Addressing management issues

July 1, 2010

Hours of operation. In general, 24/7 laboratories will appear to be more productive; however, lower test volumes on the second and third shifts may contribute to a lower total productivity level

Scope of services. Productivity levels in high-volume routine testing laboratories will be more favorable than a laboratory that performs more manual, esoteric testing. In addition, academic medical-center laboratories' productivity levels are usually less favorable than non-teaching high-volume laboratories.

The bottom line is that you should establish a productivity goal that is right for your laboratory operation. Start by reviewing and understanding the productivity data that administration is asking you achieve. Use that productivity goal as a guideline to set an achievable level for your laboratory based on your operation characteristics. Finally, review your operation and make adjustments for improvement as necessary.

—Judy A. Lien, MS, MT(ASCP) DLM
J.A. Lien and Associates
Eau Claire, WI

Bottom line: There is no magic formula to determine staffing levels. If you can obtain peer benchmarks based on hospital bed size, that is certainly a place to start, but as advised by the experts, there are numerous variables to take into account that reduce the likelihood of an apples-to-apples comparison. Make sure you and your administration are using the same productivity methodology or calculation; otherwise, neither of you will ever come to terms. The use of “billable tests” as data for benchmarking is often the most understandable method for administration.

Evaluating productivity allows you to achieve the five “rights” of optimizing labor: the right number of FTEs with the right skills working the right schedule doing the right processes in the right way.

Feeling understaffed
Q: How can I convince the administration that an increase in staff is justified in the laboratory? I believe that our test numbers and non-patient-related responsibilities justify the hiring of at least one half-time tech. Our techs take call hours and work weekends. Combine that with holidays, vacations, and sick time, and we are at full staff only about 25% of all weekdays throughout the year.

A: Productivity calculations and benchmarks may help. Evaluating productivity allows you to achieve the five “rights” of optimizing labor: the right number of FTEs with the right skills working the right schedule doing the right processes in the right way.

Calculate your productivity ratio. Productivity ratio equals paid hours per year/billable tests per year. Paid hours are used because your staff are paid whether they are productive or not. You need to know how all hours contribute to your lab's productivity. Include testing personnel, management staff (non-pathologist director, managers, and supervisors) and support staff (phlebotomists, clerks, and secretaries) for all shifts. Do not include outreach staff or your pathologist. Count your billable tests by CPT code to standardize your ratio to common benchmarks. Determine your number and see where you fall within current published benchmarks.

If you are within the range, drill down to see why you feel understaffed. Plot overall specimen volume received, specimens received per testing personnel, and specimens drawn by phlebotomists against each hour of the day averaged over a month or more. Do your highs and lows match up? Do you need to alter schedules? Look at your call hours. Is there an alternative to perform the testing needed to free technologists from call hours that take them from a scheduled shift?

Special situations can have an effect on the benchmark. Is point-of-care testing done by the lab? Do you have decentralized lab services (satellite labs) in the hospital? Do you register outpatients in the lab? Each of these can affect productivity.

If you fall beneath the benchmark, you may well be understaffed. Evaluate your current and previous year(s) ratios and compare. Demonstrating to your administration that your productivity has increased over time and relating your data to industry benchmarks allows you to use quantitative data to support your request. Share not only the what (outcome) but also the how (data and calculations) of your evaluation. You may not only get more staff but also earn increased respect for your rational, data-driven approach.

—Martha Casassa, MS, CLD(NCA), MT(ASCP)
Laboratory Director
Braintree Rehabilitation Hospital
Braintree, MA

Bottom line: In the medical laboratory, there is no such thing as “non-patient-related responsibilities.” Everything in the lab somehow relates back to the performance of a provider-ordered test. Follow our expert's advice and make sure you have good data to determine your ratio for benchmark comparison. Consider evaluating your schedule to emphasize adequate coverage during potential bottleneck testing times and reduce overstaffing during slower testing times.