Edited by Christopher S. Frings PhD, CSP
Meet Larry Crolla
This is the third of five updates to help you get to know the people who write this column each month. This month we will feature the MLO Management Q&A panelist Dr. Larry
Lawrence J. Crolla, Ph.D., is a laboratory consultant for hospitals across the country and is managing director of World-Wide Healthcare Consulting Ltd. He received his B.A. from St. Marys College, Winona, MN and his M.S. and Ph.D. from Loyola University, Chicago. He is a board certified clinical chemist and a diplomate of the American Board of Clinical Chemistry. His experience includes consulting on clinical chemistry diagnostic procedures for a major reference laboratory. He has been an adjunct assistant professor since 1973 in the department of pathology at Loyola University Medical Center, Maywood, IL. Dr. Crolla is co-author of The CLIA 88 Implementation Guidelines, a manual of explanation and forms to aid laboratories in obtaining CLIA compliance. He has also co-developed
Proformit, a capital budgeting software program, and SUMIT, a cost accounting software program for micro-costing laboratory and healthcare procedures. He consults for major laboratory testing and equipment manufacturers both here and abroad and has input in the development of cutting-edge diagnostic procedures. Dr. Crolla has been a contributing author to recent textbooks published on laboratory management and clinical chemistry. He is a regular presenter of educational and technical seminars for the continuing education of
laboratorians. Topics that he covers include finance, negotiation, project and laboratory management, and compliance with regulatory agencies. He has received the American Association of Clinical Chemistry Outstanding Speaker Award seven times. Dr. Crolla has more than 25 years experience as a consultant, speaker and educator in the laboratory diagnostic testing and healthcare fields.
Dr. Crolla can be reached by e-mail at [email protected].
Scheduling rotation assignments
Q: Our lab has tried daily work assignments made by management, assignments made by technologists on a rotating basis, and a combination of both. All seem to bring complaints that certain people get favored assignments and the same people are pulled to cover for sick co-workers, etc. Does the panel have any suggestions for fair rotation assignments that will decrease the complaints?
A: According to Alton Sturtevant, I have never been involved with a lab that did not have complaints about scheduling. We attempt to allow as much input into scheduling as possible, but in the end the manager or supervisor must determine what will work best for all concerned. In our laboratory, each department devises the best method of scheduling with either regular eight-hour shifts or some other variation such as four 10-hour days or seven-on-seven-off (7/7) which, in our case, is comprised of seven 10-hour days and then seven days off. We typically use the 7/7 concept to cover weekends and other undesirable times. We also have used contract labor to cover the undesirable times successfully.
Terry Jo Gile adds, Involving techs in the scheduling process is a good way to go. Rotate the assignments around. Often someone will do a great job that pleases most everyone. Make it a special project for that individual with supervisor approval, of course. Use written policies for vacation requests, weekend rotation, off shift/call rotation, and holiday schedules so that employees will know ahead of time what the rules are.
Marti Bailey advises, The first task is for you and your staff to decide the best division of the workload. Standard work assignments need to be developed, and these should be based on average staffing per day. Take your workload and divide it into work units that make sense. Your staff will be the best resource in determining how the work should be divided and packaged. Identify all tasks that need to be done as completely as possible so that they can be included in the workload division. The work units dont necessarily need to be designed for handling by a single technologist. In some cases, it might make more sense to design a larger work unit that will be handled by two technologists. Once this is completed, youll have developed what Ill term your workstation assignments. On a typical day, one or more technologists will be assigned to each workstation. But these assignments should equal your average staff per day.
Ms. Bailey adds, The next task is to determine who is trained to do the various workstations. I hope that every technologist is currently trained to handle all of the workstations youve identified. If not, you need to seriously consider whether you need to expand your pool of people who are trained for the various workstations. Having a small pool of people to choose from to handle particular tasks can seriously hamper efforts to keep staffing assignments even.
She continues, Once you have your standard work assignments identified and have clarified who is trained to do which assignments, rotating your staff through these assignments should be routine. It doesnt matter who does the scheduling as long as staffing is rotated evenly through all workstations. You also need to have a standard procedure for coverage when you have an unexpected staffing vacancy. This means that you should identify beforehand what the assignment changes will be if there is a sick call-off. It will be far more palatable if you have a procedure for coverage in writing and base it strictly on workstation reassignments. If the tech who was supposed to cover workstation X calls in sick, your plan might be that workstation X be merged with workstation Y. Or the plan might be for workstation Y to be merged with workstation Z, so that whoever is assigned to workstation Y can take over X.
Ms. Bailey says, Doing it this way will keep the work rearrangement at the workstation level rather than on a personal level. Since workstations are being rotated evenly, reassignments are as likely to happen to one person as another. Last, retain paper copies of work assignments as a permanent record. It might be good to distribute copies of schedules to each staff member and urge them to let you know if they think the system isnt working as intended. You also need to maintain a record of staffing changes that neednt be distributed, but should be available to anyone who wants to see it.
Bottom line. There will always be some complaints from time to time about scheduling. To minimize complaints and increase consistency in scheduling, have a written plan for scheduling and how vacations and sick leave will be covered. Make certain that cross training is adequate. Get input from everyone to come up with the best approach for the entire team. If someone complains about the schedule, ask them to make a suggestion in writing.
Team spirit between shifts
Q: We had an employee satisfaction survey that showed that the techs were not satisfied with teamwork spirit between the shifts. I have been assigned as a head coordinator for a lab committee to get a group of techs from each shift to participate in a committee to help us identify the problems that cause the lack of teamwork and how to solve the issue. Do you have any suggestions about how I can manage this group and help solve this issue?
A: According to Marti Bailey, Your work group can be successful only if they are willing and able to step back from their own personal preferences and shift members wants and needs, and focus instead on the welfare of not only the entire laboratory (all shifts), but of your patients and your hospital as well. This is a big order for a group of people who probably have fallen into a we vs. them mentality (we being their own shift and them being the other shifts). I think your best chance of success lies in devoting your first meeting to helping the group understand your expectations of them and giving them the opportunity to commit to not only the goal, but the road in between.
She continues, Staff members obviously are in favor of the goal to increase team spirit among shifts, but are they willing to subordinate their own shifts personal interests for the good of the lab? Once this general concept is understood and agreed to, its a good idea to bring forward some work rules for the group. Understanding the ethics of being a good committee member can be an invaluable learning experience that can be carried over to other committees or work groups that your group might participate on in the future. Some suggested work rules might be:
- Discussions should be open and frank.
- All opinions are important, should be voiced, and will be evaluated by the group.
- Challenge concepts, not people.
- Honest, good-natured disagreement is expected, accepted, and encouraged.
- All sensitive discussions should be held in confidence among members.
- Changes will be made by consensus, not by voting.
- Bring all issues to the table; no sidebars.
Ms. Bailey makes the following recommendations, I believe there are two keys to good teamwork across shifts. The first is excellent communication. If your lab is a 24-hour operation, the quality of the laboratorys service should be unchanged over that period. Changes in shift should be transparent to your customers who are both your patients and the physicians and nurses who interact with the lab on the patients behalf. Excellent intershift communication is a tool for keeping shift changes seamless. One way to achieve this goal is to use the nursing staffs report as a model. Each shift must provide a written record for the next shift to include special problems encountered or anticipated, messages, and customer service incidents.
Alton Sturtevant advises, Provide the committee with the results of the survey and ask them to provide suggestions as to how to handle the problem. I expect that the issues relate to the following areas of concern: poor communication, concerns of work being left for the next shift, concerns of not taking care of the instruments well, issues relating to improper paperwork, problems with cleanliness of area, and not storing the reagents properly. If the group does not respond with concrete solutions, then challenge them to interact with a different shift than the one that they work on to find solutions. Once solutions are suggested, try them for a specified time to determine the effectiveness of the plan. Also, conduct follow-up surveys that relate to the new solutions in an attempt to determine how things have changed.
Larry Crolla recommends, At a combined meeting, ask the groups to list their problems. During the listing of problems, no comments can be made. Then as a group, start solving the problems. The listing session should be led by someone who is not a laboratorian (for example, someone from human resources). If it is not really a problem between the shifts, but rather that some shifts feel they are ignored, have the group work on the solving this problem by making sure there is some shift interaction. An example could be to have continuing education meetings together toward the end of one shift and the beginning of another.
Terry Jo Gile adds, The first barrier will be finding a time when representatives from all three shifts can meet. For the meeting to be meaningful, you will have to meet two times once at change of shift between days and evenings and once between nights and days, at the very least. Team building is helped with an intershift log, in which problems and events are communicated in writing and each employee must read the log and sign off. Also having a half-hour crossover between shifts allows information to be shared. Often, the night shift feels slighted. Having supervisors from days come in early to be involved in social events as well as work events helps the night shift morale.
She continues, A second key to good teamwork across shifts is that there be a universal expectation that people of all shifts are co-workers and must be treated equally, and that everyone be supportive and respectful of their coworkers on all shifts. Supervisors are integral to establishing such an environment, because it must filter down from the top. A good way to help achieve this is for supervisors to stagger their work schedules on a regular basis so that they can be on-site for a part of all shifts. This provides the best opportunity for supervisors to compare working conditions across shifts and to work together to eliminate any real discrepancies which allow the we vs. them mentality to perpetuate.
Bottom line. Emphasize to the committee that all of us must be willing to change our own shift interests for the good of the entire laboratory. Set up work rules as suggested by Marti Bailey. Keep the communication open. Monitor the success of the committees ideas after implementation by 1) surveys, and 2) asking people how the team spirit is between shifts. Make changes as necessary to keep the between-shift problems at a minimum.
When to purchase a service contract
Q: When is a service contract justified? With money tight, we are being asked to make certain that all expenditures are necessary. I have been asked to cut back on service contracts for instruments unless it is essential. How do you determine if it is essential or not? Any ways to help make this decision will be appreciated.
A: According to Alton Sturtevant, Any instruments that perform tests that are offered on a stat. basis would have to be on the list. I would involve the medical director in adding any additional equipment. In addition, a good approach would be to determine if there are any other local labs that could/would perform tests when your equipment is out of order in a turnaround time that would be acceptable to your clients. Pair with another local lab to allow each of you to back up the other when your instruments are not functional. In this manner, each of you could purchase a less expensive service contract and both have the potential for saving money.
Dr. Sturtevant advises, Another approach would be to review past history of down time and determine that you do not need to carry a full-service contract, or maybe no service contract on the more reliable instruments if they are not needed for stat. testing. An approach that I favor is to take a less extensive contract to cover a limited number of preventative maintenance visits and parts. This is also a roll of the dice. It will protect you on expensive parts, but you could be liable for the labor and travel expenses. Any approach will certainly be tested, for it is extremely rare not to need service periodically on an instrument.
Terry Jo Gile adds, It depends on the level of service you require. Do you need immediate 24/7 service, or do you have backup instrumentation that can be used until a service rep arrives? Do you have an in-house biomedical engineering department capable of servicing the equipment, or do you have to rely on the manufacturer? Review past history on the instrument to determine the type of service calls you have requested and the times you were down. Older instruments often require more service.
Larry Crolla responds, Look at a past history of service calls and also the age of the equipment. Use this data to help justify your decisions. Remember insurance is always a gamble. Some people win, and some people lose. If your gear breaks a lot, you win but is this really a win?
According to Marti Bailey, This is where it pays to have good records. If you do not have a written record of instrument problems and each service call requested by instrument, then your impression of whether a service contract is needed or not will be less than factual. If this documentation is lacking, I highly recommend that you get a system set up and running. I have found that service contracts are less likely to be cost effective for general lab equipment such as refrigerators and centrifuges. Microscopes are an exception to this rule of thumb. Annual or biannual microscope service by a professional is well worth the money, in my opinion. If your institution has a biomedical repair department, check with them regarding their services. The folks who staff these departments can often provide service on general equipment. It often pays to have service contracts on specialized laboratory analyzers, but the real litmus test is to compare what it would have cost for your past years service with and without a service contract. To do this, you need a record of your service calls and what repairs were performed. If you dont have this on hand, perhaps your vendor could provide you with the information. Unless your instrument has relatively few problems, a service contract may very well pay for itself and then some.
Ms. Bailey recommends, Look very carefully at the various service contract options offered. Realizing that a request for service made in the afternoon may very well not result in a service representative arriving onsite until the following day, a business hours contract may meet your needs. Your hours of operation and whether or not you have a backup instrument available are key factors in making this decision. Since its the top of the line, youre paying a pretty penny for a full service contract. Before you buy another one, make certain that one of the less expensive service contracts wont meet your needs.
Bottom line. Consider a service contract for those instruments that provide critical testing without a backup instrument. Compare what your costs from last year would have been with and without a service contract. Make your decision on an instrument-by-instrument basis.
Decision making at the highest company level
Q: How is it possible in a hierarchical organization, (specifically a diagnostics manufacturing company), with multiple management levels, to optimally influence top management to understand a process/project and reach a decision relatively quickly (within weeks, not months)? By top management, I am referring to the absolute top decision makers in the company, and not to the management level just above ones own organization.
A: Alton Sturtevant reminds us, Most organizations that do not have top management interacting in the field tend to be slower than is desired in making decisions. The only solution to this issue is to find a way to have the decision maker or someone that can influence the decision makers to see the issue firsthand. Find a way to get this person into a position to understand the issue and take action.
Terry Jo Gile adds, The corporate climate will dictate whether you can talk to anyone within the company or must follow protocol and go up the chain of command. In larger companies with multiple divisions, it is often more difficult to go outside the chain. Talk to your immediate supervisor and see how it is done where you work.
Larry Crolla advises, There is an old saying, Its hard to make an elephant dance. It is the nature of the beast. You can educate the top levels of an organization on process, but you never know what their marching orders are from the board of directors. Also, you may not know what other projects or events are weighing into their decision process hence, slow decisions.
According to Marti Bailey, Your problem can best be addressed by identifying the prime stakeholders for each decision that needs to be made. People need to join forces to move projects through to final decision. Most issues/problems/projects flounder unless one or more people actively keep it on the front burner. If there is not at least one person championing a particular issue, its likely it wont go anywhere.
Ms. Bailey adds, I would suggest that you talk to your boss about this and try to figure out a strategy. Perhaps your boss can talk to other managers at his or her level to find out if they are all experiencing the same difficulty, or if some may have already figured out a way to get things on the fast track. There certainly are some decisions that cant and shouldnt be made quickly; however, months to make a decision should not be the standard. One problem may be that you and those above you do not agree on the issue in the first place. Since your organization is so hierarchical, you need to get the full support of each layer above you. If you and your boss believe strongly in a project and want to get it approved, but the person your boss reports to is not aligned with you and your boss, Im sure this will affect both the speed of the decision and the outcome itself. It sounds like you all need to do a better job of selling what you believe in.
Bottom line. What may be an A priority for you may be a C priority for one of the companys top managers who is more involved than you are in the total company. Work on ways to sell your ideas and present these ideas to your boss for feedback. Find a way to get this person to understand the issue and take action.
Christopher S. Frings is an internationally known consultant and speaker on the topics of leadership, managing change, time management, reaching goals, and stress management. His consulting firm, Chris Frings & Associates, is in Birmingham, AL.
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