October 2010 Clinical Laboratory News: The Future of Lab Leadership

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October 2010: Volume 36, Number 10

The Future of Lab Leadership
What Will it Take to Navigate the Changes Ahead?

By Bill Malone

Everyone working in clinical labs today knows that the field faces a huge challenge as the baby boom generation starts to retire in growing numbers. However, what is less obvious about coming changes in laboratory practice may have just as great of an impact. Demands on laboratorians from inside and outside the lab are forging a new kind of workforce in an atmosphere of intense pressures from an economic recession, shifting business models, and stepped-up scrutiny from regulators. Added to these strains, upcoming generations of laboratorians in the lab are bringing new expectations of what work is all about, an especially stressful environment considering that this is the first time that four distinct generations of laboratorians are in the workforce at the same time.

At a symposium at the 2010 AACC Annual Meeting in Anaheim, Calif., three lab leaders took the podium to make the case that all of these challenges make effective leadership more important—and more rewarding—than ever. Titled “Leadership Skills for the Laboratory Professional: Generational Differences, Leadership Styles, Conflict Resolution, and Change Management,” the seminar engaged a packed room of attendees with ideas about how current and future generations of lab leaders will be able to plot a course through a dynamic and uncertain era in healthcare. Speakers included moderator Carmen Wiley, PhD, Brad Karon, MD, PhD, and James Hernandez, MD.

Leaders who can’t cope with these changes risk not only their personal success but the ability of their labs to fulfill their mission in healthcare, according to Hernandez. “We’re moving essentially from a cottage industry in all of healthcare, and particularly labs, to what is really a medical-industrial complex. And whether we like it or not, we are going to be practicing in a more complex, interdependent environment and it’s going to put pressure on lab directors and other supervisors to boost their leadership abilities,” he predicted. “A system is only as strong as its weakest link, so if someone in the lab is stressed and not attentive, or for whatever reason not a part of the team, that creates a very dangerous situation and could compromise patient safety.” Hernandez is assistant professor of laboratory medicine and pathology at Mayo Clinic College of Medicine, and medical director of laboratories and chair of laboratory medicine at Mayo Clinic in Scottsdale, Arizona.

Future leaders
James Hernandez, MD emphasized that communicating core values 
is essential to coping with change.

New Generations, New Challenges

In addition to the forces outside the walls of the lab pushing change, Wiley emphasized that understanding each of the four generations present in today’s lab is essential to building strong teams and healthy communication. Each of the generations has its own distinct worldview that helps determine their business focus, motivation, loyalties, and values (See Figure 1, below). She defined the generations as traditionalists (1922–1945), baby boomers (1946–1964), Xers (1965–1977), and millennials (1978–2003). “We need to understand what motivates each generation of workers in the lab and how to retain great employees from all generations,” she said. Wiley is director of chemistry and immunology at Sacred Heart Medical Center and PAML reference laboratory in Spokane, Wash.

Although understanding each of these generations in a lab is far from hard science, Wiley underscored the fact that leaders with poor people skills will find that their technical knowledge is not enough to get them through in today’s clinical labs. “I would argue that we all have to know the hard science, but a lab is not a robot,” she said. “A lab is made up of a system of individuals, and we need to be able to make our employees feel valued and enjoy the work that they’re doing. They can’t do that, in my opinion, without leaders that understand them.”

Figure 1
Generational Differences in the Workplace
Baby Boomer
Birth Years
Business Focus
Long hours
Time off
Time off
Company Loyalty
Money is
Status Symbol
Means to an End
Today’s Payoff
Family & Success
Source: Carmen Wiley, PhD

Currently, most managers are baby boomers, which in many cases can put them out of sync with the values of Xers and millenials who are working for them. This can lead to managers perceiving their younger employees as having a poor work ethic, less commitment to their jobs, or less respect for their employer than they actually do, Wiley explained. One such conflict is work hours. Boomers tend to emphasize longer hours, while Xers emphasize productivity. “A lot of boomers have really dedicated themselves to their jobs and really take pride in putting in very long hours. But today, they’re working with other generations who are more interested in being very efficient and highly productive while they’re at work, but don’t see the value in being the first person at work and the last person to go home,” she said. This effect goes both ways, however, and younger workers need to understand where their managers are coming from in the same way, Wiley added.

The generational difference extends beyond the basics like work hours, though. For example, millenials tend to be technologically savvy, highly creative, and enjoy working in teams. They also are more likely to be relatively impatient and expect instant rewards and respect. This means that millenials won’t expect to pay their dues in the way that other generations did, and they expect constant feedback and the ability to express their opinions, Wiley said. These characteristics can add up to a profile that seems overly demanding to generations with different values.

“Millenials might seem high-maintenance when you’re not used to working in that way,” Wiley said. “I don’t necessarily believe that we have to accommodate all their requests at all levels, but trying to meet some of their needs will go a long way. On the flip side, an Xer might find it annoying when dealing with a boomer that the emphasis is all about title and recognition and making sure they get kudos for what they’ve done—so from another perspective they’re high-maintenance too.”

Keeping excellent employees of each generation satisfied with benefits and compensation also has its challenges, as not everyone is equally motivated by money, time off, or the ability to be an individual at work. “We know that when we’re dealing with our millennial population, they are very interested in their quality of life and making sure that they have enough time for their families and other civic opportunities in the community, whereas with our baby boomers, they are very focused on monetary rewards for a job well done,” Wiley said. “So maybe our millenials would prefer to accrue vacation at a greater rate, which would be more satisfying to them than a raise, whereas you have an older generation that might put more value on the raise.” Rewarding employees with a wide variety of incentives is not easy, however, even if an institution’s human resources department is very flexible, though some labs have managed to pull it off (Read more in CLN Online).

Even though most lab directors and managers will not have the flexibility to offer all the benefits that please everybody, lab leaders do possess the ability to employ “softer” types of benefits and leadership strategies that keep these generational differences in mind, Wiley said.

“It is well within your power, if you know that you are working with a group of millenials, to make sure that they are getting feedback on their performance or assign a project to a group of people instead of an individual. These are things that don’t require monetary resources that you can implement by improving communication with your staff,” she said. “Perhaps, if your institution permits it, you can allow people to wear their iPods while they’re working on the bench because it gives them a little personal freedom, or maybe you can make your boomers a little more comfortable working with millenials by setting some basic guidelines on dress codes and enforcing them consistently.”

Culture and Conflict

If nothing else, the constant change in labs and the new demographic realities mean that tackling conflict will be a top priority for any lab leader. Managers must know how to think strategically to avoid conflict or to seek it, depending on the circumstances, stressed Karon, who is associate professor of laboratory medicine and pathology and director of the hospital clinical laboratories and point-of-care testing at Mayo Clinic in Rochester, Minn. “Effective leaders not only have to be able to resolve conflict, but at other times effective leaders have to be able to create conflict,” he said.

Karon noted that dealing with conflict successfully begins with understanding the nature of the conflict, a process laid out by Warren H. Schmidt and Robert Tannenbaum in two seminal articles in the Harvard Business Review—“How to Choose a Leadership Pattern” (1958) and “Management of Differences” (1960), which both set records for reprint requests in publications worldwide. “A good leader can define and sharpen where the conflict lies, and separate out the personal feelings and politics from the nature of the conflict,” Karon said. “The bottom line is that conflicts can be prolonged if the leader doesn’t identify the nature of the disagreement.”

Schmidt and Tannenbaum point to conflicts of four basic natures: fact, goals, methods, and values. Knowing which is the source of conflict helps parties operate under the same assumptions and keeps egos from getting in the way, Karon said. After ascertaining the nature of the conflict, a leader must decide whether he or she wants to try and minimize the conflict or promote it, depending on the circumstances.

If the harmony of a team is judged to be more important than the outcome of their decisions, a leader may chose to avoid conflict by putting together a team of like minded individuals, Karon said. The downside to this approach is that, in the long run, it can stifle creativity. In a different situation, a leader may actually want to promote conflict when the issues at hand need to be clarified, when members of a team need to learn from each other in order to make better decisions, or when there is enough time for a group to creatively come up with new solutions to a problem.

When choosing to highlight differences or seek conflict, however, leaders do risk creating worse interpersonal conflicts and draining energy from a group if the conflict does not become resolved successfully, Karon said. “I think the most important variable to consider is the importance of the question or conflict to long-term goals and values of the organization. Creating conflict takes time and energy, and should be limited to conflicts or questions that are fundamental to long-term goals or values.”

To help leaders navigate among these strategies to suppressing or creating conflict, Karon further elaborated five basic conflict resolution styles a leader can choose from based upon two factors—the problem sparking the conflict and who’s involved. The conflict resolution styles include retreat, harmonize, battle, bargain, and collaborate. “All leaders come into a situation with inherent traits and styles,” Karon said. “So, you need to recognize your inherent style for conflict resolution as well as the other styles out there, and the most effective leaders can go into a meeting and quickly chose the most appropriate style, even when it’s not necessarily the most natural to them.”

In the retreat style, withdrawal is the dominant behavior, and the conflict is not truly solved. As an example, Karon described a situation where a physician calls the lab insisting that an unfamiliar test be sent out. In this case, a laboratorian may not say yes or no, but instead ask for time to learn more about the test before going forward. The second style, harmonizing, aims to preserve a relationship by accommodating the other party. This style is useful when it’s more important to maintain a relationship than tackling the issue at hand. However, this runs the risk that the source of the conflict is not really solved, and that other parties may come to assume that they will always get their way. Third, battling your way through a conflict can be appropriate in times of crisis or extreme time pressure. In this style, individuals choose to pursue the correctness of their position in a competitive way. Obviously, the disadvantage here is that such a style can create a negative and competitive aftermath. “Battling is appropriate when there is a core value at stake, and somebody has to lose, such as if someone refuses to label a specimen correctly, or some other issue of patient safety,” Karon explained.

In the fourth style, bargaining, a person approaches a conflict as an opportunity to negotiate. A good example of this style is when a physician asks the lab to run a test stat when it’s not normal to do so. In this situation, a laboratorian could offer to go ahead and run the test stat, as long as the physician agreed to come down to the lab and discuss the need for the test and help the laboratorian understand the medical urgency. The danger with this style is that, over time, others learn to assume an inflated posture when approaching a conflict, watering down the result, Karon said. “It’s like going to buy a car. If you’re a leader and make it a habit to always bargain, that’s how people that interact with you are going to react.”

Finally, collaboration as a conflict resolution style seeks a win-win solution. For this style to work, parties must perceive the process as mutual problem solving where the needs and interests of everyone are considered equally. This approach can build trust and integrate viewpoints, but tends to be very time consuming and energy intensive, so it can’t be applied to every situation.

Although self-awareness and a solid understanding of different approaches to conflict will help a leaders guide their labs through future changes and stresses, creating organizational cultures based on core values, trust, and personal integrity is still the most important factor, Karon said, whether looking at leadership now or the future. “Certainly healthcare is changing rapidly, and generational challenges appear to have risen acutely as the fourth generation has entered the workforce,” he said. “However I wonder if you turned the clock back 100 years, whether you might hear the same comments being made. I think on the whole, a different set of skills will be needed, as the apprenticeship model of healthcare training and leadership will give way to a model demanding recognition and respect for workers from day one. As healthcare leaders we are not prepared to do that now.”

Managing Change

A theme running through the entire symposium, whether in examining generational values or conflict resolution styles, was that change is constant, stressful, and demanding of lab leaders. “There have been more changes since 1900 than in all of recorded history prior to 1900, and this can lead to overload. This is actually what’s happening to a lot of us in the laboratory,” said Hernandez. “It’s more complex to run the lab and it’s more difficult. Laboratorians are having to do more work with less resources, and we are one of the most highly regulated sectors of healthcare, and those regulations cause stress. We also have a lot of bureaucracy, and lots of policies and procedures, which tend to de-motivate people. Also, since labs are more distant from patient care, we can become commoditized, and all those things lead to stress.”

People always seem to resist change, no matter where they are, and usually respond with stress and fatigue that can drag down a lab, Hernandez noted. To cope with change, Hernandez recommends lab leaders work to improve their communication skills and build on a solid foundation of core principles that keep people grounded. “Leaders who are advancing change have to communicate the vision and the reasons for the changes very clearly, and sometimes that means repetition in different formats: visual, newsletters, and face-to-face meetings,” he said. “People always say ‘what’s in it for me,’ so that’s a real priority for leaders to reframe the issue and try to tailor a message for a specific audience about what is in it for them. But there is no magic: change is one of the most difficult things we deal with in the lab.”

Since change is persistent, Hernandez underscored the fact that any institution must have a core of higher-order values that can guide laboratorians’ decisions even when circumstances constantly seem to shift around them. Hernandez described the work of Leonard Berry who wrote “Discovering the Soul of Service.” Berry pictures the values of an organization as three concentric rings with core values at the center that never change. The innermost ring is core strategies, which rarely change; the second ring is integrated sub-strategies, which undergo frequent change; and the final ring is execution, which changes continuously. If a lab leader effectively communicates a lab’s core values, laboratorians will be able to better manage shifts in the outer rings of strategy and execution without losing sight of what really matters, Hernandez said.

Lab leaders get into trouble when they fail to focus on core values and instead only emphasize execution. “If we only tell people, ‘just do this,’ that’s just the execution part, and it leaves the person not really sure about why they’re doing what they doing,” Hernandez said. “On the other hand, with a focus on the core values, like patient safety, the reasons why the lab does something remains steadfast, even as the way things are done may change.”

Leveraging core values can only go so far, however, if a leader is not perceived as authentic and trustworthy. Hernandez used the example of a well-known U.S. Navy commander, Mike Abrashoff, who wrote about his unique leadership style on his ship. Abrashoff credits his success with two basic ideas: replace command and control with commitment and cohesion; and engage the hearts, minds, and loyalties of workers with conviction and humility. Following this advice and leading by example can work in a lab to build better teams, Hernandez said. “I think the biggest part of what Abrashoff was doing just boils down to authenticity. He walked the walk and talked the talk. So once people understood that he was authentic—that he was not trying to manipulate them—they would follow,” he said. “And he was listening aggressively. I love that term, because the leader is the thermostat for the lab, so if there is a climate of trust, people feel safe to evaluate errors in the lab.”

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