Addressing management issues: nonactive medical director and core lab supervisor working too many hours. (Management Q&A).

Nonactive medical director

Q: I work in a 200-bed acute care facility. Our medical director is very aloof and is disinterested in providing direction for our laboratory. This is affecting the morale of the employees. As a supervisor, what can I do to change the atmosphere?

A: Larry Crolla recommends, "Try talking to the medical director and explaining what is happening. Offer solutions that the director can use to correct the problem--like suggesting that he hold a quarterly continuing education session or that he bring in a good case on occasion to show the staff how they have contributed to the patient diagnoses. Ask the medical director about reviewing surveys together when they are returned from your proficiency agency. You can also ask that the director attend your monthly lab meetings, even if it's only for five minutes, to answer staff questions."

Alton Sturtevant suggests, "A subtle, yet effective, method may be to define the team leaders for the various areas of the laboratory (i.e., hematology, chemistry, preanalytic, etc.), and identify them in an organizational document. Sit down with the medical director and go over this structure. Let him know that these leaders are responsible to you, him and the administration for making the laboratory a functional and responsible department. Tell him that you expect him to meet with you and these team leaders on a routine basis to deal with the issues affecting the lab. This group should also develop routine operating policies for the laboratory to respond to the needs of the medical staff."

Dr. Sturtevant adds, "Organize the periodic consultation meetings with a predefined agenda to meet the needs of the laboratory as defined by the JCAHO and/or CAP. Send a copy of the agenda to the medical director, copied to administration, so that all parties will be informed as to the functions of the meetings. Inform hospital administrators about what you have done, and let them know that this structure will provide periodic input to you and the administration on the laboratory for review. Let the director know that regular visits and reports are needed for continued input to administration. Ensure that this interaction and reporting happens.

"Organize routine meetings and continuing education sessions with the medical director and the laboratory staff during his visits to increase staff and director interaction. Involve the director in personnel evaluations and routine competency reviews. Keep the medical director informed of all procedures to be reviewed, changed or deleted to proactively drive the process. Ensure that periodic reviews of JCAHO and/or CAP checklists are reviewed and approved by the medical director and the specific team leader. The approach discussed here is one designed to encourage appropriate director participation in the lab. Should this approach fail to yield the anticipated results, talk directly with your boss and ask him for advice about how to approach the situation with the medical director.

According to Marti Bailey, "There is variation in direct involvement by medical directors with their laboratory staffs. Just like other physicians, medical directors come in a broad range of technical, human resource and management skills. They probably function in large part according to their particular skill sets that, in turn, define their comfort level with certain activities. Just as varied as the medical directors themselves are the job situations they are hired into. In some cases, they're expected to be actively involved with setting direction for the laboratory, while in others they're expected to serve mainly in a technical capacity. In the latter, a laboratory manager or chief technologist usually heads laboratory operations.

"There probably is no one perfect model to follow. Trying to pressure a lab director who has no interest in leading the department or being involved with management functions could easily have a negative outcome. If there is a lab manager or other person at a level between the supervisors and the lab director, then he should have, by default, stepped into the leadership role for the department. It is a lab manager's responsibility to manage the department along with assistance from the supervisors. In this situation, the lab director could certainly serve in a capacity only as consultant for technical or patient-care related issues without the department suffering."

Ms. Bailey adds, "If there is no one between the supervisors and the lab director, it seems to me that this is a golden opportunity for one or more of your supervisors to step up to the bat. Since the supervisors are the people who work most closely with the staff, it is their interest in the staff and in providing good laboratory service that should have the most impact on morale, regardless of the attitude of the lab director. You should get beyond believing that the morale problem is the fault of your medical director. Supervisors are the ones who need to forge excellent relationships with their staff and let them know every day that they're there to help the staff succeed. They're also the ones who can provide an uplifting atmosphere in the day-to-day workplace."

Bottom line. A job description with expectations is needed for all jobs in the hospital, including the medical director of the laboratory. Encourage appropriate medical director participation in the lab. Should this approach fail to yield the app ropriate results, talk directly with your manager and ask him for advice based on specific deficiencies of the director. If all of this fails, then a new director of the laboratory is probably needed.

Core lab supervisor working too many hours

Q: When our laboratory decided to create a core laboratory, management combined the hematology and chemistry supervisory positions to create a new core lab supervisor position. Nothing else changed, including the salary. I now find myself working 60 hours a week to keep up with all the paperwork and problems. What are my options?

A: Marti Bailey points out, "You always have the option of looking for greener pastures if you feel that's a possibility. I'm sure you understand that the situation you find yourself in is not unique. All of the downsizing, rightsizing, mergers, and other reorganizations happening in today's business world seem to have a common theme, and that is fewer people doing more work. In some cases, this is certainly justifiable, but increasingly I see employees beaten to death with insatiable demands on their productivity. A lot of employees take it as long as they can and then just leave."

Ms. Bailey adds, "There is at least one other option available to you--redistribute your workload. There are two ways to go with this, but delegation is at the heart of either. This may be an opportunity for you to provide development for some of your staff members, and in this respect, assigning some of your work to others could be considered a growth challenge. On the other hand, some of your additional workload could justifiably be shared among all of the staff. I'm sure that a fair share of the work you do as supervisor is repetitive, would lend itself to a written procedure and could be handled by someone else other than yourself.

"I don't think that you should simply assume that because two positions were merged into one, you are expected to handle all the tasks and responsibilities of those two jobs. I think it's more likely that merging of the two supervisory positions was not intended to be an isolated change, but that others are depending on you to make additional operational changes needed to accommodate the core lab model. I think you need to develop and then propose a plan to distribute a portion of your workload so that you face a reasonable share of the work of the department."

Alton Sturtevant recommends, "Review the defined structure and your current functions to determine whether you are functioning as you should be, based on the reorganization. If you are not functioning appropriately, then change your functions to meet the definition of the department. If you continue to work the excess hours, talk to your manager and explain your quandary. If you cannot direct changes to help you to meet the need to work less hours, then you must convince your manager to change the functions of the job, or you might do best to seek another position.

According to Larry Crolla, "You need to discuss this issue with your superior. You also need to have options open if you have to take a firm stand (i.e., another job waiting in the wings). I would approach it from the standpoint that you are working extra hours because the scope of the job has changed, and you are supervising more people (rather than bring up the fact it is two jobs in one). Also, no one should have to work a 60-hour week consistently. It sounds like extra help is needed. You may want to lay all your cards on the table because the extra money won't keep you happy for long if you work a 60-hour week every week of the year."

Bottom line. Review the defined structure of the position and your current duties to determine if you are functioning as you should be based on the reorganization. Effective delegation could be a partial solution to your problem. If you continue to work the excess hours, talk to your manager and explain your quandary. Suggest proposed changes to your manager to help direct things in a positive direction.

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.