Successful change management practices are essential for the implementation of improvements within organizations. Change management agents are essential rolesin an organization to bring about successful change. The organizations culture needs to be at an adaptable state to enable change to successfully take place. Change management can negatively affect an organization if certain steps are missed or rushed. There are critical success factors for implementing change and employees need to be ready to accept the change. There is need to place emphasis on frequent communication between the employees and organization, if employees are not connected and consulted about the change, and feel that they have a say in the direction of the change then change can be very difficult to implement, and often is not successful. Successful change management can assist the organization to contribute to competitive advantage within its industry (McFarland, 2016), it can aid employee engagement and therefore increase production and innovation. This paper examines how change management plays a critical role in an organization when looking to automation to make their business more competitive and sustaining. This paper focuses on the challenges of bringing automation to organizations, and in particular the benefits of bringing an auto-embedder to the histology laboratory. This paper examines the deployment of automation within a histology laboratory where the change management was initially unsuccessful. The paper describes how the automation was successfully deployed and what lessons were learnt. The aim of this paper is to show how change management and organizational culture adaption is so important to bring successful change. This paper proposes a suitable model for a more modern approach to change management when implementing new initiatives.
Today automation is used across the world to provide a benefit across numerous industries, such as parcel sorting, food packaging, and medical diagnostic kit production.
Automation can reduce time spent on tasks and can provide a business with a more streamlined workflow. Automation also brings the benefits of less overheads and a good return on investment (ROI) and offers cost saving strategies. Automation brings transformation, financial and competitive benefits to organizations (Devitt, 2017). Some histology automation has proven difficult to implement; this evolution has progressed from inferior to superior process (DeSalvo, 2019).
Automation can offer either a sustaining or a disruptive ROI.Where automation is described as disruptive it is when there are no financial benefits thatare associated with the investment, disruptive automation can often result in a worse performance for the business (Christensen, 2000). Sustaining automation is where the business receives a positive return financially, and the business receives an overall improved workflow for the operation as well as ease of use for the user.
It is important to note that just because automation can offer positive rewards for the business it does not mean that automation will be financially viable and socially engaging, or that it will be accepted by the organization and in particular by the employees.
Automation within operations, such as an auto-embedder in a histology laboratory, can offer a sustaining environment in which there are headcount savings, and also a reduction in turnaround times. Automation ensures a higher quality end product(Cuddihy and Garrity, 2014). Using the example of laboratory automation within a histology department, an auto-embedder can provide a histology laboratory with a good investment.
The workflow through the histology laboratory involves the tissue trimming of samples, processing the samples, embedding the samples in to a block, and slicing the embedded sample block which the sample is then fixed to a slide, staining the slides and dispatching the slides to the pathologist. Figure 1 below shows a high-level overview of this process.
Figure 1. A basic overview of the steps that histologists take to get tissue samples fixed to a slide. From arrival in the histology department to dispatching to pathology (Wall, 2020).
An auto-embedder could give an internal rate of return (IRR) of 73%, and it takes about two years for such equipment to show weighted average cost of capital (WACC) payback (Wall, 2019).
A reduction of turnaround times will be of benefit to an organization and investors, this can potentially offer more scope to increase the amount of work output through the department. Automation will bring faster results and require less overhead costs (Nasim, 2015).
Today within the histology laboratory there still remains a high number of manual processes (Tufel, 2015), this provides an opportunity for organizations to revisit their operations, especially in the contract research (CRO)arena where quality needs to remain central and match high output times, the number of people needed to do the job is driven by the operations metrics.
Sheppard (2015, cited Tufel, 2015) suggests that the need for human intervention for histology process is still present today with embedding and block cutting, and histology is one of the last areas to be fully automated. Phelan (2014) suggests that histology continues to be more manual processes compared to other laboratories within medical settings.
Taking a look at one of the areas Sheppard mentions above, embedding, what efficiency potential would an auto-embedder bring to the organization? Table 1 below shows the metrics for a manual embedding andfor the automated embedding process.
Table 1 below shows that automating the embedding process would bring a significant reduction in turnaround time. Some laboratories have invested in automating the embedding process, however often the equipment is not utilized to its full potential (Wall, 2019), and if the environment does not match that of the workforce then the equipment can lay redundant which then moves a good sustaining product to a disruptive one.
This also brings negativity from the employees around the equipment, this can quickly manifest across the department, and across the global laboratory setting. This sets the organizational culture to a more negative approach to any proposed automation.
Number of blocks embedded per day
Days of embedding based on a standard of 1150 blocks
5 days (35 hours)
1 day (7.5 hours)
Table 1. A comparison of a manual verses an automated histology embedding process, metrics transcribed from a histology laboratory based in the United Kingdom that were recorded in 2019 (Wall, 2020).
Histology laboratories are challenged with finding ways to increase the throughput whilst maintain and improving quality of the end product to the customer. Table 1 above shows the standard metrics used for standard processing methods for one project. The table shows the standard blocks of 1150, this would be several tissues fixed into the wax block, depending on the tissue being fixed there could be approximately 1 to 5 tissues in the block. To manually embed a standard project would take a histologist approximately five days and on average they would embed around 221 blocks per day. On average to manually embed a standard project would take 35 hours. The auto-embedder can embed a standard project in 7.5 hours. There would often be two or three histologists working on the project embedding, using the auto-embedder would mean you would only need one histologist to feed the auto-embedder and troubleshoot.
The auto-embedder provides a significant reduction of time for a project and it offers opportunity for histologists to shorten turnaround times and therefore the auto-embedder offers a sustaining piece of equipment for the laboratory.
If automation can provide a business with a sustaining and competitive future, why do we not embrace automation across all of histology laboratories? The simple answer to this lies within the organizations culture. It lies in the change management practice and processes, and from this communication is one of the bigger drivers.
The example discussed could have provided the organization with a significant saving, however the change management process around implementing the equipment were not adequately managed, and the histology team did not buy into the equipment, the team did not see the benefit of why automation may be good for their operation as well as for the business.
The team felt that the auto-embedder hindered their work, that the quality was not good enough, and because of negativity, even though it was automating the embedding procedures it would still mean some of the embedding procedure would need to be manually performed.
At another site that the auto-embedder was used, it was only used for some of the tissue embedding and most of the histology procedures were performed by hand. There had been several discussions between the histology technologists at across the different sites about how the auto-embedder took time to load and had errors which resulted in downtime, which spiraled into negativity and resulted in communication noise that the auto-embedder was not fit for purpose. To note, the auto-embedder was an old model which had been superseded.
This shows that without the right change management for implementing automation it can have a negative psychological impact on the work force, and it can also impact the production of the department.
This project was managed by a remote member of the department; they had not been working in the laboratory for a number of years, which meant that they were removed from any of the improvements that had made it into the department.
The project was initiated without a consultation phase for the team, they were told what they needed to do and given little opportunity to discuss logistics and issues.
The benefits for the histologists and for the organization had not been promoted.
The outcome from the department was to decline the purchase of the auto-embedder and for them to continue with their manual processes.
This was because department leaders did not see the true benefit, the organizational culture was immersed in negativity towards the automation, the team did not see why the automation would be a good fit. The project was poorly managed and the psychological safety of some of the team was compromised.
The following year one of the research associates took the project on, and they included team members to trouble shoot and look at the end product.
They liaised with pathologists and got feedback that the quality of the slides coming through from the auto-embedder was high, and there were no undesirable differences or artefacts between the manual embedded slide to that of the automated slide. Key stakeholders were aligned and the manufacturer visited the laboratory numerous times to work with the team.
Each phase of the project involved the team, and many other key stakeholders to histology. The team were able to speak openly, comfortably, and change other processes in the laboratory in readiness for the auto-embedder.
The auto-embedder was purchased and successfully implemented into the normal histology workflow.
The auto-embedder reduced the histologist’s embedding time by 80% (Wall, 2019), this percentage was calculated using metrics that are seen in table 1. This is a significant reduction of time where the histologist can be utilized elsewhere in their role.
We need to challenge ourselves within our organizations to look at what rewards automation can bring to the business, and think about how it can be of benefit to the user, for example the associated health and safety benefits like reducing the potential for repetitive strain injuries that may exist with manual processes.
This would involve the automation being effectively deployed across the department in the organization, which means that the culture and the change management practices need to be right for a successful deployment of the equipment. It means we have to involve the employee’s that would be operating the equipment and communicate effectively.
Organizational culture is shaped by the employees; employees are the identity of certain cultures with the business (Ritson, 2019), what this means is that it is the employee that makes or breaks the success of the change to be implemented in the organization. So any change, such as the implementation of automation, must be carefully managed in order for it to be a success. Employees need to feel part of the change, and that their opinions count, employees need to understand the ‘why’ for the proposed change.
The employees did not initially see the benefit of bringing automation to histology, this culture was set by the team.
Effective change management creates an environment where the employees feel psychologically safe, and a psychologically safe environment will provide the right environment for employees to be innovative and drive business outcomes (Gartner, 2020), therefore in the right environment employees will be engaged in the change process.
Consideration needs to be given to the cultural background of the employees to minimize any potential risk to the harming of the employee’s psychological safety. Today it is of greater importance to have cultural awareness because we are operating in a greater culturally diverse population (Chen and Starosta, 2016).
Employees need to understand the reasons behind any proposed change, so in the example of the auto-embedder it is imperative that the change management process involves the employees, and that the ‘purpose’ and ‘why’ for the change is center to discussion with stakeholders. Communication needs to be often and two-way between the organization and the employees.
Change should not be a surprise to employees and often in our fast paced environments organizations want to move quickly to continue to secure their competiveness, or to react to a changing environment. If organizations do not consider the employee when making changes then it risks the change not happening because the employee does not understand ‘why’ and ‘what’ is happening, and this is a great risk to the engagement of the workforce.
In 1996 Kotter suggested that successful change is 70-90% leadership, so what goes wrong when we try and implement new initiatives in the organization? We simply do not include the right people at the planning stage, there needs to be acceptance of the change and employees need to feel part of the change and that their opinions and ideas are taken into account.
Behaviors and constraints are critical success factors for successful implementation of change, 65% of managers that were interviewed, across a global histology laboratory setting, said that change management is a key factor for any strategy, and that it must also involve the employees (Wall, 2019).
To successful implement innovation such as the auto-embedder the right leader needs to lead through the change ensuring that the team feel they are part of the change, this will ensure the organizational culture changes to accept new practices and procedures. It will ensure that the team feel psychologically safe and engaged to accept the change and promote it. The change management agent cannot change the culture, but they can influence the culture to start to adapt in a positive way.
Table 2 below shows the steps for a modern approach to change management. The organizational culture needs to be considered and matched with the right change agent leader. The change management leader is essential to the success of bringing new innovation, such as the auto-embedder, into organizations.
When teams see the benefit for themselves, feel included in the planning and implementation, as well as understanding why we are looking to automation and the leadership for the change is right the change can happen and become the new normal.
Table 2. Steps for a modern approach to change management (Wall, 2020).
When change management is successful it provides organizations with opportunity to gain a competitive advantage within its industry, it promotes innovation and employee engagement because the employee is connected to the change, and therefore the organizational culture adapts with the change to a new normal.
Employees are the organizations culture, if the change is not managed successfully it can have a detrimental effect to the business because the culture is set to the normal state and therefore it cannot adapt without the employee’s influence. It can also have a negative result to the employee’s engagement which over time causes harm to the success of the business.
Employees are a priority for change management to be a success (Rees, 2015), if employees do not buy in to the change the probability of the change being successful is low.
Change management is important for organizations because it brings an innovative and productive competitive potential.
If the right steps are taken to manage the change, such as the steps proposed in table 2, change can be successful and bring about the associate benefits such as offering a higher quality product, shorter turnaround times and thus a greater efficiency and capacity to increase production.
The examples described in this paper show that if employees are included and feel part of the change then the change is more likely to be successful, this requires the right change agent to lead the team through the change.
Employees are the organizational culture, the normal state of the environment is that culture, if changes are made then the culture needs to adapt, in order to adapt to a new culture normal, employees need to change. Only when employees embrace the change will the culture adapt.
The benefit that the automation brings to the organization far outweighed the initial negativity and false start. Newer team members have started within the organization and the auto-embedder is their normal, this is the cultural adaption. The organization has increased production offering a similar or greater quality end product to the customer. This was achieved through a carefully managed modern approach to change management.
Author: Sarah E. Wall
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