In the past year, we have all been paying close attention to the
effects of prospective payment. Medicare’s DRG system, however, is
only the beginning of the health care industry’s full-scale switch
to a competitive mode. The future will bring very different priorities,
and lab management formulas that worked in the past are already becoming
Managers determined to succeed must start readjusting now. Those
who perceive DRGs as a purely negative force will have to begin viewing
them as a challenge to grow in knowledge, skill, and responsibility.
Let’s face it: Some of us have gown complacent in familiear
routines and forgotten what it feels like to institute change through
creativity and innovation.
Our professional evolution will require the skills of authentic
management and a good measure of political savvy. We will explore these
two important areas in depth.
Authentic management is real, not phony; trustworthy, not
unpredictable; and flexible, not rigid. It is a style based on
openness, responsivess, and constructive action. How can you tell
whether you ae an authentic manager? Look to your employees’
reactions for the answer. Your management is perceived as genuine:
* If employees consider some conflict as a normal part of decision
making, and if conflict is handled openly. This indicates that you have
created an atmosphere in which people feel free to communicate their
needs and problems with a reasonable hope of resolution.
* If the staff attacks problems informally without worrying about
* If employees view frustration and dissatisfaction as an
opportunity for solving problems and take responsibility for doing so.
* If they work as a team and feel entitled to a role in planning
and setting standards.
* If you recognze and encourage expressive or intuitive behavior as
well as stricitly task-oriented action.
These hallmarks of authentic management all focus primarily on
human resources–the most valuable channel to higher productivity. Begin
to develop this kind of management style by recognizing your primary
responsibilities to your department. These can be analyzed as seven
basic functions: planning, organizing, directing, controlling,
coordinating, evaluating and appraising, and communicating. Some of
those terms may sound similar, but each represents a vital component of
creative management. In the future, we will ignore any one of them at
our peril. Let’s examine each more closely.
1. Planning. We plan in order to avoid crisis management. Short-
and and long-range strategic planning forms the backbone of an
organized, responsive work environment. Plans for each laboratory area
should integrate departmental and institutional concerns. In other
words, consider the laboratory as part of a total system and not as an
isolated special-interest group.
Involve supervisors and bench staff in making plans and setting
objectives. Most important, keep yourself well versed on coming trends
and outlooks in health care; on new procedures, technology, and testing
sites; and on changing employer attidues toward the use of personnel.
This involves some homework. The future of the hospital laboratory
has been thoroughly dissected in major medical and hospital management
journals and the popular business press. If you haven’t been
following these articles, you have a lot of back reading to do before
you can lay meaningful plans for the lab. You must plan for what will
be, not for what was.
Expand your inerest beyond the lab, and read what the decision
makes read. Your library should include books like “In Search of
Excellence,” “Megatrends,” “The One Minute
Manager,” and “Putting the One Minute Manager to Work,”
in addition to standard lab management texts.
2. Organizing. Organization begins with a careful evaluation of
existing systems and their relevance to the demands of patient care and
prospective payment–demands that can sometimes conflict. A new
organizational mentality is emerging in health care. These days, we
must examine the delivery of lab services in terms of outcome rather
than concentrate on process alone. Clinical laboratories have always
been strictly process-oriented. Our quality control and review systems,
as well as actual test procedures, are all processes. Now we must
expand that focus to see what each process costs and yields.
Review your department’s written policies to judge their
impact on efficient service and employee job expectations. Poorly
formulated policies and position descriptions hurt productivity. Make
sure that each position description is appropriate to the job and that
it includes adequate performance standards to measure employee
Develop supportive relations with other depatments. At the same
time, your lab as a cost center must compete with them for a share of
the pie. You will need new ideas and a willingness to depart from
tradition in order to keep ahead of the game.
Get staff members involved at all levels of any reoganization
effort. This is the basic principle of “Theory Z,” the
much-touted Japanese management style. It is basically a commonsense principle: Problems are best solved by those who encouner them on a
3. Directing. The director of a play offers guidance to bring out
the best in each performer and the best production as a whole. The role
of direction in management is similar, and it is a lot easier when the
staff participates in decision making. Delegate authority in fact, not
just in word, by assigning important tasks and the responsbility for
accomplishing them. Employees respond best when they know they will be
accountable for the results.
Learn to operate with a realistic awareness of cost limitations,
and instill this awareness in the staff. Work on establishing effective
time management techniques, and encourage employees to do likewise.
Deal with conflict directly. Trying to avoid or suppress it will
depress morale. and when changes must be made, involve employees right
from the start.
4. Controlling. Control extends to the department’s major
financial and business of decisions. You will needs a comprehensive
financial management system that includes realistic productivity
measures, micro cost accounting, budget and expense monitoring, and
purchasing and inventory control.
Learn to prepare comprehensive departmental reports of laboratory
activities and staff contributions. Monitor whether personnel are being
used effectively. Keep employees involved in and informed about the
lab’s financial affairs.
5. Corrdinating. An effective coordinator is a mover, not a doer.
Here your role is that of a facilitator and gatekeeper of department
activities. You also serve as a public relations representative, a
catalyst for other supervisors, and a leader in applying staff talent to
the search for greater efficiency.
6. Evaluating and appraising. The point may sound familiar, but it
is terribly important: An effective structure of employee recognition,
reward, and discipline is based on objective-oriented, competency-based
position descriptions with measurable standards of performance.
Appraisal forms should reflect these standards, emphasizing growth and
development rather than punshment. There are many resources available
to help you develop these essential documents. In addition to
individual employee appraisals, consider a performance auditing system
to evaluate your department’s overall delivery of services.
Whatever system you use, it should focus on employee recognition
and job enrichment. If you can take time to correct employees’
mistakes, you can also take time to tell them when they have done a good
job. None of us is so secure that we cannot benefit from some praise
now and then. Many scientists tend to be somewhat reluctant to give
praise, especially to employees who merely satisfy job requirements.
These very people, however, may be most badly in need of encouragement
in order to excel.
When employees help develop their own paths to job enrichment, it
deepens their commitment to self-improvement. Offer them encouragement
by supporting continuing education attendance and by acknowledging their
competence assurance activities.
7. Communicating. All your managerial prowess is worthless without
effective communication, especially now as workplace cooperation becomes
increasingly vital. Establish an intra- and inter-departmental
information system that is open, clear, and comprehensive. Extend lines
of communication to your peers in other areas of the hospital.
Pay special attention to verbal and writing skills, because the way
you package your information is just as important as the message itself.
A scientific and technical background seems to have prevented many
laboratory professionals from developing a clear, direct writing style.
You can’t sell your ideas without being able to write an effective
report, memo, or letter.
Build a high profile for yourself and your department. Try
creating a system of troubleshooting rounds with all nursing units and
other departments. Get involved in institutional activities,
committees, and community organization. Stay active in professional
organizations that serve as advocates for your profession and help
influence regulatory agencies. You will not only grow professionally
but also tap into an excellent intelligence network for upcoming
These are the major elements of authentic management. In a perfect
world, honing them would be enough to guarantee a smooth-running
department. But as well all know, effective managers hae to be smart
and savvy as well as competent. Over the years, I have put together my
own definition of political savvy. Managing is not just what you do;
it’s also how you do it. Getting to know your bosses, their
management styles, how they judge you and see your role–all contribute
to your political success. You must learn to speak their language and
understand their power plays.
That’s why it is so important to keep abreast of hospital
journals. Don’t be reluctant to send pertinent clippings to
directors or administrators to indicate your interest or alertness.
Respect the credo of bosses: “Don’t bring me your problems.
Bring me solutions.” Your imagination and initiative can make
their job easier.
Learn how your supervisors will judge you. Here are some of the
areas that hospital administrators tank high in priority when rating the
worth of a department head, plus a checklist of questions on how you
* Relationships within the department. Do they contribute to
smooth and efficient functioning?
How good is your technical competence and your ability to relate to
employees? Does pertinent information travel freely upward and
Are you fully informed of your department’s functions and
processes, and how they relate to the institution as a whole?
* Relation with other departments and personnel. How well do you
interact with other departments and staff members?
Do you resolve imterdepartmental conflict on a one-to-one basis or
seek help from the administrator?
* Official relationships with outside personnel. How do you relate
with personnel outside the institution, such as patients, families,
agencies, and vendors?
Are you sensitive to others’ concerns, and do you respond
* Creativity and initiative. Do you constantly seek opportunities
to streamline procedures and improve operations in the lab and the
Do you establish a creative work atmosphere that movitates
employees to seek improvement?
Are you open to suggestions, or do you feel threatened by
worthwhile proposals from others?
Are you myopically traditional or willing to change long-standing
* Dependability. Are you willing to volunteer extra effort and
time when needed?
Can you perform well under adverse circumstances?
Do you maintain and upgrade your management skills though
Can you demonstrate your managerial competency by certification or
graduate-level courses in management?
* Ability to work independently. How much time must your
administrator spend to monitor your department’s operations?
Do you keep administration informed of major decisions, while not
bothering them with trivial problems?
Do you reliably convey vital information to and from upper
* Institutional loyalty. Do you measure the value of activities
from the institution’s standpoint or from a narrow outlook of
Do you balance support for your own departmet with an appreciation
of the problems of others?
Do you help employees understand and appreciate the
institution’s problems and interests?
* Accurate position description. Does yours accurately reflect
your duties and responsibilities?
Does it clearly state accountability and authority levels?
Are standards of performance relevant to job requirements?
Does the description reflect the institution’s goals and
expectations as well as yours?
This checklist emphasizes the need for today’s health care
manager to combine technical, financial, and interpersonal skills.
Technologists in a management role may face many stressful situations,
such as making potentially unpopular decisions, implementing unwelcome
changes, and facing greater accountability than ever before.
On the positive side, this is an exciting time of opportunity for
professional and personal growth for those willing to keep pace.
Managers who are reluctant to change will join the dinosaur club. Those
willing to try new and unfamiliar problem-solving paths have a far
better chance of success. So will those able to project sincerity,
goodwill, and a strong commitment to quality.
Others must accept you as a person before they will accept what you
stand for. Don’t hesitate to start thinking, looking, and acting
like a manager. Begin by obtaining business cards if you don’t
already have them. If the hospital won’t bear the cost, have them
printed yourself. Their effect on your professional image is amazing.
These reflections on the emerging role of the laboratory manager
were confirmed in a recent article in The Hospital Manager. The drive
for greater productivity, it stated, fuels the two major trends that
affect the role of the hospital middle manager. The first trend is
toward a broader span of control, as the size of middle management
contracts. The second is a decentralization of authority, bringing
managers more influence in decision making, resource allocation, and
“Both these trends will require more sophisticated supervisory
skills, technical knowledge, and coordinating talents than were required
in the past,” the article said. Managers will have to get
“people smart” to handle the growing move toward meritbased
pay systems, more sophisticated performance appraisals, and legal
pressures in the workplace, it concluded.
Obviously, these challenges won’t be easy, and some of us will
decide not to meet them. Every decision involves risks, but risks also
involve rewards. I believe the rewards will outweigh the risks for
dedicated and talented people in this field. Someone will have to run
our clinical laboratories, after all. Will it be you–or someone else
who saw the opportunity and took it?