Laboratory Administration & Management of Pathology Practices
Leading / interfacing
General


Topic Completed: 1 April 2013

Minor changes: 15 January 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: laboratory administration[title]planning

Richard E. Horowitz, M.D.
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Cite this page: Horowitz R. General. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/managementlableadership.html. Accessed September 24th, 2020.
Introduction
  • To administer or manage means doing four things: Plan, Lead, Organize and Control
  • In previous chapter, we outlined the Essence of Planning, using a Template for Strategic Planning that culminates in specific goals for each section of the laboratory with detailed objectives and a business plan with financial projections and budgets
  • This chapter outlines the general and specific leadership responsibilities and interfacing requirements of pathologists, the essential communication and interpersonal skills (Emotional Intelligence) that are pre requisites and "How to" connect and lead in the pathology group, in the medical staff, in the laboratory, in the hospital and beyond
Leadership Responsibilities
  • Pathologists are expected to be brilliant physicians and make accurate diagnoses but they are also responsible for the overall performance of their laboratory
  • They must establish goals and objectives and determine the organizational structure
  • They are responsible for employees, equipment and supplies
  • They must assure quality and comply with laws and regulations and show a positive bottom line
  • In other words, pathologists, in addition to being doctors, have to be managers; they are expected to plan, to lead, to organize and to control the laboratory
Leadership Requirements
  • Pathologists must be leaders in their hospitals or health systems, leaders in their professional organizations and in their community
  • The prime competencies required for leadership are professional and technical expertise and interpersonal and communication skills
  • A leader must also be able to lead and motivate, be decisive, be able to delegate and yet be humble and always ethical
  • The toughest of these tasks is leading, all pathologists need to be leaders, leaders in their practice group or academic department, in their laboratory - even young pathologists just out of residency are given responsibilities for leading laboratory sections
  • Most important, a leader must have emotional intelligence, or simply another way of defining interpersonal skills; emotional intelligence is what effective leaders have
Emotional Intelligence for Effective Interfacing and Leading
  • Dr. Daniel Goleman, the psychologist who articulated the concept, contends that intelligence and technical knowledge are important, but emotional intelligence is the sine qua non of leadership (Working with Emotional Intelligence; 2000, Emotional Intelligence; 2006)

  • He studied nearly 200 large companies and found that effective leaders have a high degree of emotional intelligence while individuals without it, even though they may have a first class education, exceptional training and have good ideas, are not effective leaders

  • According to Dr. Goleman there are five components: Self Awareness, Self Regulation, Motivation, Empathy and Social Skill:
    • Self awareness means recognizing and understanding your own values, moods, emotions and drives and their effect on others; leaders with high self awareness are self confident and realistically assess themselves and others
    • Self regulation is the ability to control or redirect disruptive impulses or moods, to temporarily suspend judgment - to think before acting; the self regulated leader is never impulsive and is seen as trustworthy and open to change
    • Motivation is the third essential of emotional intelligence; it is a passion for work for reasons that go beyond money or status or the usual rewards
    • The motivated leader pursues goals with energy and persistence, not for what it will get them but for achievement's sake alone

  • The first three components of emotional intelligence, self awareness, self regulation and motivation are skills about managing the self; the last two, Empathy and Social Skill, concern a person's ability to manage relationships with others:
    • Empathy means considering your associates and employees' feelings when making decisions; empathy requires the ability to understand the emotional make up of others, to care about it and treat people with consideration
    • Social skill is not simple; it's more than friendliness, although people with high social skill are rarely mean spirited; social skill means proficiency in managing relationships and building networks; an ability to find common ground and build rapport

  • Developing or enhancing emotional intelligence and thus leadership effectiveness is not simple; it cannot happen without a sincere desire and a concerted effort
Beyond the hospital
  • Achieving excellence, renown and a reputation outside the hospital or healthcare system inevitably makes the pathologist more valuable inside the system
  • Prerequisites
    • Maintain an academic and intellectual attitude
    • Recognize the value of organized medicine
    • Understand your role in your community
    • Develop a philanthropic agenda
  • Some Things to Do
    • Obtain an appointment at your local Medical Schools - teach, attend conferences, bring students or residents to your hospital for rotations and participate in research studies
    • Become active in professional societies, including the local Pathology Society, County Medical Association, AMA, ASCP and CAP - not only as a member, but as a contributing member of committees and eventually as one of the leaders
    • Become active in your community - have a civic and political agenda - serve on the school board, join service organizations
    • Participate as a contributor and also as a leader in community and hospital fund raising campaigns
Connecting to clinicians
  • Pathologists are "Information Specialists"; they do not perform surgery, prescribe or administer medications; they provide information that other physicians use to diagnose and treat
  • The effective transmittal of that information demands interpersonal and communication skills and requires interfacing with the pathologists’ prime information recipient - the clinicians
  • The pathologist's relationship to other physicians is that of colleague, consultant, friend and educator but requires diplomacy, empathy and humility
  • Prerequisites
    • Remember you are a physician first and a pathologist second
    • Comport yourself and dress like the clinicians
    • Have knowledge and experience in clinical medicine and patient care
    • Know how to use the laboratory to solve clinical problems
    • Be sensitive to the unique problems of clinicians
    • Be informed about key and critical patients
  • Some Things to Do
    • Obtain a locker in the Surgeon's dressing room and change into scrubs there - like the other docs do
    • Make "rounds" in the Doctor's Dining Room twice a day - at morning "break" time and at lunch; never eat lunch by yourself, behind your desk in the basement
    • Make your office a welcoming place for clinicians to come and look at the slides of their patients' biopsies or just to come and chat
    • Personally call all critical surgical pathology diagnoses - but don't only call the surgeon, also call the primary care physician who referred to patient for surgery in the first place
    • Establish a computerized system of critical values in clinical pathology and pro-actively call the attending physician with the results, but be aware of the sensitivity, specificity, predictive value and interfering substances of the test before calling
    • Establish a system for complaint management and conflict resolution; handle complaints yourself - do not delegate; when a problem arises, always thank the individual who brings it to your attention
    • Develop social connections with clinical colleagues
Leading / Connecting in the hospital or healthcare system
  • Because the pathologist laboratory director is responsible for the overall operation of the laboratory, including assurance of quality and budgetary prudence, there must be a good working relationship with the administration of the hospital or healthcare system
  • The pathologist will necessarily interact with many department, including nursing, human resources, finance, purchasing and information technology
  • The pathologist (and the laboratory) will report to, and be accountable to the hospital administration is some way
  • Thus the pathologist must be able to deal with these non-physicians, be familiar with their nomenclature and know how to use their services to help the laboratory achieve excellence
  • Prerequisites
    • Knowledge of health care economics
    • Empathy toward the problems faced by hospital administration
    • Knowledge of hospital organization
    • Regularly scheduled, monthly, formal meeting with the administrator in charge of the Laboratory with an agenda that includes: review of workload, revenue, budget variance and productivity; there should be discussion of needs, problems, incidents, any awards received or papers published
    • The pathologist should establish rapport (professional and social) with the COO, CEO and CFO and with key people in the sponsoring organization, e.g., religious order, municipal or county boards and governing bodies
  • Some Things to Do
    • Conduct daily "administrative" rounds - walk by the offices of the various administrators, just to say "hello" or to see if they want to get a cup of coffee - or at least say "hello" to their secretaries
    • Maintain a high level of visibility; continually remind administration how critical you are to the operation of one of their largest departments in terms of overall management responsibility, test selection, assurance of quality, result interpretation, adherence to regulations, medical-legal responsibility and cost control
    • Prepare an Annual Report of the laboratory's activities, demonstrating that the pathologist is indispensable
    • Participate in the laboratory and hospital budgeting process
    • Participate in hospital committees such as Utilization Review, Joint Commission Inspections, Purchasing, Information Technology
    • Participate in hospital events, e.g. Christmas parties for employees
    • Volunteer to be active in, and contribute to fund raising campaigns
    • Conduct nursing "rounds" - visit each nursing station in the hospital at least once a month to find out if the laboratory services are satisfactory; this establishes a relationship between the pathologist and the rest of the hospital; take the chief tech with you - the nurses and the doctors you encounter will see who is in charge and the chief tech can implement needed changes; report both problems and compliments back to the laboratory personnel
    • Volunteer for in-service educational programs for nurses and other hospital personnel, e.g. seminar for chaplains regarding autopsies
    • Volunteer to be the medical information officer for the hospitals information system - no physician is better suited than the pathologist to fill this role since the pathologist is an expert in computers, automation, QC and QA as well as disease and practice management
Leading in the laboratory
  • Pathologists, unlike other physicians, are responsible for the quality of work of large numbers of others, including phlebotomists, technicians, technologists, doctoral level scientists as well as transcriptionists and clerical personnel
  • This staff produces much of the work output of the laboratory without direct, personal oversight of each procedure or test by the pathologist
  • Thus the pathologist, who has both the operational and legal responsibility for the laboratory's work, has to be a true leader who inspires, serves as a role model, and motivates the staff to attain the highest levels of ethical and conscientious performance
  • Prerequisites
    • Know the basic principles of management & administration: planning, leading, organizing and controlling
    • Assure productive work and worker achievement
    • Be competent in the technical aspects of anatomic and clinical pathology
    • Know employees by name, know something about their personal lives and respect their worth
    • Be able to communicate the clinical significance of test results to laboratory staff and to demonstrate the importance of their work in patient care
  • Some Things to Do
    • Construct and display an organizational chart that clarifies authority and reporting relationships
    • Make work relevant and meaningful by involving employees in decision making when appropriate
    • Make daily "rounds" in each section of the laboratory, greeting each employee by name, getting a sense of the workload, staffing, any problems or interesting cases; don't neglect the evening, graveyard or weekend shifts, surprise them with occasional donuts or pizzas
    • Participate in the special activities of the lab staff, including social events
Leading / Connecting in the medical staff organization
  • The medical staff of a hospital or health care institution is responsible for establishing, monitoring, assessing and ensuring compliance with standards for professional quality and performance
  • The medical staff organization is responsible for appointing and re-appointing the institution's professional staff and for delineating the privileges of each appointee
  • In many instance, the medical staff is also responsible for establishing and maintaining an educational program for its members
  • Much of the work of the medical staff is performed through committees such as Infection Control, Transfusion, Tissue and the Executive Committee
  • It is essential for pathologists to become active and to assume leadership positions in the medical staff organization
  • Prerequisites
    • Communication skills
    • Read the medical staff By-Laws and Policies; be aware of the structure and hierarchies of the medical staff organization
    • Volunteer for service on committees, especially those in your area of expertise
    • Volunteer to chair committees, but first know how to conduct and chair a meeting
    • Volunteer to present educational programs, but first know how to give a talk
  • Some Things to Do
    • Cheerfully accept any committee assignment
    • Request assignment to specific committees, e.g., tumor board, infection control, transfusion, tissue committee and volunteer to chair the committee
    • Participate in Medical Staff oversight functions such as Utilization review, peer review, performance measurement and outcomes research
    • Present educational programs, such as CPC's and organ recitals
    • Contribute to, or edit, the medical staff newsletter
    • Establish periodic conferences with clinicians regarding appropriate use of the laboratory
    • Participate in Medical Staff social events, e.g., dances, golf tournaments
Leading / Relating in the pathology group
  • The organizational structure of pathology groups varies widely
  • Some groups are part of a larger entity, such as Permanente or an academic medical practice group
  • Sometimes, a single pathologist has a contract with a hospital and employs other pathologists
  • In other cases, there is a partnership of professional corporations
  • Other models include simple employment by a commercial laboratory or by a government entity, such as the VA
  • Regardless of the structure, pathologists will probably spend more time with the practice group than with their families, and thus both professional and personal satisfaction depend upon a collegial and supportive practice environment
  • Prerequisites
    • A written organizational chart showing the lines of authority and reporting relationships of all the members
    • A written mission and vision statements for the group, separate from the mission or vision of the hospital, as well as a budget for the operations of the group
    • Accepted policies which define each member’s role in the group and procedures for scheduling and vacation planning
    • Written position charters (job descriptions) for the director and for each of the pathologists and other professionals, e.g., PhD chemists, detailing the authority, responsibilities and domains of each
    • Regularly scheduled, formal meetings of the group
  • Some Things to Do
    • Communicate informally on a daily basis; maintain an "open door" policy
    • Prepare an assignment calendar and vacation schedules
    • Establish a peer-review and internal consultation methodology that is non accusatory and non punitive
    • Have bi weekly or monthly formal group meeting, with an agenda addressing recurrent items such as fiscal review, operations review, discussion of incidents, schedules, etc., as well as an open agenda with subjects that can be brought up by any member of the group
    • Encourage social interaction among the group members and their families
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