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Monday, July 24, 2017

Eliminate the Laboratory Internal Customer


I was at a laboratory conference recently and again went through the ever-present hand-to-heart, sonorous syrup voicing “We have great respect for you, our staff, for all you do.  You are our most important internal customer”.  
To which I say “bull-pucky” !!
Before you get the wrong message, I will be clear beyond clear:  Laboratory staff is essential to laboratory operations and function and culture.  This rant is in no way intended to suggest or imply anything other than the critical role laboratory workers play.
It is the term “internal customer” that gets my ire; it is both meaningless and trite.  
The term customer is well defined as a person (or organization) that has a use or interest in our product of services.  Customers may (usually) pay a fee for use, and often (but not necessarily) have a choice of supplier.  Importantly Philip Crosby pointed out the very definition of Quality is the degree to which we meet the NEEDS (as opposed to the “wants”) of the customer.  
Put together we have a good sense of who a customer and what they should be able to expect from us. 
 In exchange for a fee we must meet their needs and expectations (within the limits of the product). If we can do that we can say that we have met the needs of Quality and perhaps earned the opportunity for a repeat customer.    
We can monitor our customers to determine their degree of satisfaction with our actions through satisfaction surveys, or received comments, or complaints monitoring, all of which gives a picture, but never is as good as monitoring repeat business. 
There are a bunch of definitions for “internal customers”; most typically “a co-worker, another department, or a distributor who depends upon us to provide products or services which in turn are utilized to create a deliverable for the external customer. 
  Examples might be the sales department, or the accounting department as a customer of manufacturing.
Interesting, and maybe relevant to some industries, but it is hardly applicable to what happens in a laboratory.   
Calling our laboratory staff our internal customer is just an incorrect and nonsense use of a wrong term.
There are certain situations where staff are justifiably very interested in the results of certain laboratory tests.  Staff should be aware when there is an increased risk of communicable disease or toxic chemicals within their vicinity.  That doesn’t mean they have a right to breach patient confidentiality, but they should be made aware of the accessibility of potential risk factors.  
So I have come up with a classification table that defines three levels of “customers” that works really well in the medical laboratory setting but does not use the term internal or external.  I strongly advocate for adoption.
Medical Laboratory Customers are individuals who directly or indirectly order or use or services including our generation of information.  These customers are either clinicians (doctors, nurse practitioners) or patients.  These customers, depending on the medical services system may nor may not pay a fee and may or may not have a choice of supplier.
Medical Laboratory Interested Parties are individuals who are not customers but have a definite interest in results.  These may include patient friends or family or community contacts, or laboratory/institution contacts (such as nurses, technicians, housekeepers, visitors etc.)  who may be at risk of certain exposures.  It may include Public Health workers whose job it is to do further follow-up.  
Medical Laboratory Stakeholders are individuals or groups who have work necessity to be aware of activities or risks within the organization and their potential impacts.  This might include (but not be limited to) institutional administration, media services, legal and liability services, union stewards.
This classification works on many levels.  It makes the point that direct users of our information and service have a special connection with us and we have a special responsibility for them.  Second it highlights that our customers can have impact on many that surround them and we have a responsibility that they too are protected from harm.  Third, it acknowledges that there are others that have a “need to know” even if they don’t need to know a lot of details.
Customers, Interested Parties, Stakeholders… and NO Internal Customers.  
How good is that!!!