Managing Change in Clinical Laboratories

Change is inevitable, and as a leader of a clinical laboratory, you are expected to lead, implement, and manage change. This means dealing with a wide range of challenges. Change is both a challenge and an opportunity for growth. Research facilities and technology are evolving rapidly, with more opportunities in recent years. Laboratory managers need to be as adept at generating new ideas as they are at research methods. 

In addition, consistent changes in healthcare, such as introducing accountable care organizations, payment bundling, and payment incentive plans for positive outcomes, are encouraging laboratories to move towards stability and sustainability. Clinical laboratories should reduce costs, provide essential access to care, and reduce unnecessary testing in research facilities. This requires changing old protocols ingrained in physician practices and clinical laboratory research. 

Change means doing things differently than originally intended. If adequately directed and implemented, the proposed changes will improve the working environment of your laboratory, increase quality and contribute to long-term outcomes. Although people want change, they fear it. So resistance is inevitable. Resistance comes in various forms; to manage this resistance:

1. You need to change your management approach, considering the environment and the people involved. 
2. You need to improve your skills so that your employees can develop and achieve better results and ultimately even accept them. 
3. Utilize the power of persuasion and fine-tune these skills to cater to individuals and groups.
4. Finally, use your own experience, the experience of others, and research on the subject to apply your strategies.

This article discusses important questions about change, such as: What is change? Why do we need to manage it? What are the critical concepts of change, and how do they fit into your work environment or clinical laboratory? Why do people resist change? What are the means of controlling change? Finally, as a manager, how can you solve problems and help promote constructive changes in your clinical laboratory?

Key Concepts of Change 

Much has been said about the different perspectives on growth and change. Some are old and experimented with, while others are new and popular. Firstly, change can be planned or unplanned. Planned changes are also known as anticipated changes, which are intentional and well thought out. They are implemented carefully and analyzed to produce valuable results. Planned changes to clinical laboratories may include, for example:

• Relocation or renovation of laboratory space
• Acquiring new or automated equipment

Unplanned change is a change that is not anticipated. There are three levels of planning change. Each level represents the circumstances that require change. Emergent change occurs when an essential issue creates the need for change. Opportunity changes occur when an opportunity arises. In some cases, these changes result from changes in different areas, improvements in technical equipment, or newly acquired skills of people. Evolutionary change is a change that occurs over time. It is changed that results from gradual adaptation; it can be planned but is often also spontaneous.

Types of Change 

Change is inevitable in any group, and in healthcare, change happens very quickly. The continuous change approach in healthcare requires us to do more with less. To make a change, you need to understand the types of change and align your management techniques with the goals of each type. The three types of change are:

• Transitional
• Transactional
• Transformational

Transitional change is complex because it replaces processes or strategies with new concepts and methods. The aim is to increase productivity by replacing old processes with new ones. You can incorporate new projects or interests and set appropriate start and end dates for the development process. An example of a temporary change is introducing new automation where processes were previously done manually. For example, in a blood donation center where all cross-matches were done manually and are now automated. 

Transactional change occurs when organizations make changes to promote competitiveness. It can be implemented without requiring much work. It is usually based on improving existing practices, strategies, standards, or conditions. Transactional change is usually the least resistant because it continuously adapts existing practices and reinforces what is already in place. An example of this type of change is the implementation of additional training to further develop current practices, such as training certified phlebotomists for point-of-care testing so that medical technologists and technicians have more time to perform more specialized or complex tests.

Transformational change is the most challenging type of change because it is linked to the human side of progress and is the most resisted. As the name suggests, this change is a complete change of working culture and requires a different perspective. It is determined by strategic changes that occur over a prolonged period. This type of change is merging two different clinics or medical schools.

The Changing roles in Clinical Laboratories

It is essential to recognize that we face different challenges in responding to change in the clinical laboratory environment. The role of the laboratory manager is to have a proper insight into change and manage change. Different roles are taken up by each person in the laboratory. It is not enough to manage change; it must be led in the following way:

• Laboratory managers and administrators need to foster the vision. 
• Managers and laboratory supervisors must guide their staff and direct their efforts to improve their work. 
• Managers should provide expectations and communicate them effectively. 
• The technical supervisor should carry out and implement tasks. 
• The supervisor should also ensure success by managing mistakes. 
• The general staff have the most challenging task: they have to change the process while maintaining the quality of the current strategy
• The general laboratory staff is responsible for maintaining customer expectations and ensuring test results. They bear the brunt of the strain and stress, the burden of changing interactions, and implementation errors.

Why do people resist change? 

Why do some people find it hard to adapt to change? Generally, people do not like difficulties. By anticipating resistance and preparing for it, resistance can be controlled. In the long term, managers and employees who constantly resist change have a measurable impact on the organization, including reduced productivity, poor customer satisfaction, and the loss of valued customers. Excessive resistance can also hinder change. While it is unrealistic to know all the causes of resistance to change, being prepared to predict and manage it is a proactive step. Being aware of practices that indicate possible resistance can help people recognize that these problems need to be addressed.

It is essential to recognize all resistance factors to change. Here are a few of them:

Fear 

People have always feared uncertainty. They fear that new approaches won’t work, they won’t be skilled in dealing with new conditions, and they will perform poorly with the modified process.

Lack of Trust

When employees doubt their leaders and question their intentions, they resist change.

Need of Reassurance 

People don’t like to change their habits and routines. Many employees feel attached to the old way of doing things or have personal inclinations and specific ways.

Change is un-required 

Some employees find the old/current way of doing things acceptable. As a result, they may not understand the need for change and do not see the benefits.

Lack of Knowledge 

Employees may be concerned that they do not have the skills or information to implement change. They may doubt their ability to cope with change and feel that they may lose what they once had. They may have to start again, dislike retraining, and feel less prepared than before.

Poor Communication 

Employees may feel they were not informed of changes. As a result, they may feel that their judgments and opinions do not matter.

What Are The Various Stages of Change Management?

Prepare

Communicate with the employees effectively to prepare for the change. Communication should be an open line and should include transparency and organize regular meetings. Prepare and maintain open lines of communication by organizing regular meetings and keeping them as simple as possible. Communicate the current situation to employees and demonstrate the importance of the proposed changes. Convince them to be determined to make the change. When the motivation for change is explained to employees, they should respond. Understanding the usual positives and negatives of change can help them adapt and overcome resistance. Encourage employees to empower themselves to change and involve them in the process. Plan and promote plans of action and be prepared to act quickly. Using universal thinking and a shared imagination is key to preparing for the unexpected, outlining tasks, and determining reasonable and appropriate outcomes.

Implement 

Implement and organize change by assigning tasks and deadlines for completion. Hold employees accountable for meeting the set deadlines. Ensure that each implementation period comes at the right time to ensure the completion of the next phase. Turn the vision into reality.

Monitor

Introduce a feedback process, review the process, and establish key metrics. Follow up on each assignment to manage any delays. 

Sustain 

Ensure that employees have not reverted to the previous ways. Recognize the person who made the change successful and show your appreciation in words or actions. Talk about progress at every opportunity. Give examples of overcoming difficulties when interacting with change and repeat the stories you have heard. Incorporate the beliefs and qualities of change when recruiting and training new employees. It’s important to recognize the people in your unique change coalition and ensure that other employees, old and new, value the commitment to the change. Plan to replace key leaders of change when they leave. This will help ensure that their legacy is not lost.

Reevaluate.

Assess the process and analyze it to see if further changes are essential. For example, can the process be improved? Brainstorm ideas and ask questions.

Reference 

1. Garcia, L. S., Bachner P., Baselski, V. S., Lewis, M. R., Linscott, A.J.,  Schwab, D. A., Steel Jr., J. C. H., Weissfed, A., Wilkinson, D. S., & Wolk, D. M. (Eds.). (2014). Clinical laboratory management (2nd ed.). Washington, DC: ASM Press.