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Quality of care calls for joy and compassion.

Taking steps to support the sheer pleasure of working reaps financial as well as psychological benefits.

No wonder laboratory medicine has lost its glow. Health care facilities and laboratories are chasing after quality assurance with total quality management and other models. Plans drawn with neat boxes, circles, and arrows are projected on screens at special meetings. The viewers include third-party payers, who are squeezing patients, physicians, and health care facilities harder than ever.

Patients are paying higher insurance premiums with larger deductibles on plans that are less comprehensive than before. Accounting firms are hired to find another dime or nickel in any corner. Increasing demands are being placed on health care providers by regulatory agencies, physician review organizations, credentialing committees, and boards of registration.

As mounting pressures reduce the joy of participating in laboratoty medicine, it is incumbent upon each of us to resist the natural response to succumb. By retaining joy and compassion in our interactions with the many constituencies who cross our path, we can promote the quality of our lab services. Only by feeling joyful in the work environment can laboratorians produce and deliver the highest possible quality of service.

One Boston-area community hospital has enrolled every employee in an ongoing program to improve client relations. Clients are defined as employees, patients, and others who deal with the hospital, including the person who calls the wrong number. Efforts to increase the amount of joy at the hospital have bred a staff that collaborates better than ever in delivering top-quality patient care.

* Individual action. Unfortunately, broad-based programs of this kind are rare. Even without institutional support, however, individuals often act on their own to promote quality by bringing joy and compassion to their interactions with others. My own experience, in a number of institutions, yields the following examples:

[paragraph] An oncology patient complains of too much mayonnaise in a tuna salad sandwich. The head chef at the hospital delivers a new sandwich - in person.

[paragraph] The surgeon holds a nervous patient's hand as anesthesia leads to another level of consciousness.

[paragraph] Two phlebotomists' bubbly good humor is so contagious that patients ask for them and tell friends about them. Blood donations from hospital employees rise noticeably.

[paragraph] A woman delivers a healthy infant after experiencing a difficult pregnancy. The obstetrician doesn't hide his tears of joy as the baby releases its first cry.

[paragraph] The cashier in a hospital cafeteria greets every employee by name after their first meeting.

[paragraph] A receptionist stands by the hospital entrance, not behind the designated counter, to greet, direct, and assist each person. Employees respond by smiling whenever they walk past him.

[paragraph] A patient traveling out of state with his young daughters has chest pain and stops at a local hospital. The cardiologist takes the children into his home during their father's brief hospitalization.

[paragraph] A nurse sits with patients when she can, just to talk with them, rather than conversing with other nurses.

[paragraph] Some patients feel ill after donating a unit of blood. The pathologist calls these patients at home to check on their condition and thank them for their donations.

[paragraph] A hospital has promised another hospital 20 miles away a copy of a patient's medical records, but the courier fails to pick them up. The medical records clerk, unasked, delivers the records at the end of her shift.

These 10 anecdotes portray the empowerment of individuals to maintain the human attributes of joy and compassion in a system that rarely acknowledges such factors. As leaders in the lab, we must recognize humane actions. We must learn to model our own behavior to convey and spread joy and compassion with each personal contact. We must design systems that will expand these attributes in our departments. Accounting for successes in this regard pays off financially, too.

* Accountants step in. Laboratorians enter the profession to serve and to be respected as members of a health care team. Instead, too often we grumble about salaries, benefits, hours, conditions, and unions. Physicians feel trapped by advancing age and by fear of a new organization that will exclude them. Health care facilities are demoralized by legislators, bean counters, and administrators who are most deeply concerned about this year's financial report. What they don't see is that a myriad of forces opposing the preservation of an environment that fosters respect, joy, and compassion adversely affects productivity.

Sooner or later consultants are hired whose suggestions may not benefit the organization in the long run. In one case, a nationally prominent accounting firm suggested that a hospital eliminate evening hours for blood bank donors. This change caused the two popular phlebotomists mentioned in one of the anecdotes above to quit. Yet their warmth had cemented the loyalty of a group of employees who had returned repeatedly to donate blood. Following their departure, the number of donations dropped sharply. Buying blood from the American Red Cross has cost the hospital many times the phlebotomists'modest salaries. The accountants did not understand the value of two employees who conveyed joy in their work.

The same audit recommended reductions in lab personnel based on other laboratories' staffing requirements for an equivalent workload. The so-called excess was actually attributable to high employee turnover, which the audit failed to identify. By addressing the issue most frequently mentioned by departing employees - low salaries in a competitive market - the laboratory cut turnover in half in six months. Consequently, it met the goal established by the accountants through reducing the training needed for newly hired employees. Further, morale and productivity gained a boost as staff appreciated the attention and recognition they were receiving. The accountants had projected staffing needs based on workload without understanding the factors that lead to low productivity: lowered morale, higher turnover, increased training costs.

Mere recognition has been shown to increase productivity. It is not unusual for people to remain in jobs they enjoy despite opportunities for higher pay, more convenient commutes, or better hours.

* Self-training session. As long as employees are human beings, not robots, they will respond positively to acceptance, appreciation, and joy. Try the following exercises, summarized in Figure I:

[paragraph] Step 1: Recognize success. Identify a coworker who routinely conveys happiness to others. Put on paper how this person expresses joy. Write a letter to him or her, praising these inspirational powers.

[paragraph] Step 2: Start with yourself. Write down three things you can do immediately to be more joyful at work. Pick one to concentrate on for each of the next three weeks. Examples include recognizing other people's successes, greeting coworkers with a smile, and asking colleagues about their concerns.

[paragraph] Step 3: Don't let yourself off the hook. Quality consists of more than completing a transaction. It involves doing so with both parties satisfied in their hearts and a smile on their faces. Tomorrow, smile all day. Thank people whenever appropriate. It is a start and it feels good.

[paragraph] Step 4: Plan. Identify one area in which a poor attitude is adversely affecting productivity. Define the factors involved and outline a solution. Design a plan with a schedule to implement this solution.

[paragraph] Step 5: Be accountable for success and failure. Good quality in the laboratory can be financially accounted for in terms of sales, just as foreign products of better quality than those made in the United States have gained market share from domestic producers. Similarly, poor quality in the laboratory - the need to repeat tests, re-collect specimens, issue corrected reports, recalibrate assays - can be financially accounted for in terms of the expenses of poor quality. The success and failure to provide a joyful and compassionate environment can be accounted for financially.

Workplaces that inspire joy have higher retention rates and higher productivity than places that do not. At a time of serious financial stress and general distress, we can find and keep many outstanding employees through the inexpensive means of caring for them. Further, laboratorians who are joyful and compassionate will demonstrate their feelings to clients, leading to greater client loyalty, higher staff retention, and growth of the client financial base.

Finally, pursuing joy and compassion is a worthy objective in itself. We naturally strive to provide a joyful and compassionate environment at home. We must also focus on promoting these objectives at work, where we spend so many hours of our lives. Should they not be joyful as well?

The author is a clinical pathologist based in Massachusetts.
COPYRIGHT 1992 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Author:Kaufman, Harvey W.
Publication:Medical Laboratory Observer
Date:Apr 1, 1992
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