Code-Switching for Effective Communication in the Clinical Laboratory

By Melissa Duong - March 03, 2026

After a recent laboratory incident, a group of subject-matter experts convene and pose targeted but constructive questions and recommendations for the laboratory personnel.  

  • Safety/regulatory: “Has the lab completed the Workplace Incidence Report required by OSHA?” 

  • Human Resources: “This state’s workers’ compensation legislation indicates the lab also needs to…” 

  • Quality: “Let’s conduct a Root Cause Analysis to retrospectively investigate this event. We’ll also initiate a Failure Modes and Effects Analysis to proactively prevent recurrences.” 

  • Finance: “What are the unexpected expenses to be accounted in budgeting variances?” 

  • Operations: “What steps can mitigate impact on testing volume throughput?”  

  • Laboratory: “Thanks for your all your questions, let’s take this step by step…” 

This example illustrates how the laboratory is an interconnected space in a vast healthcare landscape. When a laboratory can leverage the power of language through applying code-switching, pathology and laboratory professionals can effectively address unique stakeholder perspectives, personalize messages for a specific audience, and optimize stakeholder engagement and buy-in.  

What is code-switching? 

Simply put, code-switching is a practice where the speaker adapts their communication based on the audience to improve shared understanding. In the 1950s, linguist Einar Haugen described code-switching as the ability to transition between languages and dialects.1 This initial definition carried a negative connotation but has since evolved to a more positive view, where code-switching crafts the precise message to fit the audience. Gumperz and Dell further stratify code-switching as situational or metaphorical code-switching. With situational code-switching, communication changes based on topic, place, person, and purpose. In metaphorical, language fluctuates based on symbolic social messages, like in promoting unity and rapport. Code-switching can be applied to various domains, one of which is the workplace.2,3 Carol Myers-Scotton’s version of code-switching departs from traditional theories and explains that code-switching is an intentional social strategy for individuals ‘toggling’ their language and behavior between normative and non-normative features.1,2 Functions of code-switching can vary to include emphasis of a point, group identity, and audience diversity.4 Although some linguists believe code-switching solely applies to language and dialect transitions, many adopt the view of this author that code-switching spans the gamut of how people adjust the way they communicate, speak, present themselves, and behave.5   

Laboratory personnel can consciously apply code-switching in the workplace. This allows the lab to communicate the same content to diverse groups with distinct audiences in mind. It also emphasizes different messages based on factors such as feeling, person, topic, etc. Hence, code-switching transcends the boundaries of traditional definitions and improves communication. Speakers develop unique variations of communication in different settings for each audience that match the speaker’s personal voice.   

In the opening vignette, a lab professional adapts different phrases, terminology, and perspectives to address each stakeholder’s questions about safety, quality, finance, or operations. Nevertheless, how the lab professional formulates concepts and actions together, with reasoning, humor, and camaraderie, remains faithful to the speaker’s style and is not considered inauthentic nor insincere. Like switching between codes, the form and content of conversation may vary for different audiences, but the speaker’s unique style persists.   

Code-switching in action  

Professionals can combine code-switching and complex adaptive systems theory to better advocate for the laboratory and improve patient safety through better communication.6 The complex adaptive systems theory is a form of systems thinking that analyzes systems’ interconnected components and accounts for positive and negative feedback loops, creates a comprehensive perspective that guides code-switching.7 While code-switching takes intentional effort and additional learning, there are multiple organizational benefits in proper integration of code-switching with complex adaptive systems theory (Table 1). Collaborators can code-switch to align with each other’s background and interests. This can empower people to create alignment, improve communication, and underscore crucial content.   

Table 1. Examples of factors and rationale for applying code-switching in the laboratory. 

Benefits 

Rationale 

Raising the laboratory impact 

  • Critical need for effective communication due to large impact on patient care 

  • Accounts for 7 billion annual test volume in U.S.8  

  • Constitutes 3-5% of healthcare spending9  

  • 70% of healthcare decisions rely on laboratory test results9  

Simplifying technical concepts 

  • High likelihood for lab professionals to interact with those of non-laboratory background 

  • Growth of healthcare administrators has outpaced growth of physicians10  

Improving the laboratory work environment 

  • The lab has a median 3-year average in turnover for all laboratory personnel at 16.2%, and over 50% of laboratory staff were somewhat satisfied to dissatisfied with their employment11,12  

  • Improve communication:13  

  • Mitigate project delays and decreased productivity with $26k loss per employee annually 

  • Improve low morale contributing to stress and employee turnover 

  • Nearly 50% of survey respondents indicated that communication systems for error reporting were inadequate. This is an opportunity for improvement6  

The first step of code-switching is to understand the audience. This means that laboratory professionals must understand the organization’s structure and the stakeholder’s organizational role and purpose (Figure 1A). The organizational pyramid depicts a simplified enterprise hierarchy, conveying a strategic, tactical, and operational level.14,15  

Strategic level 

  • Sits at the apex of the pyramid 

  • Consists of executive leadership, who is responsible for developing the vision, values, and key performance indicators (KPIs) and propagating these throughout the organization14  

  • Favors “why?” questions to better understand and improve processes 

Tactical level 

  • Sits at the middle layer of the pyramid 

  • Consists of mid-level management 

  • Establishes procedures and identifies resource needs through what and who questions15  

Operational level 

  • Sits at the pyramid base 

  • Represents workforce majority, front-line employees15  

  • Utilizes “how?” questions to concentrate on details like how change impacts daily workflow, which is necessary to achieve results 

Laboratory leaders are most likely at the tactical or operational level and can craft the story based on who you’re talking to. This integration of language and knowledge can improve how the laboratory engages, negotiates, and collaborates with different stakeholders.  

Figure 1. A. Organizational Hierarchy; Figure 1B. Strategic Prioritization   

To apply code-switching, pathologists and laboratory professionals should assess the organizational hierarchy in which they practice. Optimize executive buy-in through project prioritization that incorporates data into strategic alignment to drive business goals. Data can involve financial related factors including financial viability and market growth and non-financial related factors including innovation and social responsibility.16 One tool to synchronize project prioritization with organizational initiatives is based on strategic fit (Figure 1B). Leaders should focus their efforts on projects in the upper quadrants and persuade leaders to invest and/or support projects through incorporation of data, KPIs, and association with strategic initiatives.17   

Code-switching for buy-in  

 Communication changes based on who we speak to, which is a form of situational code-switching. One example of where code-switching to engage stakeholder buy-in could be used is for a capital budget proposal of new laboratory instruments. To optimize executive buy-in, laboratory leaders should highlight the relevance of this project in supporting strategic initiatives such as quality care or service growth. Presenting to financial leaders would include: 

  • A detailed discussion on return of investment 

  • Operational expense variances 

  • Negotiation of service contracts 

  • Cost-savings 

If one of the KPIs is monitoring overtime, any data on how this instrument could reduce manual labor would also be beneficial. Discussion with operational leaders would concentrate on process changes from current state to future state, resource allocation for implementation and integration, and supporting data on potential improved turn-around-time and improved quality. Conversely, regulatory focused personnel emphasize training documentation and maintenance per instructions for use (IFU). This reflects the Markedness model as pathologists and laboratory professionals foster buy-in with an effective choice of shared words and perspectives. Alternately, conveying the significance of new instrumentation to front-line employees should prioritize details on changed daily workflows, such as improved efficiency and how to operate, troubleshoot, and maintain instruments.   

Applying knowledge, moving forward  

So what happens when we apply code-switching to the clinical vignette about a chemical spill and exposure from the beginning of this article paper? 

After describing the overall incident, pathologists and laboratory professionals can emphasize to the Finance team that there was a one-time expense leading to a budget variance of X% this month hiring a chemical spill response team for cleanup. Regarding HR and Regulatory, the critical detail is that the employee involved is safe and cleared by Occupational Health. However, new training documents should be created to improve chemical safety education. The Quality team might be interested in documentation of the investigation, root cause analysis, and corrective action. Corrective action that requires funding can be associated with strategic initiatives such as employee well-being to optimize buy-in. Operations would focus on impact on specimen processing time. Meanwhile, front-line employees value clear communication on how much longer the chemical response team will be in the area preventing employees from accessing supplies and equipment.   

This communication change displays situational code-switching based on the stakeholder and emphasizes different key points based on stakeholder background.  

Code-switching is an adaptable approach to drive alignment, improve communication, and underscore social messages, and can provide multiple benefits for the laboratory environment. It provides a basis for pathologists and laboratory professionals to address challenges in the dynamic healthcare space. 

 

References 

  1. Nguyen, T. (2015). Code-switching: a sociolinguistic perspective. Anchor Academic Publishing. 

  1. Albarillo, F. (2018). Information Code-Switching: A Study of Language Preferences in Academic Libraries. College & Research Libraries, 79(5), 624–644. https://doi.org/10.5860/crl.79.5.624 

  1. Tuah, D., Shin, C., Gedat, R., & Jazlan, M. (2021). The Language Ecology of the Kedayan in Sarawak: A Quantitative Survey on Language Sustainability. Ecology Environment and Conservation, 27(October Suppl. Issue), 33–38. 

  1. Malik, L. (1994). Socio-linguistics: A Study of Code-switching. Anmol Publications. 

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  1. Rege, A. (2017, November 9). Growth of healthcare administrators outpaced physicians, increasing 3,200% between 1975-2010. Becker’s Hospital Review; Becker’s Healthcare. https://www.beckershospitalreview.com/quality/hospital-physician-relationships/growth-of-healthcare-administrators-outpaced-physicians-increasing-3-200-between-1975-2010/ 

  1. Nadeau, K. (2024, August 26). MLO’s 2024 survey of laboratory professionals. MLO; Medical Laboratory Observer. https://www.mlo-online.com/management/careers/article/55131251/mlos-2024-survey-of-laboratory-professionals 

  1. Novis, D. A., Nelson, S., Blond, B. J., Guidi, A. J., Talbert, M. L., Mix, P., & Perrotta, P. L. (2019). Laboratory Staff Turnover. Archives of Pathology & Laboratory Medicine, 144(3). https://doi.org/10.5858/arpa.2019-0140-cp 

  1. HR Vision. (n.d.). The Signs and Costs of Poor Communication in the Workplace. HR Vision. Retrieved August 31, 2025, from https://www.hrvisionevent.com/content-hub/the-signs-and-costs-of-poor-communication-in-the-workplace/ 

  1. Dolgova, O. (2023, November 28). Mastering Strategy vs Tactics: Keys to Business Success. M&BD Consulting; M&BD Consulting. https://www.mbdconsulting.ch/publications/key-principles-successful-strategic-planning-importance-timing 

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Melissa Duong