Angela M. CaliendoSuccessful healthcare systems find ways to ensure that goals and objectives of individual departments are aligned with broader organizational missions. This is easier said than done, however, as too often gaps exist between the two, negatively impacting patient care. Here, Angela M. Caliendo, MD, PhD, discusses how to tackle competing missions. She is professor and vice chair of the Department of Pathology and Laboratory Medicine at Emory University School of Medicine in Atlanta, medical director of Emory Medical Laboratories, and an attending infectious diseases physician at Emory University Hospital.

Corinne Fantz, PhD, a member of the CLN Patient Safety Editorial Board, conducted this interview.

What makes a successful mission statement?

A successful mission statement leverages the collective strengths and diversities across an organization and focuses all employees toward one common goal. This can be particularly challenging in healthcare where departmental and administrative silos loom large. But if leadership and staff align their individual goals with system goals, the organization is likely to benefit from increased patient and employee satisfaction.

Another ingredient for mission statement success is for all its components to be valued. For example, if the mission statement encompasses clinical service, quality, teaching, and research, then employee participation in all these activities must be supported.

What is the value in aligning missions in healthcare?

Aligning missions creates momentum for an organization. It uses strength in numbers to push the organization towards a unifying goal. Coalescing employees and goals across departments improves productivity and may change the way the organization designs processes because goals are focused globally, rather than locally.

Laboratories are quite familiar with standardization and structure, but we may be guilty of improving our own processes at the expense of the larger system. With shrinking budgets and increased responsibilities, systems that align missions and build partnerships across departments will ensure patients receive the highest quality and safest care even while the organization maintains financial strength and employee satisfaction.

Fighter jets
Like these fighter jets, alignment of individual goals is necessary for success of the team. How do you define competing missions?

Simply put, they are goals that are not aligned. To illustrate, let's compare an entire hospital's interests versus those of an individual physician providing clinical services. The hospital may be focused on improving efficiency, lowering costs, and achieving quality metrics targets. In contrast, the physician's department may be focused on increasing research dollars or clinical trial participation. In this example, the physician is caught between the competing missions of the hospital and his department. If missions were aligned, these types of conflicts likely would be reduced, although not completely eliminated, unless there happened to be adequate revenue to support each mission equally.

What are the most common reasons that priorities compete or conflict?

Some of the most common reasons for conflicting priorities include different values, limited resources, silos, and not taking the time to align goals. Effective leaders need to clearly state the aligned goals, continually communicate the goals, stick with them, and make them part of organizational and departmental culture.

Can you provide examples of competing priorities that place patients at risk?

One example is the ability to coordinate care when systems have been optimized in silos. Patients in these systems move from place-to-place to accommodate service line schedules, rather than the hospital organizing its systems according to the needs of the patient. When competing priorities are present, care that is not coordinated may lead to redundant orders for lab tests. The outcome is that patients feel mistreated because they must have their blood drawn multiple times.

Similarly, labs that do not release critical values until they reach the patient's clinician by phone may be optimizing their process for documentation. But the lab actually may be delaying care by not entering the result into the patient's record, which could enable another provider to act on it.

Misaligning financial incentives is another example. As clinical revenues decrease, hospitals may have fewer resources to support infrastructure and therefore have difficultly maintaining a safe level of care. Supporting the infrastructure not only includes adequate staffing, but also should value opportunities for continuing education and training, investing in new technologies, and replacing older equipment at reasonable time intervals.

Priorities that Can Compete with Each Other

  • Fiscal responsibility
  • Revenue growth
  • Employee satisfaction
  • Employee safety
  • Patient safety
  • Physician satisfaction
  • Patient satisfaction
  • Quality of patient care
  • Compliance
  • Efficiency
  • Reputation
  • Teaching responsibilities
  • Introducing innovative new technologies/testing
  • Research

What strategies have you used to work through competing priorities?

A great place to start is to communicate system goals clearly and consistently. When competing priorities arise, create multi-disciplinary working groups that include patients to help align goals through compromise and consensus. Then rank the priorities to effectively manage resources. There are limits to what can be done each year, so be flexible, choose wisely, and support those projects where funds and time can be dedicated to doing them well.

Examples of Competing Priorities that Involve Laboratory Services
Goals in conflict
Possible solution
To meet financial goals of the institution, lab outreach program pushes broad use of tests that have limited utility. Financial vs. quality of care Lab outreach focuses on tests of high clinical value. The hospital hires a pathologist-in-chief or chair, whose main interest and expertise is research or surgical pathology, to oversee the clinical laboratory. Research vs. clinical services Delegate responsibility for the laboratory to a clinically oriented vice-chair or laboratory director. To improve coordination of patient care, the lab provides test results for physicians' early morning rounds. This requires lab staff to work the nightshift or come in very early, and to draw patients' blood at 4 a.m.

Employee satisfaction vs. quality of patient care

Patient satisfaction vs. quality of patient care

Rewards/incentives for staff who come in early.

Draw blood at 11 p.m. the previous evening.

Physician finds it very dissatisfying that she cannot re-label mislabeled specimen. Physician satisfaction vs. patient safety Medical director re-educates the physician regarding why relabeling is an unsafe practice. Privacy concerns are exaggerated to the point that staff is fearful of communicating to patients' next-of-kin. Compliance vs. quality of care and patient satisfaction Rebalance goals with help of the privacy officer and risk management staff. Patient is dissatisfied when told she cannot eat for 12 hours before lab test. Patient satisfaction vs. quality of care Educate patient regarding need for accurate lab results. Medical technologists complain that efficiency is decreased and turn-around times are slower because they are training students while doing clinical work. Patient care vs. education

Hire a technologist dedicated to teaching the students.

Level the work load by emphasizing teaching when lab tends to be less busy.

With the changes coming to laboratories under healthcare reform, do you think we will see more or fewer competing missions?

If we are to deliver high-quality, cost-effective healthcare, addressing laboratory utilization will be essential under healthcare reform. This means successfully transitioning from our current model, in which the more laboratory tests that are done, the more revenue that is generated, to one focused on cost-effective quality care. In the latter model, reducing laboratory tests may well be the higher value to the system. This environment may create more opportunity for competing missions as funding for research, teaching, and clinical care shrinks. Although there will be challenges, the incentives and motivation to align missions has never been greater. I believe this is one of the true opportunities that will come out of healthcare reform.

Effective Strategies for Laboratory Managers to Work through Competing Priorities

  • Provide clear, concise, and consistent communications of system goals.
  • Use multidisciplinary work groups that include patients.
  • Rank the priorities and fund those with the highest impact.