1. Laboratory Management
The Nature Of Management In The Clinical Laboratory
Part 2

2. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\
The dual hierarchy in health care

3. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ Dual Hierarchy In Hospitals
Under the new administrative pattern, the medical directors of the professional service departments (radiology and pathology “laboratory medicine”) are responsible to:
the governing board through the executive committee of the medical staff
At the same time they are also responsible to the hospital administrative hierarchy,
which may be concerned with the management and financial issues of their departments, such as the laboratory, than in direct care to the individual patient

4. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ Dual Hierarchy In Hospitals
This may place the medical laboratory director in a conflict situation,
attempting to be responsive to the needs of the medical staff,
which is primarily concerned with quality of patient care and outcomes,
as well as to management demands of hospital administration

5. الهيكلية الإدارية للمختبرات وبنوك الدم
اولا: وحدة المختبرات وبنوك الدم ويتبعها إداريا وفنيا:
دائرة المختبر المركزي والمستودعات
ودائرة المختبرات وبنوك الدم
 ثانيا : مختبرات وبنوك الدم في المستشفيات وتتبع الإدارة العامة للمستشفيات إداريا  وتتبع وحدة المختبرات وبنوك الدم فنيا وهى:
دائرة مختبر وبنك الدم في مستشفى كبير (أكثر من 100 سرير) مثل:
مجمع الشفاء الطبي ومجمع ناصر الطبي ومستشفى غزة الأوروبي ومستشفى النصر للأطفال ومستشفى شهداء الأقصى
قسم مختبر في مستشفى صغير (اقل من 100 سرير) مثل:
مستشفى كمال عدوان ومستشفى بيت حانون ومستشفى النصر التخصصي ومستشفى الدرة ومستشفى أبو يوسف النجار ومستشفى الهلال الاماراتى

6. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ Dual Hierarchy In Hospitals
To be effective, the laboratory director manager must understand individual and professional viewpoints and balance his respective interests while interacting with both sides of the dual hierarchy
Table 1-1 shows differences in professional cultures among health care professional groups

7. Contrast, for example, the differences in viewing resources:
MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ Dual Hierarchy In Hospitals
Contrast, for example, the differences in viewing resources:
hospital administrators (health services management) focus on allocating scarce resources,
where as the attending physician sees that all required resources should be available to maximize the quality of patient care

8. Differences in professional cultures among health-care profession groups
Feature
Health Services Management
Clinical laboratory Technical Staff
Physicians and
Pathologists
Basis of knowledge 
Social and management sciences
Combination of biomedical and social sciences
Primarily biomedical sciences
Patient focus
All patients in the larger community
Patients represented by specimen samples clustered by type of laboratory analyses requested
Individual patients categorized by type of disease
Exposure to clients while in training
The clients are primarily nurses and physicians.
Relatively little exposure to them during graduate school training
Clients are attending physicians and nurses, to whom limited exposure is possible
Great deal of exposure but not necessarily what they will see in practice
Time frame of action
Medium, to long range; gather information, analyze data, engage in long- range strategic planning
Short range with emphasis on timely results and quick turnaround of data
Generally short range; cause- effect relationships, although varies by specialty
View of resources
Limited; main challenge is one of allocating scarce resources
Recognize some limitations but more narrowly than the administrator
Resources essentially unlimited; resources should be available to maximize the quality of patient care

9. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ New Relationships
The new laboratory manager also finds himself faced with a crowd and new relationships and variables to be balanced
The Figure shows (top down) requests of the organization for comprehensive services and efficiency, and productivity and cost-containment expectations from his immediate supervisor
While handling these, the manager must balance requests by subordinates for higher pay and factors to enhance job satisfaction in the laboratory
On either side, peer department mangers expect coordination of efforts and cooperation

10. Relationships & variables to be perceived and balanced by a laboratory manager

11. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ Managing versus Doing
One of the most difficult obstacles for the new supervisor is the transition period between staff responsibilities and management responsibilities
When supervisor is needed, the common method was to evaluate the staff members within the dep. for the best-performing technologist
This was then appointed supervisor on the assumption that because he performed well at the bench, he would automatically make a good supervisor

12. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ The Supervisor's Circle Of Influence
All levels of management have supervisory functions and successful supervisors are the key to successful laboratory administration
The laboratory supervisor is the most significant member of the management team in influencing staff
Not only the supervisor's awareness of his new responsibilities but also his manner and attitude in dealing with his staff are important

13. The supervisor's circle and influence
Your attitude about employees
How you treat employees
How employees react
Production of employees

14. The staff begins to grumble over the decision
MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ The Supervisor's Circle Of Influence
Suppose a supervisor must find a way to schedule staff for holiday coverage of the laboratory
rather than discussing various options with his people, he arbitrarily assigns them confident that they would merely fight among themselves if he did not
The staff begins to grumble over the decision
One the third scheduled holiday, one of his staff has called in sick
Supervisor reaffirms in his mind that this typical of how incompetent the staff would have been in determining their own schedule and vows to continue making decisions without their input

15. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ The Supervisor's Circle Of Influence
The supervisor has the ability to create an environment encouraging effective and efficient operations
It is up to the supervisor to develop surroundings in which people will want to work to their full potential
In the clinical laboratory, as in any organization, there are those who are only interested in picking up their paychecks, but most employees would like something more out of their jobs
The supervisor has the responsibilities of acting as a catalyst in causing efficient and rewarding performance

16. How to create an environment to encourage maximum accomplishment?
MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ The Supervisor's Circle Of Influence
How to create an environment to encourage maximum accomplishment?
A worker's job must define goals which are explained and clearly understood by everyone involved
Not only must they understand goals, they must also recognize the kinds of personal judgment they can apply to the operation
Removal of obstacles that might stand in the way of the worker's effective performance
The working environment should encourage personnel to do their jobs as the supervisors want them to be done

17. MAKING THE TRANSITION TO LABORATORY MANAGEMENT\ The Supervisor's Circle Of Influence
The worker must have the sense of being a vital part of the organization. The supervisor must be aware that subordinates are people with needs and desires to be considered
The supervisor must realize that some of his workers may have useful ideas for solutions to current problems

18. EDUCATING LABORATORY ADMINISTRATORS
Many laboratory supervisors and managers have been promoted into their positions on the strength of their technical abilities
More often they received their training on the job

19. EDUCATING LABORATORY ADMINISTRATORS
The classroom setting:
is adequate to:
introduce the principles of management science
and the basic techniques of effective supervision,
it does not provide a complete preparation for administrative responsibilities
The same as academic grades are incomplete predictors of success for performing laboratory analysis
Facilitating the development of technical managers requires an understanding of what technical managers need to learn and a sense of when they are most ready to learn

20. EDUCATING LABORATORY ADMINISTRATORS
New supervisors were polled to determine their feelings of need as they began new careers, the following results were obtained:
89% wanted more knowledge on human relations
59% needed better communication techniques
40% felt deficient in personnel procedures and record- keeping
39% needed help in operation planning
27% wanted better methods of staff development
Most needs were for effective methods in dealing with people
This knowledge is not easily or simply obtained

21. CHALLENGES FOR TODAY'S LABORATORY MANAGER
External forces has driven clinical laboratories to change in recent years:
Governmental intervention
Cost - containment initiatives
Increasing competition
Society demands for access to complex diagnostic services
These changes pose a significant challenge for the laboratory manager

22. CHALLENGES FOR TODAY'S LABORATORY MANAGER
One of the most important measures of an organization's strength to remain competitive and survive is its ability to change
Inherent in the change process is a degree of resistance and uncertainty about the net impact of any change innovation
A systems analysis model has been described to assist the laboratory manager in planning for and implementing change.

23. CHALLENGES FOR TODAY'S LABORATORY MANAGER
Systems analysis: 
is a problem solving technique that decomposes a system into its component pieces for the purpose of the studying how well those component parts work and interact to accomplish their purpose
From a systems analysis perspective, four distinct yet interactive components or dimensions make up the managerial setting:
task,
structure,
technology,
and people.

24. CHALLENGES FOR TODAY'S LABORATORY MANAGER
The ability to predict how modifying one dimension of the system is likely to have an impact on other dimensions is the key to both designing adaptive change strategies and successful implementation.
By viewing the laboratory setting from a holistic perspective, resistance to change can be minimized and results can be more accurately predicted.

25. CHALLENGES FOR TODAY'S LABORATORY MANAGER
Task
Mission, Goals and Objectives of the laboratory
Structure
characteristics of the organizational chart,
division of labor
lines of communications and authority
workflow
Technology
Tools and instrumentation to accomplish goals
People
laboratory employees’ knowledge
skills
attitudes and expectations

26. CHALLENGES FOR TODAY'S LABORATORY MANAGER
The interactive nature of each dimension with double-ended arrows
Lack of uniform personnel standards
Lack of upward mobility

27. CHALLENGES FOR TODAY'S LABORATORY MANAGER
The modification of one dimension of the system is likely to have an impact on other dimensions, for example:
If the mission of the laboratory was expanded to include services for other organizations (task change)
This change would probably have an impact on:
the workflow (structure dimension),
the demands on testing equipment and data processing (technology dimension),
and personnel requirements needed for the increased volume

28. CHALLENGES FOR TODAY'S LABORATORY MANAGER
The Figure displays selected negative characteristics of laboratory medicine influencing each of these dimensions that make managing a clinical laboratory difficult
The task dimension is faced by and responsive to demands in the marketplace for increased numbers of diagnostic procedures in opposition to cost containment efforts

29. CHALLENGES FOR TODAY'S LABORATORY MANAGER
Laboratory work, even with advances in technology, remains stressful
Managers must also deal with dissatisfaction on the part of technical staff members when expectation for more challenging work are not realized and salaries remain mediocre in contrast to those of other health - care professionals
In conclusions laboratory managers should be aware of challenges inherent in administering the clinical laboratory
The systems analysis viewpoint shows how interactive the components of the clinical laboratory are

30. Laboratory Management
Laboratory Planning, Organizing and Control

31. Introduction
To carry out the management process, laboratory supervisors and directors should:
Determine objectives as part of the planning process,
Construct an organization able to do the work needed to fulfill the objectives,
Direct the activities of staff toward meeting objectives
And compare actual results to measure success or failure in the achievement of goals

32. Introduction
Controlling healthcare costs is an important issue which has induced significance changes in management practices for service providers
One of the most notable changes is an emphasis on strategic management and planning with a focus on goal formulation and design of specific strategies to be competitive

33. 1- STRATEGIC MANAGEMENT AND PLANNING
Strategic management is defined as:
The development and implementation of the laboratory's overall strategy, in relation to its current and future demands for service
Strategy is the mean by which long-term objectives will be achieved
The long term existence of an organization depends on a Strategic management
Strategic management activities transform the static plan into a system that provides strategic performance feedback to decision making and enables the plan to evolve and grow as requirements and other circumstances change
strategy which is a Greek word meaning the use of armies in a battle

34. 1- STRATEGIC MANAGEMENT AND PLANNING
There are six related major tasks in the strategic management process:
Goal formulation
Environment analysis
Strategy formulation
Strategy evaluation
Strategy implementation
Strategic control

35. Overview of the strategic management process

36. Strategic Planning Process
Clinical laboratories need to analyze the external environment, opportunities for growth and development in new service markets, as part of a strategic planning process
Example of a strategic planning process:
Strategic Planning
Developmental planning
Operational planning
Implement the plans
Monitor performance
Recycle annually or when significant new data are obtained

37. Strategic Planning Process
A- Strategic Planning
Review existing mission and goals using articles of incorporation, minutes of board meeting, etc.
Develop base line data
Asses market demand
Estimate market share
Identify strategic issues eg. competition
Evaluate alternative courses of action and identify strategic directions for various market segments
 the distribution of demographic variables in a patient population, often represented by the percentage of a given race, age, sex, or ethnic derivation.

38. Strategic Planning Process
B- Developmental planning
Determine geographic alternatives
Determine financial feasibility
Design construction, etc..
C- Operational planning
Establish operating budget.
Establish capital budget.

39. Strategic Planning Process
D- Implement the plans
E- Monitor performance
F- Recycle annually or when significant new data are obtained
autocratic or democratic

40. 2- PLANNING AT THE DEPARTMENTAL LEVEL
The initial function of departmental management is planning
The laboratory manager must determine both laboratory goals and objectives, as well as the means for achieving them, before he can organize, direct or control the results

41. 2- PLANNING AT THE DEPARTMENTAL LEVEL
Planning can be divided into four phases:
Establishing the goals and objectives for the laboratory
There is a clear direction before the laboratory manager begins planning strategies
Formulating policies to carry out objectives
Developing intermediate and short - range plans to implement policies
Stating detailed procedures for implementing each plan
Systems theory treats an organization as a system. A system can be either closed or open, but most approaches treat an organization as an open system.

42. 2- PLANNING AT THE DEPARTMENTAL LEVEL
It is difficult to separate planning from organizing and controlling functions
The following Figure shows the relationship of organizational hierarchy to general planning and control mechanisms
The pyramid structure is typical when describing a hierarchy
The inverted pyramid reflects the degree of detail in each of the mechanisms listed in the planning and control structure

43. 2- PLANNING AT THE DEPARTMENTAL LEVEL
Laboratory planning & control structures
Planning & control
mechanisms
Organization Hierarchy

44. 2- PLANNING AT THE DEPARTMENTAL LEVEL
Deals with
e.g. introduction of new tests
e.g. rules for action that will contribute to the successful achievement of goals and objectives. He might establish policy regarding cost/test ratio
To achieve short - range plans
e.g. applying special procedures governing the staffing and instrumentation required.
The rules that govern everyday testing.

45. 2- PLANNING AT THE DEPARTMENTAL LEVEL
Planning is referred to as preparation for where the organization is going
Establishing policies and procedures addresses the question of how the organization is going to achieve specific goals
As shown in the previous figure planning mechanisms go from the abstract (general purpose objectives, strategies, goals) to the specific (rules)
In between are the principles and rules of action known as policies and procedures, which guide an organization
Their purpose is to designate the means to be used in their accomplishment

46. ESTABLISHING POLICIES AND PROCEDURES
Variations
Origin
Characteristics

47. A. Variations
Within the clinical laboratory, individual policies and procedures will vary according to purpose and application
Policies will vary in specificity; some policies should be stated in general terms to allow flexibility, examples include:
Policy dealing with time off for continuing education may be written in general terms,
by contrast a procedure written to protect against hepatitis will usually be quite detailed

48. B. Origin Policies and procedures may originate from various stimuli:
From the organization itself
From government institutions
From agreements with other agencies
From tradition

49. C. Characteristics Policy must be:
reasonable, flexible and comprehensive
Preparation of manual for the adopted policies and procedures
Manual should begin with broad objective narrowing the focus to details for its accomplishment in the form of policies, procedures, methods and rules as shown in the following example

50. Example on Establishing Policies and Procedures
Objective:
To provide optimum service in the laboratory department for both inpatients and outpatients
Policy:
It is the policy of the laboratory to maintain:
24 hours service 7 days a week for inpatient testing
and 8 hour service 5 days a week for all outpatient procedures, unless special arrangements are made

51. Example on Establishing Policies and Procedures
Maintain sufficient laboratory staffing around the clock for all inpatient services
Provide outpatient services between the hours of 8 AM and 4:30 PM Monday through Friday, and 8 AM to noon on Saturday
Schedule appointments for all outpatients

52. Example on Establishing Policies and Procedures
Method:
Laboratory staff will be assigned to the following shifts:
7am to 3:30 pm; 3pm to 11pm; 11pm to 7am
Obtain approval from medical director or administrative director to schedule outpatient procedures outside the regular assigned hours
Daily work schedules and job assignments will be posted 2 workdays in advance

53. Example on Establishing Policies and Procedures
Rules:
All employees will report for duty at time assigned
Deviations from these hours without prior approval will be considered cause for possible disciplinary action
Three reported incidents of unexcused tardiness of more that 10 minutes will result in a written and verbal warning
Five reported incidents of unexcused tardiness of more than 10 minutes will result in 1 day suspension without pay
Additional reported incidents of unexcused tardiness will result in termination

54. 3- LABORATORY ORGANIZATION
Organization in the clinical laboratory refers to both structure and process
The three key elements of organization are:
Tasks to be performed
Individuals who are to perform the tasks
The clinical laboratory as a workplace

55. 4- CONTROLLING OPERATIONS IN THE LABORATORY
The final management function of a laboratory administrator is controlling
Laboratory administrator must be sure that plans are carried through the organizational and operational phases so that goals are met
The control process is closely linked to both planning and organizational structure

56. 4- CONTROLLING OPERATIONS IN THE LABORATORY
 The control process involves three steps:
Establishing standards
Measuring performance against these standards
Correcting deviations from standards and plans

57. 4- CONTROLLING OPERATIONS IN THE LABORATORY
Controlling involves locating operational weaknesses and taking the appropriate action to ensure desired results
Standards may be suggested or mandated by an accrediting body or governmental agency
Control is also applicable in the management of human resources for the clinical laboratory
Form for staffing control by ensuring adequate coverage before an absence is granted
Personal policies and procedures are the established standards against which performance is measured
Standards are mathematically determined to control the quality of any given analytical process