Automation, the workforce, and the future of the laboratory

July 1, 2011


ur core laboratory at the University of Iowa Hospitals and Clinics performs 3.2 million tests/annually, serves a 735-bed hospital with a level 1 trauma center and specialty clinics. Recruiting and retaining highly skilled and motivated staff to provide exceptional service is an increasing challenge because of the national shortage of laboratory professionals.

Data on laboratory vacancies reported by the American Society for Clinical Pathology (ASCP) show the progression from concern to crisis. In 2002, vacancy rates for staff-level medical technologists ranged from 6.0% to 10.2%. By 2009, nearly half (43%) of laboratories reported hiring challenges. Vacancies are highest for blood banking (11.6%), chemistry (8.6%), hematology (7.0%), and microbiology (6.8%), according to the most recent survey published in the April 2011 issue of LabMedicine and available at

Many of the nation's college programs for laboratory professionals have closed, producing fewer graduates. The U.S. Department of Health and Human Services reports that by 2012 roughly 138,000 laboratory professionals will be needed; fewer than 50,000 will be trained.

Managing the workforce shortage

As a clinical pathology laboratory manager, my responsibility is to procure resources: people, equipment, and inventory. Is automation the solution to the workforce shortage? I believe that automation is not the solution but, rather, one important component of a strategy that includes everything from streamlining processes to employee satisfaction programs.

Streamlining through LEAN

Prior to implementing a pre-analytic instrument, the core laboratory incorporated the elements of LEAN production into the manual processes. LEAN is based on principles, practices, and tools that focus on eliminating waste and maximizing value defined by the customer. The redesign resulted in fewer steps and incorporated one-piece flow to move samples through the accessioning, centrifugation, and aliquoting processes. Median pre-analytic processing time was reduced from 29 minutes to 19 minutes.

The automation journey

Improvements to the pre-analytical process were adopted and sustained, creating a ready environment for launching our automation journey. The launch involved installing a pre-analytical instrument which integrated the sample preparation and testing into what our employees call the “sample superhighway.” The implementation team created new process maps, conducted observations looking for opportunities for improvement (OFI), and analyzed test turnaround times (TAT). This team monitored key indicators and made improvements to workflows. The laboratory experienced decreases in TAT, with select chemistry tests decreasing from 40 minutes to 30 minutes and other assays decreasing from 50 minutes to 40 minutes. TAT is tracked and recorded every two hours with failures investigated. The team relentlessly looks for OFI. TATs are discussed at hand-off between shifts, and graphs of daily, weekly, and monthly TATs are posted for all to see.

Applying principles of LEAN production before and after implementing automation generated excellent outcomes. Greater gains were realized by implementing middleware, software that augments the functionality of the laboratory information system, or LIS, by creating an environment where calculations and decision-making rules are applied. Middleware increased autoverification from 45% to 98% for chemistry tests and from 45% to 85% for automated complete blood counts, or CBCs. These strategies allowed us to produce reliable, consistent times for reporting results.

While improving service, we also manage volume increases with fewer hours worked. Our laboratory volume has increased by 20%, worked hours have decreased by 9%, and our productivity (billable tests/hours worked) increased by 32%.

Attracting and retaining the best

We cannot continue this success, however, without skilled, dedicated professionals. The shrinking applicant pool means that certified laboratory professionals can be more selective. We developed strategies to increase our applicant pool and become the employer of choice. We were dismayed when our medical laboratory science (MLS) training program became a victim of budget cuts, but the laboratory rebounded by becoming a clinical site, providing us with a well-trained applicant pool of 10 to15 MLS graduates each year.

The team approach

Employers recognize that engaged employees give companies a competitive edge, and hospitals and laboratories are conducting engagement surveys to measure employee commitment. We are using this information to develop initiatives to become the “employer of choice.”

Focus groups were convened on topics staff determined to be areas for improvement. The open and sincere discussions helped us to move toward a collaborative environment, creating teams for scheduling, reward and recognition, hiring and selection, new employee training and mentoring, and quality assurance.

Teams comprise staff and a member of management who functions as a resource. For example, the focus group on scheduling identified employees' desire to improve scheduling practices to address work-life balance. A team was organized with representatives from all three shifts, a member of management, and an expert in collective bargaining to work toward solutions. Our interview and hiring team developed a two-part interview using structured behavioral questions and a practical examination for staff who perform testing and interpretation. The team's mission statement says it best: “Hire for attitude, train for skills.” Our successes were recognized with the Improving Our Workplace Award, or IOWA!

Transforming the future together

These improvements are a tribute to the collaboration of staff and management. Everyone has a voice in creating a vision, developing strategies, and taking action. Our people transformed our laboratory, driving excellence into all aspects of the operation as we harness the power of automation.

M. Sue Zaleski, SCT(ASCP)HT, is the clinical pathology laboratory manager of the core laboratory at the University of Iowa Hospitals and Clinics, Iowa City, IA.