Addressing management issues

Jan. 1, 2009
Future of small hospital labs

Q What is the future of the small hospital
laboratory? Is “mega-commercial management takeover” an inevitability?

A Alton Sturtevant comments, “Laboratory testing for
hospitalized patients will always be needed. The form that testing takes
will definitely change over time. Where testing is performed, and by
whom, is largely in our hands to determine, based on our actions or lack

“If we are complacent and do not take control, then
testing may move to the nursing or patient-care staff — completely
outside of our control. This is not to say that some testing should not
move to the bedside or be performed by personnel with specific-only or
limited training. If we are concerned about the quality of testing and
want to remain in the process, we then should embrace performing testing
— based on clinical needs and financial constraints — wherever it is
best suited to be accomplished. Be a part of the solution, and do not
stubbornly resist change to the point of becoming extinct. Come up with
workable approaches to the testing needs of your facility and champion
them. Help set up programs and solutions that mesh testing into the
hospital as needed.

“A time will come when using a large lab is needed as a
supplement to your service, evolving over time, depending on technology,
personnel availability, and finances. Be open to all types of these
arrangements; do not look at them selfishly but, rather, from an
institutional point of view.

“Having a large lab involved can create anxiety — as does
all change — but it can also create stability for current staff, if they
work within the system. My takeaway to you is to do the most that you can to
make your small institution successful; and, by doing so, you will ensure
the success of your laboratory as well.”

Larry Crolla responds, “For the outreach portion of the
lab, I do not think this will be case initially. We have to see, however,
what the new government healthcare reform will be like. If we go to a system
of only a few insurers, then those insurers can dictate in what direction
labs will go; most small hospital labs will be out of the outreach business,
since they cannot contract for multiple states.

“As far as inpatient testing is concerned, I think the
hospitals will do whatever is necessary to keep costs down. If your lab can
stay competitive, then you will be okay, at least for the next five years.
The problem will come when new equipment is needed. Most likely, the
manufacturers of multichannel analyzers will not waste their R&D money to
create additional routine equipment with updated technology; pricing for the
lab is already approaching that of radiology equipment, which has a better
return on investment (ROI). Hospitals will be unlikely to invest in this
low-ROI equipment. Labs will be relegated to using the same equipment with
new ‘skins,’ (i.e., color and model number change).

“After a time, only the mega-centers will be able to
afford new equipment. Manufacturers will then make equipment to handle large
throughput — again adding to the cost because of fewer sales and this
specific design demand. That is when the mega-centers will take over and
leave the hospital labs to be, essentially, STAT labs. Ten years will be the
longest period we could hope for without any of this happening; but, most
likely, five to seven years is the when this shift will begin taking place.”

Marti Bailey says, “Depending upon the circumstances, the
future of some small hospitals might be more secure than you think. Small
community hospitals, supported by local residents who place a high priority
on having their own hospital, are most likely to survive. I can think of a
number of these that have shown relatively strong financial performance due
to local support; and as long as this support continues, I see them as
likely to maintain their independence. Many of the citizens in the
communities I am speaking of are resistant to obtaining their healthcare
anyplace except at their local hospital. These same folks would find the
sale of their local hospital to a large chain equally unsavory and will
continue to offer strong financial support to prevent this from happening.

Bottom line. Our diverse expert opinions demonstrate
the complexity of the issue and reflect the volatility of our marketplace
and economy. As we head into uncharted waters with a new administration,
small hospital managers must stay abreast of new policy and payment rules;
monitor payers to know from what entity they purchase business; watch the
competition; participate in local activities to know what is likely to
happen in a given area (e.g., a large business shutting down); track and
replenish equipment replacement costs (not just depreciation); and cater to
create loyal customers that will support them in tough times.

Internet surfin’ vs. housekeepin’ chores

Q We cannot block Internet usage so what are some creative
ways to discipline employees who use the Internet instead of contributing to
“housekeeping” needs (like stocking the lab area with supplies, cleaning and
dusting, cleaning centrifuges, and other such chores)? Many younger
employees are lazy and unmotivated to do anything other than the testing

A Larry Crolla suggests, “Update job descriptions to
include whatever work you require to be done. Contributing to housekeeping
activities, inventory control, and whatever else you deem as needed work is
now included in all job descriptions. Make all employees aware that these
written duties will now be evaluated as part of everybody’s performance
review. As far as the Internet usage is concerned, you can also make a
policy that its use is allowed only for work-related activities and that
abuse carries some penalty.”

Marti Bailey says, “If you have employees who have enough
time to play in CyberSpace, then there is a bigger problem than just
inappropriate use of company resources. Research your company’s policy on
personal use of business computers. Is there a written policy? If there is,
get a copy, then read and digest it. If there is not a company policy, then
contact Human Resources and/or IT to find out why not and whether an
unwritten policy exists that is universally accepted. Contacting managers of
other hospital departments to gather their experience with the problem
should also prove useful.

“If you have a written institutional policy, then your
job is to enforce it. If you are not doing this, then you are
negligent. If there is no written policy, then the lab needs to either
develop its own or, at least, make a statement that defines appropriate and
inappropriate use of computers.

“Once a documented policy has been shared with your
staff, it becomes a performance issue for those who choose not to follow it.
Any infractions should be documented and the employee counseled. Continued
failures to comply with the policy should constitute cause for dismissal.You
cannot take a lighthearted approach to this. Employees will learn to follow
the policy when they understand that their jobs will be on the line if they
do not.

“Identify these ‘non-technical’ chores and put into place
a written record to ensure that they are completed — with all staff members
participating. Assign each task to a particular workstation or person in
that log so that you can record the date(s) and the person(s) completing the
task(s) so that you can monitor compliance.

“Re-stocking of a workstation should be done by
whoever is assigned to it. Other chores like cleaning centrifuges have
far more serious consequences due to safety and regulatory
considerations if not completed and documented.

“All in all, it appears that you need to tighten up
your ship. Review written policies with your staff members, who are then
expected to follow in order for their performance to be considered
satisfactory. Equally important is to review the consequences of
failures to follow policies.”

Alton B. Sturtevant opines, “Many companies deal with
the use of the Internet as a part of their communications or information
systems (IS) policies, which cover the laboratory information system,
telephone system, voicemail, personal computers, or any of
company-provided electronic equipment. Use of personal cell phones, MP3
players, radios, televisions, and other personal electronics are usually
detailed in this policy as well. Such a policy usually stipulates when
and how an employee should use these devices.

“A discussion of transmission or reception of
harassing, vulgar, obscene, or threatening material is usually
highlighted to ensure that the employee is well informed with regard to
use of either personal or company equipment or systems while at work. If
the employee is provided company equipment, then he is informed that any
use of said equipment in the manner described here while at work
or while away from work is prohibited.

“The policy should 1) assert the company’s right and
intention of monitoring on an ongoing basis the use of said electronic
systems, including the excessive use of the company’s Internet system,
and 2) state that the company intends to use any currently available
monitoring technique to include but not be limited to a) reviewing
e-mail sent or received on the company Internet or e-mail system, b)
auditing detailed Internet activity, and c) investigating and/or
implementing whatever other measures are necessary. Finally, the policy
must include the warning that any employee who violates the policy may
be disciplined, up to and including termination.

“Speak with your network manager or your IS manager
to see what they are doing or can do to help quantify wasted time on the
Internet by your personnel. Without specific software measuring systems,
you are limited to direct observations. Meet informally and formally
with your supervisory staff and other departmental managers, and ask for
their solutions and opinions to help with this situation.

“Solicit employee input relating to the issue.
Emphasize your company policies. Explain how Internet use can be a time
waster and affect productivity. ‘Slack’ times at work should be used to
perform duties such as cleaning and disinfecting the work area, stocking
and rotating supplies, performing equipment maintenance, maintaining
continuing education activities, reviewing and writing procedures, and
other necessary activities that contribute to the well-being of the lab.
Document the meeting through published Minutes that are distributed to
the staff. The meeting may serve to encourage less unnecessary use of
the Internet. Do not expect to eliminate the problem entirely through
this discussion. Assign specific personnel to perform the ‘slack-time’
activities that you have identified as a way of achieving needed
functions within your lab, not as a way to ‘make work’ to justify staff.

“Walk through the lab to observe any activity that
would violate any policy. Speak with persons violating the
Internet-usage policy just as you would any other bad behavior. Follow
disciplinary policy in dealing with violations.”

Bottom line. Two issues are involved here: one
being personal use of company resources and the second, staff work
effort. To address personal use of company resources is to establish
limits (or not) in a policy. After a policy becomes effective, it must
be enforced. To categorize all younger employees as “lazy and
unmotivated” is an admission of the manager’s incompetence. The manager
should understand what motivates the younger generation(s) and cater to
their needs in order to get them involved in housekeeping activities. It
is not “rocket science;” it is management.

Anne Pontius is a senior medical practice consultant with State Volunteer Mutual Insurance Company in Brentwood, TN, and president-elect of CLMA 2007-2009. Send questions to Ms. Pontius at
[email protected] .

MLO’s “Management Q & A”
provides practical, up-to-date solutions to readers’ management issues from a panel of laboratory management experts. Readers may send questions to the
Anne Pontius at [email protected] . Unless otherwise noted as “confidential” by readers, all queries will be considered for publication without further notice to them. Names, institution, city, and state will be removed before publication. The following panel of laboratory directors, managers, and supervisory technologists have provided their input in the answers given in this column:
Marti K. Bailey, MT(ASCP), work unit leader, Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA; Lawrence J. Crolla, PhD, consulting clinical chemist, Departments of Pathology and Respiratory Care, Alexian Brothers Hospital, Elk Grove Village, IL, West Suburban Medical Center, Oak Park, IL, and Northwest Community Hospital, Arlington Heights, IL; and Alton Sturtevant, PhD, laboratory director, LabCorp, Birmingham, AL.