Employee-retention strategies, from boosting morale to promoting CE

July 22, 2020

Today’s lab managers are pursuing a wide range of employee-retention strategies, including initiatives to boost morale and develop careers.

Retaining existing staff members is regarded as less expensive than recruiting new employees. While not focused on laboratory professionals specifically, a widely cited 2004 study found that the average cost for hiring healthcare staff ranged from $276 for administrative assistants to $36,743 for attending physicians.1

Employee retention also promotes stability and is an important aspect of creating a positive work culture. “Focusing on creating, developing and sustaining a highly engaging environment is the best way to ensure appropriate staffing levels and provide a high quality of service and the best patient care,” explained Tajana Turato MS, MLS (ASCP)cm, Laboratory Operations Manager, Clinical Pathology, Department of Pathology and Laboratory Medicine at Lenox Hill Hospital, New York, which was voted Medical Laboratory Observer’s 2020 Lab of the Year.

Overcoming challenges

However, lab managers face daunting obstacles to sustaining adequate staffing levels. As Danielle Stroughton Duncan, Director of Education at COLA noted, “The medical laboratory industry has struggled to produce and maintain trained professionals for several years.”

An aging population is fueling demand for lab tests and, in turn, lab technologists and technicians. The Bureau of Labor Statistics (BLS) predicts that employment for clinical lab technologists and technicians will grow 11 percent, adding 35,100 positions from 2018 to 2028. There were 331,700 positions nationally in 2018.2 The demand is even more robust for phlebotomists. The BLS expects demand for this position to climb 23 percent, adding 29,500 jobs from 2018-2028. There were 128,300 positions in 2018.3

At the same time, current shortages for key personnel exacerbate the situation. Vacancy rates in 2016 varied by department from 4.7 percent in atomic pathology to 10.98 percent for laboratory personnel focused on information systems, quality assurance and performance improvement, according to a survey conducted by the American Society for Clinical Pathology (ASCP). The vacancy rate for the core lab was 7.54 percent, and it was 8.11 percent in phlebotomy, 8.47 percent in hematology, and 5.93 percent in microbiology.4

There are several reasons for the vacancy rates. First, Duncan said that the number of academic programs has declined significantly. According to the ASCP, the number of training programs declined 30 percent from 659 programs in 1992 to 468 in 2002.5

On a positive note, Duncan said, “There has been an increase in the amount of online offerings with a combination of in-person rotations, which is a promising addition to the field of MLT and CLS/MT.”

 “In addition to declining training programs and graduates, the industry is also impacted by an aging workforce. Older laboratory professionals have outpaced younger professionals entering the market. Therefore, the industry experiences higher retirement rates,” Duncan said.

ASCP data highlights this demographic issue. In 2016, the retirement rate was highest (28.3 percent) for LIS/QA/PI and lowest for phlebotomy (10.76 percent).4

Education as retention strategy

Against this backdrop, lab managers have adopted numerous strategies to retain staff.

According to a State of the Industry survey from Medical Laboratory Observer released in April 2020, the most common tactic is supporting continuing education. Nearly two-thirds, or 60 percent, of respondents said they do this, with 39 percent of them rating continuing education with a four or five on an effectiveness scale in which one is the lowest ranking and five is the highest. 6

Lenox Hill Hospital requires most lab employees – including all medical technologists – to earn 12 continuing education credits annually, so the department pays for relevant webinars.

“We use continuing education credit requirements as an opportunity for laboratory staff to create opportunities for engagement. Webinars offer an excellent occasion for the team to learn about relevant topics and discuss its implications in a laboratory group setting,” Turato said.

Outside of webinars, lab managers create other opportunities for education. For example, the department hosts an annual Evening of Cytopathology event. The cytology team “chooses a topic of interest and invites a nationally recognized speaker in the discipline to present a conference to the cytopathology community in the metropolitan area,” Turato said.

Jon Harol, Founder of Lighthouse Lab Services, a management consulting firm that also operates a recruiting service, suggested that labs reimburse employees for the costs associated with sought-after certification programs – such as in blood banking or molecular biology – and then tie that investment to a commitment from the employee to stay at the institution for a specified number of years. “I think that is a great partnership opportunity because it benefits both of them,” he said.

While paying for such a program might seem expensive, it may be cost effective in comparison to the expense of recruiting and potentially relocating a candidate from outside the organization. And lab managers may find themselves paying for a signing bonus as well, he said.

Turato said her lab does not pay for certification programs, but Lenox Hill Hospital’s parent organization, Northwell Health, does offer reimbursement for traditional degree-seeking programs.

Other tactics lab managers use to retain staff include clinical ladders (33 percent), which allow staff to climb steps within a job title, such as from novice to expert, and daily huddles (40 percent), according to the MLO survey.6

Climbing career ladders

Career ladders are popular with staff because they provide employees with opportunities to advance in the profession. “A lot of people have been in the field a long time, and I think they get frustrated when there is one lab manager and two supervisors and everybody else is staff,” Harol said.

“You are not able to create more lab directors, but you are able to create more levels,” he said, such as level one, two and three for medical technologists. Harol suggested that labs create two tracks in the career ladder: one for managerial skills and a second for technical knowledge.

A study involving 23 clinical laboratories, which was conducted by the American College of Pathologists (ACP), suggested that career paths and continuing education were associated with lower turnover rates. The three-year turnover rate for all lab staff was 3.3 percent lower for labs that develop career paths and 3.6 percent lower for labs that provide funding for external continuing education, compared with labs that did not implement these strategies.7

Staff huddles

Staff huddles are another recruitment option. At Lenox Hill Hospital, “our weekly ‘Let’s Connect’ meetings are short, 15-minute departmental huddles, which offer a chance to reignite our passion for laboratory science while learning how to connect with our patients and customers and celebrate team members’ outstanding contribution to these causes,” Turato said.

Giving people an opportunity to lead projects is another way to promote career advancement within the lab, Harol said.

Turato said, “We routinely involve our team members in performance-improvement projects, quality initiatives and workflow design, which ensures that any solutions implemented are built from the ideas and input of the users.”

Harol recounted an anecdote about a lab manager who surveyed the laboratory scientists on her staff to find out what kinds of activities they would like as a reward. What she found is that staff members had different ideas about the type of activities that motivate them. For example, some staff members liked the idea of going out on a sales call to a potential outreach client, while others liked the idea of working on the laboratory information system (LIS).

“I don’t think most managers have gone to that level of understanding, so they end up hurting morale because they are making the person who doesn’t want to go on a sales call go on one, and they are making someone else who doesn’t want to work on the LIS system be part of that. If they align people and what motivates them with the task that needs to be done, everybody would be happy. That is a realistic solution,” Harol said.

Managers at the Minnesota Public Health Lab also work to develop career opportunities for staff members, according to an article in a 2019 issue of Public Health Reports. The public health lab encourages staff to create an individualized career development plan, which allows “staff members to maximize job duties that play to their strengths, prioritize learning objectives, and identify leadership opportunities,” the authors wrote.8

In a 2018 survey of 122 employees, the Minnesota Department of Health found that career-growth assignments, such as short-term projects or mentoring opportunities, impacted job satisfaction in a positive way.8

Continuing education, staff huddles, and career-advancement strategies also help nurture a positive culture within the lab, making it a more appealing place to work. “I don’t find medical lab scientists to be super money-motivated. If we call a scientist and are able to offer $1 or $2 more an hour to go to the lab across the street and they are happy where they are, they are not going to move for that,” Harol said.

Harol said negative cultures fester when managers favor certain employees over others, such as when developing shifts and schedules and sharing important information. Instead, Harol urged managers to treat everyone fairly and communicate openly.


  1. Waldman J, Kelly F, Arora S, Smith H. The shocking cost of turnover in health care. Health Care Manage Rev. 2004; 29(1): 2-7.
  2. BLS.gov. (2019). Medical and Clinical Laboratory Technologists and Technicians: Occupational Outlook Handbook: U.S. Bureau of Labor Statistics https://www.bls.gov/ooh/healthcare/clinical-laboratory-technologists-and-technicians.htm Accessed 29 June 2020
  3. BLS.gov. (2019). Phlebotomists: Occupational Outlook Handbook: U.S. Bureau of Labor Statistics https://www.bls.gov/ooh/healthcare/phlebotomists.htm Accessed 29 June 2020
  4. Caldwell B. American Society for Clinical Pathology. Laboratory workforce report. https://www.ascls.org/images/Government_AffairsGAC/Symposium/Caldwell_ASCPStudies_2019.pdf Accessed 30 June 2020.
  5. The American Society for Clinical Pathology. The medical laboratory personnel shortage. https://www.ascp.org/content/docs/default-source/policy-statements/ascp-pdft-pp-med-lab-personnel-short.pdf?sfvrsn=2. Accessed 30 June 2020.
  6. Wilson L. Many ways to recruit and retain lab staff. Medical Laboratory Observer. 54(4): 29.
  7. Novis D, Nelson S, Blond B, Guidi A, Talbert M, Mix P, Perrotta P. Laboratory staff turnover: a College of American Pathologists q-probes study of 23 clinical laboratories. Arch Pathol Lab Med.2020; 144 (3): 350-355.
  8. Strain A, Sullivan M. Strengthening laboratory partnerships, enhancing recruitment, and improving retention through training and outreach activities: the Minnesota Experience. Public Health Reports. 2019; 134 (Supp 2): 11S-15S.