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 Laboratory Management

Handout 1

CLINICAL LABORATORY

A facility where microbiological, serological, chemical, hematological, immunohematology, immunological,

toxicological, cytogenetics, exfoliative cytological, histological, pathological or other examinations are performed
on material derived from the human body, for the purpose of diagnosis, prevention of disease or treatment of patients by
physicians, dentists and other persons who are authorized by license to diagnose or treat humans.

Republic Act No. 4688- Clinical Laboratory Law; Clinical Laboratory Act of 1966

AO 201 s. 1973- The 1st implementing rules and regulation

AO 27 s. 2007

- Revised Rules & Regulations Governing the Licensure and Regulation of Clinical Laboratories in the Philippines
- The registration operation and maintenance of Clin. Lab. In the Phils.
- Preventing substandard, Improperly managed and poorly equipped clinical laboratories

National Reference Laboratory (DEPARTMENT MEMORANDUM No. 2009 – 0086)

• RITM - Dengue, Influenza, TB and Malaria

– NRL for confirmatory testing of blood units

• SLH - HIV/AIDS, Hepatitis, Syphilis and other STI

• East Avenue Medical Center - Toxicology and Micronutrient Assay

• NKTI - Hematology / Immunohematology

• Lung Center of the Philippines - Biochemistry

Classification of Laboratories

1. Classification by Ownership
2. Classification by Function (Clinical Pathology, Anatomic Pathology)
a. Clinical Pathology
b. Anatomic Pathology - Surgical pathology, histochemistry, immunopathology, cytology and post-mortem
examinations
c. Forensic Pathology - Includes all medico-legal examinations
3. Classification by Institutional Character
4. Classification by Service Capability
a. General Clinical Laboratory
b. Special Clinical Laboratory
- Assisted Reproduction Technology Labs
- Molecular and Cellular Technology
- Molecular Biology
- Molecular Pathology
- Forensic Pathology
- Anatomic Pathology

Other Laws to consider on Constructing a Clinical Laboratory:

 • P. D. 1096- National Building Code of the Philippines and Its Implementing

• P. D. 1185- Fire Code of the Philippines and Its Implementing Rules and Regulations

• P. D. 856- Code on Sanitation of the Philippines and Its Implementing Rules and Regulations

• R. A. 1378- National Plumbing Code of the Philippines and Its Implementing Rules and Regulations

• R. A. 184- Philippine Electrical Code Manual on Technical Guidelines for Hospitals and Health Facilities Planning and
Design

• Health Facilities Maintenance Manual. Department of Health, Manila. 1995

• Manual on Hospital Waste Management. Department of Health, Manila. 1997

Documentary Requirements:

• Form No. 4-01: Application for Permit to Construct notarized

• Letter of Application to the Director of the Bureau of Health Facilities and Services

• Letter of Endorsement from the Director of the Center for Health Development

• Four (4) Sets of Floor Layout, showing location of equipment and areas required,

• appropriately dimensioned, properly identified and completely labeled

• DTI/SEC Registration (for private clinical laboratory)

MANAGEMENT

What is management? Many attempts to define management into a single sentence or phrase however, failed to clearly
define just what is included in the term “management”. Working with and through people to accomplish a common mission is
usually the core of the short descriptions that have been proposed. There are five ingredients and/or conditions necessary for
management to succeed which includes:

Mission – goal that the organization’s sub-unit expect to accomplish

Authority – needed to direct the team toward the goal
Resources – includes people, equipment, supplies and money
Responsibility – for achieving the goals assigned
Accountability- for using the resources established

“Management’s job is to see the company not as it is, but as it can become”- Teets, John

DEFINITIONS OF MANAGEMENT

MANAGEMENT comes from the Italian maneggiare which means to handle also from the Latin manu agere which
means to lead by the hand. It also comes from the French word ménagement which means the art of conducting or directing).

Management is the effective motivation of men and the efficient utilization of resources for the attainment of a pre-
determined objective.

Management is a distinct process consists of planning, organizing, actuating (leading) and controlling, which are
performed to determine and accomplish the objectives by the use of people and resources.

Management has been called the art of getting things done through people. This means that activities are completed
and accomplish efficiently and effectively with and through other people.
 “Management is the art of “knowing what you want to do”
and then seeing that it is done
in the best and cheapest way.
- F.W.Taylor

Management as a process
“consisting of planning, organizing, actuating and controlling,
performed to determine and accomplish the objective
by the use of people and resources.”
- George R. Terry

THE NATURES OF MANAGEMENT

Management is both an art and a science.

It is an art because it results in the accomplishment of objective by the use of human efforts. It requires skills and
careful study of its application.

Management is a science because it is a systematic body of knowledge. It gathers and analyzes facts and formulates
general law or principles from these facts.

As an art and a science, management seeks to integrate into a unified, coordinated whole of all the essential factors
that make up an organization.

THE FUNCTIONS OF MANAGEMENT

The functions of management refer to those distinctive activities that must be carried out by the manager if the
objectives of an organization are to be achieved. These functions of management may be grouped into planning, organizing,
directing and controlling.

1. Planning

Planning is the foundation of management. It is the thinking and analysing portion of management process.
It involves setting of organizational goals, designing the course to take, devising methods to use and identifying
resources needed in achieving the goals.

In general, planning can be strategic planning, tactical planning or contingency planning.

a. Strategic planning is concerned with the identification of the mission and of those objectives that will permit its
most efficient pursuit. It is a long-range planning that is normally completed by top-level managers in an
organization. Examples of strategic planning would be who could be the customers, what products should be sold
and what services can be offered.

b. Tactical planning is a method on accomplishing the goal of the organization. It is a short-range planning that
develops a very detailed strategy about what needs to be done, who will do it and how it should be done. It is
usually done by low-level managers.

c. Contingency planning allows alternative courses of action when the primary plans that have been developed do
not achieve the goals of the organization. It serves as a back-up plan if things go out of hand.

2. Organizing

Organizing is the grouping together of men and establishing relationships among them, defining authority
and responsibility to all personnel who will perform the work is very important in order to use maximum advantage of
the laboratory’s materials and resources for the attainment of the common objectives.
 Division and arrangement of tasks is well assigned on a framework that links all worker, tasks and resources
together. The framework is called organizational structure. Structure of an organization shows positions in the
organization, usually beginning with the top-level manager (chairman/president), and presented in an organizational
chart.

3. Directing

Directing is a process in supervising, or leading worker to accomplish the goals of the organization. It involves
giving assignments, assisting workers to carry out assignments, interpreting organizational policies, and informing
workers how well they are performing. Managers must have leadership skill, motivating skills and communication skills
in order to get workers to perform effectively.

4. Controlling

Controlling involves the evaluation of activities. It is the process of determining if the company's goals and
objectives are being met. This process also includes correcting situations in which new developments or unexpected
circumstances arise.
The controlling involves:
1. Establishing standards of performance.
2. Measuring current performance and comparing it against the established standard.
3. Taking corrective action that does not meet the standard.

Control compels the events to confirm to plans.

 Planning, Organizing, Leading & Controlling (Newman & Summer)

 Planning, Organizing, Commanding, Coordinating and Controlling (Henri Fayol)
 ‘POSDCORB’: Planning, Organizing, Staffing, Directing, Coordinating, Reporting & Budgeting (Luther Gulick)
 Decision Making, Organizing, Staffing, Planning, Controlling, Communicating & Directing (Warren Haynes & Joseph
Massie)
 Planning, Organizing, staffing, directing & Controlling (Koontz O’Donnell)

Planning Organizing Directing Controlling

1. Defining goals. 1. Assigning task, people 1. Leading and 1. Monitoring
and arranging motivating activities.
2. Establishing resources to people.
strategy and accomplish work. 2. Changing plans
schedule. 2. Influencing for new
2. Establishing working people to work development.
relationship. hard and achieve
the 3. Resolving
3. Determining what organizational conflicts and
needs to be done, goals taking corrective
how it will be done actions.
and who will do it.
4. Quality assurance

DEFINE AND DIFFERENTIATE

The term manager is commonly confused with terms like director, supervisor and administrator. It is therefore very
important to better understand their differences in order to be aware of their own functions and duties.

1. A manager is a person who plans, organize, direct and control the work of others in order to run a business efficiently
and achieve its goals.
 2. A director’s role is to design, develop long term future plans and implement the strategic plan for their company in the
most cost effective and time efficient manner.

3. A supervisor is an employee of an organization with some of the powers and responsibilities of management, occupying
a role between true manager and a regular employee. A Supervisor is responsible for the productivity and actions of a
small group of employees. An employee is a supervisor if they have the power and authority to do the following actions
(according to the Ontario Ministry of Labour):

Give instructions and/or orders to subordinates.

Be held responsible for the work and actions of other employees.
Administer discipline and penalties.

4. An administrator determines the purpose of the organization, the strategic role it will fulfill within the context of a
larger system or environment, and its goal. It also prescribes boundaries of responsibility and accountability through
the definition of an organizational structure and budget limitation

ESSENTIAL CHARACTERISTIC OF A MANAGER

Although knowledge in the field in which he is operating is necessary to the manager, essential characteristics are
needed for him to succeed in his role.

1. Vision – Managers must have the ability to foresee something and sees the need for change first and to be ready with
solutions before the problem arise. He or she challenges the status quo and forces honest assessments of where the
organization is headed and how it can best get there.

2. Motivation – It is the set of processes that moves a person toward a goal. Motivation is directly proportional to
production. High motivation brings high production.

3. Decision-making ability – A manager who cannot make decision must yield authority to one who can. It is very
important that a manager performs decision for the benefits of the organization.

4. Good health – It embodies more than physical fitness. It means living a balanced life physically, emotionally and
spiritually as the best antidote to tensions, illustrations, strains and effort.

5. Humility – This implies the recognition that we have shortcomings that we are not self-sufficient and that we need the
help of our subordinates just as much as they need our help.

6. Leadership – It is an interpersonal influence directed toward the achievement of a goal or goals. This is another
important characteristic of a manager that might bring motivation and success of the organization.

7. Mentorship – A formal relationship between a newly hired employee and a veteran employee role model that provides
support and encouragement to the new employee. Managers should have the ability to teach new employees, helping
them resolve personal problems and work-related issues and conflicts.

MANAGEMENT LEVELS

In most companies or laboratories, "management" employees are separated from production workers in a hierarchy
that includes at least three levels of management:

1. First Line Managers – This is the lowest level in an organization responsible for the work of others. They direct operating
employees only; they do not supervise other managers.

Example of first line managers are thee technical supervisor in research department and clerical supervisor
in a large office. First level managers are often called supervisor.
 2. Middle Line Managers – This can refer to more than one level in an organization. They direct the activities of other
managers and sometimes also those of operating employees. Their principal responsibilities are to direct the activities
that implement their organization policies and to balance the demands of their supervisors with the capacities of their
subordinates.

A chief laboratory services and departmental heads is an example of a middle manager.

3. Top Managers – This is composed of a comparatively small group of executives. They are responsible for the overall
management of the organization. It establishes operating policies and guides the organizations interactions with its
environment.

An example of a top manager is the president of the hospital.

ROLES OF A MANAGER

In 1973, Henry Mintzberg provides one of the first comprehensive studies of the nature of managerial work. He found
that about:

1/3 of manager’s time is spent in dealing with subordinates.

1/3 of manager’s time is spent dealing with external (outside the organization) matters.
1/3 of manager’s time is spent in a variety of activities including contacts with supervisors, tours of the workplace and
thinking.

As a part of their job, managers serve the company in a number of different ways, playing several different roles.

Interpersonal Roles

1. A manager is a symbol or figurehead. This role is necessary because of the position occupied and consists of such duties
assigning certain documents required by law and officially receiving visitors.

2. A manager serves as a leader – that is, hires trains, encourages, fires and remunerates, judges.

3. A managers serves as a liaison between outside contacts such as the community, supplier etc.

Informational Roles

1. As a monitor, manager gathers information in order to be well informed.

2. Managers are disseminators of information, flowing from both external and internal sources.

3. Managers are spokespersons or representatives of the organization. They speak for subordinates to superiors and
represent upper management to subordinates.

Decisional Roles

1. Managers as entrepreneurs are initiators, innovators, problem discoverers and designers of improvement project that
direct and control change in the organization.

2. As disturbance handlers, managers react to situations that are unexpected, such as resignation of subordinates, firings
or lose of customers.

3. A third decisional role is that of a resources allocation.

4. Finally, managers are negotiators when conflicts arise.

WHAT MAKES A GOOD MANAGER?

 The qualities that top management contenders possess have described as follows:

1. Appearance – Conspicuous obesity or extreme emaciation are negative mark in men. Conservative dress can be faulted
in women. A good quality suits with a fresh, bright coloured blouse is excellent. Jewellery should be muted, air neat.

2. Personality style – You can learn manners and poise. Adopt diplomatic approach and act with difference.

3. Articulateness – This is increasingly important because even if you have the roper educational background, superb
dress and manners, good looks etc. You will ruin your chance if you are a “linguistic cripple.”

4. Energy, drive and ambition – Easy to recognize, through the quick stride, fresh appearance, superb physical health.

5. Positive attitude – Without being an utter fool, you can beat the pessimist by consistently displaying a constructive,
cheerful outlook in life.

6. Thoughtfulness – No one wants a “yes” man. An intelligent man and woman usually weigh a question for a second or
two before responding.

7. Overall composure – The nail biter, hair twirler, foot topper or chain smoker goes beyond an initial interview unless his
or her credentials are so outstanding that allowances must be made for nervous habits.

8. Aura of leadership – An erect carriage, heels held high, an agreeable manner and self confidence connote leadership
qualities. You must be sure of yourself to lead others and most importantly that you inspire trust and are likeable.

9. Bright, informed, and with sense of humor – If you are intelligent and well rounded, you will come across as such. A
degree of humour adds sparkle.

10. With variety of interests – Without being the least bit pedantic, you can learn a little about many fields- art,
architectures, politics, travel, language, economics, and literature etc.

MANAGEMENT SKILLS

Robert L Katz, has identified three basic types of skill; technical, human and conceptual- needed by all manager.

1. Technical skill – is the ability to use equipment procedures and techniques of specialized fields. A surgeon, medical
technologist, nurse and a pharmacist all have technical skills in their respective areas. The manager needs enough
“technical skill” to accomplish the mechanics of the particular jobs he is responsible for.

2. Human skill – is the ability to work with, understand and motivate other people, either as an individual or as a group.
Managers need enough of this human relation’s skill to work with other organization members and to lead their own
work groups.

3. Conceptual skill – is the mental ability to coordinate and integrate all of the organization’s interest and activities. A
manager needs enough conceptual skill to recognize how the various factors in a given situation are interested, so that
the action he takes will be in the best interest of the total organization.

Management Performance – Peter Drucker, argued that a manager’s performance can be measured in terms of two
concepts: efficiency and effectiveness.

As he puts it, efficiency mean “doing things right” and effectiveness means “doing the right things”.

Efficiency is the ability to get things done correctly. It is an “input” – “output” concept. An efficient manager
is one who achieves output, or results, that measure up to the inputs (labor, reagents, supplies, equipment and time)
used to achieve them. Managers who are able to minimize the cost of the resources they use to attain goals are acting
efficiently.
 Effectiveness is the ability to choose appropriate objectives. An effective manager is one who selects the right
things to get done. A manager who selects an inappropriate objective- to convert the laboratory into automation when
the hospital caters to the poor community – is not an effective manager.
INDICATORS OF LACK OF MANAGEMENT SKILLS

1. Inability to maintain adequate staff. The deficiency may be due to an insufficient number of trained workers or efficient
use of the personnel available.
2. Recurring or persistent misunderstanding within the hospital.
3. Frequent or recurrent confusion concerning requisitions or reports of laboratory work.
4. Frequent “rush” orders for supplies.
5. Low morale in the laboratory.
6. Request for deserved pay raised by competent workers (funds are available).
7. Excessive cost of operations.
8. Ignorance of the cost of operation.
9. Expenditure of much of manager’s the time in making minor decisions.
10. Inability to do more tests when a key individual has a day off.
 Handout 2

PLAN AND PLANNING

A plan is a predetermined course of action intended to facilitate the accomplishment of a task, work
or mission. It also keeps in view the necessities of the management.

Planning is the methodical selection of a series or set of complementary actions for the purpose
of pursuing an improved position. It is deciding in advance what to do, how to do it, when to do it and who
is to do it.

THE NATURE OF PLANNING

Long-Range Plans – visualizing what goals must be realized at certain future dates. This nature
of planning is commonly associated with strategic planning which has a long time frame, often three years
or more

Short-Range Plans – this covers daily to annual plans. This is also known as operational planning.

THE IMPORTANCE OF PLANNING

Planning plays a vital role in preventing mistakes and recognizes hidden opportunities. Preparing
a satisfactory plan of the organization is essential in planning process. It enables the management to focus
clearly on what they want to achieve, and how and when they can do it. It helps in forecasting the future,
makes the future visible to some extent. It bridges between where we are and where we want to go.
Planning is looking ahead.

VALUES DERIVED FROM PLANNING

1. The achievement of the objective of the organization in the most efficient and economical manner,
thus maximizing profits.
2. The use of efficient methods and the development of standards necessary for accurate control.
3. Integration of activities of the different units in the organization toward goal-directed actions.
4. The reduction of emergency and unexpected problems.
INDICATORS OF POOR PLANNING

1. Late submission of results/reports.

2. Idle machines.
3. Materials wanted.
4. Some machines doing jobs that should be done by smaller machines.
5. Some laboratory personnel overworked, others are underworked.
6. Skilled workers doing unskilled work.
7. Laboratory/personnel fumbling on jobs for which they have not been trained.
8. Quarrelling, bickering, buck-passing and confusion.

BENEFITS OF GOOD PLANNING

1. Jobs turn out on time.

2. Good relationship with other departments.
3. People using their highest skills.
4. Workers know how their jobs fit into the total pattern.
5. Machines doing their proper jobs.
6. Equipment in good shape.
7. Materials available.
8. Waste kept to a minimum.

QUALITIES OF A GOOD PLANNER

1. Should have good judgment, imagination, foresight and experience.

2. Has the ability to evaluate laboratory opportunities and hazards.
3. Proficient in the determining of objectives.
4. Ability to accept changes.

HIERARCHY (TYPES) OF PLANS

1. Purpose or Mission – This states the purpose of the organization and its main reason of existence.
This is broad, yet clear and concise, summarizing what the organization does. It directs the
organization, as well as all of its major functions and operations, to its best opportunities.

2. Objectives – Objectives or goals are the end toward which planning, organizing, staffing, leading
and controlling are aimed. For example, the objectives of a medical equipment company might be
to make certain profit by producing a given line of blood collection equipments.

3. Strategies – Strategies denote a general progress of action implying commitment of emphasis and
resources to attain broad objectives. For example, if a medical company has a goal of profitable
growth at a certain policies as to market directly rather than through distributor or to concentrate
on propriety products or to have a full line of products.

4. Policies – Policies are general statements or understandings which guide or channel thinking and
action in decision making. Examples are policies to hire only university-trained technicians to
encourage employee suggestions for improved cooperation, to promote from within, to conform
strictly to a high standard or medical ethics, etc.

5. Procedures – Procedures are plans that establish a required method of handling future activities.
They are truly guides to action, rather than to thinking, and they detail the exact manner in which a
certain activity must be accomplished. For example, if a laboratory policy may grant medical
technologists vacations; schedule vacations to avoid disruption of work, set methods and rates of
 vacation pay, maintain records to accomplish employee a vacation, and provide means of applying
to the vacation.

6. Rules – Rules are required actions chosen from among alternatives. It requires that a specific and
definite action be taken or not with respect to a situation. For example, “no smoking” is a rule.

7. Programs – Programs are a complex of goals, policies, procedures, task assignment, and steps
to be taken, to carry out a given course of action. They are ordinarily supported by necessary capital
and operating budgets. For example, “Primary Health Care Program of PAMET.”

8. Budget – Budget is the statement of expected results expressed in numerical terms. It is also
referred to as a “numberized program”

Figure 2.1: The Hierarchy of Plans

STEPS OF PLANNING

1. Identify Goals – A goal is an end that the organization strives to attain. It would guide and identify
where or what the organization wish to be.

2. Evaluating Current Situation – The organization must know where it stands. They must identify
where they are and how they got there. It is essential to determine if they are on the right track.
Each personnel must have a clear understanding of the available resources and how they can
utilize it.

3. Establishing Time Frame – There should be acceptable period of time for each plan to achieve
its goals. Most plans are limited by short term constraints, steps must be taken to ensure that
situation improves in the shortest period of time. This would enable managers to plan where they
want the organization be in 1 to 5 years
 4. Setting Objectives – Objectives are short term standards that are allowing the manager to achieve
its goals, step-by-step. These serve as specific benchmark to know whether standards were met.

4 Basic Characteristics of a Good Objective Indeed, it must be:

1. Clearly Defined and Understood S – Specific

2. Obtainable and Realistic M – Measurable
3. Strict time period in which it should be A – Attainable
accomplished R – Realistic
4. Measurable T – Time Bound

5. Forecast Resources Needs – One major consideration in planning is FEASIBILITY of goals and
objectives. A manager must consider the availability of resources, the possibility of obtaining the
additional assets needed and eventually ends in the development of the laboratory budget both
operational and capital.

6. Implement Plan – This is where the manager designs its STRATEGY for attaining obstacles and
impediments.

2 Basic Ways for implementing a plan or obtaining the desired performance:

a. Tools of persuasion – Focused on working with and through people. This is best described
by listing key words such as: communication, involvement, inclusion, education, training,
cooperation, building confidence, support, consultation, feedback, sharing information and
responsibility.

b. Tools of Control – involves the allocation of resources. By virtue of the manager’s position
and formal authority such as: 1) allocation of financial resources (selection of equipment and
supplies and number of employees) through the budgeting process and 2) the process of
staffing and scheduling of job assignments, managers can obtain and maintain control.

7. Creating Feedback Mechanism – A plan must have a system to check on its progress, with the
information gathered on its system; the plan would be changed relative to the results gathered to
better achieve its goals.

TYPES OF PLANNING

1. Strategic planning – Is a conceptual and deals with the sweeping question of what to do. This
type of planning is concerned with the identification of the mission and of those objectives that will
permit its most efficient pursuit. It involves analyzing competitive opportunities and threats, as well
as the strengths and weaknesses of the organization, and then determining how to position the
organization to compete effectively in their environment.

Strategic planning generally includes the entire organization and includes formulation of objectives.
Strategic planning is often based on the organization's mission, which is its fundamental reason for
existence. An organization's top management most often conducts strategic planning. Strategic
planning is usually based on long-term projections and a global view that can impact all levels of a
laboratory's operations.

2. Tactical planning - Is the method on accomplishing the goal of the organization. This is
intermediate-range planning that is designed to develop relatively concrete and specific means to
implement the strategic plan. Middle-level managers often engage in tactical planning. Tactical
planning often has a one- to three-year time horizon. It is the detailed, often day-to-day operations
needed to meet the strategic goals that have been set
SETTING GOALS AND OBJECTIVES

The first step in laboratory planning is the establishment of general goals (also known as mission
statement) and specific objectives by the laboratory staff. The use of such objectives for purposes of
management is known as management by objectives (MBO).

Goals are those general and qualitative statements of overall philosophy of the organization. An
example of goal is:

“A commitment by the hospital laboratories to be a vital component of hospital whose goal is to

provide a patient’s care environment of excellence, to serve the community and to serve as a setting
for clinical teaching.”

Mission is the final and ultimate goal. An example of mission is:

“The mission of every hospital laboratory is the constant provtrdgision of timely and accurate test
results for the purpose of assisting the physician in the delivery of good patient care.”

Objectives represent the interim goals by which the mission is the most logically and effectively
pursued. They should be quantifiable statements which are achievable over a designated period of time.
An example of objective might be:

“To evaluate available approaches to automation of antibiotic susceptibility testing and to

implement the optimal approach by the end of the fiscal year.”

Objectives may be immediate (priorities), intermediate or long range. Because of the constant
change in the progress of organization, objectives require revival and updating.

MANAGEMENT BY OBJECTIVES

Management by Objectives – Is a process of formulation, performance and assessment, and as

such, it provides means of focus on pertinent factors and issues that affect the practice of laboratory
medicine. As a tool of management, MBO encourages discussion, interaction and consensus decision-
making among all organizational levels of the laboratory.

Characteristics of Objectives in MBO Programs:

a. Follow well-thought-out plans and long term goals
b. Be based on a collaborative agreement between manager and employee
c. Be within the power of individual to accomplish
d. Be person specific
e. Be measurable

Essential Factors in Laboratory Planning (Operational Data):

1. Past experience – Refers to the totality of an organization’s awareness based upon the prior
observations and participations of its membership. As with all input, careful assessment must be
made in order to determine what is valid from what is not. Input must represent well-supported
conclusions based on accurately recorded data, such as test volume, income and expense figures
and work hours.

2. Market potential – May be stated as the known or estimated expenditures for given services in a
given locals or as projections of these expenditures contingent upon specific plans and anticipated
developments. These analyses and/or projections are critical to any contemplation of expanded
services and must include not only a determination of current sales, but also how these sales might
be profitably increase with careful strategy.
 3. Competition – An analysis of most market potential areas will usually disclosed a relatively
consistent set of competitive forces. A brief assessment of these appears in the table 2.2 below:

Competition Strengths Weaknesses Strategy

Physicians’ Office Profitability Limited range of tests Efficient, comprehensive
Laboratories and convenient out-
Patient convenience Limited availability patient services

Lack of quality control Competitive prices

progress
Area hospital Must be assessed Must be assessed As above
laboratories individually individually
Commercial Good quality Inconvenient As above
laboratories Impersonal
Wide range of tests
State health Good quality Inconvenient As above
departments Small direct costs Impersonal PR program (unfair
Slow results competition)

Table 2.2 Assessment of Hospital Laboratory Competition

4. Hospital/Laboratory Relations – These are difficulties and problems that results between those
responsible for providing laboratory services and those accountable of administering overall
hospital policy. These are due to the aberrant and bizarre configuration of most hospital
organization which resulted from the orthodox relationship of the medical staff to the remainder of
the structure.

Figure 2.2: Diagram demonstration of the unorthodox configuration of most hospital

organizations. The area occupied by the medical staff represents not necessarily numbers,
but rather authority.

5. Regulatory and Accrediting Forces – The laboratory industry has been subjected to a large and
ever-increasing number of regulations and performance standards. This phenomenon
characterizes the constraints currently being imposed on all providers of medical services.
 6. Laboratory Trends – They are defined as a series of events constituting a pattern that suggests
both its origin and probabilities for continuation. They serve as valuable indicators of consensus
thinking within the industry and as such, provide an important means by which one’s own thinking
and practices maybe influenced.

7. Medical Trends – The pattern of tests requests is a useful indicator of the relative value with which
the physician perceives the wide range of laboratory services. Any assessment of changes in
laboratory requests patterns include an assessment of improved disease evaluation and the
probabilities of sustained utilization.

8. Socio-political Trends – Events that have been already affected hospital laboratories include the
legalization of unions in non-profit institution and he legislations of equal job opportunities.

Operational Data Planning Goals

Past Experience Strategic Mission
Market Potential

Competition

Objective
Objective
Hospital/Laboratory
Tactical Objective
Relation
Objective
Objective
Regulatory and
accrediting forces
Medical trends
Socio-political Trends

Table 2.3: Essential Factors in planning in the hospital laboratory

PLANNING THE LABORATORY DESIGN

The successful design of a functional clinical laboratory either new or repeated requires the close
cooperation of the following groups:

1. Laboratory director and the entire laboratory staff – In order to prevent misunderstandings, all
recommendations and changes must be documented.

2. Consultants or designers of laboratories.

3. Architect or architectural firm – They are essential in preparing the various drawing and
specifications. The final, approved copies will be submitted and used in the building process by the
contractor for construction.

Traditionally, laboratories have been organized in a mixture of approaches: for example, clinical
chemistry is technique oriented; clinical microbiology is techniques and disease oriented; urinalysis is
specimen oriented; hematology is specimen and organ system oriented and blood bank is product oriented.
THINGS TO CONSIDER WHEN SEARCHING FOR THE RIGHT LOCATION TO START A
LABORATORY

1. Assessment – always remember the 4 P’s

P – Product
P – Price
P – Place
P – Promotion
 What are the customer needs?
 Who is the competition?
 Do you have the right testing menu, equipment, and facilities?
 Do you have enough personnel?
 Do you have adequate financial resources?
 Do you know what it costs to do a laboratory test (test–cost analysis)?

2. Define your costumer segment

 Physicians, nurses, dentists, other healthcare providers
 Other hospital labs, physician office labs (POLs)
 Insurance companies
 Identify unique socioeconomic and/or ethnic groups
 Look for population shifts and location (urban, rural, suburban)
 Colleges, universities, and other schools
 Nursing homes, home health agencies, and clinics
 Veterinarians and other animal healthcare facilities
 Researchers, pharmaceutical companies, clinical trials

3. Process - Develop a sales/marketing plan and team

 Set goals
 Ensure infrastructure (courier service, LIS capabilities, customer service personnel, etc.)
is adequate
 Develop additional test menu items
 Educate laboratory personnel in customer service
 Support and maintain existing client services
 Advertise/public relations

4. How to market? - Review test menu for comprehensive services (niche testing, esoteric testing,
other unique services that could be provided to an eclectic group)
 Place advertisements
 Develop brochures, specimen collection manuals, and other customer-related material
Develop website
 Attend/participate in community health forums
 Identify specific target customers:
 College/school infirmaries, health clinics, county laboratory facilities,
industrial/occupational facilities (pre-employment, drug screening)
 Nursing homes, extended care facilities
 Drug/alcohol rehabilitation centers, correctional facilities
 Physician offices (POLs), groups, and specialties (pediatrics, dermatology, family
medicine, etc.)
SPATIAL CONSIDERATIONS IN LABORATORY DESIGN

The location of the laboratory must be carefully studies in relationship to other hospital services, to
traffic, to supporting and to users. For example:

1. The blood bank and the critical care laboratory procedures should be readily accessible to the
emergency room, operating rooms and intensive care unit. The location of blood bank should
allow rapid donors if the blood bank is responsible for donor procurement, phlebotomy and/or
aphaeresis.

2. A specimen collection area or phlebotomy area should be planned in proximity of the

ambulatory care facility and the admitting office.

3. If the laboratory is serving an in-patient population, accessibility to corridors and elevators

providing access to the main patient care units is essential.

4. The specimen receiving, data processing and reporting center serve as the hub of the
laboratory. Radiating from this should be the various laboratories.

5. The critical care laboratories and large volume laboratories (such as hematology and
chemistry) might be closely related to the central areas.

6. These laboratories with greater turn-around-time (TAT) and/or less volume, as well as those
requiring special safety features (such as clinical microbiology and radio assay laboratories)
might be removed from the central area.

7. The intra laboratory traffic flow must be separated from the outside. Provisions should be made
for ambulatory patients and blood bank donors coming into the laboratories.

DIFFERENT LABORATORY DESIGNS

These three are the things to remember when planning to design a laboratory:

1. Functional Design – It should be designed according the functions and easy way of communication
for the different members of the organization.

2. Regionalization – It is a consolidation process on a grander scale. In this ‘hub and spoke’ model, a
single core laboratory serves as the hub with one or more other laboratories serving as the spokes.
It requires significant up-front resources to initiate a regionalized laboratory, considerable space
requirements, commitment from senior personnel, and long-term, continuing education for the staff
in dealing with this change.

This type requires a highly cooperative environment among all parties involved and can
take years to fully implement. In this model, two or more hospital laboratories form an
interlaboratory alliance and come to agreement on the location of laboratories, retention of staff,
instrumentation used, and information management system. Often, a large, core laboratory facility
is centrally located to accommodate the routine and the more esoteric tests. Stat or rapid-response
laboratories are located at individual hospitals to handle urgent test requests. This model works
particularly well where a large, comprehensive laboratory already exists among a number of smaller
community-based hospitals. A variation of this model is one that focuses on specialization and
laboratory expertise.

The advantages of such a consolidation are standardization of procedures, equipment,

quality-control programs, and reporting formats. Reducing equipment redundancy, maximizing
specimen throughput, and utilizing staff more effectively can achieve significant cost savings. One
 laboratory consolidation of services allowed for a 25% reduction in labor; bulk purchase of common
supplies reduces costs; and multiple purchasing agreements can be consolidated. The challenges
in implementing and succeeding with this model include specimen transportation, resistance to
change, personnel issues, morale issues, ‘lost identity’ of the laboratory, and union problems, and
thus require careful consideration in the planning process.

3. Physical design – Physical design are important regardless of the type of laboratory. Location of
specimen processing area, patient registration and data entry, specimen testing workflow, short-
and long-term storage, and laboratory information system (LIS) connectivity requirements must be
considered. Spatial requirements in relationship to other hospital services (proximity to emergency
department, intensive care units, and surgical operating suite) should be viewed as a
multidisciplinary process. Robotics, pneumatic tubes, computers, including intranet and internet
accesses, and facsimile machines are the new tools used in modern laboratories and must be
accounted for in the design plans. Electrical power, temperature/humidity controls, water and
drainage sources, and air circulation/ventilation issues must be considered for placement and
adequate quantity. Regulatory compliance codes must be carefully reviewed and implemented
appropriately to ensure safety, ergonomic, and comfort needs. To ensure one meets local, state,
and federal codes, a qualified and experienced architect who has experience in designing clinical
laboratories should be consulted when considering laboratory relocation or renovation designs.
This also minimizes costly change orders and maximizes functionality and workflow.

LABORATORY PHYSICAL DESIGN CONSIDERATION

1. Identify space needed: for offices, personal facilities, storage, conference/library area, and
students.

2. Routinely review all floor plans and elevations for appropriate usage as well as to ensure that space
and function are related. Handicap accessibility may be required.

3. Develop and use a project scheduler.

4. Fume hoods and biological safety cabinets must be located away from high traffic areas and
doorways.

5. Modular furniture allows for flexibility in moving or reconfiguration of the laboratory according to
current and anticipated needs.

6. Conventional laboratory fixtures may be considered in building depreciation, whereas modular

furniture is not.

7. Base cabinets (under laboratory counters) provide 20 to 30% more storage space than suspended
cabinets.

8. Noise control in open labs may be obtained by installing a drop ceiling. Installation of utilities above
a drop ceiling adds to flexibility in their placement.

9. In general, space requirements are 150 to 200 net square feet (excludes hallways, walls, custodial
closets, etc.) per FTE, or 27 to 40 net square feet per hospital bed.

10. Rooms over 100 square feet must have two exits; corridors used for patients must be 8 feet wide,
while those not used for patients must be 3 feet 8 inches wide.

11. An eyewash unit must be within 100 feet of work areas.

 12. Suggested standard dimensions in planning and designing a laboratory:
 Laboratory counter---------------------------------------- width: 2 feet 6 inches
 Laboratory counters to wall clearance -------------- 4 feet
 Laboratory counter to counter clearance ----------- 7 feet
 Desk height ------------------------------------------------ 30 inches
 Keyboard drawer height -------------------------------- 25 to 27 inches
 Human body standing ----------------------------------- 4 square feet
 Human body sitting --------------------------------------- 6 square feet
 Desk space ------------------------------------------------- 3 square feet

DIFFERENT LABORATORY SERVICE MODELS

1. Traditional “closed” laboratory – The traditional hospital laboratory has discrete sections in
hematology, chemistry, microbiology, and blood bank, generally separated into rooms or sections.

2. “Open” laboratory – The discrete services are placed in one large room with portable walls that
can be adjusted as needed based on volume.

3. Core laboratory – A common type of consolidation has been hematology and chemistry
laboratories (“chematology”) (Bush, 1998).

- Advantages include handling stat requests, improving off-shift workflow, and avoiding chronic
staffing problems

4. Regional laboratory – Specific low-volume or expensive laboratory services currently provided by

more than one regional hospital laboratory, that are consolidated into one hospital laboratory. For
example, consolidation of all virology or PCR testing into one hospital laboratory.

5. Reference laboratory – Traditional full service laboratory that handles all types of testing,
especially esoteric tests.

1. Dengue, Influenza, Tuberculosis and

other Mycobacteria, Malaria and other
parasites, Bacterial enteric diseases,
Measles and other Viral exanthems,
Mycology, Enteroviruses, Antimicrobial
resistance and Emerging Diseases
NRL for confirmatory testing of blood
units.
2. HIV/AIDS, Hepatitis, Syphilis and other
STIs.
3. Environmental and Occupational
Health;
Toxicology and Micronutrient Assay
4. Hematology including
Immunohematology, Immunopathology
and Anatomic Pathology
5. Biochemistry

6. Point-of-care – Laboratory testing that is brought to the patient's bedside. Test menu is generally
limited to a few basic chemistry and hematology tests (e.g., glucose, pregnancy, activated clotting
time, blood gases).
7. Stat laboratory – Rapid response laboratory that is often located in or near an emergency
department or surgical suite. Provides critical laboratory tests such as hematocrits and blood gases.

8. Limited service – Laboratory provides limited menu of routine (like CBC, chemistry panel,
prothrombin time) and/or specialty services (like fertility testing) on a stat or non-stat basis. Includes
downsized hospital labs that retain stats and some routine tests but send most work to an off-site
core laboratory.
 ORGANIZING

Handouts 3

DEFINITION

Organizing is a process of structuring activities, materials, and personnel for accomplishing

predetermined objectives. It is done in such a way that efforts and expenditures are minimized and output
is maximized. Organization consists of knowing the tasks, and understanding what knowledge and
expertise the employees must possess in order to perform the tasks, and understanding the physical, and
capital requirements that must be assembled to accomplish the desired results.

Organizations are social entities that are goal directed, deliberately structured and coordinated
activity systems and are linked to the external environment but with an identifiable boundary.

DIMENSIONS OF ORGANIZATION

1. Contextual Dimensions – Characteristics of organizational setting that influence and shape

the structural dimensions. These are integral to the organization as such, it is vital to the very
existence and performance of the organization, such as the number of employees or technology or
machine to be used.

2. Structural Dimensions – Describe internal characteristics of an organization. These makes up

the requirements to operate as described by the contextual dimension. It is “dependent” on the
contextual dimension.

Contextual
Viewed as “causes” of the structural dimensions
such as “independent variables”.
Size (measured as number of employees, total
sales, and assets)
Technology (tools, techniques, actions use to
transform inputs into outputs)
Goals and strategies
Culture (values beliefs, and norms shared by the
employees.
Structural
Viewed as “consequences” or “effects” or
dependent variables.
Formalization (use of written documentations such
as job description, procedures)
Specialization (degree of subdivision of tasks into
separate jobs / division of labor)
Hierarchy of authority (depicted by vertical lines in
organization chart; described by number of levels
and span of control.
Centralization (extent to which decisions are
made at the top of the hierarchy rather than
delegated to lower levels
Professionalism (level of formal education and
training of employees)

CONCEPTS OF ORGANIZATION

Over the centuries various concepts have been applied to effectively handle an organization. They
have been changed to gain greater efficiency and to meet set goals. They may also vary due to culture or
ethnicity of person handling the organization and the employee itself. There are many concepts introduced
but some are considered “flawed”, or ineffective.

1. Herd concept – Staffs are coerced upon the established rules and regulations. Leader has the
exclusive power to decide and enforce an unquestionable rule. The leader here is seen as the
person with the highest authority. The leader may not be involved in the personal affairs of the staff.
The staff are made to obey rules that are set y the leader and complains are minimized.
 2. Man to man concept – individuals are in direct relation to the supervisor. There is a direct
delegation of authority and responsibility of the leader to the staff. Leaders are in direct relation to
the staff.

3. Social concept – supervisors and subordinates are regarded as a member of the team. Each
problem is viewed in its overall effect on the organization to the staff. All people in the organization
works toward a common goal. All issues are discussed and each opinion is given the same
importance as others. Decisions are made for the common good.

TABLE OF ORGANIZATION

An important management tool is the organizational chart. An organizational chart shows

hierarchical relationships between functional areas in an organization. An organizational chart helps clarify
work flow, reporting lines, and areas, be it by division, laboratory, or specialty areas.

Chief
Pathologist

Pathologist Pathologist Pathologist Pathologist Pathologist Pathologist

Hematology Blood Bank Chemistry Microbiology Serology Microscopy

MT MT MT MT MT MT
Superviso Superviso Superviso Superviso Superviso Superviso
rr r r r r r

STAFF STAFF STAFF STAFF STAFF STAFF

STAFF STAFF STAFF STAFF STAFF STAFF

STAFF STAFF STAFF STAFF STAFF STAFF

STAFF STAFF STAFF STAFF STAFF STAFF

STAFF STAFF STAFF STAFF STAFF STAFF

Example of an organizational chart (Clinical Pathology laboratory)

 The chart specifically indicates positional authority. Authority implicitly accompanies a position on
the organizational chart, and its location on the chart implies a degree by those who directly report to the
person in authority. The organizational chart is a contract of sort, as it unambiguously illustrates the
structure of the organization and the relationships among the people within it. It also serves as a visual aid
for evaluating this purpose as the position of greater responsibility is placed on the top, while positions
carrying lesser responsibilities lie below.

STAFFING

The functions of clinical laboratories are critical to good patient care, diagnosis, and management.
It is estimated that 85% of physician’s medical decisions are based on laboratory results. This alone implies
that a laboratory must be adequately staffed not just in numbers but equally important is their qualifications.

In a clinical laboratory, unlike other organization such as in marketing or company, the law specifies
the minimum number of staff that should e employed to be able to operate. This protects ensures that
patient will be attended well and the employees are not overworked. For example, as indicated in R.A 7719
of 1994, for a blood bank to operate it should have at least:

Category A – 4 RMT (1 RMT for AM, PM, night shift each. 1 RMT off)

Category B – 5 RMT (2 RMT for AM shift, 1 for PM and night shift each, 1 RMT off) and there is a
donor recruitment officer, which can be a Doctor, Medical Technology or nurse.

This should be headed by a pathologist, hematologist, or a physician but should have had
at least 6 months training in Blood Bank from an accredited institution, and has a 1 year experience
in blood banking.

It can also employ a medical laboratory technician under the supervision of the registered
medical technologist. A medical technologist is allowed to supervise up to 2 laboratory technician.

DIVERSITY IN THE WORKPLACE

If human nature was consistent and everyone had the same characteristics, there would be no
need for supervisors, policies and procedures, and managers. This is more evidently seen with today’s
globalized work environment making decision, involving staff a very difficult one.

Selecting the right person for the job is not easy. Identifying candidates for the “right fit” based on
education, technical skills, experience is easy. Often the most difficult part is identifying those personal
traits that are conducive to being a team player which re subjective. Misunderstandings based on culture,
ethnicity, religion may inadvertently result to a missed opportunity for both employee and employee,

Characteristics to look for in a potential employee may vary depending on the position or the nature
of the job he is applying for. Common characteristics may include ambition, creativity, energy,
communication, enthusiasm, leadership, tenacity, independence, team-player, and initiative.

JOB DESCRIPTION

A job description is a list of the general tasks, or functions, and responsibilities of a position.
Typically, it also includes to whom the position reports. The analysis looks at the areas of knowledge and
skills needed by the job. Role is the set of responsibilities or expected results associated with a job. A job
usually includes several roles.
 It is very important to review the accuracy because it potentially sets the foundation for the scope
of the jobs for until the organization or the duties of the employees have been changed. This will ensure
that job duties listed are really needed, have not changed, or could be improved.

There are five key sections common to most job descriptions:

A. Job titles: should be consistent throughout the laboratory with consideration to local and national
nomenclature that may be used in describing job titles. It may also be related to the position and
gives an overview about the nature of the job.

B. Qualifications: describes the education, experience, traits (e.g. honesty, punctual, personality,
etc) that a person must have to properly fit for the position. This defines what an applicant or
employee should have in order to effectively perform the job.

C. Duties: must be identified to ensure that the incumbent understands what he/she must do. It
enumerates the things that must be done and/or what are not done yet but are needed to be
completed.

D. Responsibilities and accountability: identifies or delimits how much authority one has during
decision-making. It ensures that an employee exercises decisive authority over a subject to which
he is accountable. It also minimizes conflict because of overlapping of decisions especially by
managers.

E. Job relationships: it states where the incumbent will report to or where he/she reports to be it
internally or externally. This is particularly important is a workplace is very diverse. It is very
important to keep the flow of communication open and to address the problem properly by reporting
it to proper authority.

JOB SPECIFICATION

Job specification is a list of qualities that an employee must have to fit for the position. It makes
sure that a qualified person occupies the position. It avoids under-qualification or over-qualification. As the
qualifications have been met, it is expected that the employee will be productive and will meet what is
expected of him/her. This may include age, educational background, years of experience, skill, previous
job, trainings and seminar, license, and certificate.

Below is an example of a job description for a Medical Technologist Supervisor (Blood Bank):

Job Title: Medical Technology Supervisor

Department: Clinical Pathology
Section: Blood Bank

Job Summary:
Under general Supervision: coordinates services in the unit and supervises staff performance to
achieve unit goals and objectives.

Specific Duties and Responsibilities:

1. Coordinates work and services of the unit based on hospital work standards and procedure to
achieve objectives.
2. Supervise and direct staff performance.
3. Participates in budget preparation and monitor expenditures.
4. Maintains cleanliness and safety in the work area.
5. Maintains quality control and assurance program.
Regular duties:
1. Organize work and institute discipline in the section.
2. Process reports and requisition.
3. Maintains quality control and quality programs.
4. Prepares schedule of staff.
5. Initiate request for routine supplies and inventory of it.
6. Accounting for work done.
7. Performs job function of med. Tech staff as the case arises.
8. Performs special procedure such as apheresis, antibody screening.
9. Prepares reports, monthly accounts, and consumption.

Key Organizational Relationship:

Reports to: Division Chairman
Supervises: 8 Medical Technologists, 1 Nurse
Coordinates with: Other sections in the department and interdepartment as the need arises.

Job Specification:
Education: Bachelor of Science in Medical Technology
Experience: 5 years
Specialized knowledge/training: aphaeresis, antibody screening, training in HIV Testing.
License: Professional Regulation Commission

WORK SCHEDULE

Work schedule also entails planning to ensure that work will not be disrupted due to understaffing
or in cases of absences. It will also be not economical if the number of staff is not maximized because of
overstaffing. Doing work schedules is inherent to the nature of job, workload, and efficiency of staff. Here
are some of the rules undermined during preparation of schedule.

1. Two-deepness rule – A laboratory should at least have 2 staff per shift who can perform the job.
This is to address problems because of absent employee since it is inevitable so to speak as one
time or another certain personal problems may arise. It ensures that work will not be disrupted in
such cases.

2. No more than 5 consecutive working days – This is to follow the directives indicated in the Labor
Code here in the Philippines that an employee should not work more than 5 days in a week.

3. 2 days off – Also as indicated in the Labor Code.

4. Rotate shifts with fairness – This is to ensure that there will be no conflict when it comes to
schedule especially to laboratory operating 24 hours. Not all employees may like morning shift or
night shift.

5. Give opportunity to the staff to request their duty – To avoid absences, staff are given a chance
to tell the supervisor their desired duty or off in advance to make the necessary adjustments.

6. Post schedule in advance – This will address the problem of absences since the staffs know the
schedule in advance and again to make adjustments to their schedule as the case maybe.

7. Stick to the approved schedule as closely as possible – To prevent mixed-up of schedule,

however if changes are inevitable the supervisor should be informed in advance.
PERFORMANCE APPRAISAL

The word “appraisal” is derived from the Latin word appratiare which means to set a price or value.
In this case, employees work for compensation. A formal performance appraisal is also known as merit
review or performance evaluation. It is a planned, periodic management activity to evaluate an employee’s
on-the-job behavior, competency, work skill improvement, need for training, and progress towards
completing goals, salary, and promotion. It is a key human resource function that is closely integrated not
only with compensation and training but also for career planning.

Advantages of performance appraisal

Performance appraisal is done mainly for assessment if an employee is performing well his/her
duties. It promotes good communication between leader and staff not only during conflicts but also for a
well-performed job. It provides constructive feedback so as to improve the performance of staff with short-
comings, thus provides an opportunity to refine job skills, educational needs, and/or behavior. It is also
done so that staffs are well aware of the things that are expected of them.

Disadvantages of performance appraisal

Although appraisals are done without harm on mind some effects bad effects are inevitable. Staff
may experience it as an added stress since he/she has to meet the expectations especially the staff
exhibited poor performance. It may be a source of conflict between staff and managers and promotes
competition among staff. It is also an added work especially for managers.

TYPES OF APPRAISAL

1. Formal appraisal - Generally occurs at least annually on a specific date and time, such as
employee’s anniversary of hire date or as advised by the HR department. Appraising all employees
at the same time period is generally viewed as most fair because the same guidelines can be
applied to all employees evaluated.

2. Informal appraisal – This is useful for monitoring behaviour modification, recognizing

accomplishments, identifying stumbling blocks in achieving set goals, giving support where
applicable, and fostering ongoing communication between formal appraisals. it also ensures that
the formal appraisal does not come as a surprise to employees. They know what to expect and can
work at fulfilling those expectations.

Other Types of Appraisal

Appraisals are done to check the performance of each employee. As such, managers are not the
only one tasked to do appraisals. Depending on the culture in the organization, managers may
misunderstand staff and sees staff at his/her poor performance.

1. Self-appraisal – Generally distributed approximately 2 weeks prior to a formal appraisal and are
not meant to take place of a manager’s appraisal, they give a different perspective of an employee’s
performance and possibly a better understanding of the potential obstacles that may impede
performance.

2. Peer-to-peer appraisal – Requires trust among employees working together. Co-workers are
asked to evaluate each other. This approach may engender fears among staff, some without
foundation, that need to be addressed. Conversely, if you are working with experienced and sincere
employees, the process may prove to be educational.

3. 360-degree evaluation – Designed to obtain well-rounded appraisals that tend to be reserved for
individuals in management-level evaluations, both trust and a comprehensive training program are
required to successfully implement this technique. The evaluation is often done anonymously and
invites, open, constructive in-depth feedback.