Building an Positive Laboratory Culture of Quality

Michael A Noble MD FRCPC

Chair, Program Office for Laboratory Quality Management

Chair, Clinical Microbiology Proficiency Testing

University of British Columbia.

Vancouver BC Canada

Why talk about laboratory Culture in a workshop on Knowing Your Customers

THE INEXTRIBLE LINK BETWEEN STAFF, CUSTOMERS AND SUCCESS

• Without your staff there will be soon be no customers.

• Without your customers there will soon be no need for staff

Why talk about laboratory Culture in a workshop on Knowing Your Customers

THE INEXTRIBLE LINK BETWEEN STAFF, CUSTOMERS AND SUCCESS

• Without your staff there will be soon be no customers.

• Without your customers there will soon be no need for staff “Clients do NOT come first.

Employees come first. If you take care of your employees, they will

take care of your clients”

Richard Branson Successful Entrepreneur

Have you ever noticed…

• By experience and by word-of-mouth, there are some laboratories with a reputation for being an good place to work because most people agree:

• There is a good feeling of comradery • There is a sense leadership is open to new ideas • Staff are comfortable is expressing their opinions • Staff see their opinions are valued • When we find a problem the first response is to fix it • The laboratory celebrates its targets • The laboratory promotes and supports

continuing education for everyone

Have you ever noticed…

• By experience and by word-of-mouth, there are some laboratories with a reputation for being an good place to avoid because most people agree:

• Everyday is another day of stress • There is an open message of just do your work • It is clear that management is not interested

in your thoughts or ideas • When we find a problem the first response

to find out who is at fault. • The laboratory promotes and supports

continuing education, but only for a selected few

It is NOT that one has a laboratory culture and the other does not…

Both places have a culture…

But one has a

POSITIVE Culture and the other has a

TOXIC Culture

What do we mean by “Culture”

Culture is that cluster of values, beliefs, assumptions

and behavioural norms that are shared by

members within an organization.

Culture is not innate: it is the outcome of actions

Cultures are the culmination* of

once conscious or deliberate effort and decisions

that ultimately became

part of an organization’s

unconscious habit.

*where the “culmination” may not last forever.

Culture has it impacts throughout the organization

Culture impacts many aspects of an organization’s

strengths and stability

Performance Retention Innovation

Agility Competitiveness

Finances

BEHAVIOURS

BELIEFS VALUES

ASSUMPTIONS

BUT HERE IS THE IMPORTANT THING: Culture is fluid, and is…

Definable Measurable

and Alterable

And the Impact of Culture is both Internal and External…

“There is a POSITIVE relationship between a people oriented culture

and Customer Satisfaction”

Bremer, M Developing a Positive Culture where People and

Performance Thrive. Motivational Press

2018

Most Management are Oblivious of their organization’s culture until the “A-HAH” Moment…

Errors become obvious to your clients Bickering breaks into BATTLES Sick Leave becomes STRESS LEAVE Staff turnover interferes with workflow Someone lodges a workplace harassment

complaint

What is the Culture you are working in?

Maybe you

should find

out!

First step… Make a “Diagnosis”…

• Start with your own Assumptions?

• Ask your staff?

• Measure using objective standardized tools?

• Act first… Question later?

First step… Make a “Diagnosis”…

• Start with your own Assumptions?

• Ask your staff?

• Measure using objective standardized tools?

• Act first… Question later?

Organizational Culture Assessment Instrument • First published in 1999

• Kim S. Cameron and Robert E. Quinn

• Now used by over 5000 organizations

• Verified and Validated in hundreds of industries

• How OCAI works • Balanced Questionnaire on opinions

• Based on the approach of Competing Values

• How we perceive our organization working NOW

• How we would PREFER to see our organization working

Categorizes Culture into four characteristics Hierarchy (CONTROL) The processes that bring order and CONTROL to an organization such as standards and guidelines, top down management, process and procedure, quality control, accreditation etc.

Clan (COLLABORATE)

The processes that bring collective COOPERATION to an organization such as staff engagement, kaizen, work related education, etc.

Adhocracy (CREATE)

The processes that bring CREATION to an organization such as research and development, new programs, new methods, new strategies, etc.

Market (COMPETE)

The processes that lead to COMPETITION such as methods that increase market share such as market strategy, market growth, customer satisfaction.

Categorizes Culture into four characteristics Hierarchy (CONTROL) The processes that bring order and CONTROL to an organization such as standards and guidelines, top down management, process and procedure, quality control, accreditation etc.

Clan (COLLABORATE)

The processes that bring collective COOPERATION to an organization such as staff engagement, kaizen, work related education, etc.

Adhocracy (CREATE)

The processes that bring CREATION to an organization such as research and development, new programs, new methods, new strategies, etc.

Market (COMPETE)

The processes that lead to COMPETITION such as methods that increase market share such as market strategy, market growth, customer satisfaction.

All are inherently Good None are inherently Evil

In a SUCCESSFUL culture

BALANCE MATTERS

Organizational Culture Assessment Instrument

• Examines organizational culture through a series of strategic questions that highlight how I feel organization culture is shaped

• How are things TODAY?

• What would I prefer TOMORROW?

Organizational Culture Assessment Instrument

Organizational Glue NOW PREFER

A The glue that holds our organization together is LOYAL and MUTUAL TRUST. Commitment to this organization runs high

B The glue that holds our organization together is COMMITMENT TO INNOVATION and DEVELOPMENT. There is an emphasis on being on the cutting edge

C The glue that holds our organization together is EMPHAIS ON ACHIEVEMENT and GOAL ACCOMPLISMENT

D The glue that holds our organization together is FORMAL RULES AND POLICIES. Maintaining a smoothly running organization is important

TOTAL 100 100

Organizational Culture Assessment Instrument

Organizational Glue NOW PREFER

A The glue that holds our organization together is LOYAL and MUTUAL TRUST. Commitment to this organization runs high

15 30

B The glue that holds our organization together is COMMITMENT TO INNOVATION and DEVELOPMENT. There is an emphasis on being on the cutting edge

15 20

C The glue that holds our organization together is EMPHAIS ON ACHIEVEMENT and GOAL ACCOMPLISMENT

25 10

D The glue that holds our organization together is FORMAL RULES AND POLICIES. Maintaining a smoothly running organization is important

45 40

TOTAL 100 100

Organizational Culture Assessment Instrument

Management of Employees NOW PREFER

A The management style in the organization is characterized by TEAMWORK, CONSENSUS, and PARTICIPATION

B The management style in the organization is characterized by INDIVIDUAL RISK TAKING, INNOVATION, FREEDOM, and UNIQUENESS

C The management style in the organization is characterized by HARD-DRIVING COMPETITIVENESS, HIGH DEMANDS, and ACHIEVEMENT.

D The management style in the organization is characterized by SECURITY OF EMPLOYMENT, CONFORMITY, PREDICTABILITY, and STABILITY IN RELATIONSHIPS.

TOTAL 100 100

Organizational Culture Assessment Instrument

Management of Employees NOW PREFER

A The management style in the organization is characterized by TEAMWORK, CONSENSUS, and PARTICIPATION

20 35

B The management style in the organization is characterized by INDIVIDUAL RISK TAKING, INNOVATION, FREEDOM, and UNIQUENESS

15 15

C The management style in the organization is characterized by HARD-DRIVING COMPETITIVENESS, HIGH DEMANDS, and ACHIEVEMENT.

35 15

D The management style in the organization is characterized by SECURITY OF EMPLOYMENT, CONFORMITY, PREDICTABILITY, and STABILITY IN RELATIONSHIPS.

30 35

TOTAL 100 100

Competing Values of Organizations and Cultures

Flexibility and Discretion

Stability and Control

Inte

rnal

Fo

cus

and

Inte

grat

ion

Exte

rnal

Fo

cus

and

Dif

fere

nti

atio

n

Flexibility

Versus

Control

Internal Focus

Versus

External Focus

CLAN ADHOCRACY

MARKET HIERARCHY

OCAI Values in Groups of Medical Laboratories

0

10

20

30

40Clan

Adhocracy

Market

Hierarchy

Group A OCAI (mean values)

Now Preferred

05

10152025303540

Clan

Adhocracy

Market

Hierarchy

Group B OCAI (mean values)

Now Preferred

2017 2018

OCAI Values in Groups of Medical Laboratories

0

10

20

30

40Clan

Adhocracy

Market

Hierarchy

Group A OCAI (mean values)

Now Preferred

05

10152025303540

Clan

Adhocracy

Market

Hierarchy

Group B OCAI (mean values)

Now Preferred

2017 2018

When NOW and PREFERRED are Aligned

the culture is REASONABLY BALANCED

OCAI Values in Groups of Medical Laboratories

0

10

20

30

40Clan

Adhocracy

Market

Hierarchy

Group A OCAI (mean values)

Now Preferred

05

10152025303540

Clan

Adhocracy

Market

Hierarchy

Group B OCAI (mean values)

Now Preferred

2017 2018

When NOW and PREFERRED are NOT Aligned

there may be OPPORTUNITIES FOR ADJUSTMENT

Small Change can have Big Effects • Discussion Groups

• Discussion groups • Education programs • Invitation speakers

• Colleagues • Accreditation Bodies

• EQA

• Communication Improvements • Newsletters • Bulletin Boards • Facebook ???

• Participation programs • Storytelling • Opportunities for Improvement

• Be the Change

Making Change

• OCAI as a starting point

• Provides a measured starting point

• How do people perceive work now

• Investigate the greatest Now-Preferred gaps • Why is there a gap?

• What can we do to close the gap

• Develop a follow-through strategy.

• Be the Change

In summary… • Laboratory leaders MUST be aware of Organizational

Culture BECAUSE… • It is real and impacts almost every significant aspect

of Quality and Leadership. • It can be Measured and Revealing • It can be (with commitment) Changeable

• A POSITVE Culture can lead to improvement for

staff and customers. • A NEGATIVE Culture will lead to poor performance and

increased error

For More Information…