An expert from ASCLS provides a unique take on the looming shortage in laboratory personnel.
There is no question that the clinical laboratory workforce shortage is going to drastically impact the ability of many laboratories across the country to provide patient care. Most of us have read, or are at least aware of, the American Society for Clinical Pathology’s (ASCP) 2014 Vacancy Survey of Medical Laboratories.1 If you do a Google search using the phrase “Laboratory Workforce Shortage,” you can find a multitude of articles discussing the shortage that define the causes and that pose a variety of solutions.
So, what are some of the causes of the workforce shortage? Certainly the pending retirement of many of the Baby Boomers in the workforce is going to have a significant impact. This will be even more pronounced because many individuals in the current workforce delayed retirement after the bank collapse of 2008 when many lost a significant portion of their retirement funds. However, since the economy has recovered and the market is at all-time highs, those individuals are now ready to retire.
In addition, there are just not enough students graduating from the existing Medical Laboratory Science (MLS) and Medical Laboratory Technician (MLT) programs, and not enough slots in those programs to replace those individuals who will be leaving the workforce. In an article from Clinical Laboratory News published November, 2015, Kimberly Scott highlights the problems that medical laboratory science (MLS) programs are facing and provides some excellent recommendations on how to address the issues and increase the number of students graduating.2
What about Recruitment and Retention?
A lot has also been written on how to effectively recruit and retain employees. Conventional wisdom is that if you pay more and provide good benefits you will have a better chance of hiring quality employees. If you also provide a positive work environment along with the better pay and good benefits, you have an improved chance of keeping those employees. All of this is true, although it does not do anything to change the facts of the workforce shortage; there are just a finite number of qualified candidates for open positions. If successful, however, it does help you staff your laboratory and potentially shift the burden of the shortage to that hospital across town.
What else can you do?
Given that the number of available candidates to fill open positions is shrinking and recruitment and retention only gets you so far, laboratory leaders must look at alternative solutions to their staffing problems. If you are not going to be able to fill your open positions, then what else can you do?
One way to address the staffing shortages is to look internally and review laboratory processes. This assessment can help determine if there is an opportunity to improve processes, adjust staffing or even rearrange equipment to improve efficiency so that you can get by with fewer staff, if needed. Here are a few things to consider:
Auto-verification before Automation
If there is one thing that you can do to increase efficiency, it is to implement auto-verification (sometimes called auto-validation). I have worked with laboratories where close to 95% of tests were auto-verified in their automated sections, which means the techs can be spending less time reviewing results and more time on more appropriate tasks.
Review the Data
One of the most valuable tools used as a consultant is the “staffing to demand” analysis (S2D). Identify your specimen volumes by day of week and hour of the day, and graph the volumes against your current staffing schedule. Make sure you plot graphs for every day of the week. This visual analysis will provide an excellent tool for identifying busy or slow times in the work day and allow adjusting of staff to the actual demand.
Follow the Specimens
Take time to perform observations and map out the specimen flow process. This evaluation includes looking at the entire inpatient and phlebotomy process, starting with how phlebotomy orders are received to resulting of tests. Get out the sticky notes, and construct the process flow map on the wall. Look for waste (waiting, down time, movement of people, convenience in location of equipment and supplies), and see how thing can be done differently to improve the process. You would be amazed at how much waste you can identify (and eliminate) by doing this exercise.
Follow the Techs
Conduct observations of your technical staff in all areas on all shifts. How do the staff move around the laboratory, and how does this change on different days, evenings and nights? How do individual staff members work differently doing the same jobs? Spaghetti diagrams are very useful here, in addition to work/time studies, to identify variation. This assessment will also help eliminate waste and standardize the work processes.
In addition, make sure to look at the type of work each of your techs are going. Does the task require a MLS to be the one doing it? Aligning the task with the appropriate level of experience allows you to use staff more appropriately.
Look at Your Laboratory
The final option to consider is the actual physical layout of your laboratory. Laboratory leaders should look at their lab from the viewpoint of a night shift tech and how much ground those individuals have to cover to get the work done. Laboratories (or sections of laboratories) tend to be designed with day shift operations in mind. Day shift operations usually have lots of staff present to do the work, whereas night shift techs usually cover the same amount of ground with considerably less staff. Can you redesign your laboratory to improve efficiency and reduce steps?
As discussed, recruitment and retention strategies will only get you so far. There are only so many qualified candidates available, and that pool is shrinking while the need for qualified laboratory personnel continues to grow. By taking a hard look at your internal processes and staffing, you can work to eliminate waste and improve efficiency to allow your laboratory to operate with fewer staff if and when the needs arises.
- Garcia, Edna; Ali, Asma; Soles, Ryan; & Lewis, D. Grace. The American Society for Clinical Pathology’s 2014 Vacancy Survey of Medical Laboratories in the United States. Am J Clin Pathol 2015; 144:432-443.
- Scott, Kim. The Laboratory Workforce Shortage Demands New Solutions. Clinical Laboratory News, Nov. 2015.
- Lafferty, Erin. Transforming Your Lab from a Cost Center to a Strategic Asset. Oct 28, 2016.