Addressing management issues

April 1, 2009

Edited by C. Anne Pontius, MBA, CMPE,

Preferential treatment

Q We work in a
large lab. Recently, we have had an influx of several new employees.
Those of us employed here for up to 25 years have noticed “preferential
treatment” being meted out to these newcomers. Why they need to take
breaks whenever they feel the urge is beyond those of us who have been
sticklers about taking breaks and lunches at certain times on our
shifts. In fact, we were told by our lab manager that the law “
us to do this. Is this true? If it is, do we remind management to treat
all of us equally? The fluidity of these frequent, unscheduled breaks is
truly interrupting the workflow in the lab. Help!

A Larry Crolla says,
“State laws and union contracts influence breaks; usually there is a
window during which breaks are to be taken. Assuming you have such,
there has to be some flexibility since the whole lab cannot break at the
same time because it is supporting patient care. A possible remedy could
be to bring up the situation at a lab meeting in a general discussion
about maintaining adequate staffing at all times of the day. This way,
no individuals are selected for admonishment; the situation is resolved
by the group. Most labs folks usually check to see that the team as a
whole can handle the load while they take a break since the lab must
remain open.”

According to Alton Sturtevant, “The Department of
Labor stipulates that federal law does not require lunch or coffee breaks;
but when given by the employer, they are typically five to 20 minutes (see
) and count as paid work
Bona fide meal times typically lasting at least 30 minutes or more
are not counted as paid time for the employee. Some state laws may impose
more stringent requirements upon the employer relating to breaks, so it is
important to understand the specific requirements for your area.

“The employer has the right and responsibility to
schedule breaks and lunch periods to accommodate the workload. It is
customary for the personnel manual to address these issues, and it would be
a major oversight if not specifically addressed to provide guidance to
management. Most companies add further guidance as to how many and
general guidelines for scheduling breaks and lunches (i.e., each
employee is permitted two breaks and a lunch four to six hours into the work
period). It is common for the manual to stipulate the length of breaks and
to reiterate whether they are paid or not. There is usually some comment
relating to the fact that lunch and break times may not be saved and used to
leave work early without specific permission (which would be based upon

“Study your personnel manual to ensure you understand
the policy relating to breaks and lunches, and visit Human Resources (HR)
for any clarification. Once you completely understand the company
guidelines, visit with your immediate supervisor to express your concerns,
citing as many specific examples as needed to document the situation. The
supervisor should respond in a manner that will ensure that all employees
are treated fairly and in accordance with policy. If management continues to
ignore the issue, then you may elect to request help from HR or the next
higher manager.”

Marti Bailey concludes, “Since you now have a staff
with different opinions about work breaks, it would be in the best interests
of the group to have an honest discussion. You first need to establish
exactly what your hospital or lab’s policy is regarding breaks. If there is
nothing in writing, it is up to lab management to either spell out a policy
for the staff or to state definitively that there is no policy. If there is
no policy, it would be up to the bench supervisors to decide what is and is
not appropriate. If there is an established policy, there needs to be some
open discussion about what would work best for the group that would still
remain within the guidelines of the policy.

“If this discussion and subsequent changes in how
breaks are handled becomes a win-lose, majority-rules contest, you will
lose. Everyone’s needs and ideas must be considered when devising a
solution. Both sides will need to ‘give’ to come up with a plan that works
best for the group and for business needs.”

Bottom line. Know what your state laws and/or
union contracts specify as paid/unpaid break times. If your lab does not
have a policy specifying how breaks will be handled to cover the workload,
write one with input from relevant employees (ask HR for help, if
necessary). Just because you do not take breaks should not give you reason
to hold it against those who do (if they follow policy). Work on a
scheduling solution that meets your policy and then help enforce it by
reminding people to take their scheduled breaks.

Consequences of the bad economy?

Q We understand it is
difficult to find replacements among the lower numbers of graduates who are
entering the medical lab field. But when employees leave (for whatever
reasons), the workload is being split among us who remain since absent
workers are not being replaced. Our workloads are more taxing now than when
the hospital implemented outreach programs when we had a solid staff. Our
pay does not reflect additional responsibilities. The crowning blow is that
our wages are being frozen because of the “bad economy.” We thought
healthcare was doing fairly well in this recession, but the hospital is
attempting to “get blood” out of its remaining “turnips.” Does a law protect
us? We are exhausted from increasing workloads and disappointed in our
frozen wages.

A Larry Crolla says, “Most
hospitals are not doing well in this financial environment. Most have frozen
capital budgets; many have frozen wages and hiring; some have gone to
shortening hours to avoid layoffs. It is not a good financial situation for
healthcare in general. Because of hiring freezes, it is not as easy to find
new places of employment as it once was. Bring up your concerns at a lab
meeting for the record and also talk to the head pathologist if you believe
there is a quality concern because of staffing levels; no one wants errors
to occur.”

Alton Sturtevant says, “The bad economy seems to
affect us all — including healthcare. We are not exempt as we were during
past smaller recessions. Healthcare does seem to be exempt from the need to
lay off workers, but salary levels and increases are being squeezed. The
belief does seem to be that it is good to have a job, even if we are not
getting raises as we have in the past.

“As staff levels shrink, then we will be asked to do
more with less. A big problem, however, in the lab is that the workload can
only increase to a certain point (i.e., full capacity) before something must
give. Either staff will be asked to work overtime, more testing will be
outsourced to reference laboratories, or turnaround time (TAT) will lengthen
before good patient care and cost effectiveness will be replaced with poor
care and excessive cost.

“As the added cost of overtime, test referral, and
length of stay (LoS) increases, then it will become more cost effective to
hire staff to replace those lost through attrition. The tendency is for new
hires to be paid more than current employees due to salary compression. This
can lead to reduced morale and productivity, and resignations of those
seeking a more pleasant workplace at a more competitive salary. That is not
‘sour grapes’ but a cycle that seems to happen during this turn of events.

“This management nightmare is one I have seen time
after time. The answer is to interrupt the cycle early in the course of
events, but that rarely happens without careful upper management recognition
and intervention. Management walks a narrow path trying to balance the good
of the organization with the needs of individual departments. This situation
requires good communication between the lab and administration.
Communication of lab needs must be concise without showing panic, along with
factual documentation of costs of overtime, test referral, and TAT that
could adversely impact LoS. It is incumbent on the lab team to stay focused
on testing and TAT that most impacts critical care and patient turnover.
Testing that does not acutely effect LoS should be performed on a less
frequent basis or sent to an outside lab.

“Staffing crises are a good time for the lab to look
at test menus, as well as production and staffing schedules for refinement
that will relieve pressure on remaining staff without creating hardships on
patient care. Maintaining good morale during staffing crises is always
difficult. Supervisors should nurture good communication with the staff to
ensure that any suggestions that can
be implemented under the current situation that will benefit personnel
will be implemented as soon as possible. All team members should
be involved as much as possible in developing plans to deal with the current
staffing problem.

“Especially important is for staff to understand
that the salary and hiring freeze is not being directed at just them. In
this regard, inviting hospital administration to a lab meeting for a
‘state of the union’ discussion may be helpful This may allow the
administration to get a good sense of the lab’s needs as well as for the
lab personnel to understand the plans for the future as those develop.

Marti Bailey shares, “I doubt that your hospital
has not been impacted by the global recession. While it is true that
people still need healthcare, fewer of them can pay for it; some who can
put healthcare needs on the back burner to meet more critical basic
needs. Demand for healthcare has dwindled, just as the demand for many
other services and products, so do not allow yourself to be in denial
any longer.

“Your hospital is not the only one not replacing
departing employees. My large university hospital has committed to
eliminating a sizable number of positions within six months by attrition
(meaning no replacements of vacated positions) to stave off a budget
crisis. This means more work for fewer employees, and never have I seen
employees get paid more for working harder. Is it fair? Probably not.
While I am often angry over productivity expectations, my choices are to
stick it out and do the best I can, or to leave and likely become one of
the many thousands of unemployed.

“Understand that your employer is as affected by
the recession as others, and that you are more fortunate than many in
that you still have a job. I bet a lot of people would be more than
willing to be trained to do your job just so they could work. Look at
the big picture here, and put your situation into perspective.”

Bottom line. Even in the best of times, I
know very few lab professionals who feel appropriately compensated for
their hard work. But this is the worst of times, which means being
employed is a fortunate situation; and to stay that way, you have to
step up your abilities and pick up the slack of those that will be the
next victims of personnel cuts. Monitoring quality and staff
satisfaction is extremely important to know where problems exist. Keep
administration and pathologists abreast of situations that pose
liability risks to them. Back up your findings with good solid numbers
to show the consequences of short-staffed scenarios. Participate as part
of the solution, not part of the problem.

Anne Pontius is a senior medical
practice consultant with State Volunteer Mutual Insurance Company in
Brentwood, TN, and president-elect of CLMA 2007-2009. Send questions to
Ms. Pontius at
[email protected]

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