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Measuring performance and promotability of middle managers.

To take total quality management one step further, clinical laboratories need to focus more attention on the responsibilities and achievements of middle managers.

To be successful during the next few years, and in fact to survive, the clinical laboratory must improve the performance of supervisors and other middle managers. Laboratory directors and managers must develop performance objectives for every managerial and supervisory position. These objectives should go well beyond describing the position. They must outline conditions that will exist when a manager or supervisor has reached a high level of accomplishment.

Clear performance standards serve two purposes. First, they facilitate management in an organized, logical fashion (management by objectives). Second, they permit managers and supervisors to be critiqued fairly.

Managers should be encouraged to participate in establishing these long-range goals and to document what they expect to accomplish within a given time. To test the validity of the system of performance goals currently in place for middle management at your laboratory, consider doing the following exercise.

For each manager or supervisor, write a statement of conditions that should exist in six months if that person satisfactorily fulfills his or her responsibilities. Then ask each individual to write a personal view of anticipated accomplishments six months from that time.

Compare the statements. If you agree on important factors at least 75% of the time, your shared expectations are probably more in tune than are those of top and middle management in your average competitor.

* Scorecards. Keeping score is as important in health care management as in competitive sports. The most desirable performance objectives permit an employee to be measured continuously, first by the immediate supervisor and then by top management. As the clinical laboratory continues to realign goals in an effort to keep pace with our rapidly changing environment, it is crucial that we recognize the achievements of our staff members promptly. Quality management teams no longer confine performance appraisals to the traditional yearly ordeal. Each level of achievement brings an opportunity to establish new and challenging goals.

* Predictions. In the years ahead, the successful clinical lab will measure performance in more creative ways. For example:

* One-on-one collaboration. As group analysis of performance wanes, the employee's immediate supervisor will become more deeply and heavily involved in appraisal. Both manager and director will spend time planning and discussing what the manager is expected to accomplish, where there is room for improvement, and what the director can do to help the manager do the job better. The same pattern for manager and supervisor follows.

* Clear-cut aims. Managers and directors will establish explicit performance goals, considering such factors as quality and quantity of work done, whether the budget has been met, along with overall needs of the institution. These goals will be adjusted to accommodate changes in the laboratory as they occur.

Managers will then know exactly what they are expected to accomplish. They may, for example, be asked to reduce operating expenses by 5% or to increase revenues by 2% to 4% within a year. They may become responsible for improving supervisory Job descriptions, implementing cross-training in all lab sections, or designing and presenting in-service managerial education programs to all staff. Attending meetings and workshops given by professional associations to improve management performance may be required. It is easier to do what is expected when expectations have been spelled out and understood in advance.

* Well-rounded criteria. Short- and long-term objectives, individually and for the lab as a whole, will be established for managers. While quality and cost will continue to be important in measuring performance, more attention will be given to a manager's initiative in helping lab operations and staff to grow and improve.

Equally important will be a manager's contributions to the entire health care community, including national organizations. Managers who demonstrate civic pride and responsibility by dedicating time to associations such as the American Cancer Society and EMT service groups will shine brighter to their superiors.

* Transfer of duties. Directors who can no longer find the time to handle all their responsibilities will expect managers to fill the void. The laboratory director who by necessity spends the whole day involved with patient care considerations or concentrates on any other single area at the expense of leadership duties should consider delegating important but neglected operational responsibilities to the laboratory manager.

* Open lines. Communication between laboratory managers and directors will be frank. Managers who feel that their own supervisors could be doing more to help them meet objectives will not hesitate to say so.

* Grooming leaders. Managers will be expected to seek out and identify leaders in the lab and to help them become promotable. As a result of these efforts, supervisors will be given more responsibility and other staff members will develop supervisory potential. Setting personality differences aside, managers will see to it that laboratorians at all levels work as a team, for personal growth as well as for the good of the laboratory.

* Essential tools. Managers will have strong clinical laboratory experience, communication skills, and organizational abilities. They will be enthusiastic, innovative, approachable, and flexible in meeting special job demands, yet without losing sight of their priorities. While many of these characteristics should in fact be prerequisites for becoming a manager in the first place, some laboratorians who lack these essential traits have been promoted to management positions.

* Personal treatment. One manager's or supervisor's performance will not be compared to another's. Evaluations will be based on individual productivity. The focus will be on measurable results and accountability.

Rather than using the traditional performance appraisal forms, which are limited to numbered rating scales and predetermined categories, laboratory management will tell employees verbally how they are doing. To help facilitate constructive discussion at such evaluation meetings, we have developed a list that can be used as a guideline in measuring the proficiency of middle management.

* Split appraisals. Managerial performance and promotability should not be considered during the same review but evaluated at separate meetings. Otherwise, job potential is likely to be given more consideration than present job performance. Improving performance within the current position should be the first goal.

* Looking ahead. The clinical laboratory must focus on the future rather than on past shortcomings. Managers and directors will work together to initiate new technologies and procedures as they continually seek ways to improve the laboratory.

In the clinical laboratory that is about to embark on a new kind of testing, such as probes, flow cytometry, or cytogenetics, the director will rely heavily on the manager to research and help decide what resources will be needed for a smooth transition, including a full cost assessment.

* Acknowledgment. The manager is quickly becoming the pivotal person in the laboratory. As the fulcrum in getting the work done, managers will expect their contributions to be recognized, measured, and rewarded.

Recognition is a useful tool that all managers should use often. Besides giving employees a feeling of enhanced self-worth, it affords a benchmark for progress. Receiving an honest and well-deserved compliment can be exhilarating--and highly motivating.

In conclusion, utilizing the above ideas contributes to growth and reduces the stress that leads to burnout. After all, performance and productivity of the management team is a vital part of total quality management.

General references:

Black, H.S.; Hart, R.C.; and Peterson, O.M. Program development and the planning process in the laboratory. In: "Laboratory Management Principles and Practice," chap. 1, pp. 3-19. New York, Van Nostrand Reinhold Co., 1988.

Blanchard, K.; Carew, D.; and Parisi-Carew, E. "The One-Minute Manager Builds High-Performing Teams." Escondido, Calif., Blanchard Training and Development, Inc., 1990.

Evans, M.G. Satisfaction with the importance of various facets of the job. Personnel J. 49: 740-741, 773, September 1970.

Green, C.M. Relationship among role accuracy, compliance, performance evaluation, and satisfaction with managerial dyads. Acad. Manage. J. 15: 205-215, June 1972.

Kafka, V.W. A Motivation system that works both ways. Personnel J. 51: 61-66, July-August 1972.

Koob Cannie, J., and Caplin, D. "Keeping Customers for Life." New York, AMACOM, 1991.

Martin, B.G. 11 keys to quality management in the lab. MLO 22(1): 46-48, January 1990.

Martin, B.G., and Bissell, M.C. Organizing the functions of the lab management team. MLO 22(9): 53-57, September 1990.

Misshauk, M.J. Supervisory skills and employee satisfaction. Personnel Administration 34: 29-33, July-August 1971.

Roche, W.J., and MacKinnon, N. Motivating people with meaningful work. Harvard Bus. Rev. 48: 97-110, May-June 1970.

Wernimont, P.F. What supervisors and subordinates expect of each other. Personnel J. 50: 204-208, March 1971.

Figure 1

Checkpoints for evaluating the performance of middle managers

* Planning

Clearly understands job responsibilities and degree of authority.

Formulates realistic plans and schedules for fulfilling duties.

Classifies work to be done, divides it into workable components, and creates orderly, productive plans to complete tasks.

Prioritizes work for self and staff.

Uses resources productively.

Plans and conducts effective meetings. Avoids unnecessary meetings.

Makes sure staff members have appropriate equipment and materials needed to perform their jobs adequately. Minimizes unnecessary costs, including overtime.

* Initiative

Recognizes priorities. Corrects situations that need improvement.

Develops new approaches to problem solving.

Encourages staff to suggest and try new methods and to contribute constructive criticism in an effort to improve.

Puts into operation worthwhile suggestions made by colleagues.

Confronts difficult situations and acts appropriately.

Participates in community activities outside the laboratory and in national professional organizations.

* Delegation

Effectively delegates responsibility and authority.

Avoids trespassing on authority once it has been delegated.

Encourages staff at all levels to make suggestions and decisions.

Does not get bogged down with details.

Targets responsibilities for supervisors that will provide challenge and opportunity.

* Decision making

Makes decisions consistent with policies, procedures, and objectives of the laboratory and with its economic, social, and political climate.

When making decisions, does not exceed the bounds of authority and ability.

Considers personal experiences and those of others in reaching conclusions.

Accepts responsibility for decisions, even when others were consulted.

Makes decisions promptly but never hastily.

Makes decisions that are realistic and clear-cut.

Takes calculated risks when necessary.

Converts decisions into effective action.

* Standards

Develops performance objectives and standards in conjunction with upper management.

Uses systematic methods to measure performance, productivity, and progress of self and others.

Evaluates continually to readjust the clinical laboratory and work standard of staff as needed.

Makes sure everyone follows standard operating procedures.

Admits to failures in meeting standards and immediately looks for ways to improve.

Determines who is accountable for what, and makes accountability known to all.

* Attitude

Inspires staff to work for the good of the laboratory and patient care.

Demonstrates enthusiasm and enjoyment of work and coworkers.

Exhibits a professional attitude toward work.

Remains cool-headed in difficult situations.

Serves as a quality role model for staff.

Generates a sense of belonging.

Encourages cooperation.

Goes to bat for employees when necessary.

Maintains a proper balance of attention and interest between immediate work group and other departments in the hospital.

* Relationships

Is firm and fair in dealing with staff and associates.

Makes it easy for coworkers to acknowledge and discuss problems.

Visits staff and associates in their areas and offices.

Demonstrates interest in the personal well-being of others.

Understands staff members' problems on and off the job.

Tactfully adjusts to others' personalities and circumstances.

* Communication

Nurtures staff.

Remains aware of what employees are thinking and feeling.

Encourages staff to express ideas and opinions.

Listens with understanding and purpose.

Responds intelligently to criticism of own actions.

Handles questions to the satisfaction of those who ask them.

Explains policy decisions. Keeps staff informed of changes in policies and procedures and other matters affecting their work.

Recognizes good work. Expresses appreciation verbally and in writing, as appropriate.

Makes significant contributions at meetings by offering productive suggestions and analyses.

Informs upper management of employees' accomplishments and professional development.

* Staff development

Selects properly qualified people for jobs.

Assists new employees in adjusting to the job, work environment, and coworkers.

Creates a desire in employees to do good work.

Systematically evaluates the performance of each supervisor and other staff member.

Uses constructive criticism that reflects a helpful rather than a negative attitude.

Discusses career opportunities with the staff.

Martin is pathology management associate and professor of medical technology, and Morris is associate professor and pathology manager, at the State University of New York Health Science Center at Syracuse. Martin will become president of the Clinical Laboratory Management Association this month.
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:managers of clinical laboratories
Author:Martin, Bettina G.; Morris, Michael W.
Publication:Medical Laboratory Observer
Date:Sep 1, 1991
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