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4 Keys to Empowering Better Change Management in the Lab

Contributing Lab Leaders: Eyas M. Hattab, MD, MBA; Diana L. Kremistke, MHA, MS, MT(ASCP); Paula J. Santrach, MD; and James Nichols, PhD, DABCC, FACB

4 Keys to Empowering Better Change Management in the Lab
OPERATIONAL

Article highlights:

  • Change can be generated organically from within an organization, or imposed from without

  • Both kinds of change are easier with flexible staff who are trained to expect and even welcome it

  • Be prepared to head off attempts to bypass a change

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.

Create a culture 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.

Look for "change agents" for leadership roles

 

"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.

Diana L. Kremistke, MHA, MS, MT(ASCP)

Vice President

Diagnostic Medicine Institute at Geisinger

Invest in "change" training

 

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.

Paula J. Santrach, MD

Chair, Clinical Practice Quality

Mayo Clinic

Be prepared to enforce a change when necessary

 

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.'"

James Nichols, PhD, DABCC, FACB

Medical Director, Clinical Chemistry

Vanderbilt University School of Medicine

Contributing Lab Leaders

Eyas M. Hattab, MD, MBA

AJ Miller Professor and Chair

Department of Pathology at University of Louisville

Diana L. Kremistke, MHA, MS, MT(ASCP)

Vice President

Diagnostic Medicine Institute at Geisinger

Paula J. Santrach, MD

Chair, Clinical Practice Quality

Mayo Clinic

James Nichols, PhD, DABCC, FACB

Medical Director, Clinical Chemistry

Vanderbilt University School of Medicine

 

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