Directing change: a contemporary administrative challenge

Although most individuals who head clinical laboratories are still named Director of Laboratories, their training for this has focused principally on management training in addition to their postgraduate medical education. The implicit assumption seems to be either that direction and management are synonymous or that management is the most important aspect of laboratory administration. Common usage, albeit imprecise, fosters both of these paradigms. The proposition of this article is that directing and managing are two discrete activities of sufficiently different orientation as to require different training, attitudes, and values. Management as a generic phenomenon was codified early in this century through the works of F.W. Taylor (1), whose concepts of scientific management were embraced with zeal during World War I and were also an important conceptual basis for the managed economy of the Soviet Union as proposed by Lenin. Gradually, management with concern for efficiency and hierarchic control structures has diffused throughout social as well as business systems. Many will remember the introduction of the corporate governance system into hospitals beginning in the 1930s and its spread throughout the medical system until at present administrators of hospitals, for example, are called CEOs or presidents. Management, as narrowly defined and as traditionally practiced, is based on control of a system by adherence to prescribed standards for uniform production, to particularized timelines for delivery of product or service precisely when needed, and to predetermined budgets for efficiency and predictability. All of these are laudable and essential to the internal administration of any system. They also require a specific set of values and a set of behaviors that center on adaptability and compliance.