason most often cited was the need for more education and specialized
training. Some said that the existence of a relatively few technolo
gists trained in automation in a period of rapid expansion of labora
tory services will force up salaries of the few so trained. Hospitals
will be very dependent on the automated machinery that only these rela
tively few technologists will be trained to operate.
As mentioned in a previous chapter, men are discouraged from
entering laboratory employment by the low wages offered. Nevertheless,
the increasing entry of men into the field may have the effect of rais-
48
ing salaries more rapidly. It should be noted, also, that militancy
(including unionism) is generally on the rise among hospital workers,
a militancy that entry of more men into the hospital work force may
be expected to augment.^ One pathologist claimed that wages will
have to rise to keep pace with increments in wages paid in other health
, 50
professions.
ko
H And, of course, the rising salaries will attract more men,
produce a circular, spiraling effect.
^One pathologist, stated quite bluntly that only unionism will
enable technologists to command higher salaries. Interviewed June 19,
1967.
50
Interviewed June 7> 1967-

157
In conclusion, the investigator suggests that automation will
be a contributing factor in the raising of salary levels. MT(ASCP)'s
will, in all probability, assume many administrative responsibilities,
undergo more prolonged training, develop and perform more esoteric
tests, participate in research, and may develop a monopoly of automa
tion skills. These probabilities imply a necessarily higher salary
schedule.
Many other factors, also, will cause an increase in salary
for medical technologists. In addition to those already mentioned in
this section, the general price/wage increases that seem so permanent
a part of modern industrialized societies will have a direct influence
on the wage structure of all hospital workers.

CHAPTER IX
THE FUTURE OF MEDICAL TECHNOLOGY
"I do not apologize for extrapolating beyond
our present certain knowledge. In our kind
of world, those who are closest to important
new technical innovations have a responsibi
lity to provide reasoned interpretations of
these innovations and their significance.
Such interpretations should be, of course,
the beginning and not the end of public dis
cussion. But they cannot be made at all with
out extrapolation from present certainties
into future probabilities.11^
The basic thesis supporting this study is that technological
innovations are and will continue to effect changes in the professional
role of medical technologists. The invention of an impressive array of
automated devices has made a technical revolution in the clinical lab
oratory possible; demographic, economic, social, and political changes
in society are creating a massive demand for laboratory determinations
which will make inevitable the occurrence of this revolution.
Future technical configurations of hospital laboratories, not
predictable in every detail, are already clearly enough defined to
permit a general portrayal of the automated laboratory. A few such
1aboratories, indeed, already exist, and more are being pioneered each
2
year.
Herbert A. Simon, The Shape of Automation for Men and Manage
ment (New York: Harper and Row, 1965), P- vii.
2'l'he investigator is told that a completely automated clinical
158

159
t
The purpose of Chapter IX is to describe briefly the clinical
laboratory of the future. Such a descriptive effort will make more
meaningful the hypotheses and discussions presented in the preceding
chapters, which dealt with more specific role and attitude changes.
The Automated Laboratory--
Technological Configurations
Throughout this investigative effort, the fact that laboratory
automation is in its infancy has been given consideration; role and
other changes are often merely implied or are incipient, rather than
comprehensive and definitive. This section endeavors to describe cer
tain dimensions of technological change in the laboratory: (l) the ex
tent to which and the speed with which automation will occur, and (2)
the "completed" automated system.
An atomic holocaust or other overwhelming disaster could, of
course, prevent further extension of automation into the hospital lab
oratory, but short of such catastrophe, it is difficult to see what
factors will long delay a complete automatization of most areas of the
clinical laboratory. Vast political or economic upheavals would, in
all likelihood, only delay the process.^
laboratory now exists in Sweden. Interview with Dr. William F. Sunder-
man, Jr., Director of Clinical Laboratories, Shands Teaching Hospital,
the J. Hi 1 lis Miller Health Center, University of Florida, Gainesville,
May, 1967.
A completely automated hospital, financed by the Honeywell Cor
poration, is said to be under construction in St. Petersburg, Florida.
Interview with Mr. Richard S. Placzek, Assistant Director, Mound Park
Hospital, St. Petersburg, Florida, June 5, 1967.
*3
"The social structure for providing such services may, of course,

160
The reasons that automation will proceed throughout the lab
oratory have been discussed in previous chapters. Yet the main causes
bear reiteration: population increase and rising socioeconomic levels,
plus greater medical reliance on procedures have, with other factors,
combined to produce an avalanche of requests for laboratory determi
nations. Only automation has prevented the clinical laboratory from
collapsing or badly deteriorating in terms of quality production. More
over, the possibilities inherent in mass production of testing and in
the use of computers are rapidly augmenting the demand for tests.
The investigator believes that within fifteen to twenty years
from 80 to 90 per cent of all laboratory determinations will be per
il
formed by automated equipment. In 1965, from 25 to 50 per cent of
laboratory work in medium and large hospitals had already been turned
over to automatic equipment, and the figure was expected to rise to
75 per cent by 1975 -^ Technological inventions to effect this
be controversial; it is seemingly becoming more so in the clinical
laboratory. Nevertheless, technical innovations are not likely to be
very controversial in themselves.
^his is not to imply that 80 or 90 per cent of all ki rids of
tests will necessarily be performed automatically. It is probably
quite true that much of the work in bacteriology and other areas may
never be automated (or automated to a high degree). The point is, how
ever, that only about two dozen routine tests account for 75 or more
per cent of all work done in most hospitals. Most, or all, of these
tests can and have been automated. Sturm writes, "Most of the work
in a typical hospital laboratory consists of repeated performance of
a small number of routine tests, many of which can now be done on a
few automated devices. Analyses for glucose and urea nitrogen account
for between 25 and 35 per cent of all tests in the typical laboratory;
10 types of tests can account for 70 to 80 per cent of the entire
workload," Herman M. Sturm, "Technological Developments and Their Ef
fects Upon Health Manpower," Monthly Labor Review, XC (January, 1967),3-
5Lab World. VII! (August, 1967), 865.

161
transformation already exist, and both improvements and new inven
tions may surely be expected.
Obstacles that will retard automation are, of course, not to
be ignored. Low testing volume in some hospitals will make expensive
types of automated devices uneconomical, but laboratory testing in
the future may be handled by large regional centers serving many hos
pitals. Hence even tests "seldom performed" in one hospital alone may
be economically automated in such centers. Overnight mail service will
mean that concentration of testing in large centers will be even more
feasible.
Costs of equipment and of maintenance are currently quite
high, but greater sales volume and mass production may in the near fu
ture be expected to result in a rapid reduction of costs.
There is no need for, nor is there any evidence with which to
depict, in more than general terms, a time schedule for the penetra
tion of automation into the clinical laboratory. Many variables will
help determine such a schedule. But, as Magraw has remarked, "...auto
mation has progressed so rapidly since World War II that even the most
optimistic guesses of the time required to reach certain goals have
been grossly in error.
Much more precise in their contours are the technological
configurations emerging in the clinical laboratory. A recognizable
^Richard M. Magraw, Ferment in Medicine: A Study of the Es
sence of Medical Practice and of Its New Dilemmas (Philadelphia: W.
B. Saunders Company, 1966), p. 214.

162
system, particularly in the chemistry areas, is already in evidence,
and several descriptions are available in the literature.
Laboratory automation is, to be sure, not yet complete. Kinney
and Mel vi 11 state,
Completely automated systems do not exist if
a completely automated system is conceived of as
one which starts with a blood sample drawn from
the patient and proceeds to the automatic print
ing or recording of results identified with that
patient. The major gaps are the lack of an auto
matic or even a semiautomatic centrifugation sys
tem which retains sample identity and the absence
of an automatic method for separating serum and
distributing the sample into an analytic system.
Nevertheless, in laboratories with large testing volume, automated sys-
o
terns have developed that are virtually total.
Lindberg et. a_j_. report on developments at the University of
Missouri Medical Center:
The feasibility and medical worth of automatic
multichannel chemical testing of blood specimens
has been established both in hospitals and in am
bulatory populations. There is as yet no general
agreement on any combination of determinations as
being superior to any other, or as being univer
sally appropriate. Quite to the contrary, it seems .
entirely likely that the "batteries" will continue
to change. Furthermore, it seems entirely possi
ble that one might wish to vary the tests which
^Thomas D. Kinney and Robert S. Melvill, Automation in Clinical
Laboratories: The Present State and Future Uses of Automation. Proceed
ings of a Workshop Conference, 1967, p. 803.
8
Volume is a definite economic prerequisite for some types of au
tomated systems in laboratories. S. L. Ettman, "Advances in Clinical
Chemistry Instrumentation," The American Journal of Medical Technology,
XXI (September-October, 1963), 377. Even so, many large-volume labora
tories are without extensive automation; computers are still somewhat
rare.

163
were included in a multitest battery depend
ing upon the geographic, ethnic and environmental
factors which establish specific disease risk
at any particular test center.
The ultimate shape that multitesting will take,
then, is unclear. Certain features, however, al
ready are obvious. It is economically possible
to deliver a number of test results for very little
more cost than was formerly involved in producing
the result of a single determination. This statement
is realistic only if one assumes the existence of
some sort of electronic data-processing equipment
programmed to accept and distribute the multiple
results. Second, it has been demonstrated that
gratuitous testing does yield surprising and use
ful results, even when it is carried out in par
allel with care by highly competent physicians
utilizing more traditional approaches. In other
words, if a number of gratuitous test results are
abnormal, these may be judged by the patient's
physician to be significant and perhaps even alter
his diagnosis.
The actual chemical testing is done without ex
penditure of much professional time. Consequently,
those in the health care professions who seek methods
to broaden the distribution of health care have un
derstandably been eager to apply screening studies
more widely. Medicine being for the most part now
adays hospital-based, the hospital administrator
is thus faced with decisions concerning selection
of expensive and complex items of chemical analytical
hardware and must in addition recognize that this new
endeavor will inevitably put pressure on existing
systems which use manual processing of laboratory re
ports and bring on the specter of expensive data-
processing requirements. Without doubt, these de
velopments appear inexorable. It is only unfor
tunate that the field has moved so quickly that
proper validation of test batteries has not yet
been completed and that even chemical methodologies
have not been standardized.
The approach to multichannel testing at Missouri
has evolved through the need to remain responsive
to changing chemical methodologies and also the
likelihood that our test battery would change its
make-up. Two additional considerations shaped
our system: the existence of computer processing
capability within the institution, and consider
able reservation concerning the accuracy and

164
precision of simpler solutions.
Our equipment configuration consists of 16
individual Auto-Analyzer channels. These are
divided between three or four specimen turn
tables... .
Operation of each of the groups of determi
nations can proceed at its optimum speed. Re
sults of the various parts of the battery are
collated by the computer system after all have
been completed.
The intensity of the color developed by the
chemical reactions in the Auto-Analyzer is pre
sented as a series of continuous curves drawn
on chart paper. Each curve corresponds to a
determination of a single chemical constituent
for a particular patient.9
The authors make some interesting remarks concerning the value
of their system:
It is too soon to draw conclusions yet concern
ing the ability of this technic to detect occult
but curable diseases. It is, however, already
apparent that our former concepts of the "range
of normal" with respect to many determinations
is woefully approximate and must be re-derived
from large population samples (and generally
broadened). We are also confirming the obser
vations of others that routine determinations
of some chemical constituents will yield re
sults clearly out of the ordinary range, even
beyond the limits one can accept as normal,
and that these findings may occur in totally
asymptomatic individuals.
Serum uric acid and blood glucose are ex
amples of such determinations. Other investi
gators have raised the question: Is one now
going to deal more often with the concept of
"pre-diabetes" and "pre-gout" or indeed will
wholly unnamed diseases or conditions be dis
covered by multi test screening?
An extension of this concept is the like
lihood that disease or dysfunction may be de
tected by taking into account patterns or com
binations of test results. There is evidence
that computers can recognize patterns or com
binations of results as significant, even though
the constituent results might not be significant
Testing,
^D. A. B. Lindberg, et al.,
" The Modern Hospital, CVII I
"Computer Sets Stage for Multi-
(April, 1967), 128-129.

165
if considered individually. There is another as
pect of the issue of computer inspection of multi
ple laboratory measurements. Others have noted in
dealing with computer interpretation of electro
cardiographic measurements and other diagnostic
processes that there is considerable redundancy in
traditional measurements. This suggests that it
may be possible to eliminate some of the measure
ments or laboratory determinations which now seem
necessary. We are not yet able to confirm or con
test this conjecture.
A hopeful aspect of multitest screening is the
likelihood that the establishment of baseline values
for an individual will make subsequent deviations
from the baseline during disease more easily de
tectable.
One investigator has stressed that the concen
tration of blood constituents varies less within
time for a single person than within a population
at any moment in time. We have already convinced
ourselves that this is true with respect to serum
g1utamic-oxalacetic transaminase. This fact can
be useful in early recognition of myocardial in
fraction, provided that the previous baseline data
can be retrieved by a manual or computer system.
Developments in this area will ovvemuch to the con
cepts of "biochemical individuality" and of the
'fchemical fingerprint."
Hospitals should accept the responsibility for
becoming testing regions, not merely for those pa
tients within their walls. In order to do this,
systems must be selected which allow the test bat
teries to be altered based on cost-effectiveness
studies of the test results. It seems unlikely that
maximum value can be derived from mu 11i-testing un
less that data is processed and disseminated and,
I 0
made retrievable by electronic computer systems.
In 1966 the Youngstown Hospital Association performed 100,000
automated tests (twenty different procedures). The Association averaged
40,000 tests per laboratory worker (having employed an average of two
and one-half personnel per day) with automation, as opposed to annual
10
Ibid., p. 130.

166
average of unautomated work of 5,000 tests per laboratory worker.'^
One main reason for the Youngstown success is the use of computers
to form an automated system for the laboratory:
Technology in general and the computer in par
ticular are helping lift a tremendous burden
off the shoulders of clinical pathologists.
By creating unique instruments and systems they
are giving promise of bringing both a stagger
ing work load and the paper work associated with
it under control. The amount of work, growing
over the past decade, has been expanded into
enormous dimensions by five major considerations.
1. The recognition that the important scien
tific advances made in laboratory medicine repre
sent valuable adjuncts to the diagnosis and treat
ment of disease. As a result, there is increasing
reliance upon and an enhanced demand for large num
bers of laboratory tests which are becoming in
creasingly complex and difficult to perform.
2. An insufficient number of adequately trained
or experienced personnel able to perform these pro
cedures accurately, precisely, swiftly and economi
cal ly.
3. The use of relatively archaic methods of
clinical laboratory management, the retention of
obsolete technical procedures, and the existence of
small, cramped hospital laboratories.
4. The scanty budgets and unattractive salaries
for professional and technological staffs which re
strict entry into this field of people with talent
and strong motivation.
5. Increasing public and professional concern
with unsatisfactory levels of laboratory accuracy.
Although automation has been the answer to many of the foregoing prob
lems, it has understandably created some problems of its own. The
Youngstown pathologists made the following comments concerning such
problems:
Arthur E.Rappoport,Wi11iam D. Gennaro, and William J. Con
standse, "Cybernetics Enters the Hospital Laboratory," The Modern
Hosp? tal, CV (April, 1967), 111.
12J_bi_d., pp. 107-108.

167
In recent years, the introduction of auto
mated and semi automated testing devices which
can perform repetitive tasks mechanically has
presented the first evidence that industrial
technics can be adapted to the medical labora
tory with substantial advantage. But this has
not been an entirely unmixed blessing.
While these instruments can produce more test
results, in less time, more cheaply, using less
manpower of lesser technical training and operat
ing in smaller spaces, the number of measurements
has risen so precipitously that it threatens to
inundate clinical pathologists and physicians.
Procurement of large numbers of specimens and the
clerical procedures necessary to prepare them for
testing by automation pose significant problems
in maintaining proper identification of the speci
men, of the patient, and of the test desired.
The accuracy of calculations and the correctness
of the final test results are put in question be
cause of the enormous amount of necessary clerical
effort which still is carried out slowly and in
efficiently. As a consequence, an imbalance in
laboratory operations has developed, the automa
tion of instrumentation not being matched by a
similar increase in automation of information
handling. This imbalance threatens to cancel
or diminish the advantages accruing from the
technological advances in instrumentation.
The resolution of these problems, therefore,
requires additional technical support, precedent
for which already has been established in in
dustry and research, namely, the introduction
into the clinical laboratory of data processing
and of the computer.
Early steps in this evolution consisted of
manually keypunching all demologic patient data,
types of tests, and test results and preparing
reports using accounting machines. These pioneer
ing attempts finally culminated in the creation of
a cybernetic laboratory in which all automatic and
semiautomatic test instruments could be coupled
to automatic data acquisition systems for computer
processing of test results and quality control data.
Through such a link, all steps of the test path from
patient specimen and test identification through
test performance to entering a test result in the
patient's medical record can be monitored, controlled,
and performed by a computer.'3
13
I bid.. p. 108.

168
When automation of communications is wedded to automated
laboratory testing devices, an automated system which has distinct
advantages is created. After only eight months of operation, the
following features and benefits were noted by the Youngstown labora
tory:
1. It maintains and safeguards the identity of
the specimen from phlebotomy to preparation
of the "patient summary report" for the medi
cal record.
2. It reduces the large number of manual proce
dures and handling necessary to prepare the
specimen for automated testing--such as writ
ing name and number on test tube, running clots,
pouring plasma into another vessel--and elimi
nates cumbersome, time-consuming, repetitive
writing of specimen number or name on tubes
in laboratory accession logs and work sheets.
3. It permits the random insertion of the specimen
into an automatic turntable transport for
determinations.
4. It permits repeat tests and dilution of specimens
too high to read.
5. It links within the computer the identity of the
patient and the specimen to the test to be per
formed and prepares the final results.
6. It offers enhanced accuracy, precision and quality
control of actual test performance. The computer
automatically corrects for instrument drift and
specimen interaction.
7. It prepares an appropriate interim ward report
during the day which reduces inquiries to the
laboratory by physicians and ward personnel.
8. It prepares a daily updated "patient summary re
port" on a single sheet which permits chronological
review of all test results for an entire week.
9. The clustering of clinically relevant procedures

169
and results in an appropriate medical fash
ion permits more rapid and critical evalua
tion by the physician of all the test results,
thus eliminating the possibility of his miss
ing, disregarding or not noticing vital test
results. These are hazards which occur when
laboratory results are attached in the con
ventional, shingled method. The printed, at
tractive format saves the doctor time and ef
fort as he notes the results of all the tests
and evaluates their significance. No longer
can differences in place, technologist section
of laboratory or time of test performance lead
to chaotic, irrelevant, and nonchronological
entry into the clinical record.
10. It is often claimed that automated or computer
ized technics only transfer to other personnel
many of the acts which they claim to eliminate.
The 1080 DAS [Data Acquisition System] does
not shift to ward personnel clerical duties
which formerly may have been performed by labora
tory personnel. On the contrary, use of the tab
ulation card requisition by ward personnel has
materially simplified test ordering because of
the reduction in the variety and number of forms
and the ability to order groups of multiple tests
by a single stroke rather than having to identify
each separate procedure. Transferring the doc
tor's orders from the "laboratory order form" to
the preprinted requisition speeds up the order
ing process and reduces the possibility of er
ror.
11. The rental of the system is equivalent to the
cost of one medical technologist. This ex
penditure can be justified by the increased
productivity of the laboratory that results from
the installation of the system.
12. The receipt of an 8 1/2 by 11 inch single pa
tient report form replaces the conventional
method of receiving large numbers of individual
small report forms which are attached singly and
manually into the chart. The single sheet is
placed into the chart while that of the previous
day is removed and discarded. The alternating
use of color coded report forms each week auto
matically apprises the ward nurse of the start of

170
a new week's sequence and warns her not
to dispose of the last patient summary re
port. This system materially reduces the
time and labor in filing patient laboratory
reports.
13. The single patient report benefits not only
the ward but also the laboratory, the record
office, and business office. Instead of the
usual methods of filing large quantities of
duplicate copies either by patient or by types
of tests, alphabetically and according to day,
the laboratory receives a copy similar to that
which is prepared for the medical record. This
is filed by patient for the appropriate period
of retention and the previous report re
placed. There is an additional savings in time
required to retrieve the report and respond to
an inquiry. For the record office, microfilming
of reports is simplified, faster and cheaper.
The chart's bulk is reduced and a machine printed
record is readily inventoried for all the tests
which were performed.^
Effects of Laboratory Technology on Medical Care
The above examples of automated laboratory systems place in
relief the differences to be seen between them and most current "auto
mated" laboratories where only bits and pieces of a total system have
been automatized. In particular, the potential of laboratory automa
tion cannot be reached as long as automation of communications remains
undeveloped. Without computers, the "ultimate in laboratory devices,"*-
automation creates terrific clerical jamming and scheduling problems.
Without computers, too, potentials for screening and multiple-correlation
diagnosis cannot be realized:
14
Ibid., p. 111.
^John T. Foster, "How to Analyze Laboratory Efficiency," Modern
Hospital, CVII (July, 1966), 108.

171
Programs for utilizing available new techniques
for disease detection in systems for diagnostic
screening of the whole population can be put
into effect throughout the Nation within a few
years if sufficient funds and manpower are made
available. These plans provide for mass physi
cal examinations in which a battery of at least
twenty laboratory health tests is performed in
a period of two hours, by automated techniques,
as a preliminary to physical examination and
health counseling by a physician.1^
Magraw holds the view that the effects of laboratory automa
tion on medical practice are only beginning to be felt. Mass screen
ing by means of blood tests, for example,
...would necessarily mean that the doctor would
see and treat a proportionately greater number
of his patients in the presymptomatic or asympto
matic stage of disease. The doctor's function
would then become more a matter of preventing,
i.e., of "preventive maintenance."^
He also observes,
These automated test procedures also promise
to have an important influence in medical care.
At first glance they too appear to support un
changed the physician's present function. A
closer look, however, suggests that such economi
cal mass laboratory tests may well be one of the
first agents to move medical practice itself to
ward automation. By joining the autoanalyzer and
the computer (putting them "on line" in the lan
guage of automation) it is even now possible to
perform routinely a battery of ten or more chemi
cal screening tests on human blood at the cost
of doing two or three such examinations in the
usual manner. Studies have shown a distinct im
provement in medical diagnosis resulting from
the use of such a battery of screening tests.^
16
17
Sturm, pp. 1-2.
Magraw, p. 215.
,8|bid.

172
Kinney and Melvill speak in similar terms:
In the past a limited number of tests have been
requested on the hospitalized patient to confirm
or deny a diagnosis. More recently various types
of screening procedures to detect the presympto-
matic stage of disease are being used inside and
outside the hospital. These have ranged from simple
tests such as the uriredypstik for sugar to complex
testing for multiple chemical components of the
blood. In the future there may well be a combina
tion of these two approaches since there will no
longer be a need for a distinction to be made be
tween screening tests and conventional hospital
tests.19
W. H. Kerns has published an excellent article that centers on
the pioneering efforts of pathologist Albert E. Casey at the Birming
ham (Alabama) Baptist Hospitals. Patterns developing in Dr. Casey's
laboratories have obvious implications for the future of health care.
Kern's remarks and his quotation of Casey's statements are well worth
surveying at length:
As distinctively different as fingerprints are
each person's anthropometric measurements, includ
ing blood cells and body chemistry. Properly cor
related by a well-trained pathologist, measurements
of each will not only reveal ancestry but the pres
ence of disease or the obstruction of organs of the
body in many cases before either the patient or his
physician could possibly observe physical symptoms.
It's being done, and as new and more efficient clini
cal laboratory equipment is developed, the practice
of medicine will be dramatically affected.
In the clinical laboratories of the Birmingham
(Ala.) Baptist Hospital, a genial, balding, 63-year
old pathologist whose genius and productivity are
impressive is quickly and surely shaping the fu
ture of medical practicein and out of the hospital.
His methods of producing pattern studies, or "pro
files," correlating the results of individual tests
'^Kinney and Melvill, p. 803

173
and transmitting them to physicians, promises
to upgrade the work of the general practitioner,
complement the broad domain of the internist and
surgeon, strengthen a myriad of subspecialties
in medicine and surgery, and provide the first
broad scientific base for preventive medicine.^
Kerns remarks the savings in cost as well as the improvement in diag
nosis that Dr. Casey's system has effected. Although twenty-six of
the twenty-eight tests in the profile are now automated, Casey be-
2
1ieves that in a few years a profile of sixty tests will be common.
His views of changes coming in medical practice because of laboratory
automation are exciting:
In the near future, the combined metabolic-
hematology-cli ni cal-anthropometric profile
will be even more important. Broad implemen
tation of this profile for large segments of
the population is our goal. This will be pre
ventive medicine in its truest sense. It will
be a significant contribution to health care,
since prevention or early detection of chronic
metabolic disease will always be more success
ful than treatment of the disease at advanced
stages.
The general practitioner won't be referring
patients simply to an internist in the future.
A profile study will give him better informa
tion for referral purposes, and he may then
choose a specialist in diabetes, blood or liver
disease, or other subspecialty depending on the
results of the pattern study. Most important is
the fact that in many cases disease or organ mal
functions will be detected by clinical laboratory
tests long before the symptoms are evident to
either the patient or his physician, and treat
ment can be initiated earlier.
Hospital laboratories are going to undergo
tremendous changes. Small hospitals simply will
?0
W. H. Kerns, "'Casey's Profiles' Expand Diagnostic Role,"
The Modern Hospital, CVlIi (April, 1967), 122.
211bid.. p. 126.

174
be unable to afford the sophisticated laboratory
equipment which will be available. All the larger
hospitals will have to have it. With the communi
cations devices and technics we now have, it will
be a simple matter to tie the laboratories of
smaller hospitals to those of larger metropolitan
hospitals for the transmission of profile or pat
tern study results.
The smaller hospitals will certainly continue
to have a technologist on call for emergency rou
tine tests, such as a white count for a suspected
appendix. But the vast majority of the smaller hos
pitals' tests will be conducted in the laboratories
of major centers, or they will pool their resources
to establish such centers, because physicians will
be demanding this kind of information on all pa
tients, and the only economical method of obtain
ing it wi11 be by sending specimens to these cen- '
ters.
Laboratory design will change dramatically.
Standard laboratory casework, benches, sinks, Bunson
burners and the 1 ike wi11 be as outmoded as the Model
T. Ford. In their place will be banks of automatic
testing equipment operated by a medical technologist
who is not only trained to understand and perform the
various tests but also to make the equipment perform
as it is designed to do. We've made the progress we
have because we've tackled this whole process aggres
sively. Just because a test is now a bench test
doesn't mean it can't be automated or mechanized in
some form. We have developed methods for automating
many of them already, and we're working all the time
on others to find ways to do the same thing automatic
ally or mechanically.
Twenty years ago our present routine admission pro
file would have cost the patient about $180, if he
could get it. Many of the tests were done in the
laboratories, but usually in a series of two or three
at a time, to save money. In the meantime, the patient
was waiting in the hospital for the doctor to find
something significant in one of them. We do an ad
mission profile now for $20. That's a cost reduction
to the patient of nearly 90 per cent in laboratory
charges alone, not to mention the reduced length of
hospital stay, speed of diagnosis and treatment, or
any other factors.^
22
I bid.. p. 127.

175
A recent national conference summarized its views on labora
tory automation in the following manner:
Sophistication of test procedures, demand for
services, and automation of routine repetitive
laboratory tasks are mutually reinforcing. With
current demand patterns, some two dozen proce
dures account for 80 per cent to 90 per cent of
the workload in most laboratories. They are
amenable to automation, which in turn vastly
increases laboratory capacity and productivity
and lowers unit cost. Automation of laboratory
procedures can greatly enhance quality and qual
ity control; it can enlarge the service area from
locality to metropolis, region or state; it can
reduce patient costs to a range of one-fifth to
one-tenth of those for conventional procedures,
depending on volume. Current experience indi
cates that laboratory volume is expanding at the
rate of 15 per cent per year, roughly a five-year
doubling time. The economies of scale made pos
sible by automation provide a powerful incentive
toward centralization of laboratory facilities
for the bulk of patient tests, and radical de
partures from traditional laboratory practice
and staffing. As in many other fields, automa
tion will place a rising premium on the highest
laboratory skills, and may render many of the
lesser ones redundant.
Potentially, the entry of large venture into
the medical laboratory, increasingly through con
glomerate corporations otherwise unrelated to health
care, may be the most significant present trend from
the point of view of the laboratory-related pro
fessions. Such corporations are likely to have a
strong competitive position. Lacking effective
new initiatives by the professions, the field man may
become dominated within a decade or so by highly
centralized, automated laboratories operated as
industrial subsidiaries.
In a new form, this is merely an extension of
a trend toward private control of laboratories,
though until now control has been exercised chiefly
by pathologists and hospitals. Automation en
courages this trend by reducing unit costs on high
volume and enhancing the profit potential of large
investments. A contributing factor has been the

176
need of hospitals to help underwrite rising
deficits on patient care by imposing high,
non-competitive laboratory charges, thus rais
ing the ceiling below which others might prof
itably compete. In this situation many of the
traditional private laboratories organized and
controlled by pathologists have successfully
contracted in recent years to provide all de
terminations for many small hospitals in their
areas.
The newer type of entrepreneurial laboratory,
however, poses a much more fundamental question:
To what extent is laboratory medicine to be sub
ject to professional control and motivated by
professional requirements? Also to what extent
are pathologists and medical technologists to
become salaried employees of corporate subsid-
i ari es? ^
Possible changes in control and financing of the clinical laboratory
are not within the scope of this dissertation. Should laboratories
become, however, the province of corporate enterprise, medical tech
nologists are still likely to experience the same changes in func
tions and role attributes already predicted earlier in this study.
Implicit throughot this study is the investigator's be
lief that automation, in concert with other factors, will push the
ASCP-level technologists into a more independent, professional role
than they have ever before known. Such a new status will not have
24
been won with ease. The day of the hand-maiden may be over, but
23
National Committee for Careers in Medical Technology and the
U. S. Department of Health, Education, and Welfare, Public Health Ser
vice, National Center for Chronic Diseases Control, Manpower for the
Medical Laboratory: Resource Book. Produced for a National Conference
on Education and Career Development (held at the University of Maryland
Center of Adult Education, College Park, Maryland, October 11-13 1967-)
o Ll #
c As claimed by technologists Ruth Hovde, "The Dynamics of Edu
cation in Medical Technology," The American Journal of Medical Technology,
XXIX (March-Apri 1, 1963), 63.

177
some years of further education and struggle will be necessary be
fore medical technologists attain the semi-autonomous position of
25
nurses. p
^The calls for professionalism on the part of technologists
and the apparent determination on the part of many pathologists to
maintain their control over the clinical laboratory seemingly consti
tute a largely hidden power struggle. Another such struggle seems to
be occurring between pathologists and other laboratory scientists.
The investigator does not wish to express partiality in this issue
(although he confesses to personal bias as to how and by whom clinical
laboratories should be operated).
Interested readers may wish to consult the following articles:
Ruth Hovde, "The Dynamics of Education in Medical Technology," The
American Journal of Medical Technology, XXIX (March-Apri1, 1963), 61-75;
George J. Carroll, The Clinical Laboratory: A Challenge for the Future,
Southern Medical Journal, LVi 1 I (January, 1965), 90-95; Leonor Haley,
"Status or Status Quo," The American Journal of Medical Technology,
XXXII (January-February,1966), 28-32.

SUMMARY
The spread of automation is a major trend of our era, and the
setting of the contemporary hospital is no exception. Automation in
the hospital, by definition, must affect the professional roles of
health workers, but these effects have not as yet been analyzed socio
logically to any appreciable degree. In an effort to provide insights
into effects of laboratory automation on the role of MT(ASCP)1s--tech-
nologists registered by the American Society of Clinical Pathologists--,
an exploratory survey was conducted on a purposive (highly selected)
sample of Florida pathologists, line medical technologists, chief med
ical technologists, and hospital administrators. Utilizing a semi-
structured interview schedule, the investigator sought to develop hy
potheses concerning the effects of automation on the MT(ASCP) level
of clinical laboratory workers. The hypotheses emerging from this ex
ploratory investigation should provide for future researchers a se
ries of questions and an implicit interpretative framework now quite
1acking.
Analysis of interview materials and literature on the subject
suggested interesting role changes. in the formulation of most hy
potheses, time, correlated with degree and perfection of automated
laboratory equipment, was thought to be an intervening variable.
Although differences of opinions were found to exist among
incumbents of the focal position (medical technologists) and among
178

179
incumbents of the counter positions (pathologists and hospital ad
ministrators), on most topics enough consensus was present to warrant
interpretation.
One hypothesis developed is that automation will, indirectly,
change the role attribute of sex--that men will begin to enter the pro
fession more rapidly. In particular, it is believed that more men will
become MT(ASCP)'s as salaries and administrative opportunities increase.
A second major hypothesis is that the status of the profession of med
ical technology is likely to be raised, especially as knowledge, of the
dramatic new accomplishments of automation spreads through hospitals
and among the general public.
Hypotheses also were formulated that, in a period of fifteen to
twenty years, most MT(ASCP)'s will (1) become more specialized, (2)
come to function more as administrators than they now do, and (3) serve
as "first-line" repairmen. Their becoming administrators--coordinators
of men and machinery in the performing of laboratory determinations--
wi11 constitute a major shift in their role function, not unlike that
which has occurred in the role of the registered nurse.
It is also hypothesized that interactions between pathologists
and technologists will occur more frequently in the early period of au
tomation, but that a much greater independence from pathologists on the
part of technologists will develop as automation progresses. In addi
tion, the heightened reliability, accuracy, and speed of automated
equipment may lead to a "better relationship" between pathologists
and technologists. Automation, directly and indirectly, may contribute

180
toward greater professionalism of medical technologists. Quite ten
tatively, the hypothesis was advanced that automation will not increase
the bureaucratic aspects of laboratories.
Although a few (usually older) technologists seemed either to
dislike automation or to feel ambivalent concerning it, the majority
of technologists interviewed reacted favorably. Aside from such so
ciological or sociopsychological topics, hypotheses are offered that
automation will improve laboratory accuracy, will not lessen the cur
rent demand for technologists, and will tend to raise salaries in the
profession.

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Jeffus, Benny H., Chief Technologist, Baptist Hospital of Miami,
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Johnson, Lois B., Administrator, Suwannee County General Hospital,
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Evans, Luther H. and Arnstein, George E. (eds.). Automation and the
Challenge to Education. V/ashington, D. C., National Education As
sociation, 1962. Proceeding of a symposium held in V/ashington,
D. C., January, 1962.

191
Kinney, Thomas D. and Me1vi 11, Robert S. Automation in Clinical
Laboratories: The Present State and Future Uses of Automation.
Proceedings of a Workshop Conference, 1967- Meeting place un-
spec i f i ed.
Leonard, J. B., pathologist, Morton Plant Hospital, C1earwater, Florida,
Questionnaire returned to investigator, July, 1967-
National Committee for Careers in Medical Technology, Inc. Medical
Technologist-Pathologist: A Newsletter Relating to the Profession
of Medical Technology. Issue No. 36. Washington, D. C.: The Committee,
April, 1967.
Roth, Helga, Chief, Social Sciences and Community Programs Branch, Smith
sonian Institution, Science Information Exchange, Washington, D. C.
Letter to investigator, dated March 22, 1967-
Seckinger, Daniel, pathologist, Cedars of Lebanon Hospital, Miami,
Florida. Questionnaire returned to investigator, July, 1967.
Teloh, Henry A., pathologist, Veterans Administration Hospital, Coral
Gables, Florida. Questionnaire returned to investigator, July, 1967-
Vincinzi, R. B., pathologist, Piedmont Hospital, Atlanta, Georgia.
Questionnaire returned to investigator, July, 1967-
Weinbert, Edgar. "The Effects of Technology and Automation on Employ
ment of the Handicapped." Paper presented before the Mountain States
Regional Meeting of the President's Committee on Employment of the
Handicapped, Pueblo, Colorado, June 29, 1962.
Williams, George Z., pathologist, Clinical Center, National Institutes
of Health, Bethesda, Maryland. Questionnaire returned to investi
gator, July, 1967.

APPENDIX
TABLE 4
SUMMARY OF TRANSCRIBED INTERVIEW AND QUESTIONNAIRE
RESPONSES ON SELECTED TOPICS*
QUESTIONS
RESPONSES
YES
NO
COND
1T10 NAL
Will automation attract men into
medical technology?
24
5
1
Will automation increase the status
of (MT(ASCP)'s?
16
15
4
Will automation increase specializa
tion amonq MT(ASCP)'s?
15
5
1
Will automation increase the ad
ministrative function of MT(ASCP)'s?
15
6
1
Will MT(ASCP)'s function as mainte
nance and repair specialists in au
tomated laboratories?
18
4
1
Will laboratory automation act to de
velop independence and professionalism
amonq MT(ASCP)'s?
13
12
1
Will automation contribute to the
bureaucratization of the clinical
1aboratory?
0
10
0
Does laboratory automation cause adverse 3
psychological effects?
16
2
Do MT(ASCP)'s experience a sense of
"loss of control" over their work
with automated equipment?
3
17
0
Do MT(ASCP)'s retain a sense of per
sonal accomplishment in their work when
using automated equipment?
17
6
0
192

193
TABLE ^--Continued
QUESTIONS RESPONSES
YES
NO
CONDITIONAL
Will automation decrease the absolute
numbers of MT(ASCP)'s?
3
26
1
Will automation tend to raise the wage
level of MT(ASCP)1s?
13
8
1
Will automation better working condi
tions (physical) of the clinical labor
atory?
10
10
1
Including significant responses on interview pre-test and
regular-run schedu1es. "Don't know," and unclear responses not in
cluded.

BIOGRAPHICAL SKETCH
Myron Philip Hamer was born December 29, 1935, at Tampa., Flor
ida, where in June of 1954 he was graduated from H. B. Plant High School
In August of 1958, he received the degree of Bachelor of Arts cum 1aude
from the University of Tampa, and pursued additional work at the Univer
sity of Houston, the University of South Florida, and Mexico City Col
lege. From 1980 to 1962 he taught in secondary schools in Tampa, as wel
as in the evening division of the University of Tampa.
During most of 1962 and 1963 he worked as a graduate and teach
ing assistant in the Department of Foreign Languages of the University
of Florida and received the Master of Arts in Teaching degree (Spanish)
in August of 1963- Since January of 1964 Myron Philip Harner has been
enrolled in the Department of Sociology, University of Florida, com
pleting work leading to the degree of Doctor of Philosophy. From
August of 1964 through August of 1966 he served as graduate assistant
to the Dean of the College of Health Related Professions, University
of Florida; from September of 1966 until October of 1967 he worked as
Assistant in Administration to the Dean of the same College. On De
cember 1, 1967, he became Director of Health Occupations Education
at Santa Fe Junior College in Gainesville, Florida.
Myron Philip Hamer is a member of the Southern Sociological
Association, the American Sociological Association, the Association of
Schools of Allied Health Professions, Alpha Kappa Delta, and Tau Kappa
EpsiIon.
194

This dissertation was prepared under the direction of the
chairman of the candidate's supervisory committee and has been ap
proved by a 11 members of that committee. It was submitted to the
Dean of the College of Arts and Sciences and to the Graduate Coun
cil, and was approved as partial fulfillment of the requirements
for the degree of Doctor of Philosophy.
March, 1968
Dean, Col leg
Dean, Graduate School
Supervisory Committee:



33
...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
posit ions.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/
'2(
patient interaction.
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:
Ibid. p. 51 .
2.G
Relationships 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
(phlebotomists) 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.


71
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,^'
the critical and apparently eternal shortage of technologists, and ris
ing labor costs-^ all contribute to the rush toward automation. Even
many small hospitals (where volume might be presumed to be too small)
C 9
have installed autoanalyzers. J 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. By 1965 somewhere between 25 and 50 per cent
of laboratory workloads were performed by automatic instruments; possibly
49
^Herman M. Sturm, "Technological Developments and Their Effects
Upon Health Manpower," Monthly Labor Review XC (January, 1967) 3-
5Diebold, p. I67.
^Said to be a 15 per cent or greater per annum increase in
many laboratories. Seligson, p. 424, and interview with Miale.
5^Pyke, 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
Mi ale.
-^Seligson, p. 423.
54
Sturm, p. 3.


\h\
Since complete automation is a number of years, perhaps several
decades away, a systematic program of quality control is essential.
Quality control is neither cheap nor easy, but without it predictions
of more volume, heightened accuracy, and reduced costs through automa
tion are meaningless.'' Without accuracy, automated equipment can only
v.
be deemed a threat to patient care. If properly maintained and operated,
however, automated instruments give distinct promise of economic and
scientific benefits.
Safety and Working Conditions
Prompted by mention in the literature of improved safety and
other working conditions in automated factories, the investigator thought
it worthwhile to inquire into changes in safety and in general "pleasant
ness" of physical surroundings following laboratory automation. That
automation usually improves working conditions in factories is well known.
Steel workers are no longer directly involved with moving incandescent
ingots; chemical plant employees are separated from direct contact with
acids. In general, there are ..."greatly improved working conditions,
1 2
including greater safety and easier housekeeping."
''There apparently is a tendency for many hospitals to buy ma
chines and simply turn them on under the direction of technician-level
personnel. That such proceedings are fallacious has now been given
national recognition. Proper automation requires more highly skilled
people and coordinated teamwork. See Thomas D. Kinney and Robert S.
Mel vi 11,. Automation in Clinical Laboratories: The Present State and
Future Uses of Automation. Proceedings of a Workshop Conference, 1967-
1 2
George B. Baldwin and George P. Schultz, "A New Dimension to
Old Problems," Monthly Labor Review, LXXVII I (February, 1955). P* 165-


30
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-
18
istence or assumption of inconsistent prescriptions (or standards).
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.
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
18
Ibid., definitions selected and quoted from Table 3, PP-
10-12.
19
JNo 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 ('lew Haven, Connecticut: Col
lege and University Press, 1966).


62
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.'9
In fact,automation has even been defined as the Second Industrial Revo-
*
, - 20
1ution.
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
21
which is merely mechanized, 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
19
JJohn Diebo1d, Automation: The Advent of the Automatic Factory
(Princeton, N. J.: D. Van Nostrand Company, Inc., 1952), p. 2.
20
Magnus Pyke, Automation: Its Purpose and Future (New York:
Philosophica Library, 1957), P- 168.
21
To 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.


82
people--!s 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: a technologist said dejectedly, "I hope public opinion will
14
rise." Whatever their opinion of the current status of medical
'^Corwin and Taves, pp. 188-189.
I ^
'Interviewed June 6, 1967
^Interviewed May 18, 1967.


150
8. Number of kinds of laboratory procedures is in
creasing, including many seldom-performed tests
not economical to automate.
9. Increasing demands are being felt for ASCP
technologists to work in research projects
and in invention of new procedures and appar
atus .
10.Manual methods must still be used when equipment
fails. (Only largest medical centers can af
ford substitute devices.)
The reasons listed above are suggested by the investigator in
support of the hypothesis that in the next few decades many more ASCP
*
technologists will be utilized.
In medical and hospital literature statements were found to
lend credence to the above reasons. Kruger remarks,
The employment problem occurs because all auto
mation does not have the same employment effects.
Some installations require more labor than others.
In a strong growth industry, a rising demand for
products may more than offset the labor-saving ef
fects of automated equipment.^8
Simon illustrates the effect of growth of demand with an example:
Now, let us suppose that a specific technological
development permits the automation of psychiatry
itself, so that one psychiatrist can do the work
formerly done by ten. It is not at all clear
whether a 90 per cent reduction in price of psy
chiatric services would increase the demand for
those services by a factor of more or less than
ten. But if the demand increased by a factor of
more than ten, the proportion of persons employed
in psychiatry would actually increase.29
Or, again,
Now we must not commit the error I warned
28
Kruger, p. 200. Italics added.
^Simon, p. 36.


184
Simon, Herbert A. The Shape of Automation for Men and Management..
New York: Harper and Row, 1965-
Somers, Gerald G., Cushman, Edward L. and Weinburg, Nat (ed.).
Adjusting to Technological Change. New York: Harper and Row,
Publishers, 1963 -
U. S. Department of Labor, Background Information on Impact of Auto
mation and Technological Change on Employment and Unemployment.
Washington, D. C., September, 1961.
Walker, Charles R. Toward the Automatic Factory: A Case Study of Men
and Machines. New Haven, Conn.: Yale University Press, 1957-
. Technology and Civilization: An Introduction to Human Problems
in the Machine Age. New York: McGraw-Hill Book Company, Inc., 1962.
Articles and Per iodicals
Anderson, Ellen. "Medical Technology Today," The American Journal of
Medical Technology, XXXI (May-June, 1965) 159-168.
"Automation and the Clinical Laboratory," Journal of the National Medi
cal Association, LVIII (September, 1966), 381.
Baldwin, George B. and Schultz, George P. "Automation: A New Dimension
to Old Problems," Monthly Labor Review, LXXVII I (February, 1955)
165-69.
Bluestone, E. M. "Who Pays the Price of Automation?" Hospitais, XXXIX
(October 16, 1965) 104-112.
Brown, Donald E., "Laboratory Administration: The Role of the Patholo
gist," The American Journal of Medical Technology, XXVIl (January-
February, 1961), 38-41.
Brown, Gordon S. and Campbell, Donald P. "Control Systems," Scient? fic
American, CLXXXVII ( September, 1952), 56-64.
Carrol .1 ,George J. "The Clinical Laboratory: A Challenge for the Fu
ture." Southern Medical Journal, LVI1 I (January, 1965), 90-95.
Coutu, Walter. "Role-Playing VS. Role Taking: An Appeal for Clarifi
cation," American Sociological Review, XVI (April, 1951), 180-187.
Cunningham, J. A. "A Look at Medical Technology," Hospital Progress,
XU V (May, 1963), 144-46.


145
Changes in Numbers of Technologists Employed
The specter of unemployment is one of the more typical associa
tions made concerning automation. That automation should awaken such
fear among workers and students of technological change is quite un
derstandable and not totally unfounded. The core meaning of automa
tion is, after all, replacement of human muscle power, intelligence, and
sensory functionings, wholly or in part, with the accomplishment of
work tasks by mechanical devices. Common sense indicates that men are
replaced once they are no longer needed. Nor is common sense entirely
wrong; automation in many industrial situations may create unemployment.
The "great employment controversy" has raged for several decades
and, indeed, is not yet resolved:
Some say that automation will create more jobs
while others claim that hundreds of thousands
of unskilled and semi-skilled jobs in factories,
railroads, and mines have been eliminated. In
a sense, both positions are correct. By its
very nature, automation eliminates certain types
of jobs, causing displacement. At the same time,
new jobs are created in industries utilizing au
tomation, and additional jobs are created in the
industries manufacturing this specialized equip
ment. Displacement, however, is not the same as
unemployment. There are countless examples of
technologic improvements displacing workers. The
history of technology is but a continuum of ma- ,
chines taking over work performed by human beings.
^Daniel H. Kruger, "Automation and Manpower," Journal of the
American Dietetic Association, XU I I (September, 1963), 199-200. Somers
et aj_., remark, "Indeed ... it is the separation of gains and losses and
gainers and losers that contributes to the controversy over technology's
employment effects. Employers benefit from cost effects and consumers
from price effects, but workers may lose their jobs." Gerald G. Somers,
Edward L. Cushman, and Nat Weinburg (eds.), Adjusting to Technological
Change (New York: Harper and Row, Publishers, 1963), p. 207.


152
new pathology laboratories, the increased
reliance on laboratory findings in diagnosis
and therapy, and the more widespread use of
medical facilities by all segments of the pop
ulation all add up to a need for more quali
fied medical technologists.35
Although written ten years ago, Jackson's words could scarcely be more
appropriate to today's scene. The investigator can only concur with
the current belief that "despite continued expansion of automation in
the clinical laboratory, the demand for laboratory personnel is ex
pected to increase rapidly during the next ten years.
Only in a projection of time of fifteen to twenty years from
now would the investigator suggest (for reasons explained previously
in this section) that the demand for fully-registered technologists
may stabi1ize.
The responses on interviews and questionnaires were almost
entirely in support of the view that automation will not reduce the
need for medical technologists. Hence only a few striking or nega
tive responses will be presented.
A hospital administrator noted no immediate diminution in
numbers of medical technologists because of the big "backlog" in
demand; at some future time a few technologists may have to move
to new job locations, he estimated, perhaps to work in large group
practice medical offices. "Automation shouldn't be threatening to
^Lura Street Jackson, The Medical Technologist (Cambridge,
Massachusetts: Bellman Printing Company, 1958), p. 865.
3^*Lab World, p. 865 .


63
"automation!1 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-regu1 ating
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. 3
^Floyd c. Mann and Richard L. Hoffman, Automation and the
Worker: A Study of Social Change in Power Plants (New York: Henry Holt
and Company, I960), pp. 191-192.
23
Sultan and Prasow, p. 32.


179
incumbents of the counter positions (pathologists and hospital ad
ministrators), on most topics enough consensus was present to warrant
interpretation.
One hypothesis developed is that automation will, indirectly,
change the role attribute of sex--that men will begin to enter the pro
fession more rapidly. In particular, it is believed that more men will
become MT(ASCP)'s as salaries and administrative opportunities increase.
A second major hypothesis is that the status of the profession of med
ical technology is likely to be raised, especially as knowledge, of the
dramatic new accomplishments of automation spreads through hospitals
and among the general public.
Hypotheses also were formulated that, in a period of fifteen to
twenty years, most MT(ASCP)'s will (1) become more specialized, (2)
come to function more as administrators than they now do, and (3) serve
as "first-line" repairmen. Their becoming administrators--coordinators
of men and machinery in the performing of laboratory determinations--
wi11 constitute a major shift in their role function, not unlike that
which has occurred in the role of the registered nurse.
It is also hypothesized that interactions between pathologists
and technologists will occur more frequently in the early period of au
tomation, but that a much greater independence from pathologists on the
part of technologists will develop as automation progresses. In addi
tion, the heightened reliability, accuracy, and speed of automated
equipment may lead to a "better relationship" between pathologists
and technologists. Automation, directly and indirectly, may contribute


25
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
rotu1 a (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 Pariiament--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.^
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, 111.: The Free Press, I960), p. 80.


70
the demand for laboratory tests per patient has been soaring. ^ 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
46
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
48
1957 is now used in over eighty hospitals. Instead of two channels,
twelve-channel models are standard with an eighteen-channel machine now
^51 bid. 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 and demand for medical services on the part of the
public.
46
There 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.
^Frederick Pollock, The Economic and Social Consequences of
Automation (Oxford: Basil Blackwell, 1957) P- 66.
**^T i me, p. 68.


59
Buckingham proposes that three distinctions be made between
mechanization, mass production and automation (which, he feels, have
evolved historically in that order).'0 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.'*
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
One group of researchers has proposed a "ladder of automatic
control" classification system, with each step of the ladder indicat-
1 3
ing increased complexity of the control system. On the other hand,
Walter 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.
'*Sultan and Prasow, p. 16-17-
1 2
Ibid. "Cybernation" derives from Norbert Wiener's "cybernet-
ics"--the use of computers in technology.
1 3
Criteria 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.


43
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
18
the laboratory. 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
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. 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.
Lavinia B. White, "Thirty-five Years of Medical Technology/1
The American Journal of Medical Technology, XXXI (July-August), p. 295-
i9lbid., pp. 295-296.
20lbid.. p. 297.
21
Fagelson, p. 21.


81
Ths 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--spec¡al ization 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.


172
Kinney and Melvill speak in similar terms:
In the past a limited number of tests have been
requested on the hospitalized patient to confirm
or deny a diagnosis. More recently various types
of screening procedures to detect the presympto-
matic stage of disease are being used inside and
outside the hospital. These have ranged from simple
tests such as the uriredypstik for sugar to complex
testing for multiple chemical components of the
blood. In the future there may well be a combina
tion of these two approaches since there will no
longer be a need for a distinction to be made be
tween screening tests and conventional hospital
tests.19
W. H. Kerns has published an excellent article that centers on
the pioneering efforts of pathologist Albert E. Casey at the Birming
ham (Alabama) Baptist Hospitals. Patterns developing in Dr. Casey's
laboratories have obvious implications for the future of health care.
Kern's remarks and his quotation of Casey's statements are well worth
surveying at length:
As distinctively different as fingerprints are
each person's anthropometric measurements, includ
ing blood cells and body chemistry. Properly cor
related by a well-trained pathologist, measurements
of each will not only reveal ancestry but the pres
ence of disease or the obstruction of organs of the
body in many cases before either the patient or his
physician could possibly observe physical symptoms.
It's being done, and as new and more efficient clini
cal laboratory equipment is developed, the practice
of medicine will be dramatically affected.
In the clinical laboratories of the Birmingham
(Ala.) Baptist Hospital, a genial, balding, 63-year
old pathologist whose genius and productivity are
impressive is quickly and surely shaping the fu
ture of medical practicein and out of the hospital.
His methods of producing pattern studies, or "pro
files," correlating the results of individual tests
'^Kinney and Melvill, p. 803


50
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
a re women."
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-
tion. In I960, 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 30,000.37 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.
^Fagelson, p. 41.
^Jackson, p. 31
37N
ational 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,
Apri1, 1967, p. 4.


99
automation is irreversible, and a hospital would be almost paralyzed
should its team of automatic equipment workers leave or strike. Thus,
development of expertise (specialization) may be perceived by hospital
management as a possible threat, although the need for efficiency would
also seem to indicate that employees should be encouraged to concen
trate on tasks that fit their abilities and interests.
It is likely that as hospitals become larger, as manufacturers
develop systems for handling repairs locally, and as the pool of per
sonnel trained in automation increases, that medical technologists will
be encouraged to specialize either in automation or in manual proce-
, ^3
dures.
Mention should be made of the fact that repair and maintenance
are not being handled by ASCP technologists alone; biochemists, tech
nicians, and other laboratory personnel are also involved. Neverthe
less, the majority of respondents held the view that the ASCP tech
nologist can successfully actas "troubleshooter" and director of
routine maintenance for the automated equipment.
A sizeable minority of interviewees, however, thought that in
the future a "specialist" (described variously as a repairman or
"biomedical engineer") will be needed to handle repairs.^ A sig
nificant majority, nevertheless, agreed that ASCP technologists would
43
^This belief was advanced by a number of respondents, but was
particularly well expressed by one pathologist (interviewed June 19,
1967) who believes almost all ASCP technologists will have to be spe
cialists. They will, in fact, probably be forced to choose, at the be
ginning of their training period, a career either in automation or in
manual procedures.
^A most atypical view was that the pathologist should perform


110
In conclusion, the investigator advances a tentative hypothe
sis that automation will, with other factors, contribute to the fur
ther professionalization of medical technologists. The technical re
quirements of automated equipment are so involved as to necessitate
specialization and professionalization.
The MT(ASCP) would seem to be the most logical group of labora
tory workers to become proficient with such equipment. Persons of
lesser training may in the future conceivably operate the machinery
under supervision, but apparently are not prepared educationally to
70
cope with today's problem-ridden laboratory. J
Clinical pathologists, biochemists, and other laboratory workers
at the master's and doctor's level do have the requisite abilities to
dominate the incipient era of laboratory automation, but most of them
are already committed to distinct career patterns(i.e., as physicians
or laboratory researchers) which are more remunerative than that fol
lowed by most registered technologists. In addition, as one patholo
gist stated, research-oriented biochemists, physicians, and electronic
engineers at either the master's or the doctoral levels are far too few
in numbers and in far too great demand to play more than a supportive
role in automated laboratories.^
Registered technologists, however, are not thereby assured of
a more professional standing in the laboratory. Professionalism will
be hard-won, involving distinct efforts on the part of medical
73
As has been pointed out, a national consensus is emerging on
this point, one which is amply supported by an overwhelming majority
of interviewees in this study.
74
Interviewed June 21, 1967-


173
and transmitting them to physicians, promises
to upgrade the work of the general practitioner,
complement the broad domain of the internist and
surgeon, strengthen a myriad of subspecialties
in medicine and surgery, and provide the first
broad scientific base for preventive medicine.^
Kerns remarks the savings in cost as well as the improvement in diag
nosis that Dr. Casey's system has effected. Although twenty-six of
the twenty-eight tests in the profile are now automated, Casey be-
2
1ieves that in a few years a profile of sixty tests will be common.
His views of changes coming in medical practice because of laboratory
automation are exciting:
In the near future, the combined metabolic-
hematology-cli ni cal-anthropometric profile
will be even more important. Broad implemen
tation of this profile for large segments of
the population is our goal. This will be pre
ventive medicine in its truest sense. It will
be a significant contribution to health care,
since prevention or early detection of chronic
metabolic disease will always be more success
ful than treatment of the disease at advanced
stages.
The general practitioner won't be referring
patients simply to an internist in the future.
A profile study will give him better informa
tion for referral purposes, and he may then
choose a specialist in diabetes, blood or liver
disease, or other subspecialty depending on the
results of the pattern study. Most important is
the fact that in many cases disease or organ mal
functions will be detected by clinical laboratory
tests long before the symptoms are evident to
either the patient or his physician, and treat
ment can be initiated earlier.
Hospital laboratories are going to undergo
tremendous changes. Small hospitals simply will
?0
W. H. Kerns, "'Casey's Profiles' Expand Diagnostic Role,"
The Modern Hospital, CVlIi (April, 1967), 122.
211bid.. p. 126.


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.


24
its language, and by organization, review, and integration of its
g
knowledge and theory."
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.^
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.^
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.
8
9
10
Ibid.,
pp.
18-19
1 bid.,
P-
18.
Ibid.,
P-
13.


166
average of unautomated work of 5,000 tests per laboratory worker.'^
One main reason for the Youngstown success is the use of computers
to form an automated system for the laboratory:
Technology in general and the computer in par
ticular are helping lift a tremendous burden
off the shoulders of clinical pathologists.
By creating unique instruments and systems they
are giving promise of bringing both a stagger
ing work load and the paper work associated with
it under control. The amount of work, growing
over the past decade, has been expanded into
enormous dimensions by five major considerations.
1. The recognition that the important scien
tific advances made in laboratory medicine repre
sent valuable adjuncts to the diagnosis and treat
ment of disease. As a result, there is increasing
reliance upon and an enhanced demand for large num
bers of laboratory tests which are becoming in
creasingly complex and difficult to perform.
2. An insufficient number of adequately trained
or experienced personnel able to perform these pro
cedures accurately, precisely, swiftly and economi
cal ly.
3. The use of relatively archaic methods of
clinical laboratory management, the retention of
obsolete technical procedures, and the existence of
small, cramped hospital laboratories.
4. The scanty budgets and unattractive salaries
for professional and technological staffs which re
strict entry into this field of people with talent
and strong motivation.
5. Increasing public and professional concern
with unsatisfactory levels of laboratory accuracy.
Although automation has been the answer to many of the foregoing prob
lems, it has understandably created some problems of its own. The
Youngstown pathologists made the following comments concerning such
problems:
Arthur E.Rappoport,Wi11iam D. Gennaro, and William J. Con
standse, "Cybernetics Enters the Hospital Laboratory," The Modern
Hosp? tal, CV (April, 1967), 111.
12J_bi_d., pp. 107-108.


119
accomplishment. For instance, do medical technologists experience
the "depersonalization" so often alleged to accompany industrializa
tion and automation?
In general, administrators apparently have very little first
hand knowledge of the laboratory. They depend for their information
concerning laboratory problems on communication with pathologists and
chief technologists. It seems evident that administrators, who rarely
interact with technologists, are in the least advantageous position to
observe expressions of the feelings and attitudes in the laboratory.
Clinical pathologists, more frequently in contact with the
workers in their laboratories, were almost always able to offer an
opinion as to the feelings of technologists. The technologists them
selves, of course, were best able by far to express their own reactions
to automation. This chapter affords a forum for their observations.
The plan of presentation calls for examination of literature
relating to attitudes and other sociopsychological effects of automa
tion, to be followed by the responses of administrators, pathologists,
and medical technologists.
Although studies of attitudes of professionals to automation
seem to be virtually nonexistent, a limited number of comments can be
found in the varied writings of physicians, psychologists, economists,
and others. Their writings reflect both negative and positive senti
ment .
Buckingham states that
While automation reduces working hours, improves
working conditions in many ways, and increases


134
With hand procedures you tire. You start
off fresh in the morning, but by 3:00 o'clock
in the afternoon you're tired and have to be
careful not to pick up errors.45
In spite of some negative and some ambivalent responses, the
majority of interviewees seem not unhappy over the advent of laboratory
automation. This investigator has the distinct impression that most
medical technologists are "adjusting well" to changes in their pro
fessional role.
That some technologists should react negatively is not sur
prising. It is worthwhile to speculate on the causes of such reac
tions. In the first place, negative reactions were never found on
the part of male laboratory workers.^ Unhappiness was found largely
among "old guard" women technologists who missed the "good old days."^
This group of women have apparently internalized many of the values
and attitudes associated with skilled craftsmen--especially those re
garding accuracy and quality of work. The justified pride of regis
tered technologists in this manual competency can, understandably, be
undermined by automation. Nevertheless, "depersonalization" effect
apparently has not reached major proportions among interviewees in
45
Ibid.
^That is, dislike of automation and automated machinery.
Many men criticized specific inadequacies of present machinery but
heartily approved of their presence. Most expressed definite in
terest and enjoyment in working with them.
47
'This generalization was reached and stated independently
by a chief laboratory technologist, interviewed June 13 1967 and
by a biochemist, interviewed June 6, 1967. The latter said, "Often
the good old line medical technologists cannot adjust to automation."


109
a consulting role to other physicians and is becoming less of a lab-
69
oratory scientist. Another chief technologist claims that patho
logists do not "get too involved" as long as the machines function
well and quality control is adequate.^ A chief technician stated
with pride that "doctors now know that medical technologists are de
gree people who do. know what they're doing. They [the doctors] now
accept us for what we are."^ An administrator thought that the ASCP
technologists will become chiefs over the laboratory services and will
even interpret results, contact physicians to explain abnormal .results
"only the fully-trained technologist can relate to physicians intelli
gently."^
Although some of the foregoing comments are almost glowing in
their prediction of a more independent, professional future for medi
cal technologists, a number of negative opinions were also voiced dur
ing the interviews. One item on the questionnaire attempted to as
certain from the pathologists queried whether automation, especially
in the future, would be likely to reduce the need for pathologist su
pervision of technologists. Most replies were negative, but since
the sample was purposive (highly selected), rather than random, no
conclusion need be drawn as to how typical the negative response is
among pathologists generally.
69
Interviewed June 6, 1967-
^Interviewed June 6, 1967-
^Interviewed June 6, 1967-
72
Interviewed May, 1967-


89
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.
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? W¡11 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.


159
t
The purpose of Chapter IX is to describe briefly the clinical
laboratory of the future. Such a descriptive effort will make more
meaningful the hypotheses and discussions presented in the preceding
chapters, which dealt with more specific role and attitude changes.
The Automated Laboratory--
Technological Configurations
Throughout this investigative effort, the fact that laboratory
automation is in its infancy has been given consideration; role and
other changes are often merely implied or are incipient, rather than
comprehensive and definitive. This section endeavors to describe cer
tain dimensions of technological change in the laboratory: (l) the ex
tent to which and the speed with which automation will occur, and (2)
the "completed" automated system.
An atomic holocaust or other overwhelming disaster could, of
course, prevent further extension of automation into the hospital lab
oratory, but short of such catastrophe, it is difficult to see what
factors will long delay a complete automatization of most areas of the
clinical laboratory. Vast political or economic upheavals would, in
all likelihood, only delay the process.^
laboratory now exists in Sweden. Interview with Dr. William F. Sunder-
man, Jr., Director of Clinical Laboratories, Shands Teaching Hospital,
the J. Hi 1 lis Miller Health Center, University of Florida, Gainesville,
May, 1967.
A completely automated hospital, financed by the Honeywell Cor
poration, is said to be under construction in St. Petersburg, Florida.
Interview with Mr. Richard S. Placzek, Assistant Director, Mound Park
Hospital, St. Petersburg, Florida, June 5, 1967.
*3
"The social structure for providing such services may, of course,


157
In conclusion, the investigator suggests that automation will
be a contributing factor in the raising of salary levels. MT(ASCP)'s
will, in all probability, assume many administrative responsibilities,
undergo more prolonged training, develop and perform more esoteric
tests, participate in research, and may develop a monopoly of automa
tion skills. These probabilities imply a necessarily higher salary
schedule.
Many other factors, also, will cause an increase in salary
for medical technologists. In addition to those already mentioned in
this section, the general price/wage increases that seem so permanent
a part of modern industrialized societies will have a direct influence
on the wage structure of all hospital workers.


16
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 ansv/er.
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


CHAPTER VI I I
PROFESSIONAL CONCERNS
The purpose of this chapter is to discuss four issues, or
topics, included in the interview schedules and thought to be of
professional (and to a lesser extent, sociological) interest. The
professional topics are (1) accuracy of automated equipment, (2) safety
and working conditions in laboratories that automate, (3) changes in
numbers of technologists employed as laboratories automate, and (4)
changes in salaries following automation.
Accuracy of Automated Equipment
Though not of sociological concern per se, accuracy of automated
procedures (especially as compared with manual methods) was included in
the interview schedule. This issue, which is of obvious professional
importance, served to establish rapport early in the interviews before
the conversation turned to more behavioral matters. Moreover, accuracy
of testing devices is of more than chance interest in determining the
extent to which laboratory automation increases. The extent to which,
and the speed with which, automation progresses are prime variables af
fecting sociological change in the clinical laboratory.
Most interviewees agree that results from automated equipment
are more accurate than results from manual testing. Pathologists,
136


96
registered technologists will, in the investigator's opinion, no
longer routinely perform manual tests. Rather, they will be the in
dividuals who will coordinate lesser-trained personnel and automated
machinery in the performance of tests. The basic role function of the
medical technologist as seeker of facts upon which medical diagnosis
and care are based will not change, but the medical technologist will
obtain the facts as leader of a team of laboratory workers.^7
Such a major shift will present medical technologists with
both opportunities and problems. Though many of the old manual skills
may become redundant, knowledge of the scientific principles underly
ing them will be even more necessary. The medical technologists of
the future will need to be more knowledgeable as physical scientists
than ever before (more chemists and physicists rather than biologists).^
As administrators, however, the technologists w¡11 also need
talents and training in management and interpersonal relations. With
out doubt, many individuals do combine manual dexterity and scientific
ability with social skills, but a number of respondents foresaw problems
if the average MT(ASCP) is asked to become a supervisor.
A chief technologist remarked, for example, that "now many
medical technologists are not social-minded would not make good team
57
-''Again, the technological configurations, which will largely
be causal in effecting this major role shift, are described in the last
chapter of this dissertation.
,0
A point upon which there is universal agreement in the liter
ature and among respondents.


139
In essence, automation "improves accuracy because it eliminates
human error."Data are more reproducible."^
One laboratory supervisor made the point that medical technolo
gists (with automation) can feel more confident of accuracy and relia-
8
bility when they have to defend their results. An administrator empha
sized his belief that automation has greatly improved accuracy, es-
Q
pecially in the small hospital.
Although there seems little doubt about the ability of automated
laboratory equipment to "out-perform" technologists as far as speed and
accuracy are concerned, one caveat should be added in the strongest pos
sible terms.
Automated laboratory equipment, like any other equipment, must
be properly maintained and properly operated if it is to produce ac
curate results. Because of what might be termed the primitive nature
of current automated equipment, any laboratory that simply purchases,
plugs in, and uses such equipment is running very grave risks. The
problem has several aspects.
^Remark of pathologist interviewed May 18, 1967
^Remark of pathologist interviewed June 19, 1967-
g
Interviewed June 15, 1967.
As mentioned in a previous chapter, having to defend their re
sults is a major irritant to medical technologists in their relation
ship with physicians. Physicians are prone not to accept unusual or
"or unlikely" results on their face value, since they know full well
that laboratory work is not by any means always without error. Hence
physicians frequently question the work of technologists and often de
mand that procedures be repeated.
The fact that results of automated procedures are also questioned
indicates that many physicians are not convinced that automated equipment
is entirely dependable.
,
^Interviewed May 25, 1967-


137
medical technologists, and hospital administrators seem convinced
that automation in the laboratory signifies greater accuracy. The
importance of accuracy to patient care scarcely requires comment.
Consequently, the interesting remarks that can and should be
made concerning accuracy do not center about whether automated equip
ment can produce more accurate results,^ but rather about problems in
assuring such accuracy. Although it is far beyond the scope of this
dissertation (and beyond the competence of this writer) to discuss the
technical problems of quality control for the many types of automatic .
laboratory equipment, a necessity is felt to report some of the opinions
and statements of interviewees concerning the problem of accuracy.
One of the major motives for automating, along with those of
cost reduction and greater productivity, is greater uniformity and
standardization of products. Machinery, of course, is immune to
psychological causes of inaccurate performance, such as fatigue, bore
dom, and emotional upsets. In Chapter VII note was taken of fatigue
and monotony as possible causes of mistakes in laboratory procedures.
^The statement should be that automated equipment is more ac
curate when properly maintained and used. Probably because of misuse
and imperfections in design, a few pathologists have taken an opposite
viewpoint. For example, one prominent Florida pathologist holds that
present automated devices cannot match fully trained ASCP technolo
gists for accuracy.
Yet Sturgeon reports that the autoanalyzer in one laboratory
agreed with manual results: "Strictly objective readings give complete
agreement with manual results in 97 per cent of the tests,1' Phillip
Sturgeon and Dorothy T. McQuiston, "The Status of Routine Blood Typing
with the Autoanalyzer," American Journal of Clinical Pathology, XU I I
(May, 1965), 461.


48
technologists. They too are called tech
nicians rather than technologists. sinee
they are not reqistered.30
The essential point here 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,^ the MT(ASCP)'s constitute somewhat less than one-tenth
of current medical laboratory staffs^ 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-
33
ing themselves technologists and all others technicians is certainly
3^1 bid. Italics mine.
31
J This 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.
^T. C. Nation, "The Present Status of Medical Laboratory Per
sonnel," The Journal of the South Carolina Medical Association, LX11
(October, 1966), 410.
^One 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.


84
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) wi11 gain the most prestige, since they will be operating
the machines.^
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-
O 1
hance it if they perform more specialized tests or become supervisors.
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 techno 1ogistsbecome, as it were,
20
Interviewed June 21, 19&7- Actually, who can and should
operate the autoanalyzer and other pieces of equipment is a contro
versial question.
21
Interviewed 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).


94
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-
34
trator.
Such a change has already occurred in the role of the registered
Or
nurse, with implications for the prestige (status) of nursing. 3
The degree to which medical technologists will become super
visors logically depends on patterns of division of labor in automated
^Related questions need to be asked in regard to accompanying
changes in role attributes--wi11 different personality characteristics
and educational accomplishments be necessary for ASCP-technologists to be
come administrators.?
^Corwin 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.


160
The reasons that automation will proceed throughout the lab
oratory have been discussed in previous chapters. Yet the main causes
bear reiteration: population increase and rising socioeconomic levels,
plus greater medical reliance on procedures have, with other factors,
combined to produce an avalanche of requests for laboratory determi
nations. Only automation has prevented the clinical laboratory from
collapsing or badly deteriorating in terms of quality production. More
over, the possibilities inherent in mass production of testing and in
the use of computers are rapidly augmenting the demand for tests.
The investigator believes that within fifteen to twenty years
from 80 to 90 per cent of all laboratory determinations will be per
il
formed by automated equipment. In 1965, from 25 to 50 per cent of
laboratory work in medium and large hospitals had already been turned
over to automatic equipment, and the figure was expected to rise to
75 per cent by 1975 -^ Technological inventions to effect this
be controversial; it is seemingly becoming more so in the clinical
laboratory. Nevertheless, technical innovations are not likely to be
very controversial in themselves.
^his is not to imply that 80 or 90 per cent of all ki rids of
tests will necessarily be performed automatically. It is probably
quite true that much of the work in bacteriology and other areas may
never be automated (or automated to a high degree). The point is, how
ever, that only about two dozen routine tests account for 75 or more
per cent of all work done in most hospitals. Most, or all, of these
tests can and have been automated. Sturm writes, "Most of the work
in a typical hospital laboratory consists of repeated performance of
a small number of routine tests, many of which can now be done on a
few automated devices. Analyses for glucose and urea nitrogen account
for between 25 and 35 per cent of all tests in the typical laboratory;
10 types of tests can account for 70 to 80 per cent of the entire
workload," Herman M. Sturm, "Technological Developments and Their Ef
fects Upon Health Manpower," Monthly Labor Review, XC (January, 1967),3-
5Lab World. VII! (August, 1967), 865.


60
James Bright offers the "mechanization profile," which allows classi
fication of work sites into seventeen stages of mechanisation:
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.^
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. ^ 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
'^Sultan end Prasow, p. 19.
''The present writer attended a discussion session on the
"Social Impact of Automation" at the 19&7 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.


128
the machines. He feels technologists are proud of their equipment
25
and do receive personal satisfaction from its use.
One pathologist reported, interestingly, that the lower level
laboratory workers especially like automation and that they gain
great prestige from operating automatic devices. Registered technolo-
gists, however, may, he feels, become bored with automation.
At one of Florida's largest hospitals, the pathologist believes
that his ASCP-level personnel take real pride when.they obtain accurate
answers from the machines, because doing so is a real challenge. Au
tomation in his view is actually relieving much of the tedium and monot-
27
ony in the clinical laboratory.
Pathologists who completed questionnaire forms also overwhelm
ingly reported little or no frustration, boredom, or general unhappi
ness among their technologists. One did believe that some complaints
28
of "fatigue" indicated boredom. Another answered "sometimes" and
a third "no more than with manual methods.
The nearly unanimous opinion among pathologists that automa
tion does not bring adverse psychological reactions was generally
25
Interviewed June 19, 1967. Similarly, a laboratory super
visor remarked of one of his technologists that "she has a big smile
on her face when she can conquer the machine." Interviewed June 15,
1967.
26
Interviewed June 16, 1967-
^Interviewed June 16, 1967.
oO
A Florida pathologist.
29
A Southern pathologist noted for his work with automation,
and the third a South Florida pathologist.


ni
technologists in acquiring new skills and knowledge. A transition
era, painful for many, appears to have begun. Before medical tech
nologists achieve a higher degree of professionalism, they will probably
have to experience the shifts in functions and role attributes previously
discussed, as well as undergo the necessary changes in educational prepa
ration to be dealt with in the last chapter of this report.
Automation and Stratification
The purpose of this section is to record an unsought, unexpected
insight into possible effects of automation on stratification and sub
group formation in the clinical laboratory. For whatever reasons, other
possible effects had been chosen as topics of investigation:; there were
no questions regarding stratification within the laboratory included
on the interview schedule or on the questionnaire.
Since this Section is based solely on interviews at one hospital,
it is not the intention of the investigator to give undue emphasis to
the situation found there. Yet the nature of the hospital recommends
that at least recognition be giveiof its laboratory personnel's re
marks. The hospital involved is one of Florida's very largest hospitals,,
located in Florida's largest metropolitan area.
Visited June 16, 1967 The very size of this hospital (its
large numbers of technologists, immense laboratory work volume, high
degree of stratification and bureaucratization) endow it with unusual
importance for this study. Since degree of automation is for obvious
economic reasons very highly correlated with a large volume of labora
tory procedures, large hospitals have, in most cases, experienced more
automation than have medium or small hospitals. The trend nationally,
moreover, is for all sizes of hospitals to grow rapidly. Future lab
oratory testing may be concentrated in enormous regional medical cen
ters, which will serve surrounding hospitals. Thus, this hospital's
size and the patterns of effects found there justify unusual scrutiny.


53
Next were urinalysis (53-5 per cent),
serology (45-7 per cent), microbiology
(43.1 Pgr cent), blood bank (39-8 per
cent).
Table 3 shows salaries of ASCP technologists by state.
38
Ibid.


trc-
UNIVERSITY OF FLORIDA
3 1262 08552 6506


83
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.^
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."'^ One technologist said
there would be more prestige when medical technologists begin working
with expens i ve equipment.^
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-
1 O
lookers are concerned, if the personal goes out of it." Yet one
administrator felt that the drama associated with automation will in
crease the prestige of medical technologists.^
nterviewed May 18, 1967
^1nterviewed June 12, 1967-
1 7
'Interviewed June 14, 1967-
1 O
Interviewed June 14, 1967.
19
Interviewed May, 1967-


155
be expected to look with favor upon technological innovations that
they believe will either "put them out of business" or reduce their
incomes.
In the preceding section, the hypothesis was formulated that
there will be an increasing demand for technologists following auto
mation. This section will serve to formulate and elaborate the hy
pothesis that laboratory automation will contribute toward the ele
vation of the salaries of ASCP-level technologists. By no means, how
ever, is the claim made that automation will be the sole causal factor
in any such elevation.
There is little need unduly to belabor the well-known fact that
technological innovations (including automation) consistently work to
raise general living standards. Automation increases productivity
and "the main long-run effect of increasing productivity is to increase
real wages--a conclusion that is historically true and analytically
demonstrable." Solow points out that wage earners benefit economi
cally from automation more than do investors.^ Thus, with the excep
tion of the minority of workers displaced by automation in some in
dustries, workers tend to benefit through higher wages and salaries.
As far as medical technology is concerned, only two re
spondents suggested that automation might tend to lower salaries, and,
^Simon, p. 22.
^Robert M. Solow, "Where the Jobs Goand Where They Come
From." Think. XXXI1 I (May-June, 1967), p. 3-


183
Mag raw, Richard M., Ferment in Medicine: A Study of the Essence of
Medical Practice and of its New Dilemmas. Philadelphia: W. B.
Saunders Company, 1966.
Mann, Floyd C. and Hoffman, L. Richard. Automation and the Worker:
A Study of Social Change in Power Plants. New York: Henry Holt
and Company, I960.
Martindale, Don. The Nature and Types of Sociological Theory. Boston:
Houghton Mifflin Company, I960.
Miller, Delbert C. and Form, William H. Industrial Sociology: The
Sociology of Work Organizations. 2d ed. New York: Harper and Row,
Publishers, 1964.
National Committee for Careers in Medical Technology and the U.S. De
partment of Health, Education, and Welfare, Public Health Service,
National Center for Chronic Disease Control. Manpower for the
Medical Laboratory: Resource Book. Produced for a National Con
ference on Education and Career Development, held at the University
of Maryland Center of Adult Education, College Park, Maryland, Oc
tober 11-13 1967.
Payne, L. C. An Introduction to Medical Automation. Philadelphia:
J. B. Lippincott Company, 1966.
Pollock, Frederick. The Economic and Social Conseguences of Automation.
Oxford: Basil Blackwell, 1957-
Pyke, Magnus. Automation: Its Purpose and Future. New York: Philosophi
cal Library, 1957.
Richardson, Stephen A., Dohrenwend, Barbara Snell, and Klein, Davis.
Interviewing: Its Forms and Functions. New York: Basic Books, Inc.,
1965.
Rose, Arnold M. Sociology: The Study of Human Relations. New York:
Alfred A. Knopf, 1965
Savignat, Alain, et al. Automation: Positions et Propositions. Fre-
bourg (Suisse): Editions Universitai res, 1957-
Selltiz, Claire, et al. Research Methods in Social Relations. 1st ed.
revised. New York: Holt, Rinehart and Winston, 1966.
Shryock, R. H. The History of Nursing: An Interpretation of the Social
and Medical Factors Involved. Philadelphia: W. B. Saunders Co., 1959-
Sigerist, Henry Ernest. A History of Medicine. New York: Oxford Uni
versity Press, 1951 .


41
reflects the true beginnings of laboratory medicine and employment
of medical laboratory workers in this country.
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.'*^ In this
respect, World War I was no exception; it created a trememdous 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.^ 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
1 ?
training or to register and certify technologists when trained.
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).'3 By 1928 the need for com
petent laboratory workers had become so overwhelming that the ASCP
9lbid.. p. 32.
^See 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.
^Fagelson, p. 32.
1 3
J\bid. Other writers say 1923, but the difference is not
essential.


174
be unable to afford the sophisticated laboratory
equipment which will be available. All the larger
hospitals will have to have it. With the communi
cations devices and technics we now have, it will
be a simple matter to tie the laboratories of
smaller hospitals to those of larger metropolitan
hospitals for the transmission of profile or pat
tern study results.
The smaller hospitals will certainly continue
to have a technologist on call for emergency rou
tine tests, such as a white count for a suspected
appendix. But the vast majority of the smaller hos
pitals' tests will be conducted in the laboratories
of major centers, or they will pool their resources
to establish such centers, because physicians will
be demanding this kind of information on all pa
tients, and the only economical method of obtain
ing it wi11 be by sending specimens to these cen- '
ters.
Laboratory design will change dramatically.
Standard laboratory casework, benches, sinks, Bunson
burners and the 1 ike wi11 be as outmoded as the Model
T. Ford. In their place will be banks of automatic
testing equipment operated by a medical technologist
who is not only trained to understand and perform the
various tests but also to make the equipment perform
as it is designed to do. We've made the progress we
have because we've tackled this whole process aggres
sively. Just because a test is now a bench test
doesn't mean it can't be automated or mechanized in
some form. We have developed methods for automating
many of them already, and we're working all the time
on others to find ways to do the same thing automatic
ally or mechanically.
Twenty years ago our present routine admission pro
file would have cost the patient about $180, if he
could get it. Many of the tests were done in the
laboratories, but usually in a series of two or three
at a time, to save money. In the meantime, the patient
was waiting in the hospital for the doctor to find
something significant in one of them. We do an ad
mission profile now for $20. That's a cost reduction
to the patient of nearly 90 per cent in laboratory
charges alone, not to mention the reduced length of
hospital stay, speed of diagnosis and treatment, or
any other factors.^
22
I bid.. p. 127.


51
TABLE 2
NUMBER OF REGISTERED MEDICAL TECHNOLOGISTS,
MT(ASCP), BY STATES, SEPTEMBER, I960*
STATE
NO.
STATE
NO.
Alaska
34
New Hampshire
101
Alabama
411
Nevada
42
Arizona
222
New Jersey
554
Arkansas
197
New Mexico
141
California
2,085
New York
1,257
Colorado
600
North Carol ina
497
Connecticut
353
North Dakota
119
Delaware
88
Ohio
1,504
District of
139
Oklahorna
399
Columbia
0 regon
416
F lori da
688
Pennsy1vania
1,494
Georgia
440
Rhode Island
68
Hawaii
150
South Carolina
173
I daho
111
South Dakota
125
111 i nois
1,414
Tennessee
496
1ndiana
6 06
Texas
1,742
1 owa
362
Utah
126
Kansas
560
Vermont
49
Kentucky
668
Vi rginia
597
Lousiana
654
Washington
709
Mai ne
114
West Virginia
224
Maryland
384
Wi sconsin
958
Massachusetts 535
Wyoming
55
Mi chigan
1,461
Canal Zone
22
Minnesota
946
Puerto Rico
190
Mississippi
295
Vi rgi n 1 slands (U .S .)
3
Missouri
778
Canada
170
Montana
189
Panama
9
Nebraska
280
Other Foreign
185
ic
Adapted from Anna P.
Faqelson, Opportunities in Medical
Tech-
noloqy (New
York: Vocational
Guidance Manuals, Inc., 1961), p. 35-
The
New York total i s
proportionately low, Miss Ruth Wi1
1 i ams
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-


76
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-
4
solute. Most respondents conceded, however, that men "naturally like"
growing male presence in medical technology, it must be remembered (l)
that the interviewees did not compose a random sample of Florida tech
nologists; (2) that approximately one-half of the technologists inter
viewed viere 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.
^Fagelson 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. k2.
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 poss i bl e-'-probably because men tend to have more stable work
records (do not marry, become pregnant, and cease employment). One


APPENDIX
TABLE 4
SUMMARY OF TRANSCRIBED INTERVIEW AND QUESTIONNAIRE
RESPONSES ON SELECTED TOPICS*
QUESTIONS
RESPONSES
YES
NO
COND
1T10 NAL
Will automation attract men into
medical technology?
24
5
1
Will automation increase the status
of (MT(ASCP)'s?
16
15
4
Will automation increase specializa
tion amonq MT(ASCP)'s?
15
5
1
Will automation increase the ad
ministrative function of MT(ASCP)'s?
15
6
1
Will MT(ASCP)'s function as mainte
nance and repair specialists in au
tomated laboratories?
18
4
1
Will laboratory automation act to de
velop independence and professionalism
amonq MT(ASCP)'s?
13
12
1
Will automation contribute to the
bureaucratization of the clinical
1aboratory?
0
10
0
Does laboratory automation cause adverse 3
psychological effects?
16
2
Do MT(ASCP)'s experience a sense of
"loss of control" over their work
with automated equipment?
3
17
0
Do MT(ASCP)'s retain a sense of per
sonal accomplishment in their work when
using automated equipment?
17
6
0
192


165
if considered individually. There is another as
pect of the issue of computer inspection of multi
ple laboratory measurements. Others have noted in
dealing with computer interpretation of electro
cardiographic measurements and other diagnostic
processes that there is considerable redundancy in
traditional measurements. This suggests that it
may be possible to eliminate some of the measure
ments or laboratory determinations which now seem
necessary. We are not yet able to confirm or con
test this conjecture.
A hopeful aspect of multitest screening is the
likelihood that the establishment of baseline values
for an individual will make subsequent deviations
from the baseline during disease more easily de
tectable.
One investigator has stressed that the concen
tration of blood constituents varies less within
time for a single person than within a population
at any moment in time. We have already convinced
ourselves that this is true with respect to serum
g1utamic-oxalacetic transaminase. This fact can
be useful in early recognition of myocardial in
fraction, provided that the previous baseline data
can be retrieved by a manual or computer system.
Developments in this area will ovvemuch to the con
cepts of "biochemical individuality" and of the
'fchemical fingerprint."
Hospitals should accept the responsibility for
becoming testing regions, not merely for those pa
tients within their walls. In order to do this,
systems must be selected which allow the test bat
teries to be altered based on cost-effectiveness
studies of the test results. It seems unlikely that
maximum value can be derived from mu 11i-testing un
less that data is processed and disseminated and,
I 0
made retrievable by electronic computer systems.
In 1966 the Youngstown Hospital Association performed 100,000
automated tests (twenty different procedures). The Association averaged
40,000 tests per laboratory worker (having employed an average of two
and one-half personnel per day) with automation, as opposed to annual
10
Ibid., p. 130.


2
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.^
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,
2
but few by sociologists." Economists and industrial engineers seem
to have made most of the contributions,^and 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.
2
Arnold M. Rose, Sociology: The Study of Human Relations (2nd
ed. rev.; New York: Alfred A. Knopf, 1965), p. 433.
31 b i d .


144
unable to accommodate much of the new automated equipment. Hence,
the use of automation in laboratories designed for manual procedures
may reduce both safety and pleasantness, since, obviously, overcrowd
ing and awkward placing of equipment lead to neither.
As laboratories are redesigned for automation, however, it is
most reasonable to hypothesize that laboratories will become at least
somewhat safer and more pleasant. This will probably be so because
(l) whatever new hazards automated equipment involves will be overcome
in later models, (2) fewer possibilities will occur for breakage (less
"handling"), and (3) air-conditioning and better spacing for efficiency
23
will be mandatory.
Worth emphasizing, however, is the probability that no pro
found changes need be expected in safety or pleasantness of the labora
tory because of automation per se. The clinical laboratory has, for
decades, already constituted a safe work environment. Major problems
of accidents (breakage, spillings, infections, burns, and whatever) have
long been basically solved. There is simply no room for the accident-
prone, the careless, or the clumsy workman in the laboratory. High
standards of safety and appropriate architectural planning are the keys
to safety and pleasantness in manual and in automated laboratories.
Either kind of laboratory can be safe or dangerous, pleasant or annoying.
^At the Miami Heart Institute, Mr. John T. Thomas, MT(ASCP),
is demonstrating his professionalism and versatility by designing
laboratories to suit automated equipment. His blueprints and specifi
cations are fascinating, and what will probably be Florida's first
automation-age laboratory was probably constructed at the time of this
writing. The investigator regrets not having been able to meet Mr.
Thomas during his visit to the Institute.


40
assistants have played parts of the role of medical technologists.
Similar forerunners can be perceived for almost any modern health
profession
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- Other types of public health laboratories were
opened before the turn of the century in Louisiana, Rhode Island,
7
and Minnesota. By 1900 the census spoke vaguely of "100 technicians"
o
(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 technologists1.
^The 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.
6ibid., p. 31.
7Ibid.
g
Ibid. Not all of these were medical technicians; some were
dental technicians or were industrially employed.


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.^ |n 1784 Oliver
Evans built a fully automated flour mill near Philadelphia. ^ In 1801
Joseph Marie Jacquard invented an automatic loom, 11,000 of which were
foynd in France alone by 1812.^ 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
12
beginnings of medical technology at the turn of the century. Some
early examples include "mixers" in serology, crude automatic pipetters
4-2
in the early 1930's, and, by World War II, the autotechnicon. J
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
44
insufficiently staffed hospital laboratories." Ever since World War
OQ
JOR. H. Macmillan, Automation (Cambridge: Cambridge University
Press, 1956). Cited in Yale Brozen, Automation: The Impact of Technologi
cal Chanqe (V/ashi nqton.
Policy Research, 1963),
D. C.: American Enterprise Institute for Public
p. 6.
^Diebold, p. 1

40lbid.
411 bid.
Seligson, p. 423.
4*2
^Conversation 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.
44
Seligson, p. 423.


28
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.^
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 arid 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 roleJ7
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
16
Ibid.
^ 7j bid., pp. 13-14.


SUMMARY
The spread of automation is a major trend of our era, and the
setting of the contemporary hospital is no exception. Automation in
the hospital, by definition, must affect the professional roles of
health workers, but these effects have not as yet been analyzed socio
logically to any appreciable degree. In an effort to provide insights
into effects of laboratory automation on the role of MT(ASCP)1s--tech-
nologists registered by the American Society of Clinical Pathologists--,
an exploratory survey was conducted on a purposive (highly selected)
sample of Florida pathologists, line medical technologists, chief med
ical technologists, and hospital administrators. Utilizing a semi-
structured interview schedule, the investigator sought to develop hy
potheses concerning the effects of automation on the MT(ASCP) level
of clinical laboratory workers. The hypotheses emerging from this ex
ploratory investigation should provide for future researchers a se
ries of questions and an implicit interpretative framework now quite
1acking.
Analysis of interview materials and literature on the subject
suggested interesting role changes. in the formulation of most hy
potheses, time, correlated with degree and perfection of automated
laboratory equipment, was thought to be an intervening variable.
Although differences of opinions were found to exist among
incumbents of the focal position (medical technologists) and among
178


65
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 team 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-
28
lant which are required." The computer can also prepare separate
26
Unpublished materials given to investigator by Dr. Sunderman
In large hospitals, some technologists or certified assist
ants may specialize as blood collectors (often called ph1ebotomists,
or humorously in the medical subculture, vampires'.).
28
Sunderman. The effects and future possibilities of automa
tion of communications will be discussed at greater length in other
portions of this dissertation.


42
decided to establish a Board of Registry of Medical Technologists.
This body is responsible for examining and registering students of
medical technology that have met its educational requirements.^
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.^ 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.^ The need for assistants who could and
would perform most tests routinely, yet accurately, led pathologists
^1bid. Actually it was established as the Board of Registry
of Laboratory Technicians; the present name was assumed in 1936.
^The 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)1s,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-
'^Ellen Anderson, "Medical Technology Today," The Amarican
Journal of Medical Technology, XXXI (May-June, 1965), p. 159.
17
Ibid.


191
Kinney, Thomas D. and Me1vi 11, Robert S. Automation in Clinical
Laboratories: The Present State and Future Uses of Automation.
Proceedings of a Workshop Conference, 1967- Meeting place un-
spec i f i ed.
Leonard, J. B., pathologist, Morton Plant Hospital, C1earwater, Florida,
Questionnaire returned to investigator, July, 1967-
National Committee for Careers in Medical Technology, Inc. Medical
Technologist-Pathologist: A Newsletter Relating to the Profession
of Medical Technology. Issue No. 36. Washington, D. C.: The Committee,
April, 1967.
Roth, Helga, Chief, Social Sciences and Community Programs Branch, Smith
sonian Institution, Science Information Exchange, Washington, D. C.
Letter to investigator, dated March 22, 1967-
Seckinger, Daniel, pathologist, Cedars of Lebanon Hospital, Miami,
Florida. Questionnaire returned to investigator, July, 1967.
Teloh, Henry A., pathologist, Veterans Administration Hospital, Coral
Gables, Florida. Questionnaire returned to investigator, July, 1967-
Vincinzi, R. B., pathologist, Piedmont Hospital, Atlanta, Georgia.
Questionnaire returned to investigator, July, 1967-
Weinbert, Edgar. "The Effects of Technology and Automation on Employ
ment of the Handicapped." Paper presented before the Mountain States
Regional Meeting of the President's Committee on Employment of the
Handicapped, Pueblo, Colorado, June 29, 1962.
Williams, George Z., pathologist, Clinical Center, National Institutes
of Health, Bethesda, Maryland. Questionnaire returned to investi
gator, July, 1967.


125
automation does not mean "dehumanizing" work.
On the contrary, in most actual instances of
recent automation jobs were made, on the whole,
more pleasant and interesting, as judged by the
employees themselves, than they had been before.
In particular, automation may move more and more
in the direction of eliminating the machine-
paced assembly line task and the repetitive
clerical task. It appears generally to reduce
the "work-pushing," "man-driving," and "expedit
ing" aspects of first-line supervision.'7
In similar vein he states that
we must be cautious, then, in inferring, because
managerial work will be more highly programmed in
the future than it has been in the past--as it al
most certainly will--that it will thereby be less
satisfying or less creative.18
Pollock is probably correct in concluding that current information is
too scanty to make any judgments as to sociopsychological effects:
In conclusion, it may be said that the available
evidence is insufficient to balance the pros and
cons of the effects of automation on the workers.
Nor is it possible to pass any final judgment on
the question as to whether the workers in an au
tomatic plant or office who improve their position
as a result of the introduction of automation ob
tain any real satisfaction from their new work.19
1 n
tinguished
any event, immediate effects need in many cases to be dis-
from long-range effects. At one plant (a seamless pipe
mill) worker morale dropped during the first year following automation
because of "bugs in production" which had to be corrected. Yet, after
an incentive plan was introduced, morale and production turned upward.
^Herbert A. Simon, The Shape of Automation for Men and Manage
ment (New York: Harper and Row, 1965), p. 35-
l8|bid., p. 97.
^Pollock, p. 212. In the investigator's view, also, there is
absolutely no reason to expect uniform reactions to different kinds and


115
should be needed ("we don't need helpers"). In his words,
At first the idea was to use people at lower
skill levels, but with automation, the lower
level jobs won't exist. The lay person ex
pects that automation will do tests more
cheaply and with half-skilled people.
The pathologist expressed his disagreement with the popular view by
terminating his training program for laboratory assistants.
The investigator agrees that in the next few years (up to ten
years in the future) there may be an overwhelming need for ASCP-level
personnel in automated laboratories, but, as discussed in the previous
section "Automation and Functions," he also believes long-run changes
devices (their perfecting and the introduction of com-
again make possible employment of less educated person-
in automated
puters) wi11
, 82
Automation and Bureaucracy
In their introduction to readings on the subject, Coser and
Rosenburg state that "bureaucracy may be defined as that type of hier
archical organization which is designed rationally to coordinate the
81
Interview with chief pathologist. The emerging national
consensus on this point has already been mentioned.
82
Enough evidence exists to lead the investigator to conclude
that personnel of lesser training than that of the registered tech
nologist may be in demand even in the immediate future. Automation
in the laboratory is very incomplete, since data handling is still per
formed in most laboratories by traditional clerical methods. Until
the computer is effectively tied in with automated equipment to form
an automated system, many assistants will probably be needed to cope
with the enormous volume of clerical detail produced by the current
use of automated equipment.


8
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 Mi ami).
The pre-test of the interview schedule was accomplished at
the Shands Teaching Hospital, University of Florida, Gainesville
(a large hospital), at Alachua Genera! Hospital, Gainesville (a
medium hospital), and at Suwannee County Hospital, Live Oak (a
smal1 hospital)
^ln the United States, small general hospitals are usually de
fined as having less than 150 beds; medium general hospitals as having
150 to 11h 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-


if
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.^
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 o*
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.^
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, arid Winston, 1966), p. 51-
7 Ibid., pp. 51-52.


186
Key, P. L. "Medical Technology, Profession or Skilled Labor? A
Student's Point of View," The American Journal of Medical Tech
nology, XXXI (May-June, 1965), 219-23-
Kimball, Charles. "Changing Demands of Science and Technology," The
American Journal of Medical Technoloqs', XXXI (May-June, 1965),
207-212.
Kruger, Daniel H. "Automation and Manpower," Journal of the American
Dietetic Association, XLII I (September, 1963), 197-202.
Lab Worjjd, August, 1967-
Lindberg, D. A. B. et al. "Computer Sets Stage for Multi-Testing,"
The Modern Hospital, CVI1 I (April, 1967), 128-130.
Mann, F. C. and Williams, L. K. "Observations on the Dynamics of a
Change to Electronic Data Processing Equipment," Administrative
Science Quarterly, V (September, I960), 217-256.
Mason, Ward S. and Gross, Neal. "I ntra-Occupational Prestige Differ
entiation: The School Superintendency," American Sociological
Review, XX (June, 1955). 326-331.
"Medicine," Time, October 28, 1966.
Moon, Mary Kay G. "The 3M's of Medical Technology," The American Journal
of Medical Technology, XXXI (September-October, 1965), 3856.
Nation, T. C. "The Present Status of Medical Laboratory Personnel,"
The Journal of the South Carolina Medical Association, LXII (October,
1966), 401-413.
Neiman, Lionel J. and Hughes, James W. "The Problem of the Concept of
RoleA Survey of the Literature," Social Forces, XXX (December,
1950, 141-149.
Rappoport, Arthur E., Gennaro, William D., and Constandse, William J.
"Cybernetics Enters the Hospital Laboratory," The Modern Hospital,
CV (Apri1, 1967), 107-111 .
Rausch, Verna. "Future Advances in Medical Technology," Hospital
Progress, XLII I (March, 1962), 86-92.
. "The Future of Medical Technology," Minnesota Medicine,
XLIX (May, 1966), 775-
Seligson, David. "Automation and Labor-Saving Devices in the Clinical
Laboratory," Connecticut Medicine, XXV (July, 1S61), 423-4.


124
effect on the group's ability to complete their
portion of the job.^
The result was a greater need for coordination of all phases of the
1 2
accounting operation. Authority and responsibility tended to move
to a higher level to assure a "more efficient coordination."^
The effect of automation on individuals was varied:
For many individuals this was a period of
growth; for others a period of failure and
disillusionment. The change severely tested
marginal employees and supervisors while at
the same time giving more experienced and able
personnel the chance of their life to develop
and to demonstrate their work potentials.^
There is little need to cite writings on the ill effects of
15
industrialization on workers, since the much lamented horrors of the
assembly line are too well known to require much comment. Kimball,
for example, mentions the dark possibility that, "repetitive jobs, a
total unimaginative existence, can induce frustration, alcoholism,
mental disorder."^ Other writers, nevertheless, do not take such a
dim view of the probable effects of automation and industrialization.
Simon remarks that
1 2
A situation remarkably similar to the one that appears to
be emerging in the. clinical laboratory, where registered technologists
may have to serve mainly as "coordinators" (a major shift in role func
tions discussed in the previous chapter).
I3lbid.. p. 307-
14xL, p. 307.
^And perhaps over-emphasized.
^Charles Kimball, "Changing Demands of Science and Technology
American Journal of Medical Technology, XXXI (May-June, 1965), 212.


23
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."' 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 understanding 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
5lbid., p. 17.
6Ibid.. p. 18.
71bid.. p. 18.


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
55


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.
73


143
would somewhat improve. One pathologist gave "less spillage and break-
J
age" as reasons for greater safety; another foresaw "superior phy
sical surroundings" and "less glassware."^
Nevertheless, a significant number of interviewees states that
automation may bring deterioration in levels of safety and pleasant
ness. An administrator felt that automation would surely bring new
1 O
safety hazards of its own. A pathologist was of the opinion that ma
jor problems have occurred, since automated equipment is being installed
19
in laboratories designed for manual work. ^
In other words, new architectural designs are needed to realize
any potential for greater safety and pleasantness.^ In many cases, the
laboratory may be worse off thanbefore automation. A technologist said,
21
"The lab looks like a machine shop--more messy." A biochemist claimed
that laboratory conditions may be generally better but that problems
22
arise when automated equipment is placed in manual laboratories.
The investigator has seen, firsthand, the vexing problems of
automated equipment installed in manual laboratories. In some, auto
analyzers hang over too-smal1 benches and protrude into aisles. Labo
ratory space, so often insufficient to handle manual work, is totally
16
17
18
19
20
21
22
Interviewed May
Interviewed June
Interviewed June
Interviewed June
Ibid.
Interviewed June
Interviewed June
18,
7,
14,
16,
6,
6,
1967.
1967.
1967.
1967.
1967.
1967.


13
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."^ 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...
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").^
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
1 7
tions, how to record the interview, and how to bring it to a close. '
14
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.
15... ,
Ibid.
l6Selltiz, Chapter 7, PP- 236-278.
'^William J. Goode and Paul K. Hatt, Methods in Social Science
(New York: McGraw-Hill Book Company, Inc., 1952), Chapter 13, pp. 184-
208.


45
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.^3
bid., pp. 9~11


29
aims of this dissertation and will present their role theory mean-
i ngs:
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 (l) 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. Posit?on (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 (l) a position and (2) power, prestige, or wealth associated
with a social position. Role conf1ict for some writers has stood
(1) for inconsistent prescriptions (or other standards) held for a


112
In the clinical laboratory of this institution, a policy of
dividing the work force into an automated section and a manual section
is followed, with detailed work rules and hierarchies (work classifica
tions) for each.^
The chief pathologist of this large hospital provided the in
vestigator with one of the most enlightening interviews of the study.^
No one in any interview evinced more concern with the possibilities
and limitations of automation in the clinical laboratory. Probably his
conviction that successful automation requires the efforts of the very
best technologists led him to structure his personnel into those who
work with the machines and those who continue to function manually.
The results of this structuring, in his view, are very clear.
The "automation people" are considered throughout the laboratory and
hospital as an elite group (and indeed, the very best technologists
were chosen). Consciously created, the automation team is composed
of members who think of themselves as constituting an elite very much
^ Previous mention was made of the large number of hospitals
that prevent the specialization found by requiring technologists to
rotate from manual to automatic work. The most probable reason, it
seems to this investigator, for a "non-speci al i zat i or1)1 pol i cy in small
and medium hospitals, where dependence on automation has developed,
is to prevent work stoppages in the event that a handful of automa
tion workers become ill, resign, or, possibly, strike.
However valid their reasons, the hospitals that follow a "non
specialization" policy would seem to reduce their efficiency and create
frustration among many laboratory workers. Most interviewees held the
opinion that "some technologists are good at automation and some are
not." In the investigator's thinking, such artificial prevention of
specialization cannot be maintained as the degree and complexity of
laboratory automation increase.
77
Interviewed June 16, 1967-


85
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.


113
aware of the unusual prestige they enjoy. The pathologist admits
that the team was given the name of "special chemistry section" to
avoid jealousy on the part of manual workers. Increasing the pres
tige of the automation team is their frequent contact with a staff
pathologist assigned to work with them (especially during the diffi
cult initial period of automation).
In a quite separate interview, the medical technologist who
heads the automated team, expressed to the interviewer her belief that
morale in her area is extremely high, with all personnel eager to learn
and assume responsibility. She informed the. investigator that, although
they are not paid higher wages, her workers were always willing to stay
overtime, whereas the "manual people" do not like to do so. She re
marked, also, that the automated worker enjoys "being involved in the
whole process of tests. Sometimes they get clannish and want to gang
up on others'P
A third interviewee at the hospital was the chief technologist,
who has served twenty-four years in medical technology. She pointed
out that all new technologists are hired first into the manual sec
tion:
Then we hire into the automatic section
must be good teamworkers, have certain per
sonal characteristics, get along well with
people, be challenged by the machines, need
to be dedicated and conscientious. Many well-
trained medical technologists do not adapt. 79
It seems clear at this hospital that role attributes are being
redefined by pathologists and technologists alike. As a result of
7O
Interviewed June 16, 1967-
79
Interviewed June 16, 1967.


routine, monotonous work and that "we still retain some control, and
we decide what to call the results. I'm very grateful for the ma-
42
chines... ." Yet she also made the following remarks:
I hate the machines--! hate instruments of
all kinds. ...I don't think a woman's place
is with machines. This is only my own per
sonal opinion, because 1 hate them. But I
don't think a woman should have to do that--
we're the blood drawers and the--you know.
Far more representative of the majority view, however, were
the comments of another medical technologist who had sixteen years of
experience. She reported no feeling of loss of control over her work
because of automation. Even at the end of a very busy day, using au
tomation, there is still, for her, a real sense of personal accomplish
ment. Moreover, she stated that she still has the same personal feel
ing for the patient. Automation has apparently not removed interest
from her work:
You never know what the machine is going to
do--it's interesting just trying to keep up,
keep control with the machine. You're always
asking it, "What are you going to do today?"^
Although by its very nature the work is routine, she does not find it
monotonous. When asked for her total impression and feelings concern
ing laboratory automation, she replied,
I think it's a tremendous boon to the profes
sion. Human error is reduced to a minimum.
42,
bid.
43i
44
bid.
Interviewed June 5, 1967-


15
"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.


138
At one large hospital the chief pathologist cited a national
study which demonstrated the wide variance of results among technolo
gists, since "there is always.a human bias, especially with a skilled
medical technologist, since the skilled technologist expects to repro
duce well." Machinery, in his view, has more "objectivity" and is
standardized at each step of a procedure. "Automation is especially
valuable, not because it saves money only, but because it eliminates
* ,,2
bias.
Diane Spencer points out that "many tests now accurately done
by machines had never been done satisfactorily by conventional methods.
Important recent advances in automated laboratory equipment have occurred
More precise equipment and a greater degree of
automation have grown together since improved
precision minimizes instrument errors while in
creased automation lessens the risk of operator
error. Newer instruments also reduce the amount
of handl-ing steps for many specimens, thereby
eliminating opportunities for error that accompany
each step.1*
The results of automated equipment thus may be expected to be more pre
cise (reliable) and more accurate (valid).^
2
Interviewed June 16, 1967
3
"Laboratory Automation has Freed the Technologist," Hospital
Management, C (September, 1965), 73.
L
Robert S. Hoyt and Hugo C. Pribor, "Quality Control Saves More
Than it Costs," The Modern Hospital, CV(April, 1967), 11^.
^The following paragraph from the Hoyt and Pribor article is of
interest: "Isn't statistical quality control just a policing program?
Don't laboratory technicians resent it? No. In fact, we have found it
has a net positive effect on laboratory morale because it gives the
people a target. And in the last analysis, worker morale is perhaps the
single most significant factor in maintaining a high test quality level."
Ibid., p. 116.


78
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,
g
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.


170
a new week's sequence and warns her not
to dispose of the last patient summary re
port. This system materially reduces the
time and labor in filing patient laboratory
reports.
13. The single patient report benefits not only
the ward but also the laboratory, the record
office, and business office. Instead of the
usual methods of filing large quantities of
duplicate copies either by patient or by types
of tests, alphabetically and according to day,
the laboratory receives a copy similar to that
which is prepared for the medical record. This
is filed by patient for the appropriate period
of retention and the previous report re
placed. There is an additional savings in time
required to retrieve the report and respond to
an inquiry. For the record office, microfilming
of reports is simplified, faster and cheaper.
The chart's bulk is reduced and a machine printed
record is readily inventoried for all the tests
which were performed.^
Effects of Laboratory Technology on Medical Care
The above examples of automated laboratory systems place in
relief the differences to be seen between them and most current "auto
mated" laboratories where only bits and pieces of a total system have
been automatized. In particular, the potential of laboratory automa
tion cannot be reached as long as automation of communications remains
undeveloped. Without computers, the "ultimate in laboratory devices,"*-
automation creates terrific clerical jamming and scheduling problems.
Without computers, too, potentials for screening and multiple-correlation
diagnosis cannot be realized:
14
Ibid., p. 111.
^John T. Foster, "How to Analyze Laboratory Efficiency," Modern
Hospital, CVII (July, 1966), 108.


56
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.'
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
Di ebold:
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.
2lbid., p. 12.
^Congress of the U.nited States, 86th Congress, Second Session:


90
28
the Technologist," 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.^9
Diane Spencer, "Laboratory Automation Has Freed the Technolo
gist ," _Ho££]_ta2 .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-
29
Spencer, 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. LVII I
(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 poss i ble, 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.


57
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.^
Other, more common, definitions of automation, however, are
based upon the "performance characteristics of the technology itself.
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, I960), pp.
83-84 and 91. Cited by Sultan and Prasow, p. 13.
4
Peter F. Drucker, "The Coming Labor Shortage," in America1s
Next Twenty Years (New York: Harper and Row, 1957). Cited by Sultan
and Prasow, p. 13-
^Herbert 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.


31
diffuse aims of the dissertation.^
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.^
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 "... i ndi vi dual s: (1) i n soci al locations..
(2) behave, (3) with reference to expectations-11 With this fact
in mind, they present the following definitions:
A pos i ti on is the location of an actor or
class of actors in a system of social rela-
tionships.
A pos? t?onal 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.
90
As stated earlier, this exploratory study not 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.
21
Neal Gross, V/ard S. Mason, and Alexander W. McEachern, Ex
plorations in Role Analysis (New York: John Wiley and Sons, Inc., 1358)
bid., pp. 17-18.
Italics the authors 1.


171
Programs for utilizing available new techniques
for disease detection in systems for diagnostic
screening of the whole population can be put
into effect throughout the Nation within a few
years if sufficient funds and manpower are made
available. These plans provide for mass physi
cal examinations in which a battery of at least
twenty laboratory health tests is performed in
a period of two hours, by automated techniques,
as a preliminary to physical examination and
health counseling by a physician.1^
Magraw holds the view that the effects of laboratory automa
tion on medical practice are only beginning to be felt. Mass screen
ing by means of blood tests, for example,
...would necessarily mean that the doctor would
see and treat a proportionately greater number
of his patients in the presymptomatic or asympto
matic stage of disease. The doctor's function
would then become more a matter of preventing,
i.e., of "preventive maintenance."^
He also observes,
These automated test procedures also promise
to have an important influence in medical care.
At first glance they too appear to support un
changed the physician's present function. A
closer look, however, suggests that such economi
cal mass laboratory tests may well be one of the
first agents to move medical practice itself to
ward automation. By joining the autoanalyzer and
the computer (putting them "on line" in the lan
guage of automation) it is even now possible to
perform routinely a battery of ten or more chemi
cal screening tests on human blood at the cost
of doing two or three such examinations in the
usual manner. Studies have shown a distinct im
provement in medical diagnosis resulting from
the use of such a battery of screening tests.^
16
17
Sturm, pp. 1-2.
Magraw, p. 215.
,8|bid.


162
system, particularly in the chemistry areas, is already in evidence,
and several descriptions are available in the literature.
Laboratory automation is, to be sure, not yet complete. Kinney
and Mel vi 11 state,
Completely automated systems do not exist if
a completely automated system is conceived of as
one which starts with a blood sample drawn from
the patient and proceeds to the automatic print
ing or recording of results identified with that
patient. The major gaps are the lack of an auto
matic or even a semiautomatic centrifugation sys
tem which retains sample identity and the absence
of an automatic method for separating serum and
distributing the sample into an analytic system.
Nevertheless, in laboratories with large testing volume, automated sys-
o
terns have developed that are virtually total.
Lindberg et. a_j_. report on developments at the University of
Missouri Medical Center:
The feasibility and medical worth of automatic
multichannel chemical testing of blood specimens
has been established both in hospitals and in am
bulatory populations. There is as yet no general
agreement on any combination of determinations as
being superior to any other, or as being univer
sally appropriate. Quite to the contrary, it seems .
entirely likely that the "batteries" will continue
to change. Furthermore, it seems entirely possi
ble that one might wish to vary the tests which
^Thomas D. Kinney and Robert S. Melvill, Automation in Clinical
Laboratories: The Present State and Future Uses of Automation. Proceed
ings of a Workshop Conference, 1967, p. 803.
8
Volume is a definite economic prerequisite for some types of au
tomated systems in laboratories. S. L. Ettman, "Advances in Clinical
Chemistry Instrumentation," The American Journal of Medical Technology,
XXI (September-October, 1963), 377. Even so, many large-volume labora
tories are without extensive automation; computers are still somewhat
rare.


104
incontrovertible fact that automatic devices, when operated correctly,
produce more accurate (more reliable) results than do technologists.53
Thus, the "better relationship" results from heightened accuracy: the
pathologist's expectations for accuracy are more steadily met. Failures,
fault finding, sanctions, and re-doing of tests are all lessened.
A number of comments on this point were interesting. A pathol
ogist pointed out the existence of more "built-in accuracy."5^ Another
noticed better relationships between medical technologists and physi
cians because of "less human error" and "fewer problems brought to the
attention of the pathologist."'*' A chief technologist claims that au
tomation, when applied with tight controls, has cut down errors, leav
ing a "closer standard deviation" so that the "pathologist is pleased.
A laboratory supervisor made an important point by stating that
"now the medical technologistscan feel more confident of accuracy and
reliability when they have to defend their results.A biochemist
has observed more mutual respect between medical technologists and their
rO
pathologists following automation.'*

53
This is not to imply that technologists are usualy inac
curate: the accuracy of the ASCP technologist is justly renowned.
54
J Interviewed June 7 1967*
'"interviewed June 15, 1967.
^^Interviewed June 12, 1967-
^Interviewed June 15, 1967- This is a significant factor in
the improved relationship between the medical technologist and the path
ologist (and physicians generally). Pathologists and other physicians
are very quick to "come back" on the technologist who sends in a report
that seems unlikely or unexpected in light of known facts or appearance
of a patient. The technologist must defend her results and/or perform
the procedure again.
rO
' interviewed June 6, 1967-
* *§


116
work of many individuals in the pursuit of large scale administrative
O o
tasks." 3 Long ago Max Weber brought attention to rules, laws, and ad
ministrative regulations as prime characteristics of bureaucratic or-
. +. 84
gam zat i on.
In hospital laboratories of any size, a bureaucratic structure
exists to coordinate efforts of the various skill and specialization
levels of workers. Detailed rules are needed to regulate the work life
Or
of the clinical laboratory. p
Early in the planning of this study, a decision was made to in
vestigate the possibility that automation would increase rules and regu
lations and, generally, heighten bureaucratic aspects of the laboratory.
Virtually unmentioned in the literature, the topic of automation and
regulations was included in both interviews and questionnaires in several
kinds of questions.
Although the opinions of pathologists, technologists, and ad
ministrators were not unanimous on this issue, the overwhelming
Oo
'Lewi s A. Coser and Bernard Rosenberg (eds.), Soci olog i cal
Theory: A Book of Readings (2nd ed.; New York: The Macmillan Company,
1964), p. 463-
P4
Max Weber, "Characteristics of Bureaucracy." From Max Weber:
Essays in Sociology, eds. H. H. Gerth and C. Wright Mills (Oxford,
England: Oxford University Press, 1964), p. 196. Cited in Coser and
Rosenberg, p. 465.
8S
"Tor some description and discussion of stratification and
regulations in the laboratory, see Cornelia Van Benthem, "Laboratory
Administration: The Role of the Chief Technologist," The American
Journal of Medical Technology, XXVII (January-February, 1961), 43-47;
Martin S. Ulan, "The Role of the Administrator in the Growth and De
velopment of the Laboratory," The American Journal of Medical Technology,
XXVII (January-February, 1961), 35~37; Donald E. Brown, "Laboratory Ad
ministration: The Role of the Pathologist," The American Journal of
Medical Technology, XXVII (January-February, 1961), 38-41.


164
precision of simpler solutions.
Our equipment configuration consists of 16
individual Auto-Analyzer channels. These are
divided between three or four specimen turn
tables... .
Operation of each of the groups of determi
nations can proceed at its optimum speed. Re
sults of the various parts of the battery are
collated by the computer system after all have
been completed.
The intensity of the color developed by the
chemical reactions in the Auto-Analyzer is pre
sented as a series of continuous curves drawn
on chart paper. Each curve corresponds to a
determination of a single chemical constituent
for a particular patient.9
The authors make some interesting remarks concerning the value
of their system:
It is too soon to draw conclusions yet concern
ing the ability of this technic to detect occult
but curable diseases. It is, however, already
apparent that our former concepts of the "range
of normal" with respect to many determinations
is woefully approximate and must be re-derived
from large population samples (and generally
broadened). We are also confirming the obser
vations of others that routine determinations
of some chemical constituents will yield re
sults clearly out of the ordinary range, even
beyond the limits one can accept as normal,
and that these findings may occur in totally
asymptomatic individuals.
Serum uric acid and blood glucose are ex
amples of such determinations. Other investi
gators have raised the question: Is one now
going to deal more often with the concept of
"pre-diabetes" and "pre-gout" or indeed will
wholly unnamed diseases or conditions be dis
covered by multi test screening?
An extension of this concept is the like
lihood that disease or dysfunction may be de
tected by taking into account patterns or com
binations of test results. There is evidence
that computers can recognize patterns or com
binations of results as significant, even though
the constituent results might not be significant
Testing,
^D. A. B. Lindberg, et al.,
" The Modern Hospital, CVII I
"Computer Sets Stage for Multi-
(April, 1967), 128-129.


182
Fledderus, Mary L. and van Kleeck, Mary. Technology and Livelihood.
New York: Russel Sage Foundation, 1944.
Freeman, Howard E., Levine, Sol, and Reeder, Leo G (eds.). Handbook
of Medical Sociology. Englewood Cliffs, N. J.: Prentice-Hall, Inc.
1963.
Goffman, Erving. The Presentation of Self in Everyday Life. Garden
City, New York: Doubleday and Company, Inc., 1939. Anchor Books
. edition.
Goode, William J. and Hatt, Paul K. Methods in Social Research. New
York: McGraw-Hill Book Company, Inc., 1952.
Gordon, Gerald. Role Theory and Illness: A Sociological Perspective.
New Haven, Conn.: College and University Press, 1966.
Gross, Neal, Mason, Ward S., and McEachern, Alexander W., Explorations
in Role Analysis: Studies of the School Super?ntendency Role. New
York: John Wiley and Sons, Inc., 1958.
Haber, William, Ferman, Louis A., and Hudson, James R. The Impact of
Technological Change: The American Experience. Kalamazoo, Michigan
The W. E. Upjohn Institute for Employment Research, 1963.
International Labour Organization. A Tabulation of Case Studies on
Technological Change. Geneva: International Labour Office, 1965-
. Automation: A Discussion of Research Methods. Geneva: In-
ternational Labour Office, 1964.
Jackson, Lura Street. The Medical Technologist. Cambridge, Mass.:
Bellman Publishing Company, 1958.
Jacobson, Howard Boone and Boucek, Joseph S. (eds.) Automation and
Society. New York: Philosophical Library, 1959-
Krech, David, Crutchfield, Richard S. and Ballachey, Egerton L. In-
dividual in Society: A Textbook of Social Psychology. New York:
McGraw-Hill Book Company, Inc., 1962.
Kreps, Juanita M. Automation and Employment. New York: Holt, Rine
hart and Winston, Inc., 1964.
Li 1 ley, S. Automation and Social Progress. New York: International
Publishers Co., Inc., 1957-


CHAPTER IX
THE FUTURE OF MEDICAL TECHNOLOGY
"I do not apologize for extrapolating beyond
our present certain knowledge. In our kind
of world, those who are closest to important
new technical innovations have a responsibi
lity to provide reasoned interpretations of
these innovations and their significance.
Such interpretations should be, of course,
the beginning and not the end of public dis
cussion. But they cannot be made at all with
out extrapolation from present certainties
into future probabilities.11^
The basic thesis supporting this study is that technological
innovations are and will continue to effect changes in the professional
role of medical technologists. The invention of an impressive array of
automated devices has made a technical revolution in the clinical lab
oratory possible; demographic, economic, social, and political changes
in society are creating a massive demand for laboratory determinations
which will make inevitable the occurrence of this revolution.
Future technical configurations of hospital laboratories, not
predictable in every detail, are already clearly enough defined to
permit a general portrayal of the automated laboratory. A few such
1aboratories, indeed, already exist, and more are being pioneered each
2
year.
Herbert A. Simon, The Shape of Automation for Men and Manage
ment (New York: Harper and Row, 1965), P- vii.
2'l'he investigator is told that a completely automated clinical
158


148
very few hospital administrators, pathologists, laboratory supervi
sors, biochemists, or technologists were expecting anything less than,
at least, a moderate increment in numbers of technologists.
The investigator is of the opinion, also, that medical tech
nologists must increase their numbers markedly in the next few decades,
that only as laboratory automation develops into a total system and at
tains "maturity" will a declining demand for ASCP-level technologists
effect a stabilization in their numbers.^ The remainder of this sec
tion is devoted to a discussion of this issue and a presentation of
pertinent literature and noteworthy interviews and questionnaire re
sults.
The dynamics of the situation are best understood by consider
ing automation's "replacement effect" in conjunction with other factors.
Automation, by definition, does take over the functions of human workers,
yet the advent of automated laboratory equipment will seemingly not mean
a reduction in ASCP-level technologists. Within the next ten years, at
least, such technologists may be in greater demand than at the present
because of the following constellation of interdependent reasons:
27
In Chapter VI, the investigator presented the hypothesis that
ASCP-technologists will be needed until several decades have elapsed, at
which time lesser-trained personnel would be able to operate the improved,
more fully automated generation of equipment. Simon states, "Most auto
mation calls for increased technical skills for maintenance in the early
stages; but the farther automation proceeds, the less those who govern
the automated system need to know about the details of its mechanism.
The driver of a I960 automobile needs to know less about what is under
the hood than the driver of a 1910 automobile. The user of a I960 com
puter needs to know less about computer designs and operation than the
user of a 1950 computer. The manager of a highly automated 1985 fac
tory will need to know less about how things are actually produced,
physically, in that factory than the manager of a i960 factory." Herbert
A. Simon, The Shape of Automation for Men and Management (New York: Harper
and Row, 1965), p. 48.


5
Although some very preliminary hypotheses may be perceived i ri 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
topi cally.


TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS ii
LIST OF TABLES iv
Chapter
I. INTRODUCTION 1
I I. METHODOLOGY 6
III. ROLE THEORY 21
IV. MEDICAL TECHNOLOGYGENERAL DESCRI PTION 38
V. AUTOMATION 55
VI. SOCIOLOGICAL EFFECTS OF AUTOMATION 73
VII. ATTITUDES AND OTHER SOCIOPSYCHOLOG I CAL TOPICS 118
VIII. PROFESSIONAL CONCERNS 136
IX. THE FUTURE OF MEDICAL TECHNOLOGY 158
SUMMARY 178
BIBLIOGRAPHY 18 1
APPENDIX 19 2
BIOGRAPHICAL SKETCH 194


79
is of increasing concern among the recently emerging allied health
9
professions. 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"
9
Corwin and Taves,
pp. 188-189.


3*+
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
acts, for example).^
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
Anal vsis 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
27ibi_d., p. 59.
28
In this study questions are asked about behavior and at
tributes primarily at the level of general functions and general per
sonal qualities.


14
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
19
of insights and advice gained from this volume.
Many manuals and books written on interviewing have lists of
1 ft
loStephen A. Richardson, Barbara Snell Dohrenwend, and David
Klein, Interviewing: Its Forms and Functions (New York: Basic Books,
Inc., 1965).
19
During 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 i ntervi ewer--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!