Shared governance: one lab's experience

Medical Laboratory Observer, May, 1999 by Nancy Snyder

Does a laboratory in which everyone is in charge sound like sheer chaos? Read on to discover one lab's experience. You may be surprised.

In our laboratory, all of us are in charge - all the time. We have no chief technologist. All 16 of the laboratorians at Houlton Regional Hospital Laboratory, including 4 phlebotomists, share managerial responsibilities and are regarded as managers by the rest of the hospital. This new management system we developed is called "shared governance," and it has been working successfully now for 2 years.

Contributing factors

In 1996, our 86-bed hospital in northern Maine began to experience the downsizing that was plaguing hospitals across the country. During this process, the lab, the pharmacy, and the radiology department were put under the management of a willing but overwhelmed radiology manager, the supervisor of ancillary services, who lacked lab experience (see MLO, October 1998, "Multidepartmental management: The challenge of the new millennium," p. 36). As a result, we were forced to assume more responsibility for running the lab.

At the same time, we had a Joint Commission on Accreditation of Healthcare Organizations inspection looming. Because the new manager knew so little about the workings of the lab, we were largely responsible for preparing for the inspection, which we proudly passed with only three minor citations. The manager gave us full credit and eventually resigned his position for a new one outside the hospital.

At the same time, we faced an administrative "shake-up" - the hospital board decided to hire a new CEO, and the upper tier of middle management was completely restructured. As if that were not enough, our pathologist resigned to return to school, and the pathologist hired to replace him was herself in a position as pathologist for the first time.

In addition, our lab had a somewhat egalitarian history all along. Eight out of 12 techs were technologists and 4 were technicians, but everyone was expected to do the same bench work. We had department supervisors for chemistry, hematology, special chemistry, microbiology/urinalysis, and blood bank/serology, but they were on the same salary scale as nonsupervisors - their salaries were determined by seniority and shift differential only.

When the new CEO and administrator of ancillary services solicited lab staff members' opinions about how the lab should be managed, the consensus was that a "shared governance" model would be worth a try. Part of the argument was that we had a large enough staff so that no one person would be overwhelmed with managerial responsibilities yet small enough so that communication was manageable. In our experience, such a model would probably be difficult to implement with fewer than 8 people or more than 40.

System development

In August 1996, we developed a skeletal model of the way our shared governance system would function. We decided that committees would take over various aspects of management, including personnel, finance, public relations, education, computers, professional practices/research and development, morale, and phlebotomy (see "Shared governance organizational chart," p. 57).

At a meeting attended by everyone in the lab as well as the administrator of ancillary services, all but two members of the lab staff voted in favor of accepting the committee structure for a 2-year trial period with an option to renew the plan at the end of the first year. Once the decision was made, even the two members who had opposed the vote each chaired a committee and worked hard to make the experiment work.

Forming the committees was the next order of business. We derided that everyone in the lab would be required to participate in at least one committee and could be on as many as he or she chose. People signed up for committees according to their personal interests and talents, which helped to ensure involvement. We determined that the committees would meet at least once a month and more often if necessary. In addition, we decided the lab would have weekly meetings for whoever could attend and once a month when everyone, or at least one person from each committee, would be required to attend.

Then we developed the specific functions of each of the committees. We accomplished this by using JCAHO standards as a basis and supplementing these guidelines with any additional duties members felt were necessary (see "An example of committee responsibilities: The personnel committee," p. 58). Each committee worked on its own functions and goals and then submitted them to the professional practices committee, which was responsible for writing a self-governance handbook This handbook included a listing of all the committees with their respective functions and goals as well as a detailed personnel section delineating hiring and firing, sanctions and grievance procedures, and detailed job descriptions for use in evaluation reports.

The administrator of ancillary services reviewed the handbook periodically as we were writing it, suggesting changes along the way. The handbook was approved in February 1997, and we officially began governing ourselves.