Time Mastery

One of my favorite song lyrics is from “When I Find Home” by Cody Chestnutt: “I only got time to think about the time I don’t have” I like this lyric, because when I get really busy I sometimes enter this “freeze” moment, where I am stuck thinking about all the things I have to do without being able to do any of them.

As our work continues to get busier and busier, it is becoming more critical to have good time management skills. However, to actually master time, people need more than To-Do lists. This course focuses on twelve different categories of time mastery and participants assess their skill level in each of these areas:

  1. Attitudes
  2. Goals
  3. Priorities
  4. Analyzing
  5. Planning
  6. Scheduling
  7. Interruptions
  8. Meetings
  9. Written Communication
  10. Delegation
  11. Procrastination
  12. Team Time

However, not all of the categories are equally important in a current position. I might have no direct reports, so even though I might score low in that category, it is not really important in my current job. Based on participants’ answers, the assessment automatically creates a Skills Gap Analysis, a table in which the categories are organized according to two axes: less important to important and less skill to more skills. These tables gives participants a quick overview of which categories they have marked as more important, but have less skill in. In other words, these are the areas of development.

Mastering time and moving away from thinking about the time that I do not have, has allowed me be more proactive about my time and schedule. My written communication and meetings are more productive and better organized; I am clearer in my delegation and define authority levels; I follow my yearly goals more closely and I take the time to analyze when and why I am interrupted or interrupting, to understand what could have been communicated better. Mastering time has allowed me to rarely experience stress while at the same time being more productive. I only got time to think about the time I do have.


-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


When many of us are asked if we would be interested in learning more about improving our time management skills, our response, maybe “Yawn, I got this, after all, I am a busy professional.” What we often don’t realize is that getting to the goal, no matter how hurried or rushed, is not just often about you. Our work pace impacts others in the workplace and if we want to become a true leader, we need to master ourselves first. The first place to start on this is how we manage our time.

We have an expression in our family: “we’re always working for the farm.” When you are running a farm, you don’t get to choose your own timing or schedule in the projects that must be done. The seasons come and go and there is planting and harvesting to be done on nature’s time. There are animals to be fed and fences to be mended on nature’s time. Understanding some of these basics help us to realize that there is time in one’s schedule that we can control and time in one’s schedule that we don’t control.

As for the time you can control at work, you can select when to answer your emails, and when to have “that open door” for workplace issues, and when and how to prioritize your projects. In some cases, like the farm, you will not get to always control your own schedule and choose when important events or meetings happen. So to help with this, we can paraphrase Mark Twain: “Eat your frogs early.” This means doing your biggest and hardest task first thing every day so that you prevent procrastination and free up time in case other urgent situations emerge. For some, that may be a phone call dealing with a patient or employee complaint; for others, it may be tackling an unresolved operational issue that needs to be urgently addressed. Whatever it is, go at it first and efficiently and get the job done.

When we look to improve how we master time, we need to have an understanding of what is urgent and important and what is important, but not urgent. The best advice for time management is to work more on what is important, but not urgent, to prevent everything from becoming a last minute urgent need. If you are often focused on urgent issues every day, you are simply putting out the fires at work and never getting to the optimal operational efficiency in your area. You can begin to master this by simply blocking out a time every day that you will work on these important projects. This will soon become part of your habitual schedule and that job will get done over time by breaking these projects up into smaller blocks of time. The most productive writers often say that they sit down with their computer to write during a certain time of day, whether they feel like it or not, and much to their surprise they are able to make progress. Yes, this even works for the great story tellers of our time, such as Earnest Hemingway, who sat down every morning at the same time to write.

One of the best ways to become a time master is to understand your own biases, strengths and weakness about time management. Are you good at delegating tasks that can be performed by others? Do you lose track of time when you are interrupted in your office? There are tools that you can use to assess your time management skills, and help you work to develop better habits for improved productivity and better balance. As you begin to become more proficient in time management, you will find that your overall work place and life stress will also decrease, as you find more “time” to take on more of those projects that bring balance and joy into your work and life.


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-Dr. Deborah Sesok-Pizzini, MD, MBA is a Clinical Pathologist at the University of Pennsylvania, Perelman School of Medicine, who specializes in Blood Banking and Transfusion Medicine at the Children’s Hospital of Philadelphia.  She has a strong interest in resident leadership development, patient safety and quality, and is currently serving as a member on the ASCP Fellow Council.  She is a graduate of the ASCP leadership institute certification program and has an MBA from Villanova University with a concentration in finance.  

Organization Savvy

Understanding culture is essential to fit in anywhere: when you are traveling, with your family, and where you work. Understanding and appreciating culture is important, because you do not want to unintentionally offend someone by over-explaining a task, asking about personal lives when it is not considered appropriate, or going straight to business and skipping informalities completely when it is expected to get to know each other before attending to tasks at hand. Understanding organizational culture is therefore important for every employee. However, creating a fostering a productive culture is the responsibility of the leaders.

There is a critical distinction between the culture and the climate of an organization. Culture refers to how employees feel they are expected to do things and behave. Climate is the causal factors of the culture. Another way of putting it is that culture reflects the shared values, beliefs, norms, and expectations; climate reflects the outcomes of the culture such as engagement, teamwork, and perceived quality of work. However, it is important to note that there are two levels of culture: the ideal culture, or what should be expected; and the current culture, or what is actually expected. If we compare the climate to the human body, climate is the pulse, temperature, and blood pressure. Culture would be the bigger medical issues such as flu or cancer. The ideal culture would be a cancer-free body, while the current culture might be a body with a cancerous tumor caused by the climate of smoking. This example shows that culture is harder to change than climate: it is easier to change someone’s blood pressure than to change their cancer status.

Climate can therefore also drive and change the culture. If you want to change something in the culture, you can start with changing the climate. Let’s take the following organization as an example in which the ideal culture is that team work is valued, but the current culture shows that competitiveness is valued. The causal climate factors are in the structure of performance reviews: only individual and competitive behavior is analyzed, but not team behavior. If we would thus change the structure of the performance review (climate) we could change the current culture (competitiveness) closer to the ideal culture (teamwork).

The Organizational Savvy course focuses on how you see the current culture of your organization. It organizes the culture in three different clusters: constructive, passive/defensive, and aggressive/defensive. Each of these clusters are then divided into four styles, allowing you to understand your culture in more detail. The course explains how to improve the culture of the organization based on the profile.

Understanding what is expected in your organization sets you up for professional success and allows you to be an active member of establishing effective organizational culture. Whether you are a leader, chair, employee, or staff member, taking proactive steps to understand and foster organizational success will set you and the rest of your team and organization up for prosperity.


-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


Organization Savvy is the core of high-performing organizations. It is a mixture of staff’s emotional intelligence, interpersonal relations, skills, self-awareness, competencies, and optimized organizational culture. With my experience in centralized laboratory services, improving quality in thirty laboratories with a wide variety of organizational cultures was a big challenge. To enhance the best practices and empower quality improvement projects, organizational savvy is required. The best tools to achieve this were creating an organizational influence map, building relationships with different laboratory staff, influencing people by turning the organization into learning atmosphere, and the most important, avoid negative players.

With my journey towards excellence, I had to communicate with different leadership styles. I had great outcomes with constructive style leaders, as they are task- and people-oriented, collaborative, achievers, humanistic, and encouraging. I had some difficult times with aggressive/defensive leaders who have some insecurities. I had to assure them that our journey towards excellence is to build people before building the organization. In addition, they had to realize our organizational objectives were in full alignment with their core values and career goals. I worked on improving my personal power by using self-awareness assessments and improving emotional intelligence. My skills and knowledge in Quality of Laboratory Medicine were good enough to build credibility inside the organization. My future goal is to increase my circle of influence and reduce my circle of concerns to achieve organizational savvy and hence, the organizational vision towards excellence.


Photo -Rana

-Dr. Rana Nabulsi has a PhD in Quality Management and a master’s degree in molecular genetics. She is currently the Head of Quality at Pathology and Genetics department at Dubai Health Authority and the Chair of Advisory Board at the American Society for Clinical Pathology (ASCP) in UAE. She is doing her fellow at the American Collage of Healthcare Executives (ACHE). She is a Certified Professional in Healthcare Quality (CPHQ) by the National Association of Healthcare Quality (NAHQ)-US and certified for Green Belt -Six Sigma (SSGB) by the American Society of Quality (ASQ). Dr. Nabulsi has experience in leading more than twenty medical laboratories in achieving the College of American Pathologist (CAP), ISO 15189, and American Association of Blood Bank (AABB) accreditations. She is certified as lead auditor for ISO 9001, ISO 15189, ISO17025, and OHSAS 18001 management systems. Dr. Nabulsi is a certified EFQM Assessor, trainer and public speaker for local and International Healthcare conferences about healthcare quality, safety, and leadership.


Reacting to Change

People react to change very differently, but almost everyone has a strong opinion about it. Personally, I love change and I often go out of my way to create it whenever possible. I rearrange my furniture at home every few months.  I lived and worked abroad for years; I moved so often that for three years the longest I stayed in one place was five weeks. Now, the change I look to create is less locational and more organizational and cross-cultural. Understanding how others react to change is an essential component of the process.

The Reacting to Change course focuses understanding how you and others react to change situations and how to effectively plan and create change. Acknowledging both the emotional and practical aspects of change creates the space for coworkers and employees to get on board with the new direction and plans. Allowing people to have input wherever possible and creating session in which people can ask questions, provides valuable input and a sense of ownership, which is essential to make the change last. Furthermore, giving people time to process and move into action at their own pace is essential to create buy-in. For those people familiar with the DiSC Styles, typically those who have a C or S style tend to prefer longer timelines, while those with D and i styles can handle a faster change process more comfortably.

This course determines your thinking style: constructive, passive/defensive, or aggressive/defensive. Each style is further divided into four styles, so there are twelve total. The ultimate goal is to reduce both defensive styles and to increase your constructive thinking, which leads to constructive behaviors. This assessment indicates which behavior you exemplify when in stressful situations, for instance when a change is implemented at work. If you already have a tendency for passive/defensive thinking, it indicates that you are more likely to react that way when faced with a policy change, office relocation, or anything else that causes you stress. This assessment helps you provide an action plan of where to move your thinking and behavior towards.

Change is part of our daily interaction with the world. Gaining that self-awareness and understanding of others is critical when leading people through any type of change process, whether a policy change or a merger. Woodrow Wilson said “if you want to make enemies, try to change something”. What can you do as a leader to create even higher levels of collaboration, productivity, and satisfaction through change?



-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


During my tenure in the Blood Bank, institutions have moved from immediate spin crossmatches (manual crossmatch) to electronic crossmatches (computer crossmatch). Computer Crossmatching allows the Blood Bank computer system to match donor and recipient ABO Rh type for compatibility. In order to do so, certain standards must be met. A minimum of two ABO typings must be in the system, the patient must have a negative antibody screen, and no history of ABO Discrepancies or clinically significant antibodies can exist. If any of the mentioned circumstances are present, an immediate spin or Coombs crossmatch must be performed.

Implementing this change improved turnaround times which reduced rates of delayed transfusions and elevated patient satisfaction rates. Perhaps more importantly, another patient safety initiative was created, since two ABO types need to be performed on two different specimens. This means patient identifiers are checked and confirmed on two different specimens before transfusion. While these changes aligned with the Joint Commission’s Safety goals, internally this change impacted the Nursing and Blood Bank Departments in ways that made the transition less than smooth.

The ASCP Leadership Institute’s “Reacting to Change” module uses methodology from different industries to create powerful change. Dr. John Kotter has an 8-Step Process for Change, which resonated with my experience.  Engaging & Enabling the Organization include: communicate the vison, empower action, and create quick wins.

Since our rollout of this change lacked these steps, it wasn’t as successful as it could have been. The lack of communication and proper departmental educational in-services lead some individuals within the Blood Bank to have several concerns. Older technologists worried technology would eventually take their job, and novices worried they would unintentionally harm a patient since they didn’t physically complete a crossmatch. As for the Nursing Department, most nurses did not know about this new requirement. The importance of the second-specimen requirement was seen as a nuisance rather than an improvement to patient care. Proper educational in-services were not instilled, which resulted in more questions for the Blood Bank to answer. In addition,   two specimens were drawn at the same time, which negated the utility of the second specimen. Since education wasn’t finalized prior to implementation, the nurses and blood bank staff were frustrated.

Dr. Kotter’s Engaging & Enabling is a means of collaboration. In this scenario, collaboration between departments and having an education liaison for each department could have assisted in the execution. The use of knowledgeable, talented personnel can allow both departments to cohesively provide seamless operations. Seeking out our talented staff and encouraging them to be great enriches their sense of purpose and allows us to acknowledge them for their talents.

In order for change to be effective, we have to minimize negative reactions to change. This involves communication, education and providing data-driven results. Change is inevitable, and proper execution can help make that change successful.




-Tiffany Channer honed her skill and knowledge of Blood Banking at Memorial Sloan Kettering Cancer Center in New York, NY, where she completed her 9 year tenure at Memorial Sloan as Blood Bank Educational Lead Medical Technologist III/ Safety Officer. She’s currently working as a Laboratory Lead Technologist III at Bayfront Medical Center in St. Petersburg Florida. At ASCP, Tiffany is the Mid-Atlantic Regional Representative for the Council of Laboratory Professionals Council. Tiffany was a Top Five 40 under Forty Honoree in 2015 for her dedication and advocacy to education and laboratory medicine.

Decoding Generations

When I started my professional life, nobody talked about generations. Experience was everything: none, little, some, significant or expert. Now, conversations about generational similarities and differences are integrated into professional and personal life.

There are currently five generations at work today: Traditionalists, Baby Boomers, Generation X, Generation Y/Millennials, and Generation Z.


Understanding generations allows people to adapt their behavior according to certain preferences.Take, for example, communication styles. When communicating with someone from the Baby Boomers generation, picking up the phone might be appreciated, while sending an email to a Generation X is the best way to communicate with them. Always keep in mind, however, that generational preferences are generalizations, and knowledge about them does not substitute understanding each employee and colleague on an individual basis.

Another example of the differences between the generations is how they define their aspirations. Traditionalists value home ownership, Baby Boomers want job security, Generation X aspires to achieve work-life balance, Generation Y prefers flexibility and freedom, and Generation Z values security and stability. Understanding each generation’s aspirations allows leaders to tailor their communication style and job aspects to each individual.



-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.



As a former member of the ASCP Resident Council, I volunteered for the opportunity to serve as a beta tester for the ASCP Leadership Institute. To obtain certification, I completed 10 modules which often included a pre-course reading or interactive video assignment along with a pre-recorded webinar, post-test, and post-course evaluation. Some of these courses are also available in-person at live meetings and can include personal coaching live, online, or by phone.

A cursory internet search will reveal a plethora of written and video resources available on the topic of leadership. Additionally, many of us have participated in evaluations or trainings that sought to not only define our personal leadership skills/style but also help us to gain essential self-awareness and skills to better lead or be part of a team. Despite such experiences and even though I’ve held many leadership positions over the years, I still find it difficult to reconcile what it means to be a leader, both in terms of expectations that I hold for myself and those that others hold of me and how to build these expectations to realize a shared objective.

I was intrigued by the title of the module “DeCoding Generations”. This module was especially salient for me since I was a non-traditional medical student after initially studying to be a neuroscientist. I’ve generally been older than my fellow trainees and younger than the majority of my teachers. This generational gap has also been similarly evident within the teams I’ve participated in since I matriculated into medical school.

This module explored the core values of the following “generations”: traditionalists, baby boomers, gen X, gen Y (also known as millennials), and gen Z to help the learner understand what drives members of each group. The course then further defined the aspirations, attitudes toward technology and their careers, and preferred communication media and preferences of members of each generation. This was all with the goal of facilitating interactions, especially as a leader, with members from each generation. For instance, different generations prefer and respond better to different types of communication: in-person, phone, email, video conferencing, text, or a combination of these modalities. That’s where the “decoding” part of the module comes in. As leaders, we need to recognize how best to interact with each team member to acknowledge their core values and foster the most harmonious working relationships while working toward a shared goal.

I’m a very visual learner and intuitive person but not the most eloquent or at ease with verbal communication despite friends remarking that I’m a “social butterfly”. This module helped me evaluate ways to adapt my communication style especially when interacting with others in the two most numerous generations in the workforce: millennials (42%) and baby boomers (29%). I fall in the middle as a gen X’er (23%) and have often found myself confounded by the attitudes and behaviors of millennials and this module helped me to understand their perspective and preferred modes of communication. But what I learned most was to look at not only the differences that impair our interactions but also the similarities we share that can be used to prevent or resolve conflicts and to encourage team creativity and solidarity.



-Betty Chung, DO, MPH, MA recieved a BA from The University of Chicago, MA from Boston University School of Medicine, DO from UMDNJ-School of Osteopathic Medicine (now Rowan-SOM), and MPH from Columbia University and a decade of experience in basic science research. She completed her AP/CP residency at the University of Illinois at Chicago (PGY1-2) and Rutgers Robert Wood Johnson Medical School (PGY3-4). Her current interests lie in graduate medical education, quality improvement, hematopathology, and molecular genetic pathology.

Team Dynamics

Teams are one of the most discussed work units. We throw “teamwork” and “team ethic” around during job interviews and performance reviews. When we apply for jobs, we highlight our teamwork capabilities on our resumes. Teams are indeed essential to productive work environments because they are the vital learning units in an organization. In other words, when teams learn, the entire organization learns.

But what constitutes a team exactly? Simply put, teams are a group of two or more people that have a shared goal. Not only that, they are committed to the team process and use team language (“we” instead of “I”) when discussing accomplishments and failures. Teams also focus on learning, whether that learning comes from outside information, success, or failure. Finally, teams possess a strong sense of commitment and accountability.

Teams that consistently perform above expectations are called high-performance teams. Everyone wants to be a part of a high-performance team, but how do they happen? These teams consistently have one trait in common: experiencing and working through conflict. Conflict is one of THE best things that can happen to a team, because when handled and resolved well, teams learn, grow, and function better as a unit.

Each person has different preferences for their role on a team. Everyone gravitates toward one these five team roles: Creator, Advancer, Refiner, Executor, and Flexer. The Creator focuses on generating ideas; the Advancer communicates the ideas; the Refiner challenges ideas; the Executor implements the ideas; and the Flexer assumes any of the other four roles based on the needs of the team. High-performing teams have members who are in their preferred role where they can excel and are sustained because those roles give them energy. It is our job as leaders to find jobs, tasks, and team roles where others can flourish. Without energized people, leaders will not be able to create high-performing teams or high-performing organizations.


-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


The team dynamics module gave me a great insight into my tendencies and an understanding on effectively getting the best out of teams.

When I received my assessment results, I learned I am an “advancer.” I tend to focus on execution and I pay attention to team interactions. One weakness of this profile, though, is how it potentially interacts with creators and refiners. If one is unaware of the valuable differences in prospective creators and refiners bring to the table, an advancer may get frustrated working with them in a team.

I came to realize I should be sure to include a refiner on the team, since having only executors or advancers could mean bypassing the analysis piece. I also gained new prospective on how I perceive creators. While in the past I may have discounted them as scattered or unrealistic, I learned this stems from the fact I like concrete ideas. Embracing innovation is essential to advancement and this is where creators excel.

The sections about communication and team roles were enlightening. How creators can easily get bored with discussions that are too concrete, and how executors are uninterested in theoretical discussions. On the flip side of things, creators need to partner with advancers, refiners and executors to bring about innovation. Advancers rely on refiners and refiners can benefit from the enthusiasm and networking of the advancers. I use these important concepts now in meetings and when I try to put teams together for a given project.

Although this may come with time, leadership and team member selection are paramount to foster the trust and respect and to facilitate free expression of ideas and sharing of information.


-Laila Osama Abdel Wareth, MBBCh, FCAP, MRCPC, EMHCA is the Chief of Clinical Pathology for the Pathology & Laboratory Medicine Institute at the Cleveland Clinic Abu Dhabi in the United Arab Emirates.



Listening With a Purpose

Everyone understands that listening is an essential skill for effective leadership. But many people do not realize that there are multiple ways to listen to someone. No, I am not talking about active and passive listening, where you either do or don’t reflect back what was just said. Honestly, reflective listening can become quite awkward during a long conversation… been there, done that (and not recommended).

The five different listening approaches that this course refers to are either feeling oriented, meaning that people listen to the emotions behind what someone is saying, or information oriented, meaning that they listen for data, arguments, and structure. The two feeling oriented listening approaches are appreciative and empathic which listen for a speaker’s enthusiasm and how to provide support respectively. The information oriented approaches are discerning, comprehensive, and evaluative. Discerning listeners want to gather complete and accurate information, comprehensive listeners organize the information, and evaluative listeners critique the information and make decisions.

The job of the leader (and speaker) is to provide the information and emotion that their listeners respond to well.  The key is, therefore, to provide something for each of the five types of listeners when you are giving your next presentation.


-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


Considering myself to be a “good listener,” I was particularly interested in the “Listening with Purpose” course during the leadership institute program. I was keen to see how the “scientific approach” of the leadership institute would be applied to this particular skill. Before the course, I answered a series of questions; my answers were analysed and I received a personalized listening profile. This profile included statements about my listening tendencies in specific situations. Some were uncannily accurate: “You may mentally argue with speakers as they talk,” for example, is a true description of my frequent mental disposition at meetings and conferences!

In addition to identifying my natural listening approach (the “information-oriented evaluative” style), my profile also indicated how likely I am to use the other listening approaches. Not surprising to me was the observation that I tend not to adopt the more feeling-oriented approaches of appreciative and empathic listening. My attitude has typically been to “cut through the red tape and stick with the facts.”

Beyond the characterization of my natural listening style, my personal profile also provided guidance on how to work with my listening style and identified areas where I could grow as a listener. It was clear that with regards to listening approaches, one size does not fit all. My “good listening” skills need a lot improvement. Miscommunication, with a loss of intended meaning, will occur if I consistently use only my natural listening style without regard for the differing circumstances and situations. This certainly explains some of my struggles with people who try to appeal to my emotions instead of (or in spite of) facts to make decisions.

The course also covered communication, defined as the actual exchange of information. The course highlights the various reasons why people try to communicate: to persuade, to inform, to self-express, or to entertain. I was surprised to learn that over fifty percent of face-to-face communication may be dependent on body language and less than ten percent on the words spoken! One then has to be careful to actually process what is being said rather than just the speaker’s body language, tone, and energy so as not to lose the message.

The most important message I took from the course was the importance of letting people know you are listening to them. This requires situational awareness and understanding the intention of the speaker.  I found especially useful the behavioural indicators that let a speaker know the listener is engaged. I have actually found practical utility and deployed a couple of these: “Demonstrating an open, laidback posture” and “remaining relatively silent, not offering solutions immediately.” The course has shown me a practical way to improve my listening skills.

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-Dr. Modupe Kuti, MB, MS(Ib), FWACP (Lab Med), has served as an attending pathologist for the past thirteen years for a tertiary hospital in Southwest Nigeria, West Africa.


Groupthink and the Abilene Paradox

Everyone makes decisions and everyone makes decisions in groups. But we all have been part of groups that felt anything but productive: the end result was subpar, the process took a lot longer than if you had done it yourself, and the endless arguments and indecision caused you and everyone else on the team a lot of stress.

So how can we ensure that an effective group decision-making process is in place? How can we be certain that the decision we make as a group are the right ones?

Groupthink is when group members’ desire for harmony and unanimity overrides their motivation to realistically consider alternative courses of action. Not considering alternatives can have severe consequences as this additional information could have altered an idea or process to make it more effective. An example of Groupthink is with the company Theranos, where the entire board went along with Holmes’ ideas without looking for alternative solutions. Needless to say, they would have benefitted from those alternative options. Groupthink occurs because members of a group do not feel comfortable sharing their dissenting opinions due to high group cohesiveness, stressful situations, and a feeling that the group will always be successful.

The Abilene Paradox complements the Groupthink concept: with Groupthink it is a few members of a group that do not speak up, while with the Abilene Paradox the majority (or the entire group) remains silent. Furthermore, with Groupthink even the dissenting (and silent) member will usually feel good about the final decision, while with the Abilene Paradox members feel resentment. The reasons the Paradox occurs revolve around fears of separation and reprimand. The results are group projects that never go anywhere or fail, and separation from the group.

The good news is that both situations can be avoided by one main thing: creating an open environment in which dissenting opinions are encouraged, listened to, and incorporated. So next time you are in a group or meeting, pay attention to the number of dissenting opinions stated and how people respond to them. Reflect on how you respond to those opinions and if there is something you can do to increase the openness in your team or department.


-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


In pursuit of efficiency and continuous improvement, the pathologists, residents and technical staff at Makerere University, meet every Wednesday. They are also joined by colleagues from the Mulago National Referral Hospital under the Ministry of Health of Uganda.  The purpose of this meeting is to make decisions that pertain to teaching, operation of the histopathology service, and conducting research.

Since 2003, I have attended several of these meetings. However, the realization and achievement of goals has been poor and nearly zero in some instances. No prior agenda is sent out. During the meetings, counter-productive decisions are made. The generation of ideas, alternatives and creativity has dwindled meeting after meeting. Attendance and contribution to meetings are viewed as a waste of time and effort. This has led to low motivation, and attendance has hit an all-time low.

There is always somebody to blame for the failure in teaching, the inefficient biopsy service and the low research productivity at the end of each year. In the last team building workshop, the Mulago team did not show up despite an earlier commitment and receiving an invitation three weeks to time. In the first workshop, the executive director of Mulago did not show up even when he was scheduled to speak! We have had a share of failed projects and ventures; the FNA clinic and teaching of Cytotechnology have not gone well, establishment of the “pay for service” laboratory is struggling and embedding QA and QC systems in the histopathology laboratory has been a total failure. Lately, we lost the bid to the ASCP Cancer Diagnostics for the Africa telepathology project.

In summary, the department seems to be stuck in thick mud! What is in play here?  It is the groupthink and Abilene paradox; the making of irrational decisions and failure to manage group agreement respectively.  This is an expected natural occurrence in decision making involving groups.

The motivation for being on the ASCP leadership academy is my passion for change through leadership. That is what drives me. I love effective participation and being part of productive teams.

Following the completion of the two courses, I now clearly understand what has been happening in my department. I look back and easily recognize the symptoms of groupthink; the illusion of unanimity, self-censorship, mind guards, and shared stereotypes.

Recognition of the problem is half way to the solution. Techniques to avoid the problem are now known to me. The style of meetings in the department needs to be changed. The chair should avoid being too directive in order to ensure an open climate during discussions.  The chair should also assign a member the role of a critical evaluator and once in a while open up the meetings to important outsiders.

All the decisions to do the above had to be agreed upon by members during the weekly meetings. I now recognize and understand the play of the Abilene paradox here; that some members said “yes” when indeed they meant to say “no.” I look back and recognize action anxiety, fear of separation, real risk, negative fantasy, perceived risk and confusion of risk and certainty.

Looking at the 15 reasons as to why one ends on the road to Abilene, I can surely identify with each of them. This, I am sure, is shared by each of the staff members.

We need to avoid the trip to Abilene by making changes in the conduct of meetings. We should plan before the meetings, invite the right people, clearly state the decisions to be made, plan enough time for discussion, and set a climate of openness. During the meetings, vital questions should be asked. It takes a lot to plan but in the end, the returns are long term and a good on time invested.

What can be done differently now? Sharing the new knowledge learned during the course is the first step. The second step is to put into practice the techniques to avoid the group think and endless trips to Abilene. These must eventually become the new culture of practice and eventually spread across other university departments.


-Robert Lukande is trained as an anatomical pathologist and is currently employed at the College of Health Sciences, Makerere University, Kampala Uganda. He is a teacher, research and consultant, and is passionate about changing the lives of others through leadership. He’s the current president of APESCA and is acting chair of the Department of Pathology.