& Management ReviewClinical Leadership

Q1 2013 / Volume 27 / Issue 1

❯❯ Our 2012 Achievements Were Plentiful and Valuable

❯❯ CLMA Redefines Its Annual Event, Launches KnowledgeLab

❯❯ Our Future: Succession Planning Should be Top Priority

❯❯ Project Management: Tools to Enhance What You Do Everyday

❯❯ Strategies for Success: Long-Term Care and Laboratory Outreach Programs

Clinical Leadership & Management Review The Clinical Laboratory Management Association

(CLMA) provides leadership in the clinical laboratory industry supporting laboratory professionals at any stage of their career. We educate and advocate on behalf of our members and play a leadership role in enhancing the image and increasing the visibility of our profession.

Vision: CLMA is the premier resource for laboratory professionals, supporting them at any stage of their career.

Mission: CLMA empowers laboratory professionals to achieve excellence in leadership through forward-thinking educational, networking, and advocacy opportunities.

For more information about CLMA, visit www.clma.org.

Clinical Leadership & Management Review (CLMR)CLMR (ISSN 1553-7072), a peer reviewed journal, is a publication of the Clinical Laboratory Management Association. For information on submitting a manuscript for potential publication in Clinical Leadership & Management Review, please see our author instructions at www.clma.org.

Disclaimer: The statements and opinions contained in the articles of Clinical Leadership & Management Review are solely those of the individual authors and contributors and not of CLMA. CLMA disclaims any responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles.

CLMA invites feedback from our readers on any content within Clinical Leadership & Management Review. Please address all comments and/or questions to info@clma.org or call CLMA publications at 312.321.5111.

Editor-In-ChiefAnthony S. Kurec, MS, H(ASCP)DLMkureca@upstate.edu

Managing EditorDennis Coyle dcoyle@clma.org

Editorial Advisory BoardBelinda Baron, MHA, MT(ASCP)Martha Casassa, MS, CLD(ASCP), MT(ASCP)Theresa Colombatto, MT(ASCP)Christine DiehlJack E. Garon, MD, FCAPDr. James S. Hernandez, MD, MSDiana Mass, MA, MT(ASCP)JoAnne Milbourn, BSMT, MHSA, PMPDiane NorthC. Anne Pontius, MBA, CMPE, MT(ASCP)Caroline Satyadi, MBA, MS, CQA, DLM(ASCP), SM,

SLS, CLS (NCA, CA-DPH)

© CLMA 2013

1. The person reading Clinical Leadership & Management Review may view, reproduce or store copies of manuscripts comprising the journal provided that the manuscripts are used only for their personal, non-commercial use. Uses beyond that allowed by the "Fair Use" limitations (sections 107 and 108) of the U.S. Copyright law require permission of the publisher.

2. For permission to copy beyond that permitted by the U.S. Copyright Law and for reprints, contact publications at info@clma.org or 312.321.5111.

3. Any uses and or copies of this journal in whole or in part must include the customary bibliographic citation, including author attribution, date, manuscript title, and the URL www.clma.org and MUST include a copy of the copyright notice.

4. Personal accounts and/or passwords may not be shared.

Volume 26 / ISSue 1 / Q1 2013 [ 1 ]

Q1 2013 / Volume 27 / Issue 1

President’s MessageOur 2012 Achievements Were Plentiful and Valuable ................................ 2By Rodney W. Forsman and Meghan Carey

CLMA NewsCLMA Redefines Its Annual Event, Launches KnowledgeLab ..................... 4

KnowledgeLab 2013 Schedule-at-a-Glance ............................................... 4

KnowledgeLab 2013 Educational Sessions ................................................ 6

KnowledgeLab 2013 Exhibitors and Networking Events ............................ 8

Thank You to Our Sponsors ...................................................................... 10

KnowledgeLab Attendees will Enjoy Orlando and the Caribe Royale Property ............................................................................. 10

KnowledgeLab 2013 Session PreviewsOur Future: Succession Planning Should be Top Priority ......................... 12By Connie Broers, MT(ASCP)

Project Management: Tools to Enhance What You Do Every Day ............. 14By JoAnne Milbourn, BSMT, MHSA, PMP

Getting Control of Your Send-Out Budget… or Toto, We’re Not in Kansas Anymore ..................................................... 16By Rob Carpenter, MS, BA, MT(ASCP)

ManuscriptsStrategies for Success: Long-Term Care and Laboratory Outreach Programs ................................................................ 20By Jane M. Hermansen, MBA, MT(ASCP); and Charlene H. Harris, FACHE, MT(ASCP)

Healthcare Leadership with Labor Union Workforce ................................ 24By Caroline Satyadi, MBA, CQA, DLM (ASCP), MS, SM, SLS, MT, CLS (CA-DPH, NCA)

CLMR manuscripts include identification to the CLMA Body of Knowledge for Medical Laboratory Management.

[ 2 ] ClInICal leaderShIp & management reVIew

P r e s id e n t 's M e s s ag e

Rodney W. Forsman

President, Clinical Laboratory Management Association

Assistant Professor Emeritus of Laboratory Medicine and Pathology

College of Medicine, Mayo Clinic

Our 2012 Achievements Were Plentiful and Valuable

Looking back over the past year, we are pleased with the work accomplished and encouraged as we look to the future. CLMA has developed a new and exciting strategic plan that positions us to deliver more of the resources and advocacy you need. Highlights include:

KnowledgeLab• Solicited and accepted cutting-edge presentations to ensure we deliver the

content needed by forward-thinking laboratory managers

• Developed the first Fundamentals of Laboratory Leadership (FoLL) course to

provide new laboratory managers with the leadership skills they need

Body of Knowledge• Updated the Body of Knowledge (BOK).

• Developed an assessment tool to enable laboratory managers to evaluate their

own knowledge and identify areas for development

AudioLabs and Education on Demand• Developed an updated series of audioLabs that will launch shortly after Knowl-

edgeLab

• Updated our Education on Demand program to ensure a full library of content

that maps to the BOK

Membership and Chapters• Reached out to chapters to encourage their role in CLMA’s strategic plan as we

move forward

• Provided support for chapters to ensure ongoing opportunities for CLMA in-

volvement on the local level

Professional Advocacy• Disseminated information related to the impact of federal legislation and regu-

latory policy on laboratories

• Collaborated with liaison organizations and laboratory coalitions

• Re-launched the CLMA Advocacy Committee to promote the value of the

laboratory in patient care

• Participated in the Legislative Symposium in collaboration with American Soci-

ety for Clinical Laboratory Science (ASCLS) and other organizations

We are enthusiastic about CLMA’s future and hope that you share our vigor. We

thank all of the dedicated volunteers within our committees whose knowledge and

dedication make achievement of our goals possible. We encourage all of you to get

involved at the chapter or international level. The involvement of CLMA members

throughout our organization is what makes us strong and enables us to advocate and

provide the resources you need to demonstrate that CLMA members are leaders. n

Sincerely,

Rodney Forsman, CLMA PresidentMeghan Carey, CLMA CEO

Meghan Carey

CEO, Clinical Laboratory Management Association

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[ 4 ] ClInICal leaderShIp & management reVIew

A s s oc i At i o n n E w sA S S oC I AT I o N N E W S

CLMA Redefines Its Annual Event, Launches KnowledgeLabCLMA presents the new and improved ThinkLab, now known as KnowledgeLab 2013. The event, which is scheduled for April 7-10, 2013, at the Caribe Royale All-Suite Hotel and Convention Center in Orlando, Fla., is a whole new confer-ence. CLMA has been listening to its members and is making sure everyone will get even more from the new sessions and vendors appearing at this year’s event. From engaging educational sessions, great vendors, exciting speakers, and remark-able networking with fellow peers to a fabulous venue, this will be the event of the year for labora-tory managers and one you will not want to miss.

The new KnowledgeLab is a place where:• knowledge is gained,• knowledge is shared, and• knowledge is valued.Attendees will enjoy top-notch educational offerings:• New – Program development with a

blend of submitted as well as solic-ited educational proposals to ensure CLMA is presenting new, leading-edge, relevant content

• New – Lab Leadership Forum for seasoned laboratory executives

• New – Fundamentals of Laboratory Leadership, a course for new manag-ers that is the perfect training ground for those moving into and/or relatively new to laboratory management

• Daily general sessions where all at-tendees can come together to hear noteworthy speakers

• Education geared toward CLMA’s 10 Body of Knowledge domains, covering timely and essential need-to-know top-ics.

To learn more about the conference, in-cluding the top-notch educational offerings, ex-hibitors, and networking opportunities, visit the KnowledgeLab webpage. Register today. n

KnowledgeLab 2013 Schedule-at-a-GlanceSunDAY, APRIL 78:00 a.m. – 5:00 p.m. . . . . . . . . Fundamentals of Laboratory Leadership

(additional fees apply)8:00 a.m. – 5:00 p.m. . . . . . . . . . Ensuring Sustainability: How to Succeed in a

Changing World (additional fees apply)

12:00 p.m. – 3:00 p.m. . . . . . . . orlando Regional Medical Center Tour

MOnDAY, APRIL 88:30 a.m. – 10:00 a.m. . . . . . . . . opening General Session: Michael Laposata,

MD, PhD.10:00 a.m. – 2:00 p.m. . . . . . . . . Exhibit Hall open11:00 a.m. – 12:00 p.m. . . . . . . . Poster Presentation in the Exhibit Hall12:00 p.m. – 12:45 p.m. . . . . . . . Lunch Served in the Exhibit Hall (Round 1)12:00 p.m. – 12:45 p.m. . . . . . . . Body of Knowledge Roundtables1:00 p.m. – 1:45 p.m. . . . . . . . . . Lunch Served in the Exhibit Hall (Round 2)1:00 p.m. – 1:45 p.m. . . . . . . . . . Body of Knowledge Roundtables2:15 p.m. – 3:45 p.m. . . . . . . . . . Concurrent Education Sessions4:00 p.m. – 5:30 p.m. . . . . . . . . . Concurrent Education Sessions6:00 p.m. – 8:00 p.m. . . . . . . . . . Poolside Attendee Dinner

TuESDAY, APRIL 98:00 a.m. – 9:00 a.m. . . . . . . . . . Morning General Session: Michael Astion, MD,

PhD.9:15 a.m. – 10:45 a.m. . . . . . . . . Concurrent Education Sessions10:45 a.m. – 2:45 p.m. . . . . . . . . Exhibit Hall open11:00 a.m. – 12:00 p.m. . . . . . . . Poster Presentations in the Exhibit Hall12:00 p.m. – 12:45 p.m. . . . . . . . Lunch Served in the Exhibit Hall (Round 1)12:00 p.m. – 12:45 p.m. . . . . . . . Body of Knowledge Roundtables1:00 p.m. – 1:45 p.m. . . . . . . . . . Lunch Served in Exhibit Hall (Round 2)1:00 p.m. – 1:45 p.m. . . . . . . . . . Body of Knowledge Roundtables3:00 p.m. – 4:00 p.m. . . . . . . . . . Industry Sponsored General Session: Curt

Johnson, orchard Software4:15 p.m. – 5:45 p.m. . . . . . . . . . Concurrent Education Sessions6:00 p.m. – 6:30 p.m. . . . . . . . . . Annual Business Meeting

WEDnESDAY, APRIL 108:00 a.m. – 9:30 a.m. . . . . . . . . . Concurrent Education Sessions9:45 a.m. – 11:15 a.m. . . . . . . . . Concurrent Education Sessions11:30 a.m. – 12:30 p.m. . . . . . . . Closing General Session: Robert Michel,

Dark Report

Review the schedule online for the most up-to-date information.

*Schedule is subject to change.

Volume 26 / ISSue 1 / Q1 2013 [ 5 ]

[ 6 ] ClInICal leaderShIp & management reVIew

A s s oc i At i o n n E w s

SunDAY, APRIL 7

8:00 a.m. – 5:00 p.m.Fundamentals of Laboratory Leadership

Pre-conference Session – Ensuring Sustainability: How to Succeed in a Changing World

MOnDAY, APRIL 8

8:30 a.m. – 10:00 a.m. Dr. Michael Laposata to deliver KnowledgeLab 2013 general session presentation: Advising Clinicians on Laboratory Test Selection and Result Interpretation with a Diagnostic Management Team

2:15 p.m. – 3:45 p.m.

1A – Project Management Tools to Enhance What You do Everyday

1B - Digital Pathology

1C – IQCP-The ‘Right’ QC for Your Laboratory

1D – Laboratory Service Line Structure and Strategies - Planning for the Future

1E – In this Lifetime: Laboratorians and Clinicians Partner to Reduce Diagnostic Errors and optimize Use of Laboratory Information

1F – Surfing for Technology with a Return on Investment Approach

4:00 p.m. – 5:30 p.m.

2A – The 10 C’s of Employee Engagement

2B – The Business of Affordable Care in 2013

2C – Quality Secrets to a Complete Laboratory Convergence: Part 1

2D – Maximizing Your Laboratory outreach Program: The Path to Success at NGMC

2E – Developing the Emerging Leader – “Grow a Leader - Grow the Lab”

2F - Controlling Lab Test Utilization: A Case Study in ‘Bending the Curve’

KnowledgeLab 2013 Educational Sessions

Governance And Organizational Dynamics

Business And Clinical Operations

Financial Management

Strategic Planning And Marketing

Human Resource Management

Quality Management For Patient Safety

Information Management And Technology

Compliance And Risk Management

Medical Decision Support

Professional Development

Body of Knowledge for Medical Laboratory Management (BOK) Domain Areas

KnowledgeLab2013 CLMA ThinkLab is Now CLMA KnowledgeLab

Volume 26 / ISSue 1 / Q1 2013 [ 7 ]

TuESDAY, APRIL 9

8:00 a.m. – 9:00 a.m. Dr. Michael Astion to deliver KnowledgeLab 2013 general session presentation: The Clinical Laboratory and Patient Safety: Neglected Human Resource Considerations

9:15 a.m. – 10:45 a.m.

3A – CLMA Medical Billing Issues Committee open Forum

3B – Quality Secrets to a Complete Laboratory Convergence: Part 2

3C – High-risk Areas that Create Liability for the Laboratory

3D – Successful outreach Program: Project Management and Facilitation Associated with Clients Interfacing with EMRs

3E – The Past Is Prologue: Healthcare Reform and the Value of the Laboratory

3F – New Guidelines for HIV Diagnosis

3:00 p.m. – 4:00 p.m. Industry-sponsored general session by Curt Johnson: The Current and Future Impact of Market Forces (HITECH, Regulatory, and Scientific) on the Laboratory

4:15 p.m. – 5:45 p.m.

4A – Workforce Planning/Skills and Competencies for the Future

4B - Benchmarking: Your Laboratory by the Numbers

4C – Basic Financial Management of Laboratory operations

4D – The Times They are a Changing: How Tectonic Shifts in Healthcare IT Will Affect Lab Professionals

4E – Town Hall on Patient Safety and Quality Management

4F – Decision Support Systems Panel

WEDnESDAY, APRIL 10

8:00 a.m. – 9:30 a.m.

5A – Leadership’s Responsibilities in Managing Process Improvement Projects

5B – Reducing Phlebotomy Identification Errors in a Community Hospital Using Point-of-Care Technology

5C – Revised outreach Strategic Plan - It Takes a Village

5D – Networking Laboratory operations

5E – Transitioning to the Future of Medical Laboratory Quality Systems (ISo 15189)

5F – You Want What? Getting the Capital Your Laboratory Needs

9:45 a.m. – 11:15 a.m.

6A – Embracing Lean, Business Intelligence (BI), and Strategic Leadership to Achieve Patient Centric Process Improvements

6B – Chemical Management: 2013 Update on Hazard Communication and Chemical Hygiene

6C – How to Develop an Excellent Presentation and Make Your Meeting Work

6D – Succession Planning for Future Bench Strength

6E – Enhancing the Visibility and Value of the Laboratory that Incorporating Patient Safety Strategies

6F – Journey to Automation and Culture Change in Parallel

11:30 a.m. – 12:30 p.m. Robert Michel to deliver KnowledgeLab 2013 general session presentation: Laboratories Respond to New Healthcare Changes

*Educational sessions are subject to change. Visit the listing online for more information, including the full session description and speaker biographies.

[ 8 ] ClInICal leaderShIp & management reVIew

A s s oc i At i o n n E w s

Exhibitors:Abbott Diagnostics

Advanced Instruments, Inc.

A2LA – American Association for Laboratory Accreditation

ALCoR Scientific, Inc.

American Medical Technologists

American Proficiency Institute

American Society for Clinical Laboratory Science

AMS Diagnostics

ARUP Laboratories

Aureus Medical Group

BioFire Diagnostics

Bon Secours Health Systems, Inc.

CareEvolve

CellaVision AB

Clean Harbors

Cleveland Clinic Laboratories

Clinical and Laboratory Standards Institute

Clinical Lab Products

College of American Pathologists

CompuGroup Medical

Cooper-Atkins

Cortex Medical Management Systems

Denline Uniforms

Diamond Diagnostics Inc.

DiCon Fiberoptics

EMD Millipore

eTransX

Eurotrol

Express Diagnostics International, Inc.

General Blood LLC

GG&B Company

Gold Standard Diagnostics

Healthcare Connections, Inc.

Healthpac Computer Systems, Inc.

Helmer

Hemosure Inc.

Hettich Lab Technology

Immucor

Iris Sample Processing

Kawasumi Laboratories America, Inc.

Korchek Technologies

Lattice, Inc.

Lifepoint Informatics

Magellan Diagnostics, Inc. (LeadCare Ultra)

Maine Standards Company LLC

Maxim Staffing Solutions

McKesson

MediaLab, Inc.

Medical Courier Elite

Medical Lab Management Magazine

Medtox Laboratories

Memorial Sloan - Kettering Cancer Center

Minigrip LLC

MLo – Medical Laboratory observer

MoPEC, Inc.

Nev’s Ink, Inc.

NMS Labs

NovoPath, Inc.

orchard Software

Path-Tec

Pevco

Practice Fusion

Rainbow Scientific, Inc.

Roche Diagnostics

SCC Soft Computer

S&P Consultants

Streck, Inc.

Sunquest Information Systems, Inc.

Swisslog

Sysmex America, Inc.

TELCoR

Testo Inc.

The Joint Commission

Thermo Fisher Scientific

Titan Medical Group

TransVac Solutions

U.S. ARKRAY

US Navy Recruiting Command

Viewics, Inc.

Whirl-Pak

WSLH PT

KnowledgeLab 2013 networking EventsKnowledgeLab 2013 offers many valuable networking opportunities throughout the event. Below are some of the highlights:

Orlando Regional Medical Center Laboratory TourCome tour the Orlando Regional Medical Center and discuss laboratory operations and see new equipment with CLMA peers. The tour will take place in the afternoon on Sunday, April 7. Invita-tions were sent in March, and the tour will be filled on a first come, first serve RSVP basis.

Attendee DinnerMonday, April 86:00 p.m. – 8:00 p.m.Come mingle poolside with friends and  new peers, expanding your network!

Lunch on Exhibit FloorMonday, April 8, and Tuesday, April 9Round 1: 12:00 p.m. - 12:45 p.m.Round 2: 1:00 p.m. - 1:45 p.m.

Exhibit Hall ‘Buddy’ ProgramThis new addition to KnowledgeLab 2013 will allow you to meet up with like-minded labo-ratorians and visit the exhibits together.

Ambassador Program Become involved in CLMA’s ambassador program, which is designed to match first-time attendees with previous attendees in hopes that the two will learn from one another and have a more effective and rewarding experience. n

KnowledgeLab Exhibitors and Networking Events

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[ 10 ] ClInICal leaderShIp & management reVIew

A s s oc i At i o n n E w s

Members and past attendees told CLMA they wanted a premier, convenient location, and CLMA responded with a special discounted room rate in popular Orlando and will host all KnowledgeLab events in one location.

At the Caribe Royale All-Suite Hotel and Convention Center, business and pleasure go hand in hand. From the very beginning, the hotel redefined and elevated the standards of the meeting, conference, and family vacation experience in Florida.

Here among more than 50 lush, tropical acres, guests will discover 1,218 spacious, well-ap-pointed one-bedroom suites, 120 luxurious two-bedroom lakeside villas, expansive state-of-the-art meeting and event facilities, unmatched hospital-ity and service, and a wealth of desirable dining options and hotel amenities that will appeal to both families and business professionals alike. And it all can be found just minutes from the area’s world famous theme parks and attractions.

All KnowledgeLab activities will be held at our host hotel:Caribe RoyaleAll-Suite Hotel and Convention Center8101 World Center DriveOrlando, Florida 32821Website

Attendees will enjoy an exclusive discounted rate: $139 per room, per night. To receive this special rate, you must book your room through the CLMA online reservation system. Rooms are limited and are available on a first-come, first-served basis. n

KnowledgeLab Attendees will Enjoy Orlando and the Caribe Royale Property

Enjoy Your Visit to Orlando Come early, stay late! The Caribe Royale All-Suite Hotel and Con-vention Center is the perfect retreat in the center of Orlando. The hotel is also located minutes away from all four Disney theme parks and Downtown Disney and offers free shuttle service. Un-wind after each full day at KnowledgeLab with a trip to one of the area’s many other theme parks, attractions, arts and culture, shopping, spas, golf, dining, outdoor adventures, and nightlife.

Visit Orlando website to view exciting events and activities taking place during your time at KnowledgeLab 2013, includ-ing free things to do in Orlando. KnowledgeLab attendees also have access to advance purchase of specially priced disney meeting/convention theme park tickets. Please note the cut-off date for advance purchase savings is April 6. n

Gold Sponsor

Bronze Sponsor

Education Sponsor

Media Sponsors

ThAnK YOu TO OuR SPOnSORS!

Passport to Prizes Sponsors:American Medical Technologists

ARUP Laboratories

BioFire Diagnostics, Inc.

CareEvolve.com

CellaVision AB

Cleveland Clinic Laboratories

CompuGroup Medical

GG&B Company

Gold Standard Diagnostics

Hemosure Inc.

Lifepoint Informatics

McKesson

MediaLab, Inc.

Medical Courier Elite

NMS Labs

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[ 12 ] ClInICal leaderShIp & management reVIew

H U M A N R E S o U RC E M A N AG E M E N T

The importance of succession planning is not something new. Throughout history, great minds have understood the importance of planning and being prepared for the future. Take the words of Confucius, a Chinese phi-losopher from (BC 551-BC 479)—“A man

who does not think and plan long ahead will find trouble

right at his door.” A couple of thousand years later, Benjamin Franklin (1706-1790), an American statesman, scientist and

philosopher, said, “By failing to prepare, you are prepar-

ing to fail.” Or from current times, Brian Kelly, professional

speaker, best selling author of “Change your Thinking,

Change your Life,” entrepreneur and success expert, said,

“Action without planning is the cause of all failure. Action

with planning is the cause of all success.”

All of the experts in their times can’t be wrong. Has any-

one noticed how the word “success-ion” starts with success?

Webster’s defines success as “an event that accomplishes its

intended purpose,” the Oxford as “the accomplishment of

an aim or purpose.”

Accomplishment and purpose…what more important

purpose do we have as laboratory professionals than to as-

sure the success of our laboratories—today, tomorrow and in

the coming years. How are we going to accomplish that? Join

us for some thoughts and discussion on what has worked

for your organization. Whether you are a young tech looking

toward your future, a “less young” tech approaching retire-

ment age, or an administrator who needs to understand the

importance of having a well-functioning laboratory, succes-

sion planning is an important strategic initiative in assuring

your organization’s success today and in the future. 

With an increased focus on evidence-based medicine

and the laboratory supplying a large part of the evidence,

who is going to do the testing? For those of us retiring in

the next one to five to 10 years, maybe it isn’t our problem,

but who is going to take care of us when we need medical

care? Believing that the laboratory plays a crucial part in

achieving quality patient outcomes, I want to make sure the

place is running well when I retire!

As a lab director in a busy community hospital where

the average age of the techs is in the mid-50s, is there any

question why succession planning is a topic of great inter-

est to me personally? Seventy-two percent of our techs

are over the age of 50. Even more disconcerting is that, of

our 28 techs, more are in their 60s and 70s (seven) versus

their 20s and 30s (four). How many of you are in the same

situation? With fewer schools and intense competition for

newly graduated clinical laboratory scientists, how are we

going to attract and retain those new professionals?

In this session, “Succession Planning for Future

Bench Strength,”we’ll look at the different definitions of

succession planning and what some of the experts in the

field have to say about it. I will share strategies, as well as

share some examples from other colleagues on how they

KnowledgeLab 2013 Session PreviewSESSIOn: SuCCESSIOn PLAnnInG FOR FuTuRE BEnCh STREnGTh

Presenter: Connie Broers, MT(ASCP)Session ID: 6DDate/Time: Wednesday, April 10; 9:45 a.m. – 11:15 a.m.Body of Knowledge Domain: Human Resource Management For more detailed information about Broers’ session, visit the full description online.

Our Future: Succession Planning Should be Top Priority By Connie Broers, MT(ASCP)

Volume 26 / ISSue 1 / Q1 2013 [ 13 ]

and their organization are preparing for the future. This will be a very interactive session, so it will be a great op-portunity to steal other’s good ideas! We will discuss the foundation that needs to be set to make your laboratory a place where people want to work and what resources you need to provide to help develop those future lead-ers. We will also discuss the key role mentoring can play in this process.

When I first moved into an administrative position in the laboratory, I had three days overlap with the former director. A year later, I was still learning tricks around the office that would have been helpful to know in week one. Obviously, the laboratory and I both survived that experi-ence, but how much easier would it have been for all par-ties if there had been a plan, not just a quick fix?

Some great mentoring was a key component in my per-sonal success—or survival—whichever way you look at it! What does it take to be a great mentor, how does a mentee (the one being mentored) maximize the opportunity and learn from it? Throughout the session, we will hear what the experts recommend, how these strategies can actually work in a busy work setting, and how being a mentor has

some unexpected benefits for both the mentor as well as

the mentee. Also integral to successful succession planning

is leadership development. What is your organization doing

to promote young leaders?

How many of you had a similar experience? I learned a

lot during my first year, but the clinical laboratory spectrum

is changing so fast and healthcare in general has so many

challenges to consider, I still find myself learning something

new every day. The better prepared our successors are for

the different aspects (operational, strategic, regulatory, etc.)

of the job, the more time they will have for dealing with all

the changes and meeting those challenges.

Join us at KnowledgeLab and participate in this impor-

tant and timely topic. n

Connie Broers, MT(ASCP), is the administrative laboratory director at Lawrence Memorial Hospital, which was recently named one of the na-tion’s 100 top hospitals by Truven Health Analytics, formerly the health-care business of Thomson Reuters. Broers has 25 years of experience in a community hospital setting, has been a laboratory director for 16 years and has been an active CLMA member for the last 17 years.

Seventy-two percent of our techs are over the age of 50. Even more disconcerting is that, of our 28 techs, more are in their 60s and 70s (seven) versus their 20s and 30s (four).

[ 14 ] ClInICal leaderShIp & management reVIew

b u s i n e s s a n d c l i n i c a l o p e r at i o n s

Do you frequently get assignments from your manager or director and wonder just where you should start? Do you worry about how to get a project done on time with the resources and money available? Project management competencies are

crucial to achieving success in these endeavors.

This key topic for emerging lab leaders is designed to

provide a conceptual framework of project management,

along with some practical application for you to use in your

laboratory. You may not realize it just yet…but you prob-

ably already are a project manager. Consider that every day

you make lists, organize your work, direct others to get

tasks done, schedule time to review progress and worry

about what it is you may not have anticipated. Project man-

agement knowledge and techniques will help you pull your

current talents into a more cohesive package.

Project management is defined by the Project Manage-

ment Institute as “a temporary endeavor undertaken to cre-

ate a unique product or service.” Key attributes include:

• Results oriented – laboratory managers certainly

understand this concept;

• Requires coordination of related activities – some-

what akin to multi-tasking and “herding cats;” and

• Proceeds in steps or increments – sounds like a

process or procedure.

Project management is best viewed as a series of processes

or phases starting with the conceptual phase to define what is

needed and to be done and proceeding through to the closure

phase to hand the finished product over to the business owner.

Projects begin with answering questions such as what,

why, who and when and frequently culminate in the form of

a project charter document (similar to a policy and proce-

dure). Some businesses adhere very strictly to the use of a

project charter created, reviewed, and signed off by all par-

ties affected by the project prior to starting the actual work.

All projects are borne out of some type of business

need. Conceptualizing and clarifying this business need is a

critical first step as it forms the basis for all project work to

be done. Conceptual questions include, for example:

• Who is the business owner or executive stakeholder?

• What are the goals and objectives, and what is in-

cluded or excluded from the project?

• When can the work start and when must it

be finished?

• What constraints will the project be under?

Once this first initiating phase is complete, the project

progresses to a planning phase, where the basic information

initially gathered is expanded into more tangible plans (deliv-

erables) for use throughout the remaining phases. These plans

will address the management of scope, schedule, cost, risks

and issues, quality and communications. Containing the scope

of a project is frequently the most challenging, in large part

because new ideas or challenges come forward or because

someone just wants more. Managing scope does not mean

changes can’t be made, just that all stakeholders must under-

stand and agree to the impacts of scope change. Learning to

apply the principles of the “triple constraint” will assist.

The key elements of the triple constraint are scope, sched-

ule, and cost, with each working in tandem. When one of

KnowledgeLab 2013 Session PreviewSESSIOn: PROjECT MAnAGEMEnT – TOOLS TO EnhAnCE WhAT YOu DO EVERYDAY

Presenter: JoAnne Milbourn, BSMT, MHSA, PMPSession ID: 1ADate/Time: Monday, April 8; 2:15 p.m. – 3:45 p.m.Body of Knowledge Domain: Business and Clinical operationsFor more detailed information about Milbourn’s session, visit the full description online.

Project Management: Tools to Enhance What You Do Every DayBy JoAnne Milbourn, BSMT, MHSA, PMP

Volume 26 / ISSue 1 / Q1 2013 [ 15 ]

these elements is expanded or restricted, the others will like-wise be expanded or restricted. Generally, when scope in-creases, either schedule or cost or both will also increase. It is important to prioritize each of these elements with the busi-ness owner at the beginning of the planning process to serve as a guide. Is the sponsor’s No. 1 priority to have a fully func-tional product to meet customer needs, to have a product out the door by a specific date, or to have a project completed within a specific budget amount? The project will be planned and executed slightly different depending on these priorities.

If managing scope is the most challenging aspect of a project, managing the schedule is certainly close behind. Often the timeframe to complete a project is the least flexible of the three elements in the triple constraint. For example, the labora-tory needs to be ready for an inspection; a new financial sys-tem is scheduled to be live by the end of the fiscal year; a new physician group is moving into the medical office building and requires outpatient services. Preparing a project schedule (timeline) with the most comprehensive information available is critical to meeting your deadlines. Defining the “critical path” of tasks that must be completed will assist the project manager in staying focused on the priorities.

The vast majority of time spent on a project will be in the project execution phase. This is where you will take action to deliver on all the tasks identified in the project schedule, manage and monitor the team’s completion of tasks, and address issues that arise. Tools to assist in managing the ex-ecution of the tasks can be as simple as a checklist in spread-sheet form or utilizing project management software. Recall that one of the key attributes of a project is that it occurs in steps or increments. Regardless of what type of tool is used, the project manager is called upon to manage first things first while at the same time keeping an eye on what future tasks are dependent upon completion of earlier tasks. When a key dependent task falls behind, steps are frequently required to look for opportunities to reduce the time needed for future tasks such that the overall schedule is followed.

Just as a laboratory manager is called upon to manage the operational schedule for the lab’s technologists, holding them accountable for completion of the daily laboratory testing, the project manager is responsible for holding the team members accountable for the project tasks that have been assigned to them. Incorporating specific named resources, not just a ge-neric departmental title, into your project schedule will greatly aid your ability to manage the work to be done. A key compo-nent of every project schedule should include recurring status meetings with all the team members, at which time you will get updates from each to report on the progress of tasks completed.

Once your project has started, a parallel monitor and con-trol phase will also commence. This phase is most successfully completed by using an integrated viewpoint to include the management of scope, schedule, cost, risks and issues, quality,

and communications. Useful tools include status reports and

dashboards for review with not only the project team, but also

key stakeholders and management. Highlighting the status of

each management element with an “RYG” (red, yellow, green)

indicator will assist the project manager and management

focus on the most important priorities. Proposed changes in

scope should be accurately documented through a change

control process that includes all the impacts of the proposed

change such that management can make an informed deci-

sion. Frequently, the project schedule is distilled down to a set

of milestones that represent the critical path for ease of report-

ing and discussion with leadership. Issues that have arisen and

can’t be resolved without input from management should be

categorized by priority. All of this information contributes to

meaningful monitoring of the project.

Project closure processes are designed to ensure that a

smooth transition to an operational state has occurred as

well as to capture information from the project for use in

future projects. Conducting a “lessons learned” session can

provide vital insights regarding what to do differently in a

similar or even different type of project in the future.

Whether it is enhancing the level of details in your project

schedule, knowing that different conversations should be

had to better define scope, or identifying project manage-

ment training needs for team members, the project manager

should not overlook this opportunity.

How can a new laboratory leader begin to use project

management tools and techniques? Start by giving consider-

ation to any assignment and assess whether or not it fits the

definition. Some examples might include:

• Preparation for a regulatory inspection;

• Renovation project within the department;

• Rollout of a new point of care testing service;

• Implementation of a new information system;

• Development of a departmental newsletter; and

• Creation of a phlebotomy training program.

The list can go on and on and not all projects are as

large or complex as some of these examples. Start with

small projects and gradually apply the tools; once mastered,

add others to enhance your project management skills and

success. Lastly, always make every effort to educate those in

your department—leading them into this brave new world

of project management. n

joAnne Milbourn, BSMT, MhSA, PMP, has more than 35 years of ex-perience in healthcare within hospitals and integrated health systems, information technology organizations, commercial reference laboratories, and ambulatory and physician provider settings. She is currently working in the role of enterprise account executive for McKesson Technology Solu-tions Customer Success group.

[ 16 ] ClInICal leaderShIp & management reVIew

B U S I N E S S A N D C L I N I C A L o P E R AT I o N S

Most of us fondly remember the movie, The Wizard of Oz, with Judy Garland’s wonderful portrayal of Dorothy, a farm girl from Kan-sas. In this renowned movie, one of the most memorable scenes is

when young Dorothy emerges from her farmhouse after

a wild tornado-borne ride and steps out into the Land

of Oz. Her first words: “Toto, I’ve a feeling we’re not

in Kansas anymore.” This classic understatement could

apply in many situations, but I suggest that it is an ap-

propriate way to approach the rapidly evolving and

challenging world of laboratory send-out testing and test

utilization management.

This is now my 39th year of work in the clinical labo-

ratory field and my 28th year as a member of CLMA. For

the past 22 years, I have labored as a clinical laboratory

director, most recently and currently at a major pediatric

teaching hospital. In my career, I can think of no other

time when clinical laboratory leaders have been more

challenged with urgent, significant, and seemingly intrac-

table problems that threaten our success and ongoing

livelihood. Of these problems, the relentless pressure of

burgeoning send-out testing costs is certainly one of the

most challenging. Nationally, annual increases of 15 to 20

percent for this testing are typical.1 New tests are being

developed, released, and marketed at an amazing rate,

which only promises to increase over the next few years.

These are among the increasingly strong forces at

work that are creating pressure on clinical laboratories to

provide easy access to the latest and greatest new tests,

many of which are genetic tests which cost hundreds or

thousands of dollars. This is especially true in the pediat-

ric setting, where laboratory tests, many times for genetic

and metabolic disorders, prove to be definitive in making

or supporting the correct diagnosis. This then allows for

the timely selection of an appropriate intervention that

may prevent significant morbidity or may even be life-

saving for the patient.

The instant accessibility of information about new

laboratory tests via the Internet has changed the dynam-

ics of the test ordering process forever. A recent Google

search using the search criterion of “genetic testing” pro-

duced 12.7 million hits, with advertising links to many

test providers. In our pediatric hospital and clinic setting,

we find that many parents come to the hospital or to

their clinic appointments armed with lists of tests they

think may be of value in their situation. Providers may

sometimes take the path of less resistance with these par-

ents and that puts pressure on the clinical laboratory to

step up and provide timely and appropriate guidance to

ensure that the tests are clinically useful and add value.

This is of increasing importance as health insurance plans

KnowledgeLab 2013 Session PreviewSESSIOn: COnTROLLInG LAB TEST uTILIzATIOn: A CASE STuDY In ‘BEnDInG ThE CuRVE’

Presenter: Rob Carpenter, MS, BA, MT(ASCP)Session ID: 2FDate/Time: Monday, April 8; 4:00 p.m. – 5:30 p.m.Body of Knowledge Domains: Business and Clinical operations, Medical Decision Support, and Financial ManagementFor more detailed information about Carpenter’s session, visit the full description online.

Getting Control of Your Send-Out Budget…or Toto, We’re Not in Kansas AnymoreBy Rob Carpenter, MS, BA, MT(ASCP)

Volume 26 / ISSue 1 / Q1 2013 [ 17 ]

Q U A L I T Y M A N AG E M E N T F o R PAT I E N T S A F E T Y

evolve to require ever-higher out-of-pocket costs (co-

pays and deductibles) for patients and families. These pa-

tients and families are, of necessity, paying much closer

attention to the details of their bills and are appropriately

demanding value and accountability from their clinical

laboratory test providers. That said, clinical laboratories

have a lot going for them in the goal to maximize value

in the healthcare setting; while laboratory testing typical-

ly represents roughly 5 percent of a healthcare system’s

total costs, it can, if its services are properly delivered,

favorably influence the other 95 percent of the costs.2

In our laboratory, we have struggled to find answers

to the question of how to best ensure that the tests we

perform in-house or send out are truly clinically useful,

timely, and add value. The cost of send-out testing at

our facility grew by an average of 33 percent annually

from 2007 through 2010,3 with tests being referred to 145

different reference laboratories (see Figure 1, page 18).

We enlisted the help of our quality resources department

to help us to identify the causes of the problem and to

implement effective solutions. We produced a fishbone

cause-effect diagram4 and summarized the causes, which

were then prioritized (see Figure 2, page 19). We also

developed action plans to address the highest priority

causes that were considered to be “low-hanging fruit.”

One of the obvious high-priority needs was reference lab

consolidation, a process that was started and continues

today. In a pediatric teaching hospital environment, there

are many stakeholders in the decision of which referral

laboratory to use, especially for certain tests. But there

are also opportunities for collaboration that may allow us

to bring more testing in-house in a cost-effective manner.

We have taken an open approach to seeking input from

our stakeholders, as we also explore collaboration op-

portunities with other potential partners on our campus.

One of our more creative solutions was the formation

of a special committee to act as a vehicle to improve the

effectiveness of the utilization of clinical laboratory tests.

The committee was initially called the laboratory opera-

tions improvement committee (LOIC) and was sponsored

by the department of pathology and laboratory medicine.

It was chaired by a non-pathologist physician who is

the medical director of our bone marrow transplant lab

and has a special interest in clinical laboratory testing.

Committee membership included the laboratory medical

director, several other key physicians from high send-out

volume producing disciplines (e.g., genetics and neurol-

ogy), other key leaders and stakeholders from within the

clinical laboratory, representatives from lab information

services and computer application services, senior man-

agement, and quality resources. The committee initially

focused on provider education and lab consolidation and

had some success in slowing the rate of growth in 2011

and 2012.5

[ 18 ] ClInICal leaderShIp & management reVIew

B U S I N E S S A N D C L I N I C A L o P E R AT I o N S

In recent months, the committee transitioned to become sanctioned by the medical staff, with a reporting structure up through the chief medical officer. The name of the committee was changed to the laboratory diagnostics and therapeutics committee and membership was expanded to include a genetics counselor and physician leaders from all of the specialties that are major users of laboratory services. The committee charter was modeled after the pharmacy and therapeutics charter, and the concept of establishing and following a test formulary similar to the way one is already used in pharmacy is being developed.

One physician member of the committee, a specialist in neurology, developed (on her own time and at consider-able effort) an elaborate algorithm for the differential di-agnosis of several commonly encountered conditions. She actively uses these in the training of medical students and residents, and it has contributed significantly to our success in improving test utilization for physicians in her discipline. She has been a true champion for the cause of improving test utilization and has set a powerful example for her col-leagues. I hope that we can identify other key physicians with a similar passion among our other frequent lab test users, as I believe that this model of peer education and review works best. It is definitely not the goal of our labora-tory to become the “send-out police;” we believe that given

the proper guidance and decision-making tools, ordering providers will make the right choice in almost all cases.

Another significant recent development was our joining with a newly formed consortium called Pediatric Laboratory Utilization Guidance Services (PLUGS).6 The consortium was founded and is sponsored by Seattle Children’s Hospi-tal, under the guidance of Dr. Michael Astion. Membership is expanding and currently includes 15 members, primarily pediatric hospitals. PLUGS goals are improved efficiency, increased patient safety, and cost reduction for the patient and hospital. I believe that through the collective efforts and combined resources of this consortium, we will be able to achieve much greater success in improving test utiliza-tion in our organization.

For example, the consortium is exploring ways to make the services of genetics counselors available in real time to consortium members. The goal is to allow member laborato-ries to provide timely guidance to ordering providers about the relative value of the ordered tests and to suggest alternatives that would provide more value with greater cost effectiveness. The test utilization control model the consortium encourages members to follow is one in which the laboratory acts as a guidance service, not as a heavy-handed point of resistance. Ordering providers are given important information about the ordered tests in real time, and they make the determination to

Figure 1: Send out Cost Trends

Volume 26 / ISSue 4 / Q4 2012 [ 19 ]

proceed with the test as ordered, modify the order, or cancel the test. Experience following this model at Seattle Children’s7 showed that for 25 percent of the time for genetic tests and 21 percent of the time for tests overall, the provider either opted for a less costly sequential testing approach or canceled the test altogether. Documented savings are significant at roughly $136,000 over a 13-month period from September 2011 to October 2012.

Whatever the setting, I believe the key to success in managing and controlling laboratory test utilization begins with the clinical laboratory’s relationship with the ordering providers. I urge clinical laboratory leaders to explore their options to leverage their existing relationships with key physician leaders in their organizations.

We may not be in “Kansas” anymore, but we will find that our new healthcare “Land of Oz” is not nearly so threatening and troubling if we reach out to our physician colleagues and other internal and external stakeholders to create test utilization management systems that meet the re-quirements of our changing industry. Our patients, families, physician providers, insurance payers, accrediting agencies, and regulatory agencies all expect this from us, and we in the clinical laboratory are in a unique position to deliver. At a time when nobody is lining up to pay us more money for the testing we perform (or send-out), we must create our

own ways to ensure that we are only performing tests that

are the most appropriate, timely, and valuable.

I close with a powerful and appropriate reminder

from CLMA President Rodney Forsman8: “The cheapest test

is the one not ordered, and the most expensive test is that

which provides no value.” n

References1. Michael Astion, MD, Focus on Kids webinar : “Send-out-omics:

Reducing errors and improving quality in send out testing,” 11/19/2012.

2. Rodney Forsman, Mayo Clinic webinar: “Outreach Turning Points: Straight Answers for Tough Questions,” January 2010.

3. PPT slide 14. PPT slide 25. PPT slide 1, already cited6. See website: www.schplugs.org7. Astion, already cited8. Rodney Forsman, Mayo Clinic webinar: “Optimizing Utilization of

Laboratory Testing, 11/18/10.

Rob Carpenter, MS, BA, MT(ASCP), has been the administrative direc-tor of the department of pathology and laboratory medicine at Children’s Hospital Colorado, Aurora, Colo., since 2008. He has been a CLMA mem-ber since 1985 and is a current member of the Centennial Chapter. His professional experience includes 31 years in clinical laboratory leadership and management roles.

Figure 2: Define and Scope Problem

[ 20 ] ClInICal leaderShIp & management reVIew

G oV E R N A N C E A N D o RG A N I z AT I o N A L DY N A M I C S

A hospital-based laboratory outreach pro-gram may serve a variety of market seg-ments, including physician offices and clinics, other hospitals, long-term care facilities (i.e., skilled nursing, rehabilita-tion, assisted living and other residential

facilities), and more. The long-term care market holds

unique challenges that are due to the unique business

aspect of this customer segment. The other challenges

are due to the distinct patient care aspects that long-term

care facilities must manage and are utterly dependent

upon the laboratory for support. A successful laboratory

outreach program will be able to effectively address the

service, business and patient needs of long-term care fa-

cilities and support the integration of laboratory results

across the full continuum of care.

Outreach Benefits and Long-Term CareStrategy for success: Recognize the role that long-term

care facilities play in the continuum of care.

Laboratory tests play a vital role across the entire patient

care continuum, spanning from ambulatory (outpatient), to

acute (inpatient), to post-acute (rehabilitation and long term).

When testing ordered in all of these locations is performed

by the hospital laboratory, it supports the integration of care

by 1) providing consistency of results within the patient’s

single medical record and 2) may lower overall costs by

reducing duplication and redundancy in testing. Further-

more, within today’s integrated delivery systems, providers

and their patients move between affiliated entities, and the

hospital laboratory provides valuable support across all the

system locations. Providers become accustomed to the high

quality of testing provided by the hospital laboratory, and,

in some cases, the laboratory’s support of a long-term care

facility within the community can increase awareness of

the laboratory outreach program and lead to an expanded

presence within the overall outpatient market. Many skilled

nursing and rehabilitation facilities are serving patients that

have increasingly acute healthcare needs, and the non-acute,

ambulatory patients reside within assisted living facilities.

Laboratory outreach programs that are able to also support

assisted living facility patients will aid in promoting testing

compliance within this population. Appropriate utilization of

outpatient testing and patient compliance will be increasingly

more important as reimbursement is tied to outcomes and

healthcare systems are penalized for hospital readmissions.

Outreach Beyond the Laboratory Strategy for success: Expand your relationship into other

service lines of your institution.

In many cases, the laboratory is not the only ancillary

service that a long-term care facility requires. Patients

Strategies for Success: Long-Term Care and Laboratory Outreach ProgramsEditor’s note: This article is part of an ongoing series detailing successful laboratory outreach programs. The last installment ap-peared in the Q3 2012 issue of the Clinical Leadership & Management Review (CLMR). Visit the CLMR archive to access that article.

By Jane M. Hermansen, MBA MT(ASCP); and Charlene H. Harris, FACHE, MT(ASCP)

Volume 26 / ISSue 1 / Q1 2013 [ 21 ]

require other services that the hospital provides, includ-

ing different rehabilitation modes, respiratory therapy,

imaging, pharmacy, etc. The laboratory may serve as the

avenue for vertical integration with other services pro-

vided by the hospital or health system, which further

expands the integrated medical record and strengthens

the continuum of care.

A Good Place to Start?Strategy for success: Excellent customer support and ser-

vice will be your competitive advantage.

When hospital laboratories first begin an outreach pro-

gram, it is not unusual to target long-term care facilities.

After all, it is a familiar environment when compared to

the hospital, with patients occupying beds and requiring

phlebotomy service. In the early phases, some hospital

laboratory outreach programs may not have a well-devel-

oped infrastructure to support the traditional laboratory

outpatient market and may view long-term care facilities

as a lower-demand customer type. Additionally, in markets

where insurance contracts have severely limited the hospi-

tal’s access to outpatient laboratory testing, long-term care

facilities can provide a relatively stable source of outreach

income, as there are fewer payor-related restrictions. Due

to the relatively intense and localized service requirements

of this market segment, in most communities, there is little

competition or strategic focus on this market segment from

the national commercial laboratories. However, the compe-

tition can be fierce in some markets where regional labora-

tories that specialize in testing for long-term care facilities

have established a service niche. Regardless of competition,

when a hospital laboratory is able to provide a reliable and

skilled phlebotomy service (including STAT support) with

timely test results that are integrated into a comprehensive

medical record, the providers and their patients associated

with a long-term care facility recognize the benefits of test-

ing continuity through the outreach program.

An Outreach Customer with Unique Challenges Strategy for success: Become a healthcare partner, not

a vendor.

Performing the laboratory tests for long-term care

facilities is likely the easiest part of this relationship. By

nature of the facility’s business needs and the patients

receiving care, the laboratory must be able to effectively

balance both of these aspects in order to have a successful

outreach relationship. Many long-term care facilities ex-

perience a high level of staff turnover, and the laboratory

must continually work to establish relationships with staff

within the business office and nursing units. A success-

ful laboratory outreach program will assign a dedicated

person who is able to work with the long-term care facil-

ity and understand the day-to-day operations. They can

work together with staff members to resolve problems and

breakdowns in communication and service.

Strategy for success: Understand the specific needs of

SNF and ALF patients.

In the past, long-term care facilities were called “old

folks’ homes” and the residential population was fre-

quently ambulatory and non-acute. Laboratory tests were

ordered infrequently, and if a patient was ill enough to

require immediate testing, they were typically admitted to

the hospital. In the current healthcare environment, long-

term care facilities provide a more acute level of care

for patients and are also known as skilled nursing facili-

ties (SNF). As part of the healthcare integrated delivery

system, overall financial issues of bundled payments and

30-day readmission penalties impact the type and level

of care that long-term care facilities provide. In order to

keep patients out of expensive hospital beds, SNFs have

increased the level of care that they provide for patients

and are more like hospitals than the old folks’ homes of

yesterday. Today’s assisted living facilities (ALFs), many

of which are physically located near and dually oper-

ated by the SNF parent company, provide a non-acute

residential environment and may leverage the laboratory

in a supporting outpatient role (see Figure 1).

Figure 1

[ 22 ] ClInICal leaderShIp & management reVIew

G oV E R N A N C E A N D o RG A N I z AT I o N A L DY N A M I C S

Strategy for success: Provide flexible reporting mechanisms.Across the United States, physician offices are adopt-

ing electronic health record systems and becoming “pa-perless.” Although SNFs are providing an increasingly complex level of skilled nursing care for their patients, many have not adopted sophisticated information sys-tems at the same pace as physician offices. It is common for them to retain a hard-copy patient medical record system. This lack of electronic sophistication may make it easier for a hospital laboratory outreach program to serve the SNF customer, as manual and faxed reporting options remain acceptable. However, a manual system also creates challenges related to managing the business and billing aspects of the relationship.

Strategy for success: Establish relationships with the SNF billing office staff and manage the Part A and Part B patient census list.

SNFs typically must manage billing for a variety of patient types, and the laboratory must be able to accom-modate these different patient types. The most common challenges are related to managing billing for Medicare patients. Those that are in the first 100 days of their stay in a skilled nursing facility are considered “Medicare Part A,” and the laboratory must directly bill the facility for the testing. Because the facility receives a lump sum for the Part A patient, competitive pricing for testing may be a factor in selecting a laboratory. For patients that are not Medicare Part A (i.e., Medicare Part B and other insurances), the laboratory may bill the payor in the same manner as for other outreach testing. The largest chal-lenge in managing this billing is to know which Medicare patients are Part A (bill to the facility) and the day that they become Part B (bill to Medicare). This transition must be monitored on a daily basis to maintain the cor-rect billing status. A good relationship with the SNF bill-ing office is vital to the financial success of the laboratory outreach program.

Strategy for success: Create a policy for managing SNF patient phlebotomy.

We have acknowledged that long-term care patients are similar to hospital patients in that they occupy beds and require phlebotomy. Unlike the hospital setting, most long-term care patients do not wear an identification band and many may not be fully compliant with the phlebotomy procedures. Unlike the hospital setting, there are few avail-able staff members to assist in holding a patient’s arm or applying pressure for an anti-coagulated patient after a phlebotomy. The outreach laboratory must work with the facility to establish a process to secure staff members’ as-sistance with patients when necessary.

Laboratory Infrastructure and the Long-Term Care Outreach CustomerStrategy for success: Develop a laboratory outreach in-

frastructure that supports effective operations and business

practices.

Several elements must be present in the laboratory

outreach infrastructure to promote the successful long-

term care program regardless of the type of program (i.e.,

SNF, ALF, rehab, etc.):

• Phlebotomy Services: A reliable group of phle-

botomists is one of the core requirements for suc-

cess. Not only must they be independent workers,

dependable with attendance, and have excellent

phlebotomy skills, they must exhibit desirable cus-

tomer service skills with both the patients and the

facility staff. Also, in addition to the routine, sched-

uled phlebotomy rounds, the outreach program

must address the issue of STAT phlebotomies with

the long-term care facility. How will those veni-

punctures be established (i.e., by the facility or the

laboratory’s phlebotomy service)? What are the ex-

pected turnaround times? If the laboratory’s phle-

botomist provides the STAT services, what will the

charges to the facility be? Several models may be

found throughout the United State. In most cases,

the service is provided using hospital phlebotomy

personnel. In some markets, there are outside con-

tracted phlebotomy services that can support SNF

phlebotomy needs. And other times, the long-term

care facility will draw their own STAT specimens. It

is also necessary to establish a process to capture

mileage charges for phlebotomist travel related to

SNF Medicare patients.

• Courier Services: For specimens not collected by

the outreach program’s phlebotomy services (urine

specimens, cultures, etc.), an efficient means for

transporting the specimens to the hospital must be

in place. As discussed in prior articles in this series

(CLMR, volume 26, issues 1 and 3, 2012), a good

courier service must do more than just “grab the

specimens and go.” Similar to phlebotomy services,

different insourcing and outsourcing models are

working within the industry.

• Customer Services: Close communication with

the clinical and business staff of the long-term

care facility is important. There must be an un-

derstanding of the unique needs of these provid-

ers and patients by customer service staff for both

clinical and business needs, which (as previously

discussed) are different and more acute than physi-

cian offices or other market segments.

Volume 26 / ISSue 1 / Q1 2013 [ 23 ]

• Reporting: Various avenues for reporting results

are used, as with other market segments. However,

long-term care facilities have their own medical re-

cord number that should be visible on their reports.

Additionally, there are more frequent requests for

patient population-specific reference ranges (i.e.,

age, chronic disease, etc.). Often, a provider will

have a separate office-based practice in addition

to consulting at the long-term care facility and will

have a need for flexible reporting that separates their

private patients from their long-term care patients,

based on service location and report location. In ad-

dition to test reports, many long-term care facilities

require monthly antibiograms and quality assurance

reports for their patient population.

• Billing: In today’s healthcare environment, bill-

ing is anything but simple and long-term care

facilities add another level to that complexity. The

ability to perform client billing in addition to using

the typical hospital billing pathways is absolutely

necessary to be successful in the long-term care

market. Client billing is used when the ordering

facility is billed for the patient testing and is most

prevalent for SNF Part A patient stays. It may be

possible for the billing (and collection) process

to be handled through the hospital system, but

there are also several third-party billing compa-

nies available that are experts in the process. As

previously stated, long-term care clients are more

sensitive to pricing than is the usual outreach

customer. Because there are billing and collection

cost savings related to creating a single bill for 30

patients rather than 30 bills for 30 patients, it is

customary to offer discounted pricing for client

billing. This discount is determined based on fa-

cility guidelines and local market customary pric-

ing trends. However the discount is calculated,

pricing must never be below cost and must be

auditable. Certainly, the more routine and “easier”

part of long-term care billing is the regular patient

billing. For both types of billing, accurate patient

demographic and billing information, including

medical necessity data, must be obtained from

the long-term care facility. For determination of

Part A or Part B SNF billing, it is best to gather

this this information on a daily basis by working

closely with the SNF billing office. Rarely does the

clinical staff at the SNF have any knowledge of

the Medicare status of their patients.

• Collections: Collections for the regular patient

billing is usually handled through the routine

patient collection processes. However, as many

outreach programs will attest, collecting from

client-billed accounts is a different process from

the routine patient billing process. It is necessary

to create a defined collection process, including

the handling of bad debt clients. The hospital’s

finance department is usually a good resource

to establish guidelines that are consistent with

good business practices and the facility policies.

Finally, it is necessary to perform a monthly re-

view of accounts receivables and related finan-

cial indicators.

As healthcare continues to evolve, one thing remains

constant—the need to provide high-quality laboratory

testing support for medical providers and their patients.

Regardless of the location that the care is provided, the

hospital laboratory has a relevant and important role

across the complete continuum of care. The laboratory

outreach program can support further integration of

patient results and strengthen relationships with other

healthcare providers in the community. Through devel-

oping effective relationships, creating an appropriate

infrastructure and establishing solid business principles,

the hospital-based laboratory outreach program can have

a successful presence within the long-term care market

and the overall medical community. n

jane hermansen, MBA MT(ASCP), outreach program coordinator at Mayo Medical Laboratories, has more than 25 years of clinical laboratory experience working with hospitals in the development and expansion of their out-reach programs. Her experience includes clinical re-search, process engineering, laboratory outreach consult-ing, training and facilitation, and project management.

Charlene harris, FAChE, MT(ASCP), is the director for Laboratory Services for Sarasota Memorial Healthcare System. Harris is a fellow in the American College of Healthcare Executives, holds a double Masters in Health Administration and Health Research, and is an ASCP certi-fied medical technologist.

In today’s healthcare environment, billing is anything but simple and long-term care facilities add another level to that complexity.

[ 24 ] ClInICal leaderShIp & management reVIew

G oV E R N A N C E A N D o RG A N I z AT I o N A L DY N A M I C S

How are your work performances as healthcare leaders in managing your labor union workforce? How much knowledge or skill do you have in deal-ing with the labor unions within your organization under the current econom-

ic challenges and regulatory constraints?

In the past couple years, many experts agree that busi-

ness management practices have been more complicated

than ever before due to the economic pressures and new

regulatory obligations. In the United States, healthcare labor

management has become ever-more challenging under the

current low economic growth and the upcoming Affordable

Health Care Act for America that will start in 2013. The act

would increase taxes by $437 billion for some higher income

individuals to cover the estimated of 32 million uninsured.

This will bring new challenges to healthcare organizations.

These challenges come at a time when a number of

hospitals have closed, merged, and/or laid off staff due

to financial challenges. Many hospital executives are con-

cerned about the extra operational costs due to the addi-

tion of greater number of patients added to the healthcare

services, which institutions are obligated to provide.

In the United States, healthcare practices are governed

by various federal laws such as the Public Health Safety Act,

Clinical Laboratory Improvement Act, and the Emergency

Medical Treatment and Active Labor Act (EMTALA).1 This

statute covers all participating hospitals (those that accept

any federal dollars) with few exceptions (i.e., Veterans

Administration hospitals, Indian Health Services hospitals,

etc.). It requires hospitals to provide care to anyone need-

ing emergency healthcare treatment regardless of citizen-

ship, legal status, or ability to pay. There are no reimburse-

ment provisions. Participating hospitals may only transfer

or discharge patients needing emergency treatment under

the patient’s own informed consent, after stabilization, or

when their condition requires transfer to a hospital better

equipped to administer the treatment.2

Historical and Labor Union LawsWhat is a labor union? Unions are organizations formed

for the purpose of representing their members’ interests

and resolving conflicts with employers (Noe, Hollenbeck,

Healthcare Leadership with Labor Union WorkforceBy Caroline Satyadi, MBA, CQA, DLM (ASCP), MS, SM, SLS, MT, CLS (CA-DPH, NCA)

In the United States, healthcare labor management has become ever-more challenging under the current low economic growth and the upcoming Affordable Health Care Act for America that will start in 2013.

Volume 26 / ISSue 1 / Q1 2013 [ 25 ]

Gerhart, and Wright, 2004). Labor Day, the first Monday in

September, was designated to celebrate the achievements of

organized labor unions in protecting workers’ rights. Opin-

ions about labor unions vary—be it negative or positive—but

labor unions came about as a response to unsafe working

conditions, low pay, and unethical behavior by employers.

Labor unions have been started by organized groups of

employees who work together to keep their employer from

taking advantage of them. In the United States, labor unions

have served as the conduit toward better healthcare benefits,

unemployment benefits, safer working conditions, women’s

right, overtime pay, paid holidays and sick days, shift and

weekend differential rates, child labor laws, and many other

benefits that workers often take for granted.

The Wagner Act of 1935 (or National Labor Relations Act)

had the biggest impact on union-management relations. This

placed the protective power of the federal government firmly

behind employee efforts to organize and bargain collectively

through representatives that they chose. This act created the

National Labor Relations Board (NLRB) who governs labor

relations in the United States. This act was later amended

(known as the Taft-Hartley Act or the Labor-Management Re-

lations Act of 1947) to better balance the rights and duties of

labor and management in the bargaining arena. Most unions

in America now are aligned with one of two larger umbrella

organizations—the AFL-CIO, created in 1955; and the Change

to Win Federation, which split from the AFL-CIO in 2005. Both

advocate policies and legislation on behalf of workers in the

United States and Canada and take an active role in politics.3

The Impact of UnionsHealthcare management has become more complex

with the added layer of labor unions that can represent

an array of employees, from housekeeping staff to physi-

cians. The presence of labor unions in the United States

has been evolving the past several decades and in general

has declined the past three decades in the private sector

(35 to 12 percent); however, they have increased in the

public sector (10 to 36 percent). In general, there’s much

lower participation of union membership among younger

employees (18 to 25 years old), reflecting less than 6 per-

cent of total employees in the group. While certain states

have higher union membership and activities than other

states, most members are older and male residents of the

Northeast, the Midwest, and California.

Over the years, labor unions have had a profound im-

pact on human resource practices. For example, employee

termination must be with just cause and well documented.

A progressive discipline process (verbal warning, written

warning, counseling, penalties, termination) is often fol-

lowed to ensure protection for both the employee and

the employer. A delicate balance between the two must

be in place to avoid union grievances, with appropriate

[ 26 ] ClInICal leaderShIp & management reVIew

G oV E R N A N C E A N D o RG A N I z AT I o N A L DY N A M I C S

provisions for fair management practices. Clear and concise

policies based on the laws and practices per the Equal Op-

portunity Office Commission (EEOC) and Department of

Fair Employment and Housing (DFEH) must be established

and followed. At the time of employee orientation, there

should be a clear understanding of work expectations, as

well as what rights and options are available to them in

order to prevent abuse and improper accusations.

Unions have always been strong advocates for their

employees with the intent of demonstrating fairness in the

workplace. An example of union strength is exemplified in

the following situation: A hospital executive sent written no-

tice to all employees emphasizing the need for them to be

proficient in the use of a new and expensive medical record

information system. Their jobs were contingent in showing

proficiency in its use. Employees of this institution were rep-

resented by several unions. The labor unions collectively sued

the employer and the employer had to rescind the mandate

due to the lengthy termination process that includes additional

employee training opportunities per Memorandum of Under-

standing (MOU) for the bargaining units were not met.

Leadership and Change Management Under Labor Union Workforce

To survive business challenges in a tough labor union

environment and difficult healthcare constraints, the following

actions should be implemented by healthcare management:

1. Motivate team members;

2. Educate team members to understand the expecta-

tions of your organization;

3. Satisfy internal and external customer requirements;

4. Study market changes, including laws and regula-

tions for business operations;

5. Develop a strategic plan to ensure the future of the

organization; and

6. Be informed of all contractual arrangements.

Labor Union Workforce Management ToolAccording to Peter Drucker, a renowned management

expert and accomplished author, “Management is doing

things right; leadership is doing the right things.” Lead-

ers and managers are functionality different. Managers are

responsible for the day-to-day operations by carrying out

tasks that meet the mission objectives. Leaders develop the

vision that drives the mission for the organization. In fulfilling business accountabilities within an organi-

zation, management in labor union workforce needs to be

well-educated in the following areas:

• Business skills: Oral and writing skills, financial,

statistical analyses, quality management, etc.;

• Managerial and business leadership skills: Labor/EEOC policies, corporate/local gover-

nance, knowledge on union agreements, union

grievance procedures, law and regulatory knowl-

edge, strategic planning, employee motivation,

negotiation, etc.;

• Organizational/departmental policies: Chang-

ing business practices with attention to employee

rights and union notifications;

• Develop labor union management interac-tion skills dealing with labor union em-ployees:4 Recognizing and resolving problem

employee issues (missed deadlines, technical

errors, absenteeism, behavioral changes, staffing

conflicts, etc.);

• Know phases of employee discipline: Informal

coaching and counseling sessions—no union rep-

resentation needed, documentation, remedial train-

ing, monitoring, formal disciplinary action (need

union representation); and

• Complete documentation: (H5W method – how,

who, what, where, when, why) using specific,

non-vague words to ensure all aspects of the situ-

ation are covered.

Table 1 is an example of an employee’s documenta-

tion for unacceptable performances and presented to that

employee along with other material discussed in the meet-

ing to memorialize the session. Some employers’ Employee

Assistance Program (EAP) program would include a Formal

Supervisory Referral Program that would provide guidelines

for supervisors/managers in developing formal documen-

tation, etc. and to officially refer employees to the EAP

for counseling. Regardless, when dealing with a troubled

employee, the appropriate steps must be taken to protect

patients as well as other employees.

TABLE 1: unACCEPTABLE PERFORMAnCE DOCuMEnTATIOn SAMPLE

Document title: Coaching and counseling

Name: Lab employee full name

Job title: Laboratory technician

Job category/date of hire: Jan 1, 2013

Union membership: Yes

Situation: Erratic attendance/absences from work

Absence dates: May 11, 18, 25, June 1, 10, 18

Meeting date with employee: June 21

Follow up date scheduled: July 25

Present: Lab manager, lab supervisor, employee

Volume 26 / ISSue 1 / Q1 2013 [ 27 ]

Workplace problems from employee’s conduct:

• Reassignment of staff to complete tasks

• Loss of customer confidence

• Customer and coworker complaints

• Reduction of team morale

• Management help and assistance:

• Provided verbal instruction and guidance on com-

pany rules on June 21

• Provided written hard copies on specific atten-

dance rules and policies: ABC-2, DEF-1

• Provide training and development to motivate em-

ployee: July 2, 3

• Requested employee’s input to determine if the

work environment is or a part of the contributing

factors—record input

• Referred employee to EAP for personal reasons as

contributing factors

• Request guidance from human resources labor re-

lation—who/date/time

Common causes for formal adverse disciplinary actions:

• Incompetency – follow up coach and counseling

session (s)

• Inefficiency

• Inexcusable neglect of duty

• Inexcusable absence without approval

• Insubordination

• Willful disobedience

Conduct formal adverse disciplinary action meeting with

labor union representatives or union shop steward from the

employee’s own work environment or similar job category.

Present documentation and all attachments to employees

and human resources for employee’s file.

• Neutralize and disperse grievances tactfully and

promptly

• Prior to filing any grievance, each union employee

has an obligation to bring to the department man-

ager his or her attention to the matter.

• Answer each grievance, if any, in timely man-

ner with simple and concise sentence for the

response to state the situation or background of

action or decision.

• Always keep a copy of the grievance for your de-

partment and have discussion with the human re-

source labor relation representative of the specific

memorandum of understanding (MOU) provision

in questions and document the discussion

• When the grievance is escalated to a higher level

by the employee who did not satisfy with your

answer to the grievance and a fact gathering

meeting is scheduled

• Prepare detailed document for the incidence/

infraction/policy leading to the new policy or em-

ployee’s challenges

• Attach relevant policy/standard operating pro-

cedure/department manual/organizational goals

and objectives

• Attach labor union provision of the MOU

Attach job description/duty statement/project charters

When dealing with a unionized workforce, managers must

understand union rules and how they may limit certain

practices within a union shop. They have a responsibility

of ensuring a safe work environment for their employees

yet balance this with their responsibilities to the organiza-

tion. Hasty decisions, improper documentation, and weak

leadership can negatively impact the ability of maintaining

a strong workforce.

By avoiding these actions, one avoids perceived

hostile workplace situations, which are counter-produc-

tive and emotionally charged. To provide quality patient

care and meet fiduciary responsibilities, management

must ensure that their employees are competent and

productive, even when faced with tough labor union

mandates. Training for managers and staff proves to be

most beneficial. n

References1. 42 U.S.C., http://en.wikipedia.org/wiki/Title_42_of_the_

United_States_Code, § 1395dd, http://www.law.cornell.edu/uscode/42/1395dd.html

2. 42 U.S.C., http://en.wikipedia.org/wiki/Title_42_of_the_United_States_Code, § 1395dd, http://www.law.cornell.edu/uscode/42/1395dd.html

3. http://en.wikipedia.org/wiki/Labor_unions_in_the_United_States

4. www.nlrb.gov/sites/default/files/documents/1562/employeerightsposter-8-5x11.pdf

Caroline Satyadi, MBA, CQA, DLM (ASCP), MS, SM, SLS, MT, CLS (CA-DPh, nCA), has more than 25 years of extensive clinical experience in healthcare manage-ment and consultation (founder/principal of E-Sat Con-sulting), equipment validation, project management, business and quality performance improvement, labor

union management and contract negotiation, accreditation/external agency audit preparedness, quality management system development, and business leverage and outreach opportunity. Since mid-2012, Satyadi has served as clinical executive, chief laboratory services for State of CA CCHCS, which is located in Sacramento, Calif., and provides oversight for 34 institutions statewide.

330 N. Wabash, Suite 2000 Chicago, IL 60611Phone: 312.321.5111FAX: 312.673.6927Email: info@clma.org Website: www.clma.org