There are two basic categories of change: One is internal ("I'm going to the gym today!") and the other external ("My doctor says I have to start going to the gym").
In their own way, clinical labs face both kinds of change in abundance. While internal, organic, proactive change may go more smoothly because at some level the staff has chosen it, change is never easy, and staff still resist the alterations in their workday or forget to apply new procedures and workflows consistently. External, or reactive, change, such as meeting a new government regulation or having to fulfill larger organizational goals the lab did not participate in setting, is even more challenging. Managers have to overcome not only the intrinsic difficulty of change but also lab workers' possible feelings of resentment at the change. Lab leaders from the nation's top healthcare organizations offer these tips for managing both kinds of change.
"Our effectiveness in making change is proportionate to the degree of buy-in that we get from employees," says Eyas Hattab, M.D., professor and chair, department of pathology and laboratory medicine at the University of Louisville. He recommends creating a culture in which change is a continuous expectation, along with a framework for people in the organization to share ideas about internal changes and to give input on the best ways to execute external directives.
"When I think of individuals who have impressed me, [they] can see the big picture and also have passion," says Diana Kremitske, Vice President of Laboratory Operations for Geisinger Health System in Danville, Penn. One of her staff members, for instance, acts as an "ambassador" to the emergency department in an ongoing effort to improve process flow: She understands how the lab affects the ED, and is not only willing but eager to reach out to other departments.
Be particularly careful to choose supervisors who will set the right tone, says Paula Santrach, M.D., Associate Professor of Laboratory Medicine and Pathology and Chief Quality Officer at the Mayo Clinic. "One of the big revelations we've had is that sometimes we put people in positions because it's 'their time,' and they don't have all the skills that they really need." Supervisors who are too committed to "how we've always done it" may actually be barriers to change, resisting initiating change from within and finding ways to sabotage change that's imposed externally.
Mayo has developed a "quality fellows" program with four levels—bronze, silver, gold, and diamond—based on how much training an employee receives in techniques such as Lean Six Sigma and the Plan-Do-Study-Act (PDSA) process, and what roles they play in specific quality improvement projects. Santrach estimates that more than half of Mayo's employees are at least bronze-certified. "We are building the right kind of culture to get the change to happen," she says. "We have local, divisional, enterprise, and site projects—there is all kinds of action, all the time."
"Change" training can and should include attention to new skills, which can help with both proactive and reactive changes, says James Nichols, Medical Director, Clinical Chemistry and Point-of-Care Testing, at Vanderbilt University School of Medicine. It's not just "how-to" on new equipment, but preparation for the profusion of technological changes that genome sequencing and personalized medicine will bring. "Lack of fear for new technologies needs to be built into the basic inherent skills of the staff that we need," Nichols says.
When Vanderbilt brought lab automation to an institution it acquired, the staff had been used to processing all specimens from the ED and the ICU as "stat," regardless of how the test was ordered. They were suspicious that the new automated system would break, so they bypassed it by using the special "stat" port to process all those orders, just as they had been accustomed to. "They basically defeated the whole purpose of having automation," Nichols says. His solution? "I'd throw something in to break the stat port, or put tape over it to prevent them from using it. Eventually they discovered, 'If we use the system, it does its work for us and we don't have to think so hard.'"
Ownership remix as hospitals, national labs jockey for position
By Anne Paxton
Rationally calculating the profitability and risk of mergers or acquisitions is crucial, but many such business moves involve a gamble.
Managing population health takes on a new look
By Ann Paxton
In the past few years, the concept of “population health” has been grabbing attention as a framework for strategizing more tailored improvements in patient care—with laboratory data as one of the linchpins of those strategies.