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Organizing the functions of the lab management team.

Organizing the functions of the lab management team

Much discussion and debate over the past several years have centered on the responsibilities of the director of laboratory services. Unfortunately, much of this dialog has ignored the basic principles and concepts of management.

In this article we will describe what we believe works best: a team approach in which major tasks of the manager and director are clearly delineated. We define the director as the person with ultimate responsibility for the lab. The laboratory manager works in concert with this individual to see that daily operations are carried out. * Utilize your staff. The resources available to management consist basically of human resources and material resources. Traditional management has focused on the latter, while modern management emphasizes the former. A good definition of management is getting tasks accomplished with and through other people. This definition is not to be taken so literally as to disregard nonhuman resources.

Widely recognized functions of the management team include goal setting, planning, organizing, staffing, directing (leading and motivating), communicating, and controlling. These functions, which have both medical and nonmedical overtones in the clinical laboratory, are interrelated. Control, for example, is not possible without objectives and plans; these in turn may have to be modified because of the results of the control process.

The management team must recognize the varied interests of different groups associated with the laboratory. The laboratory as a business has clear responsibilities to its owners, its customers (physicians and patients), and such other groups as nonphysician health care professionals. If management satisfies the needs of these various groups, additional resources will typically be made available when necessary. * Who reports to whom? When more than a few people are active in any organization, the benefits of functional specialization become obvious. This holds true for the clinical laboratory. A flowchart can be devised to reflect the specified functions of the lab staff.

A group with a simple structure usually follows a line organization. In this system, authority flows directly from the top executive to the workers, usually through several individuals at lower management levels. An advantage is having defined lines of responsibility and authority. Some refer to this setup as military because the Armed Forces rely heavily on a direct chain of command. In the lab, the line organization works downward from the laboratory director to the lab manager to the supervisor and finally to the laboratory staff. * Drawbacks. The line organization does have some disadvantages. First, each supervisor must be able to perform all aspects of the job - instrumentation, training new employees, preventive maintenance and repair, quality assurance, and lab safety, including universal precautions. Second, members of the organization tend to become so involved in day-to-day operating problems that they have little time for planning. A third pitfall is that coordination between the lines of authority may become difficult, particularly in large clinical laboratories. As soon as an organization's activities become relatively complex, simple line organization, in which a single supervisor becomes responsible for too many duties, may no longer be satisfactory.

In early developmental stages of the principles of management, shortcomings of the simple line organization were addressed by making the worker responsible to two or more supervisors, each a specialist. Thus the supervisor of a specific area was in charge of all employees who worked in that area. The personnel supervisor, for example, was responsible for all personnel duties and had full authority over all workers regarding personnel-related matters.

Although this system had the advantage of utilizing the principles of specialization, serious conflicts arose when staff members had to answer to more than one person. Among the most important modern-day management principles is that every person in an organization should have only one formal immediate boss.(1) * Working through others. In a line-and-staff organization, supervisors are no longer expected to be highly competent in all phases of their jobs (Figure I). Instead, specialists function in laboratory staff or advisory positions rather than in a supervisory capacity.

Under this plan, the manager is responsible for all personnel matters, but not alone. He or she works through the hospital's human resources department as well as with the immediate supervisor in whose section the problem originated. The manager and supervisor are part of a management team that makes suggestions through the lines of authority to the laboratory director. They are involved in participative management as consultants, even though they may not be responsible for the actual design or implementation of new policies.

The distinction between line and staff departments is not always easily made. In general, line departments are those directly involved in the basic activities of the laboratory. Staff departments, which exist mainly for advisory and service purposes, support the line departments.(2)

Modern clinical laboratories are organized under the line-and-staff system. They have not only line structure but also special staff functions. These functions are basically advisory positions to the line, with no formal authority to carry out recommendations.

Staff positions are usually created for one or more of the following reasons:

[paragraph] to free the director and/or manager of detailed duties;

[paragraph] to enable specialists to assist management with expert advice; or

[paragraph] to train as a potential member on the management team - directors, associate directors, managers, and supervisors.

Although staff organizations have no formal authority with respect to the line structure, their advice cannot easily be ignored. For instance, if a supervisor in the clinical laboratory advises that a certain practice is illegal, that opinion will carry a lot of weight. A staff member then investigates, plans, advises, and serves.

The main function is to be supportive to the director and/or manager.(3) In addition, as a specialist, the staff member should solve special problems even though he/she has no direct authority over line functions. The box at right describes the various types of authority that can be given to a staff function. * Staff size. The span of control (or span of supervision) in the laboratory organization refers to the number of staff members that the director and/or manager can effectively handle. The smaller this number, the more time can be spent in training, assisting, and working with staff as well as in pursuing other activities.

At the same time, reducing the span of control will have a substantial impact on organizational structure.(4) Longer channels of formal communication, resulting from the smaller span of control and the increased number of levels in the organization, tend to impair effective communication. Since communication is the life-blood of the lab, it is a mistake to overlook the consequences of reducing the span of control.

Which structure is most desirable? The answer depends upon the nature of the clinical lab, the type and level of its employees, and many other factors. During the past few decades, business has experimented with larger spans of control and found such spans consistent with modern behavioral approaches to managing people. * Joining forces. The medical director and lab manager (also known as administrative director) must form a mutually acceptable team approach to management. The major duties of directing the laboratory's administrative and financial functions are critical.

Both individuals also have responsibilities toward maintaining JCAHO and CAP accreditation and state facility licensure. While the manager prepares operating budgets and oversees cost centers, the director is ultimately accountable for them. The director must also be directly involved in quality control and quality assurance programs related to each cost center, even though in reality the manager has immediate responsibility for the day-to-day operations that insure QA.

Similarly, while the manager is responsible for preparing reports, payroll records, and other statistical data, the medical director is in charge of physician-to-physician communication regarding appropriate testing and interpretation of test results. The director and manager work as a team in addressing communication (compliments and/or complaints) regarding the staff and functions of the lab.

The medical director coordinates the integration of pathology residents, fellows, and students into the clinical pathology teaching programs. The manager is responsible for coordinating the education and training of medical technology, cytotechnology, and histotechnology students in the laboratory's teaching programs.

Again, the key is team management. The medical director and laboratory manager each plays a major role in planning, equipment maintenance, record keeping, reports, and communication. Both individuals should participate in administrative and other important committee meetings as required. Equally important, both are responsible for professional growth and development not only for themselves but also for those who serve under their leadership.

Performing the duties outlined in this article will enable the management team to function well. We share our views in an effort to promote the principles of management as we see them. We encourage the team approach for lab services - an approach we strongly feel will insure the efficient and cost-effective operation of every clinical laboratory that follows it.

(1) Koontz, H., and O'Donnell, C. "Principles of Management," 4th ed. New York, McGraw - Hill, 1968. (2) George, C.S. "The History of Management Thought." Englewood Cliffs, N.J., Prentice - Hall, 1968. (3) Terry, G.R. "Principles of Management," 6th ed. Homewood, Ill., Richard D. Irwin, Inc., 1972. (4) Massie, J.L. "Essentials of Management." Englewood Cliffs, N.J., Prentice - Hall, 1964.
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Title Annotation:includes information on authority levels
Author:Martin, Bettina G.; Bissell, Michael
Publication:Medical Laboratory Observer
Date:Sep 1, 1990
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