Answering your questions about inappropriate use of voice mail and whether laboratorians should perform EKGs

Edited by Christopher S. Frings PhD, CSP

Hiding behind voice mail

Q: One of the department heads
at our reference laboratory facility hides behind her voice mail. She never answers her phone calls as they come in, even when she is alone in her office. She always has to return my calls, so we often end up playing phone tag. I have attended several of Dr. Frings time-management seminars, and he said hiding behind voice mail is not a good time-management technique. How can we get her to change, since this is affecting the entire facility in a negative manner?

A: When used correctly, voice mail
is a technology that can increase productivity. When used in an inappropriate manner, this technology can hurt a company. Hiding behind voice mail is inappropriate behavior because it leads to decreased productivity and time-management issues for the caller.

According to Alton Sturtevant, The failure to be responsive to internal customers in the facility is not acceptable behavior, in my opinion. I would approach the situation as follows:

  1. Express concern directly to her about not being able to get in touch with her to solve your immediate needs. Give specific examples of times and dates that the problem has occurred. Ensure that she is aware of the problem and its potential adverse affects on you and your team.
  2. If the problem continues, you have no choice but to report the problem to her boss.

Her superior must help her address the problem by telling her that he is aware of the problem, and that it must be corrected. If she keeps her phone forwarded to voice mail routinely, she must stop that behavior. There must be alternative methods of getting in touch with her to handle true emergencies or pressing issues until the problem is solved, or morale will continue to be adversely affected.

According to Larry Crolla, The only way to handle this problem is to point it out to her superiors. This is really poor customer service. The two things most important to a lab are quality operations and customer service. Any person who is not focused on customer service really doesnt belong in a lab setting. If this is a department head, it is especially bad since a poor example is set for others in the organization. If it starts to happen with external customers, the end of the lab is in sight.

Marti Bailey advises, Take the problem to the person you report to. Im assuming that this department head is at a management level above yours. If this is the case, motivation to change needs to come from above. You should check with your peers to find out if most people agree that her behavior is having a negative impact, and if so, what that impact is. Its no good just to complain that you dont like a particular behavior without providing an accurate picture of the problems or negative outcomes associated with that behavior. I do agree that the problem you describe is an unsatisfactory behavior that leads to time inefficiencies. In the meantime, have you ever tried substituting e-mails or face-to-face conversations with this person?

Bottom line. Hiding behind voice mail is unacceptable behavior for a department head. It causes time-management and productivity issues for her team members in other departments and keeps important questions from being answered in a timely manner. She may need two phone numbers; one should be for internal customers such as lab directors, supervisors, operations staff who travel, etc., and require timely answers to their questions. Any person who is not focused on quality operations and customer service really doesnt belong in a lab setting. For a department head it is especially bad, since a poor example is set for others in the organization. If all of the department heads hid behind their voice mail, the productivity of the laboratory would come to a halt.

Laboratorians performing EKGs

Q: I am the laboratory manager at
a university student health center laboratory. At our health center, laboratory staff has been delegated responsibility for performing EKGs for the past 20 years or more. Our patients are ambulatory and come to the lab for their EKGs. 

I have surveyed other student health center laboratories and found that, in the majority of places, the current practice is for nursing staff to perform this procedure. Only one other laboratory was performing EKGs, and it has been doing them for 37 years. The only reference that I could find to EKGs as a laboratory function is from 1970. I believe this practice is a carry-over from years ago.

I recently requested of our clinic management group (nurses and physicians) that nurses perform this procedure. My arguments were that EKGs are not within the scope of clinical laboratory practice, and patients would be better served if the procedure were performed at the point-of-care with physicians close by to interpret the results. My request was denied. The groups response was to offer a central location in the clinics where lab staff could come to perform EKGs. This is not possible with our small staff, and it doesnt involve the issue of, Whose job is it? Our laboratory director believes there could be a liability issue if laboratory staff continues to perform EKGs. Is this true? My other questions are, 1) in facilities similar to ours where there are no specialized staff members to perform this procedure, who should perform EKGs, and 2) what other arguments might be used in our specific situation? 

A: Larry Crolla advises, I know of
several labs that handle EKGs, so you are not unique. The liability question is best answered by your lawyer, but I would think that if people have adequate training and competency assessment to perform the EKG, there is no increased liability from the norm. (I also assume the interpretation of EKGs is done by physicians.) The other question I would ask is, If you no longer have to do EKGs, are you ready to eliminate the FTEs (full-time employees) involved in this work? 

According to Alton Sturtevant, Your argument for moving the EKG function to a point-of-care location seems like a logical one, but it was obviously not a convincing one for moving the function from laboratory services to nursing services. In addition, the management group has determined that the testing is being performed in a manner that meets its needs. EKG testing being performed in the laboratory is indeed an old practice. I doubt that any medical technology training programs teach this skill as a part of the training. The first laboratory in which I worked (a 650-bed hospital) actually did perform the function utilizing the phlebotomy and laboratory staff. The question of liability would best be answered by your facilitys malpractice insurance group. If they can provide a liability reason for the lab to discontinue the service, then administration will surely consider moving the testing to a proper department.

Dr. Sturtevant adds, In a further attempt to move EKGs, I would take the approach of proving that the laboratory was understaffed or lacks adequate space to provide the service. Evaluate the time that is required by your laboratory staff to perform all functions relating to the service and reduce the information to a cost of the function. Once the cost has been determined using laboratory personnel, perhaps it can be shown that the test can be performed more cost-effectively using personnel from another department. 

Marti Bailey recommends, Be sure to check to see if your own state has any credentialing requirements for EKG technicians. Unless you find something there, I believe you have little basis to argue. Youre basically telling me that your lab techs have been doing EKGs for over 20 years, but now youve decided that its not their job and would like the workload shifted to someone else. I feel like youre missing the boat when you ask who should perform EKGs and how you can support your argument. The most important question is whether or not a problem exists. Your letter sounds like you just dont want your lab techs to do this job any longer, but why not? Youre unlikely to make much progress or endear yourself to others if you persist in this Whose job is it? mentality.

Ms. Bailey advises, I checked with my hospitals cardiology department and found that there is a program available for EKG technicians to become board-certified. Its a nine-month program and something you might want to look into. However, this is not a requirement in Pennsylvania. I was advised that the most critical skill for an EKG tech is that lead placements be made according to the American Heart Association guidelines. I think you would better serve your staff and the university if you would focus on reliable training and regular competency checks for the laboratory staff that performs EKGs. The more different competencies that your staff members have, the more job security they have and the more marketable they are. My advice is to stop asking whose job it is and start asking how you can ensure that the job is being done well.

Bottom line. If you are successful in eliminating the EKGs from the laboratory, you may be asked to reduce your staff accordingly. Be prepared with a plan to do this. Stop asking whose job it is and start asking how you can ensure that the job is being done well by focusing on reliable training and regular competency checks for the laboratory staff that performs EKGs. The extra skill of being able to perform EKGs may help keep more of your lab staff employed.

Christopher S. Frings is an internationally known consultant and speaker on the topics of leadership, managing change, time management, reaching goals, and stress management. His consulting firm, Chris Frings & Associates, is in Birmingham, AL.

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