In the past year, we have all been paying close attention to theeffects of prospective payment. Medicare’s DRG system, however, isonly the beginning of the health care industry’s full-scale switchto a competitive mode. The future will bring very different priorities,and lab management formulas that worked in the past are already becomingobsolete.
Managers determined to succeed must start readjusting now. Thosewho perceive DRGs as a purely negative force will have to begin viewingthem as a challenge to grow in knowledge, skill, and responsibility.Let’s face it: Some of us have gown complacent in familiearroutines and forgotten what it feels like to institute change throughcreativity and innovation. Our professional evolution will require the skills of authenticmanagement and a good measure of political savvy. We will explore thesetwo important areas in depth. Authentic management is real, not phony; trustworthy, notunpredictable; and flexible, not rigid. It is a style based onopenness, responsivess, and constructive action.
How can you tellwhether 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 decisionmaking, and if conflict is handled openly. This indicates that you havecreated an atmosphere in which people feel free to communicate theirneeds and problems with a reasonable hope of resolution. * If the staff attacks problems informally without worrying aboutyour reaction. * If employees view frustration and dissatisfaction as anopportunity for solving problems and take responsibility for doing so.
* If they work as a team and feel entitled to a role in planningand setting standards. * If you recognze and encourage expressive or intuitive behavior aswell as stricitly task-oriented action. These hallmarks of authentic management all focus primarily onhuman resources–the most valuable channel to higher productivity. Beginto develop this kind of management style by recognizing your primaryresponsibilities to your department.
These can be analyzed as sevenbasic functions: planning, organizing, directing, controlling,coordinating, evaluating and appraising, and communicating. Some ofthose terms may sound similar, but each represents a vital component ofcreative management. In the future, we will ignore any one of them atour 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 anorganized, responsive work environment. Plans for each laboratory areashould integrate departmental and institutional concerns. In otherwords, consider the laboratory as part of a total system and not as anisolated special-interest group. Involve supervisors and bench staff in making plans and settingobjectives. Most important, keep yourself well versed on coming trendsand outlooks in health care; on new procedures, technology, and testingsites; and on changing employer attidues toward the use of personnel. This involves some homework.
The future of the hospital laboratoryhas been thoroughly dissected in major medical and hospital managementjournals and the popular business press. If you haven’t beenfollowing these articles, you have a lot of back reading to do beforeyou can lay meaningful plans for the lab. You must plan for what willbe, not for what was. Expand your inerest beyond the lab, and read what the decisionmakes read. Your library should include books like “In Search ofExcellence,” “Megatrends,” “The One MinuteManager,” and “Putting the One Minute Manager to Work,”in addition to standard lab management texts.
2. Organizing. Organization begins with a careful evaluation ofexisting systems and their relevance to the demands of patient care andprospective payment–demands that can sometimes conflict. A neworganizational mentality is emerging in health care. These days, wemust examine the delivery of lab services in terms of outcome ratherthan concentrate on process alone. Clinical laboratories have alwaysbeen strictly process-oriented. Our quality control and review systems,as well as actual test procedures, are all processes.
Now we mustexpand that focus to see what each process costs and yields. Review your department’s written policies to judge theirimpact on efficient service and employee job expectations. Poorlyformulated policies and position descriptions hurt productivity. Makesure that each position description is appropriate to the job and thatit includes adequate performance standards to measure employeecompetence. Develop supportive relations with other depatments. At the sametime, your lab as a cost center must compete with them for a share ofthe pie. You will need new ideas and a willingness to depart fromtradition in order to keep ahead of the game. Get staff members involved at all levels of any reoganizationeffort.
This is the basic principle of “Theory Z,” themuch-touted Japanese management style. It is basically a commonsense principle: Problems are best solved by those who encouner them on adaily basis. 3. Directing. The director of a play offers guidance to bring outthe best in each performer and the best production as a whole.
The roleof direction in management is similar, and it is a lot easier when thestaff participates in decision making. Delegate authority in fact, notjust in word, by assigning important tasks and the responsbility foraccomplishing them. Employees respond best when they know they will beaccountable for the results. Learn to operate with a realistic awareness of cost limitations,and instill this awareness in the staff. Work on establishing effectivetime management techniques, and encourage employees to do likewise.Deal with conflict directly.
Trying to avoid or suppress it willdepress morale. and when changes must be made, involve employees rightfrom the start. 4. Controlling. Control extends to the department’s majorfinancial and business of decisions.
You will needs a comprehensivefinancial management system that includes realistic productivitymeasures, micro cost accounting, budget and expense monitoring, andpurchasing and inventory control. Learn to prepare comprehensive departmental reports of laboratoryactivities and staff contributions. Monitor whether personnel are beingused effectively. Keep employees involved in and informed about thelab’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 departmentactivities. You also serve as a public relations representative, acatalyst for other supervisors, and a leader in applying staff talent tothe search for greater efficiency. 6. Evaluating and appraising.
The point may sound familiar, but itis terribly important: An effective structure of employee recognition,reward, and discipline is based on objective-oriented, competency-basedposition descriptions with measurable standards of performance.Appraisal forms should reflect these standards, emphasizing growth anddevelopment rather than punshment. There are many resources availableto help you develop these essential documents.
In addition toindividual employee appraisals, consider a performance auditing systemto evaluate your department’s overall delivery of services. Whatever system you use, it should focus on employee recognitionand job enrichment. If you can take time to correct employees’mistakes, you can also take time to tell them when they have done a goodjob. None of us is so secure that we cannot benefit from some praisenow and then. Many scientists tend to be somewhat reluctant to givepraise, especially to employees who merely satisfy job requirements.These very people, however, may be most badly in need of encouragementin order to excel. When employees help develop their own paths to job enrichment, itdeepens their commitment to self-improvement.
Offer them encouragementby supporting continuing education attendance and by acknowledging theircompetence assurance activities. 7. Communicating. All your managerial prowess is worthless withouteffective communication, especially now as workplace cooperation becomesincreasingly vital. Establish an intra- and inter-departmentalinformation system that is open, clear, and comprehensive.
Extend linesof communication to your peers in other areas of the hospital. Pay special attention to verbal and writing skills, because the wayyou package your information is just as important as the message itself.A scientific and technical background seems to have prevented manylaboratory professionals from developing a clear, direct writing style.You can’t sell your ideas without being able to write an effectivereport, memo, or letter. Build a high profile for yourself and your department. Trycreating a system of troubleshooting rounds with all nursing units andother departments.
Get involved in institutional activities,committees, and community organization. Stay active in professionalorganizations that serve as advocates for your profession and helpinfluence regulatory agencies. You will not only grow professionallybut also tap into an excellent intelligence network for upcomingchanges.
These are the major elements of authentic management. In a perfectworld, honing them would be enough to guarantee a smooth-runningdepartment. But as well all know, effective managers hae to be smartand savvy as well as competent. Over the years, I have put together myown definition of political savvy. Managing is not just what you do;it’s also how you do it.
Getting to know your bosses, theirmanagement styles, how they judge you and see your role–all contributeto your political success. You must learn to speak their language andunderstand their power plays. That’s why it is so important to keep abreast of hospitaljournals. Don’t be reluctant to send pertinent clippings todirectors 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 maketheir job easier. Learn how your supervisors will judge you. Here are some of theareas that hospital administrators tank high in priority when rating theworth of a department head, plus a checklist of questions on how youmeasure up: * Relationships within the department. Do they contribute tosmooth and efficient functioning? How good is your technical competence and your ability to relate toemployees? Does pertinent information travel freely upward anddownward? Are you fully informed of your department’s functions andprocesses, and how they relate to the institution as a whole? * Relation with other departments and personnel. How well do youinteract with other departments and staff members? Do you resolve imterdepartmental conflict on a one-to-one basis orseek help from the administrator? * Official relationships with outside personnel. How do you relatewith personnel outside the institution, such as patients, families,agencies, and vendors? Are you sensitive to others’ concerns, and do you respondaccordingly? * Creativity and initiative.
Do you constantly seek opportunitiesto streamline procedures and improve operations in the lab and theparent institution? Do you establish a creative work atmosphere that movitatesemployees to seek improvement? Are you open to suggestions, or do you feel threatened byworthwhile proposals from others? Are you myopically traditional or willing to change long-standingpractices? * Dependability. Are you willing to volunteer extra effort andtime when needed? Can you perform well under adverse circumstances? Do you maintain and upgrade your management skills thoughcontinuing education? Can you demonstrate your managerial competency by certification orgraduate-level courses in management? * Ability to work independently. How much time must youradministrator spend to monitor your department’s operations? Do you keep administration informed of major decisions, while notbothering them with trivial problems? Do you reliably convey vital information to and from uppermanagement? * Institutional loyalty. Do you measure the value of activitiesfrom the institution’s standpoint or from a narrow outlook ofdepartmental self-interest? Do you balance support for your own departmet with an appreciationof the problems of others? Do you help employees understand and appreciate theinstitution’s problems and interests? * Accurate position description.
Does yours accurately reflectyour 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 andexpectations as well as yours? This checklist emphasizes the need for today’s health caremanager to combine technical, financial, and interpersonal skills.Technologists in a management role may face many stressful situations,such as making potentially unpopular decisions, implementing unwelcomechanges, and facing greater accountability than ever before. On the positive side, this is an exciting time of opportunity forprofessional and personal growth for those willing to keep pace.Managers who are reluctant to change will join the dinosaur club. Thosewilling to try new and unfamiliar problem-solving paths have a farbetter 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 youstand for. Don’t hesitate to start thinking, looking, and actinglike a manager.
Begin by obtaining business cards if you don’talready have them. If the hospital won’t bear the cost, have themprinted yourself. Their effect on your professional image is amazing. These reflections on the emerging role of the laboratory managerwere confirmed in a recent article in The Hospital Manager. The drivefor greater productivity, it stated, fuels the two major trends thataffect the role of the hospital middle manager. The first trend istoward a broader span of control, as the size of middle managementcontracts. The second is a decentralization of authority, bringingmanagers more influence in decision making, resource allocation, andorganizational direction.
“Both these trends will require more sophisticated supervisoryskills, technical knowledge, and coordinating talents than were requiredin the past,” the article said. Managers will have to get”people smart” to handle the growing move toward meritbasedpay systems, more sophisticated performance appraisals, and legalpressures in the workplace, it concluded. Obviously, these challenges won’t be easy, and some of us willdecide not to meet them.
Every decision involves risks, but risks alsoinvolve rewards. I believe the rewards will outweigh the risks fordedicated and talented people in this field. Someone will have to runour clinical laboratories, after all. Will it be you–or someone elsewho saw the opportunity and took it?