Health care institutions both large and small often face the common problem of a lack of communication between departments and specialties that depend upon each other for information and support. Misperceptions and misunderstandings between clinicians and laboratorians over activities performed both at the point of care and in the laboratory can lead to compromised patient safety and employee dissatisfaction. Therefore, seeking to bridge this gap can assist clinical staff in gaining a better understanding of laboratory policies and procedures (P&Ps), including specimen integrity issues and what is involved in test turnaround, and also can provide the laboratory with a direct view of the challenges faced by physicians and nurses at the point of care.  

Of the several laboratory departments housed within McLendon Clinical Laboratories at The University of North Carolina Hospitals, the core laboratory offers clinical chemistry, coagulation, hematology, urinalysis, toxicology, and clinical pharmacology services, among others. Like many core laboratories across the US, UNC Hospitals’ core lab handles several areas of critical testing and analysis, yet is one of numerous additional laboratory types within the medical center. In order to expand its presence and foster better communication between core lab personnel and clinical staff, we made the decision to implement a Laboratory Ambassador Program in June 2004. The primary goal of the program was to improve patient safety by enabling our entry-level medical laboratory scientists (MLS) to hone their clinical communication and problem-solving skills through routine rounding on select hospital patient units and clinics. We began this program with core laboratory personnel serving as the first ambassadors. In 2011, the program was expanded to include microbiology and transfusion medicine to provide an opportunity for technologists in those laboratory departments to participate in clinical interactions.

This past June, the Ambassador Program celebrated its eighth anniversary and in that time, it has exceeded our initial expectations in enhancing relationships with unit based staff, including nurses, nursing assistants, unit clerks, and physicians. In reviewing the overall performance of the program, it has revealed itself to be an innovative, grass roots endeavor supported by our administration’s confidence in the ability of our MLS to expand their working influence beyond traditional responsibilities in the laboratory, as well as the willingness of non-laboratory clinical staff to work as a team to improve patient care.



Challenging the Comfort Zone
The program is designed to include five to ten MLS from the UNC Hospitals’ core laboratory at any given time based on staff availability. Once selected for the program, these staff members are trained in customer service, problem solving, and service recovery by a designated ambassador coordinator over the course of three to four one-hour sessions. Critical to the program is the following step of initiating weekly rounding on units that are selected due to certain factors, such as a large volume of nurse sample collections, complex laboratory testing, or special needs, such as collecting pediatric specimens from the PICU. Over time, the units commonly included in rounding have been the intensive care units, emergency departments, and pediatric and newborn care units, although any unit may request an ambassador. For example, UNC Hospitals have established new ICUs in the years since the program began, including a transplant ICU and a step-down unit, both of which requested participation in the ambassador program.

Common to any processes that require employees to work outside of their training and comfort zones, the laboratory ambassador program has encountered many challenges over the years, including overcoming historical perceptions of laboratory processes rigidity, determining how best to permit laboratory staff to leave the lab and perform rounding without negatively impacting normal patient testing workload, customizing rounding to optimize the positive impact on individual units’ daily activities, replacing laboratory ambassadors who are promoted into more senior positions or leave the institution, and maintaining patience and perseverance while nurturing new relationships in a collaborative framework. 



Success Ultimately Rests on the Individual
In the eight years we have been running the laboratory ambassador program, it has become evident that many key factors have led to its successful development; however, foremost among these factors is the initiative of the individual ambassador. Each ambassador is provided with ample opportunity to learn about and develop basic leadership skills and provide critical input into the total patient-testing experience (pre-analytical, analytical, and post-analytical). Therefore, it is up to each ambassador to demonstrate proper time management, creative problem solving, continued awareness of organizational culture, and a well-balanced knowledge of patient testing and laboratory P&Ps. 

In order to have a qualitative analysis of the progress of the program, measurement of ambassador performance is based on the outcomes of patients under the ambassador’s purview.  Examples of improved outcomes directly attributed to the influence of lab ambassadors include decreased patient incident reports, improved turn around times, and favorable reviews in laboratory customer surveys.

Those ambassadors who embrace the opportunity to broaden their working knowledge and experience with enthusiasm, properly prepare for rounding, and creatively face challenges they encounter, ultimately will be successful in the program and elevate its influence and reputation. For example, ambassadors are not scheduled for rounding by their supervisors; rather, they must coordinate their own absence from the work area such that their duties will be covered. This kind of initiative is necessary for the ambassador program to work. 

Staff Commitment to the Program
Many requests to be an ambassador were made during the early years of the program, but later years have shown greater self-selection. Originally, many MLS were interested and wanted to participate because the program was new and different. Now, our technologists are more aware of the initiative and work required to be successful and to perpetuate the positive reputation of the program. Given this heightened awareness of what is expected in the role of ambassador, we find that those who apply have given thoughtful consideration to these concepts, whereas others hold off on applying if they do not feel they can properly commit to these expectations. When presented with the opportunity to join the program, many MLS have found they prefer to work within the laboratories, while others eagerly look for opportunities to expand their experiences and improve their leadership skills.

As the ambassador program has matured, it has also grown and become more refined, and the recent additions of microbiology and transfusion medicine to the program were based on internal requests to help increase their scope of influence. The influx of varying disciplines has benefited teamwork within the laboratories and provided additional expertise to the units, and has further indicated that the success of the ambassador does not depend upon the originating laboratory, but upon that staff member’s personal skill set. 

Sustain Excellence Through Champions
As with any program that relies on fostering and maintaining interpersonal relationships, the Ambassador Program requires a champion who can support and encourage new ambassadors while monitoring communications and skill development. In our program, a designated lab ambassador coordinator is responsible for recruiting new ambassadors, conducting training sessions, and meeting regularly with the ambassadors to discuss progress. In reviewing the last several years of our program’s performance, we found that the scope has thrived whenever coordinators actively championed the program and provided needed support to the ambassadors.

Overall, our laboratory ambassadors have been and continue to be embraced by unit personnel, and we receive testimonials regularly from nurse managers who actively promote the program among their peers. However, integrating ambassadors into certain units was not without its challenges. We found the emergency departments to be somewhat difficult areas to establish an ambassador in due to an unpredictable patient workload and the acuity of emergent patient needs. Despite these situational issues, our ED physicians recognize the value the ambassador brings to the ED environment and refer general questions and concerns on a weekly basis. Pre-implementation concerns that the ambassadors would become intrusive to patient care activities in the ED have never been realized; rather, the laboratory ambassador has come to be accepted as a valuable asset to the unit. 

The symbiotic relationship between the ED and its lab ambassador is analogous to the overall mission of the program—open communication between the unit personnel working directly with patients and the medical laboratory personnel performing the testing has resulted in the identification, understanding, and collaborative problem solving of patient testing issues that otherwise would have been much more difficult to solve in a vacuum. 

Conclusion
In the eight years we have been running the laboratory ambassador program, we have seen a documented improvement in the quality of patient care. Among the first benefits of the program was an immediate decrease in complaints to the core laboratory from the pilot units as specific patient problems were investigated onsite by the ambassadors with rapid follow-up. Likewise, real-time, face-to-face exchanges between laboratory personnel and clinicians provided opportunities for clarification of laboratory protocol. As a result, a significant level of trust developed as misunderstandings and miscommunications about perceived laboratory sample issues were resolved before they could become a conflict. Even in recognizing these benefits, there is a continuing need to document outcomes to support the expansion of the laboratory’s role to patient units and refine the ways in which the laboratory interacts with clinical operations.

Just as health care in general is facing a rapidly changing environment, the role of the medical laboratory scientist also is evolving. New technology and innovative educational programs have shortened the learning curve experienced by MLS in the past. In today’s laboratory environment, entry-level MLS have demonstrated the ability to become successfully engaged in networking and problem solving; activities traditionally viewed as supervisory activities. This engagement provides opportunities for personal growth, leadership development, greater job satisfaction, and future investment in laboratory medicine.

Connie Bishop, MT(ASCP)-SH, is the assistant administrative director of the core specialty laboratories at the University of North Carolina Hospitals in Chapel Hill. She received a BS in clinical laboratory science from Concord College in Athens, West Virginia, is a graduate of the University of North Carolina Management Institute, as well as the Notre Dame Executive Management Program, and has an ASCP specialist certification in hematology.

Connie has spent most of her 30 years in laboratory experience at UNC and began her work there as the supervisor of the hematology laboratories conducting research and service programs, in addition to establishing the bone marrow transplant laboratory. In 1995, she was asked to create the core laboratory and has remained in her position as assistant administrative director since that time with responsibilities expanding to point-of-care testing and management of the specialty and family practice laboratories.