Strategic Processes, Job Families and Learning and Growth Initiatives to Provide Support and Progress with the Clinical Laboratory Operations Department
Strategic Processes, Job Families and Learning and Growth Initiatives to provide Support and Progress with the Clinical Laboratory Operations Department.
The put a question to to make important cost reductions in human capital within the medical laboratory industry while simultaneously increasing performance is an industry wide constant. External pressures derived from health insurers and providers are demanding reduced costs, and higher performance to raise their profits. Internal demands to not only reduce costs to offset the expenses of the institutions not-for-profit place, but to decrease processing times in order to release patients has reached all-time highs. The message is clear, improve performance and reduce costs. With departmental budges on the decline it is imperative that human resource strategies take action in order to better prepare employees to deal with the demands that are and will be placed upon them. In terms of human capital and expense it is perhaps the strategic processes utilized in the Laboratory Control Department that is the most able to offer a means of cost reduction and provide for additional return on intangible assets. However, before taking action it is required that the goals of the department are well defined and understood as well as how these goals fit into the greater process of the operation. From this point a defined analysis can occur that identifies the strategic job families of the group and how they support the overall strategic process. Finally once the process and the job families are understood, the development of learning and growth programs can occur that can be utilized to help meet the future demands of the organization.
Background:
In fresh decades the advent of and utilization of automated analytical equipment has provided a means to greatly reduce the number of employees needed as Medical Technicians in laboratories. Additionally instrument innovation has further reduced this need by expanding instrument tests menus and combining multiple instruments into larger platforms. As a result, those laboratories current with modern instrumentation have been able to reduce their equipment inventory, and reduce the overall Medical Technicians workforce by at least twenty-five percent (depending on the specific operation) while being able to handle greater volumes of work in a mighty quicker and efficient manor. At current it is generally well accepted that in order to truly make any further significant gains in productivity in this spectrum of the laboratory; it will have to come from technological advances. However, in inequity gains in the pre-analytical side of the laboratory will not gain from further advances in technology. Job functions in the pre-analytical or Laboratory Control Department is focused on data entry and the “hands-on” handling of medical specimens combined with intensive research, trouble-shooting, and problem resolution. Unlike its highly automated cousin, this labor intensive fundamental requirement to any laboratory operation will only see significant gains made through the utilization of active human resource management activities.
Clinical Laboratory Strategic Process:
The overall goal of the clinical laboratory is to provide the analytical testing of human blood, stool, urine and other body fluids as designated by physicians utilizing the appropriate test methods and within the necessary time frame. In order to efficiently accomplish this task the laboratory is broken down into basic groups each with its own specialties, capabilities, and strategic process. Each department has its own process, goals and expectations that if accomplished, will allow for the entire laboratory to be successful at its overall goal. As mentioned above in the “background” section much of the laboratory is automated and thus dependent upon technological advances to enact further gains in productivity. However the Laboratory Control Department is not in a similar position. Rather, due to its unique role, it is dependent solely on human resources for advances and improvements. This department’s role in the analytical testing of medical specimens is primarily to serve as the data entry, pre-analytical, and research and problem resolution branch of the laboratory. This department is responsible for sorting specimens, performing data and test order entry and pre-analytical specimen preparation as well as all aspects of client services, problem resolutions and other support tasks. It is this department that specimens must first pass through prior to analysis. Other than the use of computers and the electronic Laboratory Information System for data entry and information, this department is wholly dependent on human capital to do its strategy. Thus, it is this department that can either provide adequate workflow to handle the current volume thus resulting in overall laboratory success; or it can it can provide inadequate workflow to act against the overall success of the laboratory.
In this, as well as other similar departments in the industry, it is from the point of specimen arrival through the final specimen preparation and distribution that is the most labor intensive and time sensitive aspect of the overall operation. Failure for the department and its employees to achieve minimal productivity standards will result in the delay in processing of specimens and the ultimate failure to provide the clients with a guaranteed service. As a result, the reliance on a quality workforce is never more pronounced than in the Laboratory Control department. Thus, it is often this department that receives the most external scrutiny. While failures from the department are often viewed externally as overall failures, this is an overly simplistic arrive. Considerable like an automobile assembly line, an efficient Laboratory Control Department is broken down into basic components and processes that lead to the end product. And like an automotive production line, if one of the components does not perform to standards, the downstream production is greatly hindered. While the overall organizational culture is outcome oriented, the true hands-on come to correctly manage these groups is by utilizing a people oriented approach, and to a lesser degree a team approach. Currently these departments are segmented into the following primary tasks; sorting and prioritizing, data entry, and pre-analytical preparation and distribution.
Strategic Job Families in Laboratory Control:
There are a total of seven principal job families that exist in the Laboratory Control Department. Of these there are two that are the most vital; data-entry and pre-analytical. Out of these two vital job families, the most critical and strategic process is data-entry. It is this job family that all other aspects of the department and the laboratory as a whole depend on for accurate test assignment, patient identification, and productivity. Failure to attain any one of these goals will cause errors to trickle down to the point of the final report and patient medical care; if productivity is not met delays in turn-around-time will occur. As suggested by Kaplan and Norton, “The art of strategy is to identify and excel at the critical few processes that are the most necessary to the customer value propositions.” 1 As such, great care is placed on this function because it is where the most client-visible errors can occur. Additionally several additional job categories exist as support positions for the data-entry personnel. Positions exist to repair errors made in data-entry and to research and resolve other data-entry related problems. It is obvious that if the organization fails to find, train and retain skilled data-entry employees that the trickle down effects of poor quality data-entry will result in increased costs due to additional time spent in dilemma resolution, delayed processing times, and poor quality patient care.
Identifying and Supporting Data-Entry Personnel:
The identification and support process for the Data-Entry personnel is relatively rigorous. While all members of the Laboratory Control Department are required to be fully trained at this task only a select few are assigned the task as their primary duty. Initial identification of these individuals occurs at the time of the employee’s interview. Those with prior experience in the role are highly sought after and are moved to the front of other candidates. For those who have not held the position prior, any experience at other data-entry positions often provides insight to their potential. Furthermore, an honest and open discussion about the role and its demands takes place where the fact that failure to meet expectations within ninety days can lead to forfeiture of their position. Further identification comes after the individual is hired and they take part in the training program. During the various stages of the program and individuals strengths and weaknesses are monitored and quickly identified by supervisory staff. Once identified and all quality, technical, and productivity standards are met, the individual is then moved into a role best safe to their strengths. Those with the greatest skills are often placed primarily into data-entry roles. Once there these individuals devour relatively low direct exposure to employees outside of the department and utilize Leads and Supervisors as intermediaries between themselves and other inquisitive laboratory personnel. Additional support is provided in the form of both individual and group-specific meetings as well as on-going group specific training. In all of these cases the attempt to provide for and build a sense of belonging, achievement, and affiliation has been a fundamental focus. Furthermore performance recognition is provided each day in the identification of, and recognition of the group’s highest performer from the prior day. The utilization of goal-setting helps provide a focus and drive for employees and the subsequent recognition of those who surpass the goals utilizes aspects of the reinforcement theory. While seemingly minor, such recognition and overall attention has lead to the development of a highly dedicated and skilled group of individuals. Unfortunately, the industry average pay-range for these individuals is in the $11-$13 per hour range. As a result, the ability to obtain talent is increasingly difficult; and to withhold trained talent is extremely challenging. Due to these issues it has become the function of management to please these individuals, to provide support, recognition, job flexibility, some scheduling flexibility, and many “atta-boys” as well as to utilize whatever strategy possible to ensure their retention and continued success.
Training, Growth and Initiatives:
Training of the data-entry personnel is comprehensive, firm, detailed, and otherwise intensive. While a critical amount of time is spent in initial training and follow-up education, perhaps the greatest gains are made from the continuing education of their immediate supervisor. These individuals, the data-entry professionals, are expected to perform their jobs in a precise, productive manor. As a result, when they need a inquire answered, or need some other form of assistance from a supervisor, they demand the supervisor to respond in a way that is correct and does not impede their progress. Portion of the organizational culture of this department is that the employees are empowered to demand certain levels of performance from their immediate line supervisors almost to the same degree that the line supervisors can seek information from performance from them. The result promotes a sense of equality among individuals and further promotes mutual respect and achievement. Ultimately these factors combine to promote a sense of cohesiveness within the group. As suggested by Robbins, “Studies consistently show that the relationship of cohesiveness and productivity depends on the performance-related norms established by the group.” 2 However, failure at the supervisory levels to provide for such activities has lead to significant problems. It is at the immediate supervisory level that tall challenges have occurred in the last two departments that I have managed. In some cases, the supervisors felt that they were too busy to acknowledge all of the questions posed, or perhaps that a better approach to take would be to handle the problem themselves rather than train the employee how to work through the situation and be able to handle it on their own in the future. Furthermore, several supervisors have felt that they must spend the majority of their time in production rather than in the supervisory role in order to meet the appropriate deadlines. These approaches have posed to be unfortunate in that they hinder overall department progress. In the case of the supervisor that handles a problem themselves rather than train the employee how to handle it they inadvertently not only gain a area where they will have more work in the future handling this type of pickle time and time again, but they fail to empower the employee to handle this problem; thus possibly initiating a demoralizing situation. In the case of the supervisor who feels they must work in production rather than supervise they too inadvertently cause issues in that first, the employees accomplish resent because they gain the perception that they are not able to handle the task without encourage and second, if the supervisor is spending significant time in production activities how are they able to ensure that workflow is inspiring smoothly and that all questions and issues are getting addressed accordingly. In either example employee or group performance is actually hindered both in the short and long term outlooks. An additional boom to the latter pickle is that because the items of workflow and problem resolution are not getting addressed in the real-time environment additional time must be spent at a latter time to resolve issues and problems; most often after deceptive information has been reported to the client. In order to deal with this problem a supervisory training program must be developed that formally advises and instructs line supervisors how to appropriately handle their shift, and how to manage their time in order to provide the greatest amount of support possible to the most crucial positions within the department.
Growth:
Growth for the data-entry personnel is unfortunately very slight. All employees in the department, with the exception of supervisors, utilize the same pay-grade and title designation. This is a direct result of the overall organizations view that the staff of Laboratory Control Department is easily replaceable. While this may be the external view of the employees, the internal view is significantly different. Admittedly it is true that it is easy to hire an individual to take a position in the department, it is not easy to hire and retain an individual that is truly talented. It is after all the talented individuals that provide a strategic advantage in the department. In order to help hold talent it became necessary to provide some form of personal and job growth within the department. The utilization of cross-training and flexibility in assigning work offered a means to accomplish this desire. This offered multiple benefits to the organization. One is that employees do not feel “burned-out” at their primary task. Another is that employee flexibility is a key to efficient employee utilization, as such it benefited this operation.3 In order to provide cross-training and flexibility individuals were offered two options. First, the option to rotate to other laboratories in the organization (such as the emergency room / critical and trauma laboratory or Hematology- Oncology laboratory) is offered in order to benefit break up the monotony of routine work and provide for a more “exciting” work environment. Second, the offering of on-sight training programs such as billing and medical terminology courses were extended into the Laboratory Control Department. While minor, those employees who have participated in either of the programs has admitted that they enjoy the opportunity to work in various environments and that they liked the courses because they have the potential to help them achieve a higher level position in the organization. Although these programs exist, they do little to help retain talent. In fact, one of the programs helps talent find positions outside of the department. In order to help rectify this situation it would benefit the organization and its overall strategy that the employee job level or job categorizations get re-worked. Rather than have all employees listed at the same grade level, it is preferential that job grades, or steps be developed that distinguish and recognize individual accomplishment, achievement, and growth within the department.
Initiatives:
At current there are no initiatives designated that offer rewards or other tangible recognition for employees to perform at rates other than those designated as the minimum. While financial gains are not absolute solutions to improvements in employee performance or job satisfaction, they are advantages to offer, especially when employee salaries are at lower pay levels. Furthermore, in an industry that can easily lose talent due to the difference of a $1 per hour increase, the utilization of a rewards system could be of big benefit to employee retention. By breaking from a low-paying traditional compensation reach and offering some form of skill based or variable compensation package the organization would not only be adept at retaining talent, but would reduce overall expenders normally lost due to the expense of training i.e., increased production time and additional error resolution time gained as normally associated with the training and inadequacies of new employees. As suggested by Greer, “Successful job performance should then lead to feelings of accomplishment, increased pay, promotions, and other rewards – all desirable outcomes – which lead to satisfaction with the job.”4 A program as simple as a five percent bonus paid out quarterly for employees averaging 115% of productivity standards and 98% of quality markers would in all actuality not only help to retain talent, but would provide performance recognition within the group and aid to set organizational funds as a whole due to increased performance and error reduction (which are both visible to the clients).
Further initiatives to increase productivity and reduce errors within the data-entry group should be focused on the Laboratory Information System (LIMS) that is used for all data-entry and research. The current LIMS systems is approximately fifteen years ragged and consists of many poorly written software patches and many subsystems that are not user-friendly. If efforts were build into reworking some simple aspects of the system, individual productivity could perhaps increase another 5% simply as a direct result of decreasing awkward data-entry formats. In addition the increased use of electronic requisition ordering will also work to increase the hasten at which specimens are handled throughout the process. In all, through some fairly simple re-working of systems on behalf of the information technology group, the data-entry department could succor to provide the laboratory with a decrease in processing time’s thus promoting quicker turn-around-times and reporting of laboratory orders to the clients.
Maintenance:
The need to bear this strategic group does not exist simply in the current real-time. Rather a constant view on the future must always remain open. While current operations are extremely competent, the loss of just one very talented individual can lead to significant operational and quality problems from within the department. In order to help better prepare for the loss of one or more employee from this group, there are several programs currently in place. First the utilization of back-up employees to fill the voids is always an option. While those employees used as back-ups are rarely as skilled at the task as the original staff, they are generally knowledgeable about the task at hand. Unfortunately, they are back-ups rather than full-time members of this group for one reason or the other; and it is usually due to their inability to meet productivity standards. As a result, when the back-up staff is utilized the need to use two in order to replace one original team member is often a reality. To add to the problems, this takes two employees away from other duties and thus delays the entire process; all the while creating an issue that is visible to the clients in the form of delayed results. In order to help offset this ongoing problem, the hospital has aligned itself with an organization that trains unemployed individuals looking for work in the regions medical community. While this program is currently in the orientation phases and is just starting the candidate selection process, it has the potential to serve the Laboratory Control Department at this hospital as well as the other regional facilities extraordinarily well.
Summary:
The challenges to the current medical community are wide-ranging and numerous. In my analysis, I have identified many shortcomings in the operational, staffing, and procedural formats. By utilizing a strategic approach many of the shortcomings can been alleviated or otherwise made negligible. To further the abilities of the department I have identified the most important strategic process in the group and have focused additional attention and resources to this group. From identifying key employee traits and characteristics for utilization in the employee selection process for the position, to publicly recognizing the performance of top achievers, I have worked to develop this group and staff it with my most qualified employees. Additionally, by worked to develop an additional training program to help identify potential candidates for this group prior to hire I am working to help provide long-term operational stability to the department. Furthermore the possibility of offering some form of financial bonus plan and the possibility of position grades are topics that are starting to be recognized by higher level management. By providing recognition and support to this critical group the organization is receiving faster result turn-around times and a reduction in per item processing costs. As a result, clients are satisfied and costs are reduced. Ultimately, the ability to achieve greater profits from this aspect of the organization is realized. In all, the ability to recognize, utilize, promote and support this highly needed talent has made great strides over the past several years, and should continue to do so in years to follow.
Endnotes:
1.
Kaplan, Robert S; Norton, David P “How Strategy Maps Frame an Organization’s Objectives”
Financial Executive; Mar/Apr 2004; 20,2; ABI/INFORM Research pg. 40
2.
Robbins, Stephen P. “Foundations Group Behavior,” Strategic Human Resources Management, (2001): 218.
3.
Greer, Charles R. “Workforce Utilization and Employment Practices,” Strategic Human Resources Management, (2001): 179
4.
Greer, Charles S. “Foundations of Individual Behavior,” Strategic Human Resources Management, (2001): 176.
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