My hospital administration tells us that we are adequately staffed according to our test volume.  We are working our tails off and just don't understand the logic.  The administration can't (or won't) show us this "standard" they are using to calculate our staffing level.  What is the "standard"?  Where does it come from and who devised it?  Any response is welcome.  Thanks.

   We are dealing with the same thing at our hospital and my observation is that so are many others. At my organization they want to have a certain staff to patient ratio within the hospital called the FTE/AOB which stands for Full Time Equivalent to Adjusted Occupied Bed. Presently the organization is striving for a 5.0 simply meaning there are 5 full time employees for every "adjusted" occupied bed. That is how the number is determined but of course administrators can lower the number to be more lean as they see fit based on financial needs. This number applies to the entire spectrum of employees from direct care givers (nurses, PCT's) all the way to those who never see or touch a patient (loading dock staff, carpenters, etc.). The lab fits into this number within our organization but like you we are not sure exactly what weight we carry.

Different departments within the lab suffer more than others with a "blanket" approach like this. Labor intensive areas like microbiology often feel the most heat because administrators consult the bean counters to determine staffing. They see chemistry putting out thousands of tests with few staff while micro sends out a fraction of the number of "tests" but needs twice the people to do it. The contrast between hematology and blood bank is somewhat similar. Hundreds of CBC's and Protimes can be sent out by a couple of staff members while it takes the same numbers of staff to type and cross 20 units of blood and issue as many products and this only counts for maybe "50 tests". Our lab manager uses what we call a "roll up" which is simply an average of all the departments combined. That is usually presented to administration as a measure of productivity, be it fair or not.

If you are the lab manager you have to be an advocate for your staff and work the numbers to fill your needs. How you do that is up to you but that is certainly a requirement to being a good lab manager in the hospital of today. Things are getting tougher and more and more is being expected of us. You are not alone. I feel your pain and frustration because we also really want to know how "the numbers" are derived. Recently we were told we had to cut 4 FTE's within the lab. Our manager inquired where this number, i.e. 4 bodies, came from? No answer was ever given. So, as in your situation, the numbers seem arbitrary and we have no knowledge of the origin.

Perhaps hospital administrators are struggling for answers as much as we are?

LR

 

Interestingly enough the lab that I work in part time lays a claim that only 2 specimens per tech hour are performed. Being that there are only 4 1st shift techs (for a total of 32 tech hours a day) and 3  2nd shift techs (one only works 7 hours and another for only 6 hours) (for a total of 21 tech hours a day) and 1 3rd shift tech (8 hours a day) one would expect that our total volume of work for a 24 hour period would  be....(32 + 21+ 8)*2 or 122 specimens...that is the simple math of the claim. The truth is that our lab does about 250 coags, 600 cbcs, and 150 uas in a 24 hour period. I think that management sees that we are "getting by" and creatively crunching numbers to justify their actions...sounds like your management team does the same...as my statistics teacher in my PhD program said "you can make your numbers say any thing you want them too, by being creative with their outliers). While it is not necessarily right...I think it is common.

It sounds as if many of these labs (mine included) are trying to lean towards LEAN principle.  Doing more with less. This was developed by Toyota.  However, unlike their production, ours is quite variable and unpredictable and cant absorb sudden 'bursts' or increased activity as well as a car production line.  Secondly, there are lives at stake here.  There, it is just cars.

 Linear > In our state, unlike nursing, the lab doesn't have mandates for as far as minimal staffing in our department.  Nursing has mandates for a certain number of nurses per patient, we dont.  we continue chugging low staffed. 

  

Dr. George:

Interestingly enough the lab that I work in part time lays a claim that only 2 specimens per tech hour are performed. Being that there are only 4 1st shift techs (for a total of 32 tech hours a day) and 3  2nd shift techs (one only works 7 hours and another for only 6 hours) (for a total of 21 tech hours a day) and 1 3rd shift tech (8 hours a day) one would expect that our total volume of work for a 24 hour period would  be....(32 + 21+ 8)*2 or 122 specimens...that is the simple math of the claim. The truth is that our lab does about 250 coags, 600 cbcs, and 150 uas in a 24 hour period. I think that management sees that we are "getting by" and creatively crunching numbers to justify their actions...sounds like your management team does the same...as my statistics teacher in my PhD program said "you can make your numbers say any thing you want them too, by being creative with their outliers). While it is not necessarily right...I think it is common.

 

Creative stats indeed.  This is common practice from what I understand, unless you work in a government facility and some of those are just as bad.  It's high time that we as a group stop "getting by".  By that I mean that as long as you get everything done to their satisfaction, you'll get no help.  Don't work beyond your ability to maintain patient saftey and reliability.  Take time to do your work correctly so you don't have to second guess yourself.  If your work is not meeting the needs of the docs, then and only then will administration even think about helping you.  At my facilty, if the docs are happy, then nothing else matters.  I'm not saying throw down your shovels, I'm saying slow down your shovels.  It's the only way you'll get any help.  I'm sure what I just said will ruffle some feathers.  Come on, let me have it.

     Our facility recently started benchmarking through Solucient.  We answered 100 questions or so and then the information is "normalized" by adding or removing FTE's that don't belong in the data. For instance, the LIS FTE was moved to our hospital IT department and phlebotomy FTE's within the hospital were moved to the lab. Every quarter we turn in numbers on test volumes, revenue, etc and they provide a quarterly report as to where we stand compared to others in our group (who answered the same as we did).  Currently, the number that I am watching the closest (as are the "bean counters") is located in the Labor Productivity Ratios section. For the laboratory, we look at Hrs worked/100 Billed tests. At my last hospital, a different benchmarking tool was used and the questions were not "normalized", thus comparing apples to oranges. So far, this appears to be a better tool.  The Director or manager of the Lab is responsible for submitting accurate information, otherwise this data is totally useless.  I believe what it was intended to do was to be a peer review in an effort for all labs to be more efficient. (CMS will not be raising our reimbursement rates any time soon, nor will the commercial insurers...). It's to everyone's benefit to be as efficient as possible or we'll all be working for LabCorp and Quest laboratories.  Here are some suggestions for improving your efficiency and your numbers:

1)  Cross train, cross train, cross train. Of course the obvious is making sure you have more generalists in the lab and fewer department specific techs.  Our cytologist is partially cross trained in histology and our histologists perform all duties in cytology except reading of gyns/non-gyns. Our pathology secretaries/transcriptionists help out in our clinical order entry area. Our techs can all perform phlebotomy and assist with outpatients.  One histologist can work phlebotomy, 3 of our phlebotomists and most of the techs can work order entry. The manager jumps in and assists as well. No one has an absolute set schedule. Anyone may be asked to work any time, any day. We're continuing to look at creative ways to cross train that are outside of the "normal" tech to tech duties.

2)  Decrease OT to be as close to zero as possible.  Allow staff to have some flexibility with hours in order to eliminate the OT.

3)  Encourage staff to market your laboratory to their family, friends, and neighbors.  A negative staff can decrease incoming volume through negative word of mouth, thus "slitting the throat of the laboratory" and jeapordizing the jobs of the staff. It can become somewhat of a self-fullfilling prophecy if the staff worry too much about losing their jobs.

4)  Look for ways to make processes leaner.  Although we have never formally gone through LEAN, there are a lot of good ideas that come from this.  Can you eliminate steps in your daily workload?  Would it be more efficient to put serology in a different area? Encourage (and reward) staff to be creative with process improvements. Would re-arranging equipment into a core lab type set up allow you to perform more stats with fewer people?

5)  Are there any staff members who would be willing to volunteer to decrease their FTE by even 0.1?

6)  Don't allow staff to save too much PTO on the books. This affects the numbers because it is a liability to the bottom line, it's cheaper for staff to take vacation, even if it's a half day or a day at a time. You don't have to be able to give someone a week off at a time, staffing may not permit.

7)  Try to improve the morale of your staff. We have periodic "jeans" day with a red T-shirt, pot-luck meals, contests, etc.  If the staff morale improves, sick time decreases. Sick time is a liability on the books and affects those numbers that we are being held accountable for. Also, management needs to follow hospital policies on sick leave. Healthy, hard working staff, highly resent it when someone who calls in sick all of the time doesn't get disciplined.

Our department still has a ways to go, but we are improving all the time by being a team and making our own changes without being forced by the "bean counters" to eliminate FTE's.

Bottom line is that the Lab Manager/Director needs to know where these numbers are coming from and to make sure that they are as accurate as possible.  Persist in finding out what standards your lab is being held to and where have they come from.  It is every staff members responsibility to make the department as lean as possible in order to preserve job security, don't just whine and blame it on the bean counters. I would love to read if anyone else has constructive ideas that they would be willing to share.  We are all in the same boat and need to share paddles if necessary.

   

I know that my job and position is safe.  I work in a night shift position that took them months to fill with ME ..  I hate working nights, but at this present time, this works for me and my family..  However..  they cant even bribe people to take it with sign-on bonuses.

I am aware of the PTO bean counting... they recently surveyed (made everyone submit) how much PTO they have and at what rate they acrue it.  I feel that since we don't get sick time, proper, that I should be allowed to save and bank this and not feel forced to take it to make some bean-counting suit happy because his bottom line looks better. 

Cross training is great, but dont pile on too many responibilities onto people's shoulders and make them do more than capable of doing, else burn out will be a consequence of this and you will be further behind than you were originally.

Yeah Nick, crosstraining and LEAN are just a way for employers to get more for less.  No tech should be worried about job security since the profession needs 15K newbies per year while the schools only turn out 5K.  What I worry about is being treated  and worked like a mule.  It's not my job come up with ideas to LEAN out the workplace.  That's what management gets paid for.  The more time I spend doing lab assistant and managerial duties, the less time I can spend getting fast reliable results to doctors and maintaining test integrity.  I'm getting sick and tired of hearing lab managers telling us to figure out systematic problems for ourselves while they get the credit for it.  Especially while when we are putting in extra hours to cover for 3 or 4 missing FTEs while they work a 35 hour week.

I'm so sorry that you are bitter about our profession.  Might I suggest that you look for another one?  This, and many other lab managers works well over 40 hours per week without overtime and works with the staff, not against the staff. I'm on call 24/7 without extra compensation.  If we want to survive as a profession, non-management needs to work with management and not against. It has to be a team effort, not a constant whine session. If management does come up with ideas, bench techs such as yourself would be the first to complain that decisions are not made by the front line staff, but desk jockeys.  It makes perfect sense to have the front line staff look for more efficient ways of doing things.  All staff need to be part of the solution, not part of the problem.

Cathy Listermann:

I'm so sorry that you are bitter about our profession.  Might I suggest that you look for another one?  This, and many other lab managers works well over 40 hours per week without overtime and works with the staff, not against the staff. I'm on call 24/7 without extra compensation.  If we want to survive as a profession, non-management needs to work with management and not against. It has to be a team effort, not a constant whine session. If management does come up with ideas, bench techs such as yourself would be the first to complain that decisions are not made by the front line staff, but desk jockeys.  It makes perfect sense to have the front line staff look for more efficient ways of doing things.  All staff need to be part of the solution, not part of the problem.

Cathy, you should know that this is not a personal attack on you even though you've already called me bitter, told me to leave this line of work, and have assumed that I've done nothing at all to serve my facility or work on solutions.  I do not know you from Adam.  Please know that I'm working on another line of work, by the way.

When and if management does come up with ideas, they can call a meeting and discuss it with us.  That's how managers should keep techs "such as myself" involved while protecting themselves from finger pointing when things don't work.  I am a section supervisor for a 150 bed for profit hospital and I'm required to do bechwork throughout my shifts, but still keep up the supervisory duties.  Before said mega hospital corporation bought our nonprofit facility, we were happy and had 45 FTEs.  Now we have 12 and will likely soon have only 11.  I've served on several hosptial-wide and lab task force teams over the last 5 years.  All that work was canned by the new management when they arrived.  They are in the profit hospital business, not the lab business so istead of running with a plan I developed (from previous line of work) to bring in more reference lab work, they let it all go.  Now we have next to nothing for reference specimens, but we are now seeing twice as many ER patients and do twice as many surgeries here.  Yet we have less than one third of the manpower.  Techs can't make everyone happy (including themselves) if they must do the work of registration, lab office, phlebotomist, generalist tech, and lab supervisor.  Load all that on top of a bad education to pay ratio, denial of time off, lousey work schedules, and no room for advancement and all you have is job nobody can do without terrible suffering both phycially and psychologically.  I'm hearing stories just like mine from all over the country.

I couldn't agree more with you regarding the piling on of work.  Not that I am adverse to my job, however, the stretching of my description to suit their needs and others as well is getting a bit old.  We are currently doing a few things out of the scope of our job description, because it has been 'delegated' to us by a higher power.  Lately our hospital administration has been big on the delegating of responsibilities.  Unfortunately, when you are on the bottom, you get it all and from all directions.  We have to do things that should be done by supervisors, clerks, phlebs and various other entities outside of the lab (QA)..

What really bothers me are the numerous duties that are delegated to us (techs) by a supervisor that when popped in on unannounced is often surfing web or in having coffee.  (but because they were successful in delegating duties, they looked good to their higher-ups)

I used to find and take on other (laboratory-related) duties on my own when I had free time, but now that I am doing other peoples' jobs, I have had to relinquish duties that I enjoyed and that benefitted the laboratory to do these.

Nick Speigler:

I couldn't agree more with you regarding the piling on of work.  Not that I am adverse to my job, however, the stretching of my description to suit their needs and others as well is getting a bit old.  We are currently doing a few things out of the scope of our job description, because it has been 'delegated' to us by a higher power.  Lately our hospital administration has been big on the delegating of responsibilities.  Unfortunately, when you are on the bottom, you get it all and from all directions.  We have to do things that should be done by supervisors, clerks, phlebs and various other entities outside of the lab (QA)..

What really bothers me are the numerous duties that are delegated to us (techs) by a supervisor that when popped in on unannounced is often surfing web or in having coffee.  (but because they were successful in delegating duties, they looked good to their higher-ups)

I used to find and take on other (laboratory-related) duties on my own when I had free time, but now that I am doing other peoples' jobs, I have had to relinquish duties that I enjoyed and that benefitted the laboratory to do these.

Yeah, Nick, I too "catch" others that deligate work (or don't have as much work to do as the generalist tech) checking their ebay, shopping, looking at the weather, or syncing their ipods.  What really eats at me is when I'm doing a job that a lab assistant (office/phleb) should be doing and I see them involved in chit chat or reading email to pretend they're too busy to get to it.  Meanwhile, my 6 month calibration verifications are 4 months behind!!

Way to go! You have spoken truth that many 'leaders' turn a blind eye to how a person feels when he/she has to perform complex tasks under the gun and has everyone for a boss, mostly saying 'what is taking you so long!' etc, etc.  There are numerous non lab articles out stating that over multi tasking produces bad results and hurts the brain of the person being pressured into doing so many and thinking about too many really deep duties.  Here's another thing: outsiders don't realize that a tech standing still may be planning what actions come next or figuring how an instrument is working/not working, and they then conclude that tech is 'doing nothing' . Alas!