Service excellence in the laboratory

Our hospital laboratory, like many, is faced with the challenge of reducing costs while maintaining service levels. This is even more evident as we enter a new phase of healthcare reform with an emphasis on cost and outcomes. One of the keys to maintaining high service levels is to develop and foster a robust Service Excellence (SE) program that can pinpoint areas for opportunity and maintain quality. We all face the challenge of managing busy laboratories and meeting the needs of a diverse set of customers. We would like to share with readers of MLO some best practices that we have instituted through the SE program at our institution, the University of Maryland Medical Center (UMMC).

It is vital that labs nurture and retain the trust and confidence of both staff and clients. Indeed, with the new reimbursement models, future success depends upon it. Labs need to focus on the following to achieve this goal:

• Customer Service
• Professionalism and Accountability
• Human investment
• Communication, Relationship Building, and Leadership Involvement
• Efficiency and Productivity
• Advocacy, Public Relations, and Branding

By committing to and practicing all of the above, labs can increase volume (where appropriate) and revenue, improve customer satisfaction, and retain increasingly scarce talent.

Customer Service

Ignoring the significance of quality customer service is short-sighted. Providing exceptional service builds a lab’s reputation and creates trust in clients and patients. A reputation for customer service allows a lab to retain current clients and attract new ones. Staff should continually be reminded that they have a direct effect on people’s lives with every encounter; every sample represents a client and patient. Moreover, every client and patient should be given courtesy and professional and timely assistance.

In that context, here are three broad practices which we believe lab directors should put in place for all staff:

• Have staff (particularly new employees) participate in at least one service-oriented class. It should be incorporated into new employee training and become a continuing education requirement.
• Eradicate the “It’s not my job” mentality and encourage staff to assist one another and be proactive. This positive cultural attitude eventually reaches the customer (and so does its opposite).
• Enforce established standards for behavior and dress. Appearance and conduct are part of the customer service package.

Most laboratories have employees who are more visible to customers than others. Obvious examples are phlebotomists, accessioning staff, couriers, service reps, and call center staff. These employees have the ability to make or break a lab’s reputation and should be given special attention and support.

Most patients do not look forward to having their blood drawn. Knowing this, lab leaders should give phlebotomists enhanced customer service training in relation to their specific job duties. They should be provided with a script which includes the following elements: an introduction, an explanation of the process (including positive patient ID), and asking questions. As elementary as this may sound, a script helps the phlebotomist organize the interaction and cover all the important elements of this crucial interaction.

The phlebotomist should tell the patient what he or she is doing throughout the process, and communicate that he or she is willing to take questions at any time. When the interaction is completed, the phlebotomist should ask if there are any additional questions and thank the patient.

Telephone calls are also a customer touchstone. In most cases, the lab will not receive phone calls when everything is going well; the phone usually rings when there is a question or problem. Whether a lab has a call center, or has dedicated staff answering the phone, enhanced customer standards can also help in this potential problem area. Lab leaders should:

• Provide a script for answering telephone calls.
• Establish standards for the number of rings by which a telephone should be answered.
• Implement a “secret caller” to monitor call quality and ensure that expectations are being met.
• Minimize transferred calls, which customers dislike. Every transferred call is a further delay to the customer and an opportunity to disconnect.
• Make sure the staff is trained regarding the types of calls they can expect and the typical answers they should give.
• Review existing processes. Some specialized calls need to be answered by technical specialists. People and processes should be in place to handle these calls.
• Install and utilize a phone tree.
• If there is a call center, provide adequate staff. The call center is often the first (and only) impression clients have of the lab. It should be appropriately staffed with dedicated employees who can promptly and efficiently address inquiries.
• Have a system in place to triage calls. Some areas fall outside normal call center responsibilities e.g., Anatomic Pathology, Genetic Testing, and other highly technical areas.

The accessioning area, like the call center, is often the first contact many have with the lab.

Lab leaders should make sure that this team is aware of its significance and value. No testing, resulting, or treatment can be performed without first passing through the hands of accessioning. The department needs a strong leader who can guide, empower, and motivate staff. A little technical expertise and street smarts also go a long way.

Following are some tips:

• Leadership should be present, visible, and accessible.
• Procedures for communication, particularly with the off-shifts, should be reviewed and enhanced.
• Processes and task assignments should be assessed—e.g., shared specimens, add-ons, and troubleshooting.
• Staff scheduling should be planned around the heaviest-volume times—e.g., morning run, lunch, and change of shift.

Professionalism and Accountability

The way we see and feel about ourselves is reflected in the quality of our work. As professionals and as a department, we need to develop a sense of pride. Our jobs are essential to the success of our organizations and to the health and well-being of our patients. Lab directors need to instill and cultivate an environment of professionalism, responsibility, and accountability. Such an environment can be nurtured if these guidelines are followed:

• Professional standards should be enforced with regard to behavior, dress, and safety. For example, no cell phones or ear buds in work spaces. No lab coats or shoe covers outside of the lab.
• Proper attire. The staff must follow safety guidelines and don proper PPE—and not just during inspection windows.
• Accountability should be incorporated into the laboratory’s culture. All employees should be held to established standards. Infractions or deviations from process shouldn’t be ignored.
  The medical and nursing staff should be held accountable too. They are responsible for the samples they send—and the hospital’s behavioral standards also apply to them.
• Exceptions and workarounds should be minimized. They may make life easier in the short run, but are detrimental in the long run. They remove a sense of accountability and encourage a “the lab will fix it” mindset that places undue stress upon the staff, serves to reduce the lab’s value and level of respect in the eyes of other departments, and dilutes the lab’s standards.

The needs of the patient always come first. However, the responsibility for patient care does not rest solely on the lab. Lab leaders need to recognize that delays are at times pre-analytical (e.g. batching, improper/incomplete requisitions). Their responsibility and expertise doesn’t stop at their front door. The lab must work with customers upstream to expedite laboratory work with little intervention.

Human Investment

The aging laboratory workforce is creating pressure to find and retain qualified staff. The cost of turnover can be significant if it is not managed properly, so lab directors are increasingly focusing on retention. Lab staff who feel valued and empowered (and see opportunities for growth) are more motivated, productive, and likely to stay within the organization. With that in mind, lab directors should:

• Fully utilize the staff’s talents. Don’t view a person as merely “being” his or her position. Where else could a person be more effectively utilized or fill an emerging need?
• Allow more staff involvement during the hiring process—especially those who will work with the new hire. Strive for transparency and internal “openness” when posting/creating positions.
• Recognize and acknowledge when hires don’t work out, and cut losses as necessary. At times we make mistakes in hiring or promoting. When such errors occur, they should be corrected promptly. In addition, the probation period should be used for its intended purpose.
• Encourage educational opportunities that will enhance the staff’s skill set. Over time, this could bring in more business/revenue as the depth of services and the test menu increase.
• Develop and maintain a good relationship with Human Resources. Strive to establish expectations for communication and timeliness.
• Create possibilities for growth. Look for ways in which the staff can continue contributing to the department. For example, develop possibilities in management, billing/finance, quality, project management, IT, and HR.
• Foster mentorship. A mentoring program can include anything from a “buddy system” to a formal program that is as part of the lab’s advancement model.

Communication, Relationship-building, and Leadership Involvement

Communication is often undervalued and underutilized. Without open and consistent dialogue, confusion and mistrust flourish. Also, a lack of trust is one reason why violations of lab policy often are not reported. Lab leaders need to actively develop a climate of communication and trust, with management leading by example:

• Leaders need to make their expectations clear, open the channels of communication, and be accessible to employees.
• Explanations are a key component of making sure expectations are followed. For example: If a new policy is implemented, the lab director should explain why it is being instituted. Sharing information can encourage staff buy-in.
• Follow-up actions based on communications are critical. Lack of follow-up contributes to staff feeling undervalued and unheard. If lab leaders cannot act on an issue or request, they should clearly and honestly state why. In addition, shift reports and variances contain valuable information that can be acted on.
• Visibility is also key. Managers need to conduct regular rounds, consistently show appreciation, offer regular feedback, and demonstrate support.

Often, labs are divided by discipline. This is apparent even within a Core Lab setting (e.g., Techs and Accessioning, Chemistry, Hematology). Division is even more pronounced within the lab as a whole. Blood Bank, Micro, Molecular, and Anatomic Pathology act as separate, autonomous entities. This hampers productivity due to diminished teamwork, and can lead to problems such as failing to share specimens, or tests falling through the cracks. In this environment, individuals are sometimes reluctant to help one another, and there may be a prevailing sense of self-preservation. This can result in “tribal” thinking, unless cooperation is instilled into an organization’s values and reinforced by good management practice.

Managers need to encourage teamwork. They should consider instituting inter-departmental supervisor meetings, a focused chance for supervisors to meet in a peer-to-peer setting and share issues that may be impacting their staff or departments. They can also institute lead tech/shift coordinator meetings to encourage staff to find resolutions to problems as a team. Everyone should have the opportunity to participate in shaping solutions. This is extremely empowering and leads to better service and employee retention.

Efficiency and Productivity

For labs to grow and succeed, they need to be efficient, productive, and knowledgeable. Many labs are taking steps in this direction through their QA team, Lean Six Sigma engagements, or rapid improvement events, but lab directors can benefit further by
considering these actions:

• Conduct thorough training for all staff, including management, which includes generic management topics, clinical breakthroughs, and job-specific sessions.
• When contemplating educational opportunities, consider all shifts and all roles. Also, find new skill sets to encourage staff to acquire.
• Assess and revise outdated practices. Unsuccessful or impractical methods continue because we fail to address them. If something does not work or is no longer applicable, fix it or eliminate it.
• When a new process is instituted, it must be assessed regularly to determine whether or not it makes sense and adds value. Then, for practices which are fully adopted, enforcement is needed. Even “unpopular” tasks (e.g., call notification, add-on requests), are required job functions and must be performed.
• As a manager, be current. Keep abreast of trends and monitor the competition. Constantly ask: What are the current techniques? What are the best testing methods? Are there are more efficient ways of performing our day-to-day activities?
• Vigorously implement standardized processes across departments with respect to behavioral and safety standards, work tasks, and expectations.
• Hire appropriate staffing—not just “enough” to fill slots. Workload monitoring and distribution is an art. Uneven workload can lead to delay, mistakes, and dissatisfaction. Workload smoothing, whether across shifts, departments, or job categories, adds efficiency.
• Leverage technology. Think barcode readers, scanners, monitors, web-enabled devices, and electronic data interchange wherever they can be applied.
• Establish a good relationship with IT, and then work to improve it. Look for applications in the LIS which could be used more or enhanced. Are there features to assist with faxing results, receiving add-on requests, and maintaining an up-to-date and robust Professional Services Manual? Good technology is a force multiplier for human capital.

Advocacy, Public Relations and Branding

The clinical laboratory needs to promote itself, to enhance its visibility and convey a positive image. By becoming a recognized and trusted entity within its organization and community, the lab is better positioned to be an integral part of the collaborative approach to patient care. Without the lab’s services, there would be no diagnoses, no surgeries, and no treatments. Laboratory services are necessary for everything from a sore throat to a kidney transplant. Some more specific tips:

• Lab leaders should actively advocate for the lab. They should be present during any decision-making process that touches the lab, demonstrating that the lab should be a priority. Sometimes, the lab suffers from the “good child syndrome” in a hospital: only the bad child gets attention. To counteract that, lab directors should be vocal about its true value.
• Leadership should invest in public relations. This doesn’t have to be expensive and can be scalable. PR can be rolled out to units, floors, groups of physicians, or nurses in person. Material can be easily be developed and shared through email or the web.
• Efforts should be made to promote and raise the visibility of the lab and its services, whenever possible. National Laboratory Professionals’ Week is one opportunity, but this should be an all-year effort.
• The lab should enhance its presence on the Internet. A web page can function as a communications and educational tool. There may also be social media opportunities.
• Tools can be provided, such as visual aids depicting appropriate labelling of samples and volume requirements (highlight fill lines, etc.), or offering explanations for requirements and standards. Interactive videos can be incorporated.

This article started as an internal look at our own operations. We’re glad we looked with a critical eye; you can’t fix what you don’t see. By sincerely and carefully evaluating our situation, we were able to develop a fairly easy list of issues to evaluate and practices to improve, all in the name of Service Excellence. As laboratory work becomes more standardized and condensed into reliable automated processes, customer service will become a more important differentiator. Exceptional customer service is already seen as a good way to stand out. The laboratory has significant value in the healthcare arena, especially with population health management and early detection now being emphasized. Demonstrating our value and professionalism is the right thing to do for our patients, our organizations, and ourselves.

Thoko Cox, BA, serves as Laboratory Liaison for the University of Maryland Medical Center (UMMC).

Jim Cook, MBA, MT(ASCP)DLM is currently the System Laboratory Director for Houston
Methodist, a Houston Texas-based Health System and Research Institute. He formerly served as Director of System Lab Services for the University of Maryland Medical System (UMMS).