CEO SUMMARY: Some of the best stories in laboratory management are found in the unlikeliest of places. In this case we travel to the Olympic Peninsula in Washington state, where a 120 bed rural hospital has developed an energized laboratory team. It wasn’t easy and it didn’t happen quickly. But since the laboratory was revamped, it has become a source of pride for the hospital… and a valuable financial asset as well. In this first installment the turnaround takes place. Coming in the next installment: laboratory outreach proves successful in a rural setting.
LABORATORY ADMINISTRATORS who work at rural hospitals probably have the most difficult working environment in the laboratory industry.
The reasons are simple. Rural hospitals generally don’t have lots of money, so laboratories are often under-equipped and understaffed relative to the services they are asked to provide. Because rural hospitals are geographically remote, sharing services with neighboring hospitals is difficult, if not impossible.
Simply put, laboratory administrators in rural hospitals are often times allocated limited resources, then asked to do more than they are equipped to handle.
Given the daily stress of holding together this kind of laboratory operation, it is not surprising that many laboratory administrators fall into the mind set of focusing internally. They can overlook opportunities for growth and service enhancement.
Yet laboratory directors at rural hospitals have the potential to transform their laboratories into both a high-performance service center as well as a cash flow asset. Any hospital laboratory which accomplish- es this creates a win-win situation.
For the rural hospital, services are enhanced and additional operating profit flows into the hospital. For the laboratory, job security of the med techs is enhanced at the same time that funding for capital projects is generated from the laboratory’s increased cash flow.
“It doesn’t take much to make this happen given clear vision and strong commitment to change,” stated Eric Cook, Director of Laboratory Services at Olympic Memorial Hospital in Port Angeles, Washington. “Three years ago, virtually the entire laboratory staff did not believe it was possible for us to achieve what we have. Now, these same people are excited, motivated and pushing the laboratory to accomplish more!”
Considering where Olympic Memorial Hospital is located, these accomplishments are considerable. Olympic is situated at the edge of one of the largest and most isolated old growth forests remaining in the continental United States. Primeval is a good adjective to describe the nearby scenery.
Lab Services Improve
Yet in three years, a once rudderless laboratory was reorganized and remotivated. Laboratory services to the hospital improved from a point of near ineffectiveness to an admired ancillary service provider. Even more remarkable, Olympic Memorial Hospital operates a thriving, growing laboratory outreach program in a geographically remote area. Regular growth in specimen volume has required consistent additions to lab staff.
The success of Olympic Memorial’s laboratory can be duplicated. The success secret at Olympic was that both hospital and laboratory administration applied proven management principles to their problems and opportunities. They kept the strategic plan simple and helped the laboratory team implement it with confidence.
The catalyst for change at Olympic was Eric Cook. “I was hired to be the laboratory director in the beginning of 1993,” he said. “At the time I arrived, the laboratory had been without a director for more than six months. Morale was poor and hospital administration recognized that problems in the laboratory needed immediate attention.
“The laboratory had just completed a rough CAP inspection,” he continued. “The inspection identified a high number of issues which needed resolution. This became my first operational priority. But I quickly realized that there were deeper problems which required attention at the same time, otherwise the laboratory would never function effectively.”
Morale And Attitude Problems
Cook is referring to morale and attitude problems with the laboratory employees, acerbated by animosity from nurses and physicians. “Frankly, the service level from the laboratory was probably causing nearly as many problems as it was solving. The situation had deteriorated so much prior to my arrival that hospital administration had hired personnel consultants to work with the laboratory staff. The lab people nicknamed them ‘exorcists.’ This illustrates how morale was suffering in the laboratory.
“From a management perspective, I established three personal priorities. One, working relationships with physicians and nurses required immediate improvement. Two, laboratory operations needed to be straightened out. Three, the laboratory staff had to be molded back into a productive team.”
None of these priorities were achieved quickly. “Take relationships with physicians, for instance. I made myself available at every opportunity. If there was a problem, I went to personally see the doctor. My follow-up measures were extreme because I wanted to demonstrate our new attitude of service. I built personal relationships with the medical staff and nurses. It was months of intense effort before improvement in their outlook toward the laboratory became visible.
“My measure of success in this effort was when doctor complaints about the laboratory began to slack off,” he continued. “This happened after about six months. As this occurred, I took the initiative with physicians on staff to find out how we could better meet their needs.”
Earlier Turnaround Time
“Earlier turnaround of lab results in the morning turned out to be an important physician satisfier,” explained Cook. “At this time, early morning results were not getting out until about 9:00 a.m. Here was a great opportunity to improve our service to the clinicians.”
Cook’s three management priorities intersected on this goal. To improve turnaround times, he would have to orchestrate cooperation and support from nurses and physicians outside the lab and from the demoralized lab staff themselves. Everyone would have to work together as a team.
“Our goal was to have results posted into patient records and available to the physicians by 7:00 a.m.,” noted Cook. “I started this project by meeting with the laboratory staff and opening up communications. Regular meetings created the opportunity for them to ask questions, air complaints and learn what the goals for the laboratory were.
“I got help in this process from our medical director, Richard Schiefelbeim, M.D. He was a strong supporter of these efforts, because he had already experienced the doctor complaints during the six months when there was no laboratory administrator.
“To get test results out by 7:00 a.m. each morning, we had to change work schedules for phlebotomists, med techs and others. Although this doesn’t sound like a big deal for the people involved, scheduling them to come in several hours earlier each day was a major change in their life.
“We had a lot of people issues to work through to accomplish the schedule changes and generate test results earlier,” recalled Cook. “The emotional atmosphere and the hours of management time devoted to coaching people through these changes should not be underestimated. We did not even try to start this process until some nine months after my arrival. It took that long to establish trust and create an improved atmosphere of cooperation with the staff.
“Of course, delivering test results earlier each morning would affect the nursing staff, so we had to build bridges with them, identify their concerns and make it easier for them to adapt. We discovered that the nurses would be happy if we could deliver test results to the patient file and print what we call a ‘ward report’ for the nursing staff.”
“So we said ‘how about if we do both?’ The solution was to post results on our computer which the nurses would chart, as well as deliver to them a separate ward report needed for the change of shift nursing conferences,” Cook said. “This system has worked well. Since that date we’ve upgraded our HIS and LIS, permitting us to further refine this process. This was a milestone for goal-setting. A recent quality assurance TAT study confirmed that the laboratory’s morning TAT ranks in the top 20th percentile of those laboratories surveyed.”
Achievement of that goal took physicians by surprise, and created much goodwill. “Let me tell you where we started from. When I first arrived, I had one doctor tell me ‘who do I have to fight to get my test results?’ Imagine! Here is a doctor who expected some kind of struggle just to get lab results.”
Although Cook is proud that the laboratory team successfully achieved this goal, he tends to underplay many of the management challenges it took to accomplish such a major change.
“There were some additional management challenges which required attention,” he responded. “I did not mention that we have a union here. Until coming to Olympic, I had never before managed in a union environment. To be frank, it made me overly cautious during the first months. We took longer to make changes because I wanted to respect the needs of our staff and learn how the union played a role in day-to-day management decisions.”
“As it turns out, I found it to be not much different. Maybe it’s because our staff are professionals. Maybe it is the small town setting,” he added. “But the union here generally supports our efforts to improve the laboratory and pursue outreach testing.
“One specific area where we are cooperating with the union is in creating different job descriptions. At the time we decided to start a laboratory outreach program, we had about 32 employees. The need to develop client service functions, couriers, and similar job responsibilities meant the union needed to support this project. That support has occurred.”
Since Cook’s arrival four years ago, the laboratory has achieved significant things. Variable operating expense per procedure has declined 14.5%. Procedures per FTE grew by 24%. In-house testing to support clinical needs has increased. Quality management measures show regular improvement and client satisfaction is up.
The experience of Olympic Memorial Hospital provides two great examples of management success. The first example comes from the effectiveness of using proven management principles to transform an unmotivated laboratory into a high-performance asset. These management principles were accompanied by leadership and vision. It took all three to create what exists today.
But it is the second example which THE DARK REPORT finds equally exciting. Despite its status as a relatively small, rural hospital, Olympic demonstrates that opportunity exists even in the most remote locations of the United States. Here is a thriving hospital laboratory which is expanding inpatient service capability, operating a flourishing outreach program and binding the hospital closer to the community it serves.
Popular wisdom would say that it is difficult, if not impossible, for rural hospitals to accomplish all of these things. However, the laboratory at Olympic continues to grow and improve. As it does, it proves that even rural environments can support more growth and success than is generally acknowledged. This is good for the laboratory, good for the hospital and
good for the community.
To Be Proactive Or Reactive: Lab Administrators’ Dilemma
FOR LABORATORY ADMINISTRATORS, the experience at Olympic shows the other side of the management coin. Many laboratory administrators hesitate to initiate radical change in their laboratory. Why? For many reasons, but perhaps chief among them is the worry they will have to lay off people. They are also uncomfortable with changing traditional job assignments and schedules for their staff.
It is widely-recognized that most laboratory administrators fail to take initiative. As a result, when outside pressures force radical change to their laboratory, staffing cutbacks are generally more severe. The surviving staff endure wrenching change to job assignments and schedules.
In such a scenario, did the passive laboratory administrator really serve the best interests of the laboratory staff? Did the inaction of these lab administrators improve the job stability of their employees? The answer is no. Change was inevitable. When it arrived, the laboratory administrator had much less control over its implementation and impact. The pain and dislocation to loyal employees was actually greater than if the laboratory administrator had introduced changes proactively, over time.
Yet, at Olympic Memorial Hospital, the laboratory administrator’s willingness to be proactive, to risk introducing change demonstrates the benefits of decisive management leadership.
He recognized the limitations of the status quo. By challenging his laboratory staff to better meet the needs and expectations of physician staff and nurses, he restored the laboratory’s respect as a valuable ancillary service.
But look at the other positive consequences. There is an increased commitment to service within the laboratory. People like coming to work and meeting the needs of their customers. Outreach expansion has opened new career opportunities. Outreach testing has created more job stability for existing staff. Aren’t these the benefits every lab administrator wants to provide their staff? Certainly!
The experience at Olympic is not unique. Proactive laboratory administrators have comparable success stories. It is this collective body of success stories that should cause all laboratory administrators to rethink their choice to remain passive instead of becoming proactive.