The fast-paced world of the clinical laboratory encourages laboratory managers to evaluate and implement technological, process, and workspace changes in an effort to improve testing quality, turnaround time, and customer satisfaction. Managers must remember that even the simplest laboratory change may have a ripple effect throughout the entire hospital and/or medical system. This article describes a 7-step approach to assist laboratory managers in disseminating laboratory change to the appropriate customer at the right time. The approach includes the following steps: 1) identify the laboratory change; 2) target your audience; 3) build a communication team; 4) develop a communication plan; 5) implement the communication plan; 6) evaluate the communication plan; and 7) modify and execute the revised communication plan. A real-world application of the 7-step approach is described using the relocation of the phlebotomy lab for renovation as an example
The world hates change, yet it is the only thing that has brought progress.
Laboratory managers often grapple with technological, process, and workspace changes in an effort to improve testing quality, turnaround time, and customer satisfaction. Weeks to months of intense clinical and market research may be spent before a decision can be made on what to change. Securing funds may then take months to years before a laboratory change can come to fruition. Once the necessary resources are in place to make the change, the modification must be communicated to all parties affected by and/or associated with it. So how do lab managers communicate this change and to whom do they convey these differences?
Few clinical laboratory science programs offer training in public affairs communication, but this type of training is exactly what laboratory managers need to direct operations during a critical alteration of the laboratory status quo. Even the simplest laboratory change may have a ripple effect throughout the entire hospital and/or medical system. A 7-step approach to effectively communicate laboratory change is shown in Table 1. This guide can be used to assist laboratory managers in disseminating useful information to the appropriate customer at the right time. This article will describe the 7 steps involved in this approach and discuss a real-world example of laboratory change, the relocation of the phlebotomy lab for renovation.
Step 1: Identify the Laboratory Change
There is nothing wrong with change, if it is in the right direction.
Communication is defined as “the exchange of information between people.”1 One person, the sender, attempts to transfer information—the message—to another person or group, the receiver.2 The first step in communicating laboratory change is the recognition that a message must be transmitted to a receiver or quite possibly a variety of receivers. This point may seem quite obvious. However, the Joint Commission reported that “inadequate communication” is consistently the main root cause of serious patient adverse events or “sentinel events” in hospitals.3 Communication plays such a vital role in patient safety that Goal 2, “Improve the effectiveness of communication among caregivers,” was included in every annual National Patient Safety Goals since their inception by the Joint Commission in 2003.4
Seven Step Approach to Effectively Communicate Laboratory Change
Identify the laboratory change.
Target your audience.
Build a communication team.
Develop a communication plan.
Implement the communication plan.
Evaluate the communication plan.
Modify and execute the revised communication plan.
Once the change needing to be communicated is identified, the laboratory manager must select the proper time in which to announce the change. The laboratory manager must be proactive and anticipate what needs to be communicated before the difference is implemented. If the message is transmitted too early, the receiver may be confused by or altogether forget the message. A message delivered too late could lead to a serious adverse event. Messages may need to be repeated and/or modified with additional information prior to, during, and after initiation of a laboratory modification. The sender, typically the laboratory supervisor or manager, needs to keep in mind that the change communicated should be geared toward a desired outcome.2 Typically, receivers will exhibit greater buy-in for the change if they are informed of the improvements associated with the anticipated outcome.
Step 2: Target Your Audience
To effectively communicate, we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.
The second step requires some reflection on who needs to know about the laboratory adjustment. The laboratory manager must complete a stakeholder analysis5 to identify all potential audiences or receivers. The analysis must answer these 2 questions: Which of our customers will be affected by the proposed change and thus require notification? Who else has a stake in the change and must be notified of the upcoming modifications? A list of potential stakeholders typically involved in laboratory change is shown in Figure 1. This list is not all-inclusive; laboratory managers may need to expand this list to meet the needs of all of their customers.
Once the receivers are identified, the laboratory manager must create the message announcing the change. One message may suffice for all customers or a variety of messages may be needed for the various receivers. An understanding of the barriers to effective communication is imperative in crafting a message. Personal barriers, physical barriers, and semantic barriers are 3 types of barriers that are likely to hinder the communication process. Personal barriers are any individual attribute interfering with communication. Examples include basic communication skills such as speaking, listening, writing, and non-verbal skills; differences in interpreting information based on one’s experiences, prejudices, and stereotypes; and variations in egos and interpersonal trust. Physical barriers are the spatial, temporal, auditory, and other concrete distractions to communication. Examples include distance between locations, time zone differences, background noise, and no access to computers. Semantic barriers are obstacles to effective communication based on how words are used and interpreted. Using vague expressions such as “get it done soon” is an example of a semantic barrier. To the employee, “soon” may mean by the end of the week; to the boss, “soon” may mean by the end of the day. Jargon and a multicultural workforce are 2 semantic barriers that may also obstruct the communication process.2 The sender and the message must circumvent these barriers for communication to be effective.
Laboratory managers should follow the KISS principle, Keep It Simple Science, when crafting messages. Explain the change in terms relative to the medical background of the intended receiver. Keep the message brief and clearly state what will be different and the importance of the change. One message may be all that is needed to announce a simple modification while multiple messages may be necessary to convey updates on more complex alterations. Tell the customer just what they need to know and just often enough to accurately transmit the information. Excessive communication, sometimes referred to as “information overload,” could ultimately result in customers ignoring future messages.
Potential audiences to target for communicating laboratory change. A stakeholder analysis will enable the laboratory manager and communication team to identify required receivers for their messages of change.
Step 3: Build a Communication Team
If you want to make enemies, try to change something.
No matter how perfect an anticipated laboratory change may appear, people are the key to successfully making the change. A simple change may require just an e-mail announcement from the laboratory supervisor. More complex changes, especially those involving the entire hospital or medical system, require a communication team to disseminate the information. Who is picked for the team will depend on the complexity of the change, the message to be communicated, and the intended audience. The first person who should be selected for the team is the project manager. The laboratory manager may assume this role or appoint another person. The project manager oversees the planning, organization, and management of resources involved in the communication plan. The project manager is the communications facilitator and is responsible for ensuring that messages are transmitted, received, and comprehended by the various audiences.5 If the laboratory manager appoints an employee who is not a supervisor, the project manager must be thoroughly supported by the laboratory leadership. A technical representative or subject-matter expert from the laboratory should be on the communication team. This team member’s role will be to translate scientific terms into everyday language appropriate for team members and each customer. If the change involves sections outside of the laboratory, then representatives from those impacted sections should also be included on the communication team.
The laboratory manager should tap into the expert resources available at the hospital when building the communication team. Representatives from the public affairs office, customer relations office, and the hospital administration should be members of the communication team, especially for changes that will be directly felt by patients and their families. The team may also need to include representatives from safety, facilities, and/or the legal offices at the hospital. These team members have experience and expertise in using various media and will know which means are most effective at communicating change at that particular institute and abroad. These team members may have access to resources outside of the laboratory and could provide additional people, funds, and equipment to support the communication plan.
Now that the communication team is assembled, what is expected of team members? The project manager should encourage each team member to focus on the 4 P’s: Purpose, Picture, Plan, and Part to Play.6 Each team member should understand the purpose and the importance of the change. The picture of change, the end result being the expected improvement, needs to be clear to each team member. The team needs a well-organized plan to effectively and efficiently communicate the change to the various customers. Each team member should know the part he or she plays on the team and what tasks he or she is responsible for completing. An effective communication team will assist the laboratory manager in transmitting information to all customers and in thwarting off the inevitable resistors to change.
Step 4: Develop a Communication Plan
The more elaborate our means of communication, the less we communicate.
The project manager is ultimately responsible for ensuring that communications are transmitted, but this does not mean the project manager must plan or send all messages.5 Teamwork is critical for communication plan development. The project manager must synergize the input of team members to create a better plan than could be developed by the project manager and/or members working alone. The project manager should survey team members to determine the preferred mode (eg, e-mail, teleconference calls), best time, and the frequency availability to communicate with the team. A contact information sheet containing each member’s name, telephone number, e-mail address, and other pertinent information should be generated and distributed to the team.5 The frequency and duration of team meetings will depend on the complexity of the change to be implemented and the experience and dedication of team members.
The project manager spearheads the development of the communication plan, with input from the team, and must balance the time, cost, and scope constraints of the project.7 Several methods exist for managing projects such as the “Critical Path Method” and the “Program Evaluation and Review Technique.” Management tools, such as Gantt Charts, provide a graphical summary of the timeline, tasks or milestones, and personnel involved in the project.8 Software products such as Sciforma Project Schedule, Niku Workbench, Primavera, Artemis Prestige,5 and Microsoft Office Project, assist the project manager in tracking information, visualizing the project plan, and scheduling tasks and resources.9 Chances are however, that most laboratories will not have a certified project manager on staff nor access to the previously described tools. Funds may not be available to hire a certified project manager or to purchase project management tools. Additionally, simple communication plans will not require elaborate management tools.
A laboratory project manager should work with tools that are readily accessible to himself or herself and to team members. Common Microsoft Office software products can be used to manage the project. The communication plan should contain a map or outline of the plan, a timeline, and a method to track tasks with the responsible team members. Microsoft Office Word, Power Point, and Excel provide a variety of charts and graphs that can be used to map out the steps in the communication plan. Means and Adams (2005) provide an overview chapter on the basic tools and conventions of process mapping. Schedules and calendars depicting task deadlines can be produced in Microsoft Office Publisher and in a variety of other formats.10 Tables can also be created to track project tasks using common software products.
Regardless of the software employed, a simple table or task list,5 as shown in Table 2, is an effective tool for planning and tracking a communication plan. A task-tracking table should contain the following column headings: 1) Task Number; 2) Message; 3) Receiver; 4) Medium; 5) Assigned Employee; 6) Deadline; 7) Percent Complete; and 8) Comments. Columns can be added or adjusted to meet the needs of the specific project. The Task Number column gives a tracking code to each task for easy identification by all team members. The Message column lists a summary of the information that needs to be disseminated to the intended customer shown in the Receiver column. An important decision to make is the selection of the medium or media to transmit the message. “Choosing the appropriate media depends on many factors, including the nature of the message, its intended purpose, the type of audience, proximity to the audience, time horizon for disseminating the message, and personal preferences.”2Table 3 lists some of the various outlets for communicating laboratory change. Once selected, the outlet is listed under the Medium column in Table 2. The Assigned Employee column appoints a person responsible for completing the associated task, while the Deadline column displays the date, and possibly the time of day, by which the job is due. The Percent Complete column gives an approximate percentage of how much of the task is completed. The final column, the Comments column, provides a place for the assigned employee to explain details related to the task. With an outline of the plan, a timeline, a method to track tasks, and a committed team in place, the communication plan is now ready for implementation.
Neither a wise man nor a brave man lies down on the tracks of history to wait for the train of the future to run over him.
—Dwight D. Eisenhower
A craftily designed communication plan can quickly become useless if it is not carefully executed. Team members must complete their assigned tasks according to the timeline. The project manager must coordinate the team’s efforts and adjust the timeline to counteract unexpected obstacles and delays in the schedule. Team meetings should continue throughout the implementation phase as they provide an opportunity to capture pertinent information and to make changes to the plan as it unfolds.5 The project manager should update the task-tracking table, as shown in Table 2, as team members progress in the completion of their assigned tasks. Additional tasks may need to be added to the task list to reach out to unanticipated customers and/or to connect with intended receivers in another way.
Meeting minutes are another valuable tool in assisting the team in project implementation. The project manager should designate a team member or, if possible, use an administrative support employee not on the team to keep minutes of the meeting. The minutes will provide a background for follow-up meetings and a historical perspective for future projects. Meeting minutes typically contain the following items: agenda, list of attendees, discussion, findings, recommendations, and an update of the task-tracking table.5 The updated task list and meeting minutes should be forwarded to all team members or placed in a shared location where all members can easily access the documents. Information sharing will keep members on track and inform team members absent at the last meeting of any changes.
Step 6: Evaluate the Communication Plan
The problem with communication ... is the illusion that it has been accomplished.
—George Bernard Shaw
The success of the communication plan should be evaluated as tasks leading to transmitted messages are completed. The communication system should be tested periodically to ensure messages are received and understood5 and the receivers are satisfied with the method deployed. In order for this type of evaluation to occur, management must support a culture in which communication flows freely, regardless of rank or position, and without fear of retaliation. A culture which fosters error identification and reporting enables constructive feedback to be made to improve the communication plan.11 A compilation of lessons learned should capture the best and worst practices of implementation of the communication plan. This list will evolve as the plan progresses, but a final analysis, upon completion of the project, is critical for capturing a history of which customer relations activities were most successful for communicating laboratory change.5
The first step in the communication process that must be evaluated is message transmission. Did the intended customer receive the information? Table 3 lists a variety of media which can be used to communicate change. However, each outlet presents its own unique challenges in ensuring message transmission. The computer-based resources generally rely on software, hardware, Internet accessibility, and some degree of information technology knowledge. These outlets permit rapid notification, but they also enable messages to be lost in an instant. E-mail messages may need to be followed up with a telephone call or a second e-mail message. The posted information on Internet sites must be confirmed as present, secure, and accurate after the initial posting for as long as the Web site is to serve as the source of information. The more traditional communication outlets, such as flyers and signs, usually require more time to produce than electronic resources and bear an additional cost for the raw materials. The sender must verify that the flyers were distributed on time to the correct customers and that the signs were correctly mounted and remain in their proper locations. Regardless of the medium used, the sender needs to verify the intended receiver got the correct message.
The second step in the communication process that needs to be evaluated is message comprehension. Now the sender must confirm the message was interpreted correctly by the intended receiver. The old-fashioned children’s game, “grapevine,” is a good example of message comprehension gone astray. The first child in line whispers a secret message to the next child in line. The second child is supposed to whisper the same message to the third child and so on until the last child in line receives the message. The last child proudly announces that the message was, “My mother walked the hog in the dark today,” only to learn from the giggling first child that the message really was, “My mother walked the dog in the park today.”
Requiring the recipient to repeat the message back to the sender, commonly referred to as “read-back verification,” is a helpful tool in maintaining message accuracy. Read-back verification was effective at reducing errors in transmitted telephone reports of critical laboratory results12 and is a vital safety net to verbal orders.13 But read-back verification cannot be used to check message comprehension by every intended recipient, quite possibly, thousands of hospital employees and hundreds of thousands of patients. Sampling from the targeted receivers is imperative for confirming message understanding. The communication team should sample from different combinations of the various customers contacted (Figure 1) and the communication media used (Table 3). Verification can be done by asking questions about the message to test the receiver’s interpretation and to ascertain how the receiver intends to act upon this information.5 Other ways to verify message interpretation include reviewing customer satisfaction surveys, investigating quality assurance reports, monitoring performance indicators, and reviewing laboratory workload reports. Typically, the communication team will quickly learn from its customers if message transmission was very poor. However, the communication team may not receive any feedback if message transmission was fair or better. The project manager should ensure the customer groups most affected by the change comprehend its meaning. “Just because an e-mail is marked as ‘received’ doesn’t mean that it was actually read or understood.”5
The last step in the communication process that needs to be evaluated is customer satisfaction as a message that was properly transmitted and comprehended does not guarantee complete customer satisfaction. Were the receivers pleased with the timing of message delivery? Did the mode of communication meet the needs of the audience? Do the customers have suggestions to improve how laboratory change can be announced? Customer satisfaction surveys and polls can be useful in assessing these questions. Established surveys can also be modified to include questions related to the change issue to gather more specific and timely information. The lessons learned list should be updated with the outcomes of these customer satisfaction reviews.
Step 7: Modify and Execute the Revised Communication Plan
Those who expect moments of change to be comfortable and free of conflict have not learned their history.
—Joan Wallach Scott
The communication plan is a dynamic document evolving as messages are transmitted and feedback is received from customers. To complete step 7 in the approach, modify and execute the revised communication plan (Table 1), steps 5 and 6 must be continually repeated until the laboratory manager is satisfied the message of change was properly conveyed and understood. The task-tracking table shown in Table 2 is a critical tool in capturing these adjustments to the communication plan. The communication team should continue to meet as often as is necessary to execute the revised plan.
Once the project manager believes message transmission is complete, the communication team convenes for a final closeout meeting. The focus of this meeting should be twofold: task completion and historical documentation for organizational development. The communication team reviews the task-tracking table to ensure all deliverables were transferred to the appropriate recipient. Final analysis of lessons learned is captured at this meeting. Following the closeout meeting, the project manager prepares a final report for the laboratory manager. The final report summarizes the messages transmitted, the tasks completed, and the project outcomes. The project manager includes his or her conclusions and insights about the project and the performance of the communication team. The laboratory manager uses this document to ultimately decide if the project is officially complete. The final report also serves as a historical review of project successes and failures that can be used to implement other changes.5
Change Example: Relocation of Phlebotomy Lab
At some point in his or her career, a laboratory manager will face the challenge of renovating part or all of his or her lab. We faced this challenge with the relocation of our phlebotomy laboratory. The following paragraphs provide a brief overview of how we used the 7-step approach to communicate change during the phlebotomy laboratory renovation. We decided the renovation would be easier and safer for our patients and staff members if we relocated to a temporary space vs renovating in place. We worked with the engineers in the facilities department to adjust a vacant space to meet our needs. A move-in date to the temporary phlebotomy lab was scheduled based on our typically least busy day of the week and we were then on our way to using the 7-step approach shown in Table 4.
We identified our change to be “effective January 15, the phlebotomy lab will be temporarily relocated from room 426 on the fourth floor to room 211 on the second floor. The relocation, due to renovation of the old lab, is projected to last 6–8 months.” We considered all possible customers and stakeholders affected by this change. We targeted our audience to be phlebotomy staff, laboratory employees who process and test specimens, health care providers who might send patients to the phlebotomy lab, patients and their family members, referring remote clinics, housekeeping staff, and employees who work at the information desk. We assembled our communication team based on the messages we would send and our intended recipients. Our communication team contained both laboratory and non-laboratory personnel and consisted of the laboratory manager (serving as the project manager), phlebotomy supervisor, family practice clinic administrator, public affairs officer, customer relations supervisor, and a hospital administrator.
Next, we established our communication plan using the task-tracking table shown in Table 5. We used various outlets from Table 3 to transmit messages to our receivers. The laboratory manager served as our project manager, and the other team members were assigned tasks with deadlines. More tasks were added and the original tasks were updated each time the communication team met. We completed the communication tasks shown in Table 5 and then moved the phlebotomy lab to a temporary location. Just prior to the move, we evaluated our communication plan by asking questions at our staff meetings and sending e-mail reminders. The family practice clinic administrator used her communication successes and failures within her section to brainstorm solutions to problems other clinics might have. Following the move, we questioned customers who arrived at the old and new labs about the information they received. We solicited feedback from clinic staff and responded to questions from our referring providers. We reviewed patient satisfaction surveys to identify problems, concerns, and suggestions regarding the relocation and renovation. We also reviewed provider satisfaction surveys on laboratory support.
7-Step Approach Example: Relocation of Phlebotomy Lab
1. Identify the laboratory change.
Effective Jan. 15, the phlebotomy lab will be temporarily relocated from room 426 on the fourth floor to room 211 on the second floor. The relocation, due to renovation of the old lab, is projected to last 6–8 months.
2. Target your audience.
Phlebotomy staff, laboratory staff, health care providers, patients and famlies, referring remote clinics, housekeeping department, information desk.
3. Build a communication team.
Laboratory manager, phlebotomy supervisor, family practice clinic administrator, public affairs officer, customer relations supervisor, hospital administrator.
4. Develop a communication plan.
See Table 5.
5. Implement the communication plan.
See Table 5.
6. Evaluate the communication plan.
Asked questions at staff meetings.
Questioned customers about the upcoming relocation.
Questioned customers who arrived at the old and temporary new labs about the information they received.
7. Modify and execute the revised communication plan.
Solicited clinic feedback via e-mail.
Reviewed patient satisfaction surveys on laboratory experience.
Reviewed provider satisfaction surveys on laboratory support.
Throughout the renovation period, we reviewed the new monthly patient satisfaction surveys on laboratory experience. We continued to provide status reports on the renovation of the old phlebotomy lab to our customers. We were able to use the lessons learned from this communication plan to successfully implement other changes in our laboratory, such as the return of the phlebotomy lab to the fourth floor and the improvements resulting from the complete renovation.
In summary, change is imminent in the fast-paced, cutting-edge, technological environment of the clinical laboratory. The 7-step approach, shown in Table 1, can assist laboratory managers in disseminating useful information to the appropriate laboratory customer at the right time. Laboratory managers must remember that for change implementation to be effective, “You must be the change you wish to see in the world (Mohandas Gandhi).”
Task-Tracking Table Example: Relocation of Phlebotomy Lab
Lab staff must prepare for move
Staff meeting, e-mail, bulletin board postings
75% as of Jan. 10
Need orientation of temporary lab
Remind patients of location change before sending to lab
Health care providers
Staff meeting, e-mail, posters in clinic waiting areas, direction sheet to give to patients
Family practice clinic administrator, hospital administrator
100% as of Jan. 10
Need copier and supplies to prepare direction/map flyers
Patients and family
Posters, Internet postings, community meetings, intercom announcements, greeters on opening day
Public affairs officer, customer relations manager
100% as of Jan. 10
Can request greeters through volunteer office
Remind patients of location change before sending to lab
Referring remote clinics
E-mail, Internet postings, direction sheet to give to patients
100% as of Jan. 10
Remote clinic will place link on its Web site to lab’s Web announcement
Need increase in cleaning service in temporary lab and nearby restrooms
E-mail to housekeeping supervisor
100% as of Jan. 10
Provide feedback to housekeeping on effectiveness of additional service
Be able to answer questions regarding lab relocation
Posters, direction sheet to give to patients
Public affairs officer
100% as of Jan. 10
Information desk staff can make intercom announcements on opening day
How to find lab
Anyone searching for lab
Post direction signs pointing out way to lab
0% as of Jan. 10
Can post on Jan. 14 after lab closes
Old lab is closed, temporary lab in room 211
People who arrive at old lab
Poster, direction sheet to new location
0% as of Jan. 10
Can post on Jan. 14 after lab closes
The authors wish to thank Corey Koike, Jennifer Stevick, Staff Sergeant Antoine Ferrus, Jan Clark, Patti Myers, and Col James Camp for their assistance in the relocation of the outpatient lab. The authors also thank Felizitas Devine for assistance in developing the tables.
Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army or the Department of Defense.
Improving America’s Hospitals: The Joint Commission’s Report on Quality and Safety 2007. Sentinel Event Root Cause and Trend Data section, pages 45–48. The Joint Commission. Available at: www.jointcommission.org/Library/annual_report. Accessed April 26, 2010.