Medical laboratory culture is very specific, even within the health care sector. It’s precision-oriented with a high attention to detail; it’s achievement-oriented with a strong emphasis on accuracy; and it’s rule-oriented yet competitive. Roles and tasks are often valued more than laboratory professionals, putting communication and collaboration on the back burner and leaving a strain on our profession.
In this work environment, it’s important to recognize common mistakes, acknowledge factors you can or cannot control, and utilize tools to help you navigate your way through lab culture.
Having experienced conflict in the lab, I’ve learned that we can only control our own behaviors and communication should never be compromised. Through a few of my most impactful stories, we’ll see that communication is the best way to solve conflict, helping us care for our patients best.
Story 1: The Case of the Missing Block
It was my first day on the job as a technologist in histology, and I was so proud of myself for landing a position in my field. I was working at the embedding station, sticking to procedures and ensuring I was signing off on all the correct blocks. I ended the day confident that I had done everything right, but then I received a phone call from my supervisor telling me I had lost a block. I instantly felt sick to my stomach. As a tech, you associate a block with a patient, and I felt as if I had harmed a patient. I spiraled and questioned my entire career as a lab tech.
Looking back, I now know that I should not have engaged with my emotions and used the grounding technique STOP: Step back, Think, Organize, and Proceed. If I had used this tool, I would’ve told myself to step back and eliminate the negative self-talk, think rationally and not emotionally, organize my thoughts as to where the block could be, and proceed to move forward with the situation.
Thankfully, the block was found. It had accidently been taken by one of the cutters. But my emotional thinking led to more stress than I needed at the time.
Story 2: Whose Job Is It Anyway?
I was working part-time in the lab while completing my degree, but then a permanent full-time position appeared that fit my schedule perfectly. Of course, I applied for the job, but a colleague became very cold towards me when she learned that I had. She wouldn’t respond when I said hello and even left the breakroom when I entered. My initial response was to behave the same way she did. I chose to triangulate and talk about her to my colleagues. Tensions became high and I dreaded working in the same place as her, and I quickly realized she was feeling the same way.
As humans, our brains take input from an experience and add our own assumptions, beliefs, and other past experiences to it. Essentially, we draw conclusions with the ladder of inference, with one faulty thought “rung” leading to another. In this case, I assumed that my colleague was upset with me for applying to the job she wanted. But really, that person could just be dealing with her own issues. I was making it about me.
I now know I should have had a conversation with my colleague using a series of communication tools, starting with DESC: describe the specific situation or behaviour with concrete data; express how the situation makes you feel/what your concerns are; suggest other alternatives and seek agreement; and state the consequences in terms of impact on established team goals while striving for consensus.
If the person is unreceptive and the situation begins to affect patient care, be sure to assert yourself through professional assertive statements or a two-challenge rule, like these examples:
Assertive Statement: “I noticed that the blocks have not been decalcified enough before being cut, so some of the tissue is missing. This may lead to a misdiagnosis of the patient. Perhaps you can try decalcifying longer prior to cutting them, or maybe you think there’s a better solution. Let’s figure this out and agree to do this to ensure the patient’s diagnosis is accurate.”
Two-Challenge Rule Statement: “I’m still noticing there are tears in the tissue due to lack of decalcification. I feel like this is really going to lead to an inaccurate diagnosis of the patient and we need to solve this. So, let’s make a plan now and get this under control. If we can’t resolve this together, then we need to take it to a supervisor and see what they say.”
If the person’s actions pose an immediate safety concern, use CUS (“I am Concerned.” “I am Uncomfortable.” “This is a Safety issue.”) This is a great tool to use when the involved staff hold different positions, as it helps to level the dialogue to something you both understand.
In my situation, I said nothing to my colleague and resentment grew as I continued with my position. I’ll never know if our tensions affected patient care.
Story 3: Poisoning the Well
A new pathologist had been hired where I was working as a technical supervisor, and part of their position included being the medical supervisor. In the beginning, everything was great. I was excited to partner with a pathologist to build the best possible practice. Unfortunately, there was soon conflict when I realized they didn’t understand the quality control aspects of the procedure.
It’s important to note there are two types of professional conflict. Informational conflict occurs when the parties involved have different understandings of what is happening. This conflict can be easily managed by an assertive statement or a two-challenge rule. Interpersonal conflict can arise when the parties don’t get along. Quite often, interpersonal conflict arises if informational conflict is not addressed.
As time went on, resentment grew and negative behaviours escalated. We both went to our supervisors, who scheduled a visit with a mediator.
In the meantime, the pathologist sent an email about the situation that was meant only for her colleague, but she accidentally sent it to the entire department, including me. As you can imagine, it was not flattering.
She resigned from the bench and the department, leaving me without a medical supervisor. My lesson: our inability to address the informational conflict created interpersonal conflict, which created a potential gap in patient care. Had either one of us had a conversation in the beginning, this conflict would not have progressed.
These are just a few tools to use if you’re navigating through lab culture and experiencing conflict. Don’t hesitate to practise these with a friend, family member or partner to ensure you’ve grasped the full scope of each technique. And remember, we’re all human.
RHONDA POULIOT, BSc, MA, MLT
Lead, Capacity Building and Engagement
Health Quality Council of Alberta