Lab Management

Transitioning medical laboratories demand flexibility

Edited by Carren Bersch

Alton Sturtevant, PhD	Marti K. Bailey, MT(ASCP)	Lawrence J. Crolla, PhD

With the retirement of an estimated 13,000+ medical lab scientists each year for the past nine years, we have witnessed a “brain drain” of sorts in the medical laboratory. The impetus behind automating the lab is partly based on the loss and non-replacement of most of these workers. As in other industries, automation of equipment does not necessarily mean, however, that the quality of “interpretation” of results will be as accurate as in the past. We spoke with MLO’s “Management Q&A” panelists to find out what is happening in the lab right now. The discussion ranges from whom to recruit for today’s lab, to meshing traditional lab workers with tech-savvy new MLTs and MTs, to molding a “brain trust” of older mentoring or part-time techs for training purposes, to competing with industry for new graduates. The panelists also address the advantages of large and small labs, and other benefits that new lab employees might encounter in today’s environment.

Alton B. Sturtevant: Certainly a number of experienced personnel are leaving the field due to retirement, but I do not see it as a doomsday situation. Our concern over the experience of those leaving is an anxiety produced somewhat by the new people coming to us from sources other than the traditional technology-training routes like medical-technology programs. A potential lab tech should have at least an associate degree with a science orientation, although the more college education, the better. Ideally, the person should have completed a formal laboratory-training program, although training by experience in a laboratory setting as a "trainee" would also be acceptable. Those people are usually a step or two ahead of persons not having that training in quality control, writing procedures, and troubleshooting issues. On the other hand, this new breed of techs tends to be savvier with regard to computerization and automation, and can be of great benefit in today’s lab. A person will do well in today’s ever-changing medical laboratory environment if he is adaptable to rapid change, energetic, embraces technology, and has the ability to be a team player. We must create an environment that can blend the new with the long-time techs to make a smooth-running team. Open-minded leadership, competitive salaries, help with day care, good healthcare benefits, time off, limited overtime for those that do not want it, and a focus on teamwork can all work to help us to attract and retain staff.

Larry Crolla: The same type of person we have hired in the past is who we would hire today — MTs who are ASCP-certified and MLTs. Just because we have adopted automation, the job requirements, as far as ability to evaluate the quality of the results, has not changed. We require a minimum of two years of college and MLT training, and most employees would need a bachelor’s degree and MT(ASCP) certification. The way labs are changing, future techs may require some specialty certification such as molecular in addition.

Marti Bailey: Our recruiting efforts focus on MTs, MLTs, or those with a bachelor’s in biology. Recruiting has been difficult with applicants so limited. We do not have the luxury of looking for specific types of workers. Our hiring process has stringent guidelines, which require all qualified applicants to be interviewed and selection to be made based on standardized interviews and carefully documented ratings.

Sturtevant: As a lab manager obtains new employees, he should attempt to find team members who can complement one another: leaders, followers, troubleshooters, procedures writers. We do not always have the luxury of finding personnel who immediately exhibit these traits, so to find and develop these skills is incumbent upon the manager/leader. It can be helpful to assign all technical employees a "piece" of the department soon after their initial employment — specific instrument, quality control, or something else — to encourage responsibility and teamwork, and to determine future leadership roles.

Crolla: Variety is necessary to build a good operation.

Bailey: Diversity of expertise would be great; however, we are in a beggars-can’t-be-choosers situation. Frequently, our advertised positions receive no response the first time around. The candidates are just not out there, so when we do get responses, we generally do not have much of a pool from which to select. Our staffing situation has reached the point in January where we were hiring temps, particularly for our third-shift positions.

Sturtevant: Regarding the "brain trust," in an attempt to retain experienced employees, I try to assign duties based on experience and individual ability to adapt to change, to demonstrate "people skills," to exhibit an ability to train. I also look for their tolerance for Generation-X traits and their work ethic. When I have an experienced tech who just likes to work hard and not get involved with phases of the team effort, I let that person work with fewer opportunities to mentor newer techs.

Crolla: We do the same sort of thing in our laboratories, too.

Bailey: We maintain a group of trainers from our experienced employees. These are folks who are willing and able to train new staff. Not all techs are created equal in this respect.

Sturtevant: Many times the experienced techs find new energy and motivation by teaching and showing the new techs the ropes. These mentors can help mesh the traditional breed with the new techs into a smoothly functioning team. It takes a special group to make this happen, and I feel lucky when this becomes a reality.

Crolla: We are trying to retain older lab pros, even part-time.

Bailey: Unfortunately, our HR policies are restrictive enough that we cannot replace the employee and still keep her on as part-time without having a new, "casual" position approved.

Sturtevant: The lab does seem to lose some employees to industry for a change of pace, financial, travel, or upward-mobility reasons. The industry serves labs, so who better to work with current lab personnel than former lab employees. This migration seems to be inevitable as you find and recruit highly skilled personnel. When one of your team members decides to leave, wish her well and hope that she will be a "recruiter" for your laboratory because of her good experience.

Crolla: We have lost techs over the years to industry, since they usually do not have to work weekends and because industry pays better. No formal plan that I know of exists for retention, outside of making sure salaries are competitive with other hospitals in the area.

Bailey: Our basic mode of advertising is on our hospital website and, occasionally, in local papers. We have a business agreement in place with our local community college to serve as a practical training site for its MLT students. This has provided us with a pool of potential candidates we have the opportunity to observe pre-hire, which has benefitted our recruiting situation. We have found that the perceived prestige of working for our university medical center, along with our hospital’s generous educational benefits, is no longer carrying us. We have lost a good many exceptional candidates due to salary. Candidates are looking for top dollar for their labor. There is virtually no negotiation for our open positions. They are what they are. For instance, we have been turned down for day-shift positions because they include working third-shift weekends. We are in the process of trying to get approval for sign-on bonuses for techs.

Sturtevant: In order to attract and maintain adequate personnel, the salaries, as Larry says, must be competitive. Other attractions such as innovative shift schedules — seven-on/seven-off (i.e., seven 10-hour days on with seven days off) or four 10-hour days — can be beneficial to the lab and enticing to personnel.

Crolla: Our organization does not have any special "perks" yet, and we still advertise in local newspapers as well as on the Web. The only demand job candidates make is for shift availability.

Sturtevant: There are advantages to hiring to both smaller as well as larger laboratories. As a former lab director of 400+ techs, I also know that the larger laboratories have advantages to offer employees: more specialization, more automation, more volume, and more computerization without direct patient or physician contact. There are highly skilled technologists, supervisors, managers, pathologists, and doctoral-level personnel available for interaction and skill development. Personnel with generalized science education can work and learn within these environments in order to expand their marketability for future employment within the field. This is a great attraction for many.

As the current director of five smaller limited-test-menu laboratories located within large multispecialty medical groups, I focus on the benefits of working in a smaller physician-based laboratory: the ability to perform testing in more specialties, such as chemistry, hematology, coagulation, serology, urinalysis, and others; to perform a variety of assays is a plus to many people. Techs in my labs are not required, however, to give up their desire to focus on one specialty, even though they are more generalists. The intensity of the job is present but less so than in a large highly automated lab. These techs also are allowed more physician and patient contact than would be available in many lab environments. As director, I also provide one-on-one training to the supervisors and technologists through discussing procedures and reacting to questions but usually through review of QC and proficiency-testing issues. This is especially important in environments where automated QC and daily review by more highly trained and experienced personnel are lacking. This also can be a benefit to the techs as they are developing in their fields or as more experienced techs are given more depth or new insight into the laboratory science. Do not get me wrong — these techs are highly skilled and experienced, but do not have daily contact with doctoral-level personnel and usually grow through and look forward to the stimulus of this experience.

Crolla: Lab automation works, and we can use other resources to draw blood so the techs do not have to do routine blood draws.

Bailey: We are implementing new front-end automation in order to make ends meet. We seem to have a core of old-timers who are satisfied to stay where they are until they retire. We try to do as much as possible to recognize our employees and provide them with good working conditions; but in the face of having requests to refill vacant positions denied or postponed, along with recruiting difficulties, I would have to say this recruiting situation is as bad as I have seen in my entire 40-year career.