During times of economic volatility, both private and public laboratories are affected in a variety of adverse ways. However, public health laboratories (PHL) are especially vulnerable due the government funding constraints which include: budget cutbacks, decrease in reimbursements and reductions in employee development programs. Fortunately, change initiatives addressing deficiencies can be put in place to support and enhance existing infrastructures.

Achieving a successful change initiative project requires building a solid foundation with all stakeholders. Everyone must see the "big picture" regarding the goals for change. To achieve this, a continuous flow of information regarding the project's activities, barriers and results must be shared. Ongoing communication can be accomplished by utilizing process strategies.

Process Strategies

Quality improvement leaders, such as Edward Deming encourage the necessity of having a process for educating stakeholders during change management initiatives. A process is a series of connected steps or actions with a beginning and an end that can be replicated. Process strategies in change management are repetitive opportunities for stakeholder education on the change initiatives to be implemented. The probability of true transformation is at risk, without a well-defined process for ongoing information flow.

To further illustrate this point, let's review the Laboratory Efficiencies Initiative (LEI) project. This is a noteworthy model that calls for a paradigm shift within the pubic health laboratory system at national, state-wide and local levels.

Laboratory Efficiencies Initiative

As a result of the increase role of public health laboratory systems during health-related catastrophes and natural disasters, President Obama requested that $20 million be appropriated to CDC for an innovative resolution. The purpose of this funding is to address the need for current and future challenges facing public health laboratories. With the support of this new government funding, the Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC) joined forces to design and implement a project titled the Laboratory Efficiencies Initiative.

In 2011, the APHL and CDC agencies released a document outlining the LEI project. The project's vision is, "A sustainable and integrated network of public health laboratories." And the mission is, "To assure that the public health laboratory network efficiently provides high confidence scientific evidence to drive decision-making that protects and improves the health of the public."¹.  

LEI Strategic Plan 2012-2015

During 2011, APHL/CDC had a series of meetings which culminated into the LEI Strategic Plan 2012-2015. The goals and objectives of this three-year plan are to, "sustain the public health laboratory system during the time of decreased funding by changing the effectiveness of laboratory management systems and processes."²

On December 13, 2012 an APHL/CDC partnership meeting was convened. The meeting agenda covered several of the plan's goals, including data sharing, emerging technologies, informatics and workforce competencies. To address laboratory employee issues (e.g., shortages, skill building), the team is scheduled to present a workforce competencies plan in March of 2013.³

Collaborative Approach

Public health laboratories specialize in a wide range of areas, from clinical diagnostic testing to emergency response support. However, the LEI strategic plan is set with the enormous task to address the specific and unique needs of each and every type of public health laboratory. So, it stands to reason that while the APHL/CDC meetings and activities are occurring at the national, state-wide and local levels, simultaneously each individual PHL department will need to conduct ongoing internal activities. These in-house information sharing activities will support the LEI developments by helping to provide feedback as to how these developments will affect each of the unique settings.

Educate, Educate, Educate

There are three distinct process strategies which will assist individual laboratories in building a solid infrastructure for supporting the LEI change management initiatives. These strategies include: educating staff by utilizing the LEI guidebooks, education via attendance to LEI workshops and in-house learning activities by reviewing the APHL/CDC meeting summaries and updates.

Educate Via Guidebooks

APHL and CDC have published two guidebooks specific to the LEI project. They are titled: "A Practical Guide to Assessing and Planning Implementation of Pubic Health Laboratory Service Changes" and "Overview of Legal Considerations in Assessing Multijurisdictional Sharing of Public Health." The guidebooks contain valuable examples of success models and implementation tools. Information on how you may obtain the manuals is on the APHL website.

Educate Via Workshops

During 2012 there have been numerous AHPL/CDC workshop opportunities aimed at educating laboratorians on the particulars of the LEI project. John Ridderhof, DrPH, facilitated a May 21, 2012 workshop on the topic of shared laboratory services.⁴ And during September 2012, Charles D. Brokopp of APHL provided a presentation which highlighted the specific challenges facing public health laboratories.⁵ As developments from the three year plan unfold, laboratorians should expect to see additional workshops up through year 2015.

Educate via In-house Learning Activities

Ongoing department briefings of LEI's developments will make APHL/CDC's progress more meaningful to staff. The following three activities encourage team buy-in to support change management.

1. Built-In Commitment: One suggestion to accomplish team dedication to the LEI project        is to add the project to the staff meeting agenda as a permanent line item. By becoming a regular component of staff meetings, the project's developments, as they occur over the next three years, will be         kept up front and personal to each laboratorian.
2. Establish a Sense of Necessity: Laboratorians need to be aware of the importance of the LEI project and how it will impact their personal lives. For example, everyone understands their financial bottom line and the national economic conditions affecting the workplace. A clear explanation of how the APHL/CDC joint project is attempting to reverse the tide through positive transformation will establish the necessity of PHL change management.
3. Empower Staff to Identity Barriers: Conduct ongoing in-services of the APHL/CDC summary meeting reports during staff meetings. Then while reviewing reports and the change recommendations, department staff should identify internal obstacles or roadblocks, if any, that is unique to their setting. Team discussions on conflict resolution and the design of action steps to eliminate barriers can then occur. 

Conclusion

During these times of economic upheavals and public health disasters, the LEI project is a significant and timely endeavor. In order for successful project outcomes on national, state-wide and local levels to occur, all stakeholders will have to work in unison to build a solid foundation for implementing the new APHL/CDC initiatives. This can be accomplished through collaborative process strategies of continuous information flow.

Ongoing education of the LEI activities to all stakeholders is important for the overall success of project. Clearly defining and instituting in-house efforts, such as ongoing education about the vision, mission and goals; identifying barriers to success; and the ongoing sharing of APHL/CDC's summary reports are critical for change management transformation to occur. 

References

1. Laboratory Efficiencies Initiative (LEI) APHL and CDC 2011 Partnership Announcements. www.aphl.org/lei
2. Laboratory Efficiencies Initiative Strategic Plan 2012-2015. www.aphl.org
3. LEI Partners Meeting Summary. December 2012. www.aphl.org
4. Laboratory Efficiencies Initiative (LEI): Shared Laboratory Services. John Ridderhof, DrPH, Presenter, APHL Annual Meeting. Seattle, Washington.
5. Sustaining Public Health Capacity in an Age of Austerity. Charles D. Brokopp, President, APHL, Presenter. Public Health Laboratories, Institute of Medicine of the National Academies. Training, Recruitment and Retention.

Suggested Reading

1. A Practical Guide to Assessing and Planning Implementation of Pubic Health Laboratory Service Changes. www.aphl.org/lei
2. Overview of Legal Considerations in Assessing Multijurisdictional Sharing of Public Health.  www.aphl.org/lei
3. Heath, Chip and Heath, Dan (2010). Switch: How to Change Things When Change Is Hard. New York: Broadway Books of Random House, Incorporated.

Eleanor Wolfram is a certified QA&C auditor.