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The art and science of lab management.

Is lab management an art or a science? Some laboratorians say it's an art, requiring only innate ability or common sense. Others see it as a science analogous to physiology, sociology, or economics. Still others believe it is a combination of the two, demanding both creativity and the ability to deal practically with human, environmental, and financial resources.

Despite one's belief, it's evident that the traditional approach to managing a laboratory is undergoing a dramatic transformation. For decades, lab managers worried only about what went on within the four walls of their department. Their primary concerns were developing budgets and staff and making sum that tests were performed accurately and expeditiously. After all, physicians' ordering patterns couldn't be controlled anyway.

* The black box. Health care professionals outside the laboratory perceived this department as a "black box" of sorts; specimens entered the front door, and results exited the back. Managers of the "black box" were seldom accountable for the impact of those results. As a colleague of mine likes to describe it, clinical test results were dumped into a black hole to be either used or ignored as the primary provider saw fit.

Initiatives such as peer review, quality assurance, and continuous quality improvement are gradually changing this perception, and with it, the role of the lab manager. Today's managers must wear many hats. They must be a manager of people, a business manager, a consultant, and a laboratory scientist. Certainly the "art" of leadership is still important, but lab managers must also be able to integrate their leadership skills (the management of science) with the science of management.

* New tools, boundaries. Frederick W. Taylor, credited with developing the science of management in the late 1800s, defined scientific management as a systematic investigation of all facts and elements of specific work being managed. Such analysis can be accomplished by using an array of new tools - an arsenal of quantitative approaches to making health care business decisions - and by expanding the boundaries of the work that is being managed.

Laboratory managers can play an important role in the clinical management of the patient. To do so, however, they must not only monitor what and where tests are performed but also accept responsibility for the impact of laboratory data on patient care.

Armed with the tools mentioned above, managers can follow patients from diagnosis (test ordering) to treatment (impact of results). They can analyze customer-supplier relationships and the path of work flow, and develop measurable indicators for improvement. They can create flow charts to detail steps in the patient Care process and devise cause-and-effect diagrams to demonstrate multiple factors contributing to a problem.

* Team efforts. A number of health care facilities have become active participants in developing clinical practice guidelines and care plans. Often developed by an interdisciplinary team of experts for multiple institutions, clinical practice guidelines provide specific recommendations for patient evaluation, symptom assessment, and diagnostic testing.

Care plans are often developed for a specific institution by a team of representatives from the service departments that are involved. CareMaps, by the Center for Case Management, Inc., South Natick, Mass., for example, capture the practice patterns of several disciplines and arrange them to best suit patient needs. They also produce important information about quality and cost. Deviations from established patient care activities that could possibly affect a patient's expected discharge date, costs, or clinical outcome are analyzed for possible corrective action. Lab managers who become members of one of these teams have the opportunity to offer valuable insight into such areas as test relevance, test turnaround time, result variation, and lab data utilization.

* The big picture. As the science of management continues to intersect with the management of science, laboratory managers can make meaningful contributions. But they must be willing and able to see the big picture, in other words, to think in broad terms about the lab work being managed.

John R. Snyder Ph.D., MT(ASCP)SH is professor and dean, School of Allied Health Sciences, Indiana University Medical Center, Indianapolis.
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Author:Snyder, John R.
Publication:Medical Laboratory Observer
Date:May 1, 1995
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