Saturday, March 19, 2016

We can work it out (Musings on transfusion medicine succession planning)

Updated: 21 Mar. 2016 (See Further Reading)
This month's blog derives from a news item in TraQ's monthly newsletter that resulted in my thinking about a topic I've spoken and written about often, succession planning
  • Why clinical labs and anatomic pathology are at risk because of no formal succession plan to develop their next generation of management leaders (Dark Daily, 16 Mar. 2016)
The Dark Daily report focuses on succession planning in US clinical labs and anatomic pathology. To me it encompasses several related issues.

My musings focus on why succession planning is a challenge in today's clinical laboratories and what I see as the main way it can realistically happen.

The blog is written from a medical laboratory technology perspective, as that's my background, but the issues also relate to nursing and physicians.

For example, as someone involved with helping seniors in their 90s who often go to Emergency Departments in ambulances, and later become what are disparagingly called 'bed blockers' in acute care hospitals, I see how short-staffed and stressed nursing staff are in both acute care and long term care facilities. To think these nurses, or the health care system in general, could ever prepare for succession planning beggars belief. Yet many nurses no doubt mentor their colleagues.

As for physicians, and hematopathologists in particular, mentoring happens due to the efforts of exceptional physicians. These professionals give above and beyond. I often see them answering queries at 11 pm, well after their work day ends, indeed after they've tended to family responsibilities.

The blog's title derives from a 1965 Beatles ditty.

For links to news item and resources, see Further Reading at the blog's end. Please take time to read the sample quotes from those who lived through restructuring and centralization. They're enlightening.

CHALLENGE #1: Decreased CPD / CE
Decreasing budgets mean less money to train managers. Indeed, often money for continuing professional development (CPD) / continuing education (CE) all but dried up post-
laboratory consolidation.

If money were available for regional and national conferences, it went to medical directors, and perhaps to a lab manager, if any was left over. Sometimes medical directors paid part or all of their own expenses, leaving CPD/CE budgeted funds for managers and supervisors.

Today in Canada, some 20-25 years post-regionalization of laboratory services, clinical lab staff are mostly unionized and have contracts giving some degree of support such as 3-5 days paid leave for CPD/CE. But transportation to and accommodation at conferences often run over $1000, making attendance all but impossible without support.

In many cases, attending conferences also requires a supportive spouse and family to tend to extra duties with children, and generous colleagues to take up the slack at work, because while you're away, adequate replacement staff (if any at all) are seldom brought in.

Although valuable, the main benefit of conferences is not so much in hearing the latest and greatest from speakers (researchers and 'thought leaders'), but rather in socializing with peers.

It's in the socializing that you learn the goodies and tidbits not found in journals and not presented at conferences.

CHALLENGE #2: Decreased Mentoring
Staffing cutbacks leave remaining managers and administrators little time to mentor those with promising management and leadership skills.

Today it takes staff all their skill and energy to produce reliable lab test results that physicians rely on to diagnose and treat patients.

For example, with centralization and regionalization of laboratory services in the 1990s in Alberta,Canada, the first to go were middle managers. In this case, career lab technologists in affected hospitals - all experienced managers and supervisors - were left competing for the few remaining positions.

  • To see the reality of what lab regionalization means to people, see CSTM's blog on Dianne Powell below.
Under such circumstances, successful candidates often find themselves stressed to the max, not only with an extra workload, but often in unfamiliar surroundings (e.g., a different hospital in the same city).

Other contributing factors to stressed and overworked staff following lab centralization include

  • After significant change, many staff are so stressed that they may become negative, opting to do the bare minimum required for the job and fostering 'bitch sessions' at coffee and lunch. Even 'keeners' can be brought down by a steady diet of negativity.
  • Some staff come to believe, sometimes with good reason, that the organization is not loyal to them and they reciprocate the perceived feeling. Work may then become a '9-5 job' (just to earn $) as opposed to a career (lifelong journey to fulfill personally rewarding goals).
  • With centralization, more automation invariably follows because volume makes the instruments more affordable, especially given that fewer higher paid technologists are needed. To some lab workers, once the thrill of something new and shiny subsides, automation is 'okay' but not particularly rewarding.
Frankly, working with their hands and problem solving were the magical magnets that drew many to working in transfusion labs (and also microbiology). Loading mega-specimen trays, pushing buttons, and watching the instrument's software spew out results is not the most rewarding to such folks.

At the same time as automation occurs, specialized staff are lost and more generalists, as well as laboratory assistants, are hired to be supervised by a shrinking number of specialists. All of which contribute to overwork and increased stress in managers. The priority is for labs to become huge factories churning out products (lab results).

Mentoring future leaders becomes tougher and requires incredible effort by truly dedicated lab managers.

1. Health professionals should give themselves every educational advantage.

Especially in the 1990s, many exceptional Canadian laboratory technologists (and those of many nationalities) were forced to leave the profession due to lack of jobs. Others with appropriate credentials found work internationally. A BSc in Med Lab Science helped. Suspect a BSc in Nursing helped too, at least for working in the USA under NAFTA.

2. After large-scale centralization, or massive change of any kind, managers must have emotional intelligence.

From my brief experience in the world of management, managing staff is more important than all the experience and knowledge in the world (which also counts on the respect metre).

3. Formal succession planning? Are you kidding? A formal plan is tough. Mentoring is where it's at.

I know several med lab technologist leaders who continue to mentor staff informally. Mentoring occurs in nursing and among transfusion physicians too. All by folks I call the 'special ones' - health professionals who love their careers and go the extra mile to share the nuggets they've learned over many years.

Personally, I've had many talented mentors over the years. The first was Catherine Anderson, the lab manager at Canadian Red Cross Blood Transfusion Service in Winnipeg, when I was a kid of 21 years. She had CRC-BTS fund my way to local, national, and international conferences and workshops, had me speak in her place at conferences (at first I was 'shaking in my boots'), and left me in charge of a few administrative tasks when she was away. 

Plus when I screwed up, and I did, it was a learning experience, not the blame game. 

I'll mention one other mentor, Dr. David Ferguson, Medical Director of the UAH transfusion service in my days in MLS, University of Alberta, where I was also a clinical instructor for the UAH blood bank.

What David did was treat me as an equal, although I definitely was not. We shared many a laugh over student oral exams (Delicious biflorus being an answer one student gave to 'What is the the anti-A1 lectin?'). We also co-authored an immunohematology paper published in Transfusion. His reaction to reviewer feedback still makes me chuckle  today.

Mentoring is what develops future leaders in any field. Mentors come in all shapes and sizes. Some fear and resist change, others are big-picture visionaries who welcome change. A m
entor's key characteristics? 
  • Encouraging staff to be all they can be.
  • Modelling how exemplary professionals think and act.
As always the views are mine alone and comments are most welcome.

I chose the blog's title song for its lyrics about life being short and there's no time to fuss about. Mentor potential lab leaders NOW or the proverbial poop will hit the fan as experienced staff retire in increasing numbers.

Life is very short, and there's no time
For fussing and fighting, my friend
I have always thought that it's a crime
So I will ask you once again

Try to see it my way
Only time will tell if I am right or I am wrong....


CSTM 'I will remember you' blogs (in alphabetical order) 
Sample quotes related to this blog's theme
NOTE: These blogs are based on my interviews with health professionals, leaders in their field, to celebrate their outstanding careers, awards, and accomplishments. Refreshingly, besides all the things they loved about their transfusion medicine lives (read the blogs!), they also speak frankly about regrets and the realities of laboratory consolidation and cost constraints.
  • Kieran Biggins (17 Jan. 2016)
    • Also, I regret allowing myself to be consumed by change fatigue during the last few years of working for Alberta Health Services.
    • ...I became the first Transfusion Safety Officer (TSO) in Alberta. Unfortunately, as the healthcare system in Alberta was consolidated yet again and again, my employer felt it necessary to add additional responsibilities to my new position such that I soon had two full-time equivalent responsibilities: TSO and Laboratory Quality Assurance Supervisor!
    • In the last few years of my employment with AHS, there was an overwhelming culture of DON'T question any changes, keep your head down, don't make waves and don't rock the boat. Unfortunately,  this (as you know) is not me....
  • Kathy Chambers (8 Jan. 2016)
    • Accomplishments and fun: Managing a team of smart, empowered women who made the transfusion service as good when I was not there as when I was.
    • This happened at RCH in New Westminster. From designing a new lab, working in less than good circumstances... moving into the new space and doing great work in their day-to-day duties, I think we truly had a quality system before it was introduced into labs.
    • Others: Having good mentors to make me a better person...
    • Attending conferences all over the world, meeting and networking with fellow TM practitioners. Loads of memories and great friendships.
  • Kate Gagliardi (20 Mar. 2016)
    • 'Regionalization – most of us minions had no control over fundamental changes in the environment which led to multi-sited organizations – and yet I sincerely missed the glory days of a single-site academic institution and the world within it that we had created.  It would have been nice to retain some of the good things – tight, dedicated teams, which endured despite changes in the personnel and services.'
  • Dianne Powell (7 Feb. 2016)
  • As a cost cutting measure, the RAH and Charles Camsell Hospital laboratory services were to merge. The process involved much uncertainly and anxiety. Our laboratory manager at the Camsell was given a package and quietly disappeared and staff felt quite un-tethered. As supervisors, we tried to provide support for the lab staff as we were dealing with the uncertainty, but as supervisors we were also dealing with maintaining the daily routine in the lab and ensuring testing got done.

    And we were told almost immediately that
    • We would need to submit our resumes and compete with our counterparts at the RAH Laboratory for our positions.
    • If unsuccessful in the competition, there was no place in the organization for us.
    • We would be given a package and be asked to leave immediately so we should have our personal stuff packed up.
    • Sounds like the reality TV show 'Survivor', no?