EFLM Syllabus Course

Leadership and Management

Laboratory
Management
Geoffrey Baird, MD, PhD
Chair, Laboratory Medicine and Pathology
University of Washington, Seattle, WA USA
August, 2021
Speaker affiliation
o Affiliations: Department of Laboratory Medicine and Pathology,
University of Washington, Seattle, WA, USA

o Past and present membership in EFLM and IFCC working groups:

Pre-analytical phase WG

o Past and present position in your National society: Member, DGKL

(Germany)

EFLM Syllabus Course Geoffrey Baird August, 2021

Conflict of interest disclosure
I disclose the following: Consulting with Avalon Healthcare
Solutions, Inc. (a US company that authors and enforces clinical
laboratory medical and reimbursement policies for insurers)

EFLM Syllabus Course Geoffrey Baird August, 2021

Learning outcomes

If you attend this lecture, at the end you will

know/understand/learn:
1. Basic Principles of Clinical Laboratory Management
2. Common sense approaches to frequent issues that arise in the
clinical laboratory

EFLM Syllabus Course Geoffrey Baird August, 2021

Common Topics in Laboratory
Management
§Finance
§Human Resources (hiring, job force, interviewing)
§Quality System
§Regulations, compliance, inspections
§Patient Safety
§Leadership, teams, negotiation, conflict resolution, apologies
(error disclosure)
§Test Utilization/Demand Management/Stewardship

EFLM Syllabus Course Geoffrey Baird August, 2021

Requirement #1: A Backbone

EFLM Syllabus Course Geoffrey Baird August, 2021

Requirement #2: An Ethical Framework
Autonomy
◦ Help patients come to their own decision

Beneficence
◦ Do “what is best,” which can be nothing

Non-maleficence
◦ Primum non nocere, i.e. “do no harm”

Justice
◦ Deal with limited resources, allocate resources, recognize decisions could burden others, treat others
equitably
EFLM Syllabus Course
Beauchamp T, Childress J. Principles of Biomedical Ethics, 7th Edition. New York: Oxford University Press, 2013.

Geoffrey Baird August, 2021

Requirement #3: Leadership vs.
Management
§Leadership, to me, is a set of ideas and approaches
§Leadership styles
§“Soft” skills are critical
§Management, to me, is a set of actions and applications
§Example: the decision to have a morning “huddle”, and how to
structure it, is a management action, but the style of the huddle,
and how successful it is, depend on leadership skills
§Emotional Intelligence is much more important than technical
skill in leadership, but that does not mean technical skill is
unimportant
Leadership/Management “Styles” in the
Clinical Laboratory
§Directive: securing immediate compliance from team members
§Visionary: providing long term direction and vision for the team
§Affiliative: creating harmony among team members
§Participative: building commitment among team members and
generating new ideas
§Pacesetting: accomplishing tasks to high standards of excellence
§Coaching: offering long-term professional development to team
members
§Source: Korn Ferry 2015-2017 Leadership Styles Workbook
Case Study: Error Disclosure
Autonomy
◦ Patients should be able to receive unfiltered information about their health

Beneficence
◦ Disclosure in general is a requirement for “informed” consent
◦ Disclosure has often been shown to have a benefit (in terms of later litigation, etc…)

Non-maleficence
◦ Misleading patients might harm them emotionally, ie dishonesty is “bad”
◦ Telling patients bad news or about errors might harm them psychologically more than an
inconsequential error

Justice
◦ Where is justice without truth?

EFLM Syllabus Course Geoffrey Baird August, 2021

Barriers to Error Disclosure in the Lab
Often difficult to disclose someone ELSE’S error (by clinician
or pathologist)
Some differences in opinion as to what constitutes an
“error”
Lack of trust that a patient would understand the error if
explained to them
◦ Also, fear of malpractice, fear of harming the doctor-patient
relationship, general discomfort in having unpleasant
conversations, etc… (from Dr. Tom Gallagher, UW)
AMA Journal of Ethics. August 2016, Volume 18, Number 8: 809-816.

EFLM Syllabus Course Geoffrey Baird August, 2021

What Patients Want from Error
Disclosure
•They want harmful errors disclosed to them, even if the harm is
minor
•They want a healthcare provider to admit there is an error
•They want information regarding why the error occurred
•They want to know the effect of the error on their health
•They want to know that a recurrence of this error is going to be
prevented
•They want an apology
Laboratory Errors and Patient Safety 2(1). Interview with
Thomas Gallagher, 2005.
Best Error Disclosure
"I am calling to inform you about a laboratory error. The troponin
result on patient John Doe from March 14 at 14:52, which was
reported as 57 ng/mL, has been changed to 0.02 ng/mL. This was
due to a manual, data entry error. In the laboratory, there was a
specimen for troponin from another patient at the same time as
John Doe's specimen. That patient had a troponin of 57 ng/mL, and
we incorrectly entered that patient's results into John Doe's record.
We are sorry that we made this error. We are doing a further analysis
on this error to look for ways to prevent its recurrence. We will
contact you about this further analysis in the next 48 hours. Please
feel free to call the laboratory supervisor if you have questions."
Case Study – Senior Leadership
You are a department chair of a large clinical department of
Laboratory Medicine. Your regulatory head of the laboratory
has not responded to a few minor quality problems, and
you hear complaints from some of your faculty that the
individual has been loudly critical of their performance,
sometimes in front of other faculty members. What steps
do you take?
Case Study Next Steps
1. The patients are first….investigate quality concerns, discuss with leadership, address
immediately or soon.
2. Interview affected parties involved in disputes (consider confidentiality, retaliation risk, root
causes)
3. Consider mitigating circumstances (personal issues often lead to work problems)
4. Initiate performance improvement plan

Key Points:
Problems in different domains tend to occur together (consider as a Bayesian….one problem
tends to increase the pretest probability of related problems)
If you do a performance improvement plan correctly, there are only two outcomes: they get
better, or they leave.
New Case Study -Urinalysis
You have run manual urinalysis for decades, and are considering
purchasing an automated platform. One of the senior Medical
Laboratory Scientists who has overseen the urinalysis bench for
decades, and has taught generations of others how to interpret urine
sediments, does not like any of the instruments that have been
evaluated. After purchase, validation and implementation of an
instrument, you discover that this MLS performs manual microscopy
on every sample regardless of the automated instrument’s findings,
periodically overruling the instrument. Other staff are confused as to
what to do about this.
Urinalysis follow up
§We are an aging profession, at least in the US. Automation can
be seen as a threat, as it is unfamiliar and can replace some (but
not all) human functions
§There is no standardized approach to speaking with this MLS
(Emotional Intelligence)
§Recognize that in the organizational chart, there are individuals
at the top levels who are tasked with harder, broader goals and
who have more discretion about what methods to employ to
meet those goals. Those further down the organizational chart
have less discretion in choosing how to meet their obligations.
Case Study – An underperforming lab
§ One of your clinical labs has high employee turnover, with
several medical laboratory scientists quitting in the last
month. One faculty member tells you they are looking
elsewhere for new employment. Clinical quality does not
seem affected, but the group works long hours and is falling
behind because there is too much work to get through each
day.
Underperforming lab – next steps
§ Collect data – broad, structured interviews, review
performance metrics
§ Develop plan – respect all feedback (although not all
will be followed)
§ Communicate plan, expectations, timeline
§ Execute and TRACK
Test your knowledge
If you have carefully followed this lecture, you will know the answers to these
questions:
True/False: Emotional Intelligence can be more important for leaders/managers in the
clinical laboratory than subject matter expertise.
What do you consider to be the important features of an error disclosure to a patient or
physician?
What are the elements of a strong performance improvement plan?

EFLM Syllabus Course Geoffrey Baird August, 2021