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Out of the corner of her eye, Radha Samson saw Dr. Raul Garcia, the director of St. Sonia's lab, coming in the door of the cafeteria and rose to meet him. Tanya Stewart, the nurse practitioner with whom Radha had been chatting, noticed the situation and tactfully took her cup of coffee to another table.

Dr. Garcia headed up the laboratories that had responsibility for all of St. Sonia's Hospital. Dr. Garcia met Radha's glance and seemed to relax almost immediately. He pointed to a corner table where they could talk privately, and she joined him there. Dr. Garcia told Radha:

I need an iced tea, but it'll just take a minute. I want to pick your brain about how to handle some issues that have little to do with what we do professionally but everything to do with how other people think we should be doing things. I'm afraid we're going to have a wholesale mutiny in my staff if we don't do something quickly.

As they talked, Radha realized there were several key issues, as well as some tangential ones:

  1. Requests from certain departments (mainly Internal Medicine and Ear, Nose, and Throat (ENT) were accompanied by written demands for unrealistic turnaround times; then complaints came in when these deadlines couldn't be met.

  2. Some physicians were having their assistants make lab requests by phone, bypassing the new computer system, and a few of those orders had been dropped because of a misunderstanding about how to enter them.

  3. Lab technicians were feeling overworked and undervalued due to the sheer volume of requests during the current flu season.

  4. Phone and front-desk coverage during lunch and afternoon breaks (mandatory per the bargaining contract) was spread thin due to budgetary constraints; other departments that had promised backup coverage were often unresponsive or had no one to spare. Research technicians were pitching in, but morale was beginning to suffer.

Radha knew that Dr. Garcia was a good supervisor, and she wanted him to feel supported in his efforts to boost morale for his hardworking crew. As they talked, it became apparent that the department was a very tightly knit team and that losing any one staff person would probably result in the loss of several more people. She also realized that there were hospitals in the region that might be glad to hire from this highly respected group. They would be very hard to replace. Radha proposed:

Why not have a facilitated Exchange discussion with the team? We need to have everyone involved. And we need to develop better protocols for communicating with other departments. I could get Drew Johnson to facilitate the meeting. And if you can get coverage that fast, we could do it the day after tomorrow at noon. Drew reserves that time for situations just like this. We can have lunch brought in so that ...

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