Clinical Labs: Staff Management & Improvement

Staff Management in Clinical Laboratories

• Laboratory staff is vital and an expensive resource, which requires efficient management.
• Key aspects of staff management in a clinical laboratory.
• Best practices for hiring, training, and retaining laboratory personnel.
• Strategies for managing workplace challenges and staff motivation.
• Application of teamwork and leadership principles.

Personnel Requirements

• For Medical and Clinical Laboratory Technologists a bachelor's degree in medical technology or a life science field is required.
• Formal training and work experience can also qualify medical technologists.
• For Laboratory Technicians an associate's degree or certification from a vocational school or hospital training program is required.
• Certification from recognized bodies such as ASCP, ASCLS, NCA, and CLSI.

Improving Laboratory Testing

• CLIA ‘88 defines the requirements for laboratory personnel to ensure accurate and competent testing.
• Tests are classified into complexity categories with specific requirements.
• Low complexity tests are simple (e.g., urinalysis).
• Moderate complexity tests are more detailed (e.g., microbiology cultures).
• High complexity tests are advanced (e.g., molecular biology tests).
• Personnel qualifications depend on test complexity, ranging from a high school diploma to a doctorate.

Staffing Ratios

• Staffing ratios vary depending on the laboratory's needs and test complexity.
• Increased lab staff favors technicians.
• Decreased staffing requires more technologists with supervisory qualifications to meet regulatory requirements.
• If the laboratory has more technicians, they can handle less complex tasks, but qualified technologists may still be needed for oversight and supervision.
• Technologists are often required as technical supervisors for complex tests, especially during night or weekend shifts when staffing may be lower.

Training and Competence

• Accreditation emphasizes ongoing training for laboratory staff.
• The College of American Pathologists (CAP) states that labs must have a functional continuing education program and a system to assess employee competency.
• Training and competency assessments must be documented in personnel records.
• Each technologist or technician must be competent in performing laboratory tests.
• On-the-job training can be integrated into lab operations, especially for laboratory assistants and phlebotomy staff.
• Training allows for job improvement and promotion opportunities.

Internal Training Program Benefits

• Labs must develop their own skilled workforce due to a decreasing labor pool.
• Internal training helps reduce the impact of staff absences or unfilled positions and provide staffing flexibility.
• Cross-training ensures labs remain functional during staffing shortages.

Continuing Education

• Professional development is offered through journal reviews, educational programs, and seminars.
• Organizations include ASCP, ASM, NCA, and CLMA.

Laboratory Staffing Definitions

• The size of a laboratory affects staffing needs due to physical space limitations and workload demands.
• Small laboratories may require fewer generalists, while large laboratories may require additional personnel.
• Being close to high-use areas (ER, ICU) reduces transport time.
• Decentralized services like STAT labs, outpatient facilities, and nursing units require extra staff but improve turnaround time.

Test Complexity

• Test complexity determines staffing models.
• A generalist model suits small hospitals or physician office laboratories (POL) that outsource specialized tests.
• A specialist model is required for tertiary-level laboratories performing high-complexity testing.
• Service levels define lab activities, including specimen collection and support for physician office laboratories (POLs).

Staffing Models

• Flexible staffing adjusts personnel based on workload demand, with staff being floated or cancelled.
• Fixed staffing maintains a set number of full-time equivalents (FTEs) based on projected workload and budget constraints.

Generalist vs. Specialist Staffing Models

• Traditional Model: Laboratories employed specialists, and each technologist's competency was assessed for their assigned section.
• Modern Model: Simplified testing by automation and computerization allows labs to adopt a generalist model.
• Generalists are cross-trained to perform testing in multiple areas, allowing greater flexibility in staff assignments.
• Cross-training involves training an individual to perform tests in more than one laboratory section.
• It allows lab managers to assign staff based on real-time needs, increases flexibility in scheduling, and helps reduce staff shortages.
• Its challenges include a need for more resources for competency assessment and additional training costs, and may not be suitable for highly complex testing areas.

Esoteric Testing

• Esoteric Testing Areas are highly specialized laboratory tests that require advanced technology, specialized expertise, and extended processing times, often in reference labs or research centers.
• They include complex techniques like molecular diagnostics, are performed less frequently and used for rare diseases, have longer turnaround times, and require expensive equipment and trained personnel.

Hybrid Staffing Model

• Combines generalists and specialists with cross-training in common tasks and specialists for complex tests.
• This balances cost, efficiency, and quality.

Tracks

• Laboratory professionals can choose administrative or technical specialist tracks.
• Career growth opportunities help reduce staff turnover, enhance job satisfaction, and improve problem-solving.

Cost Management

• Labor costs are a significant part of the laboratory budget.
• Adjusting the skill mix of assistants, technicians, and technologists can help optimize costs.
• Key Considerations include CLIA '88 requirements determining the right mix of generalists vs. specialists and using cost-benefit analysis.

Staff Scheduling

• Ensures laboratory operations run smoothly while considering employee needs.
• Balances laboratory needs with the work-life balance of employees.
• Key elements of success include open communication and understanding employee preferences.
• Employees select their shifts within scheduling guidelines on a first-come, first-serve basis.
• Employees of equal skill level can swap shifts with managerial approval.
• Employee involvement improves job satisfaction, reduces scheduling conflicts, and promotes work-life balance.
• Flexible staffing adjusts staffing levels based on volume and workload and is more common in larger labs.
• Fixed staffing maintains a set number of staff and ensures consistent coverage.
• Work-Life Balance helps to increase employee retention rates, job performance, and morale.

Success Metrics

• Reporting Efficiency is defined as the percentage of test results reported within the required timeframe.
• It impacts patient care and faster results reduce hospital length of stay; crucial for reference laboratories.
• It can be measured by the percentage of tests reported within the required timeframes.
• Turnaround Time (TAT) is defined as the total time from specimen collection to final result reporting.
• TAT can be measured by time taken to obtain the sample, time for labeling, transportation, and preparation, testing, analysis, validation of results, and delivering results to clinicians.
• It is essential for critical and emergency testing- helps laboratory managers optimize staffing levels to meet demand.
• Metrics include percentage of tests completed within target TAT and monitoring collection times.
• Productivity Measurements include the number of tests performed per staff member and is measured by tests per FTE, workload units per shift, and cost per test.

Success Productivity Measurements

• Helps assess efficiency in resource utilization, affects staffing decisions, is crucial for budgeting and cost control.
• Challenges include differentiating manual from automated tests.
• The number of billable tests completed directly impacts financial negotiations.
• Inability to complete billable tests efficiently can disrupt inventory levels, pricing, and overall lab efficiency.
• QC testing consumes resources but is necessary to maintain test accuracy and accreditation standards.

Managing Nonbillable Tests

• Repeating tests due to lab protocols, physician-requested repeats, and QC testing.
• Batching, implementing automated QC systems, and reviewing physician test ordering patterns can help to handle these tests.
• Managers should monitor the ratio of billable vs. nonbillable tests, adjust batching strategies, use workload-based staffing models, and analyze contract requirements.
• Productivity measurement provides performance evaluation and helps identify inefficiencies, improving resource allocation.
• It may create pressure on staff and shift the focus towards speed over quality.
• Managers should balance productivity and quality, and include proficiency testing results, error rates, and turnaround time.
• Computerized scheduling considers staff skills, training, and workload, the decision to use it depends on lab size and costs.
• Use historical data to predict staffing needs, and adjust schedules based on volumes and fluctuations.
• Maintain adequate trained personnel.

Outsourcing Laboratory Tests

• Outsourcing Laboratory Tests has become another option.
• Reference laboratories have expanded into routine testing and Factors to Consider When Deciding to Outsource are: cost per test, turnaround time (TAT), and the volume of tests.
• Outsourcing can free up in-house staff and resources for higher-priority STAT tests
• Can create dependance on external vendors, potential reporting delays, and less control over test quality

Creative Scheduling Models

• Job sharing involves two employees splitting one full-time role to reduce costs and increase flexibility.
• Flexible work hours involve employees working shifts that suit their personal needs and lab requirements.
• Telecommuting is remote work for non-laboratory functions, while self-directed teams collaboratively manage schedules.
• Non-traditional shifts (10 a.m.–6:30 p.m. or four 10-hour workdays) provide alternative work-life balance solutions.
• Advantages include improved employee satisfaction, better workload fluctuations, and reduced space requirements.
• Challenges include complexity in managing schedules and the need for clear policies.