Reorganize, promote, shift, assess—staying staffed amid a shortage

Sherrie Rice

June 2023—The labor shortage may ease now and then for some laboratories in some areas, but the general outlook is that it will stick around for a while—if not forever.

“We have a highly trained workforce, and so they don’t just grow on trees,” said Christina Kong, MD, professor of pathology at Stanford University, in a CAP22 session on how to use creative approaches in the face of the shortage. For Dr. Kong and Stanford colleague and co-speaker Jennifer Fralick, executive director of anatomic and clinical pathology laboratories, it’s about changing the way the laboratories work. As Fralick put it, “They’re strategies to stretch or refocus the staff.”

One example at Stanford was the understaffed point-of-care testing department, where “we had the wrong staff doing the wrong jobs,” Fralick said. “We had a primarily CLS-staffed point-of-care department doing administrative work.” The solution was to reorganize such that the clinical laboratory scientists were relieved of the administrative tasks and moved to technical work only—“the work they studied for and that they’re licensed for,” Fralick noted.

Histotechnology was suffering the biggest shortfall, one for which “we were begging, borrowing, and stealing,” Fralick said. So they did a service line growth assessment, she said, to figure out how best to support it. “We looked at the oncology plan, at the surgical strategies, because they impact our histology staffing,” and they reassessed their staffing plans by examining volumes, safety, and regulations.

They had to account for digital pathology processes, too, because “it’s not seamless” or easy, Fralick said. “There is a lot of maintenance on the scanners, for example.” Now, laboratory technicians are key to their digital pathology workflow. “They are the ones doing the scanning and the ones maintaining the scanners,” and they’re doing quality assurance. “It’s been a blessing to have this position,” she said, “because it has offloaded the need to have so many histotechnologists.” The laboratory technicians also have a path to train to become histotechnologists. “Since we don’t have a histotech school to partner with, we’re kind of doing it on our own.”

In the end, they came up with a staffing reassessment plan—a 30-page business case is how Fralick describes it—that meets today’s needs in histotechnology.

“Top-of-the-license practice” is the approach they have taken for several Stanford laboratories, not only because it’s good for morale and thus retention, Fralick said, but also because some of the staff then become easier to hire. Lab technicians, lab assistants, and surgical pathology technician positions (the latter to relieve PAs, “one of the hardest staffing issues,” she said) are easier to fill. “They require training, but you can bring someone in with a high school diploma,” and without certification.

They have shifted to medical laboratory technicians some of the clinical laboratory scientist tasks, such as temperature audits and supplies ordering.

“We’ve seen so much job satisfaction. We’ve seen people smiling, happier at work,” all while “plugging the gap” in staffing, Fralick said.

Building a small labor pool is another of the steps they have taken. The cost to bring in temp workers “is not pretty,” she said, referring not only to the cost to interview, onboard, and complete the related administrative tasks but also the training. Temporary staff “have to learn your system, your policies. In some labs, based on the complexity, it could be four to six months before that person can work on their own.” And the training takes others off the bench such that there are now two vacancies—one for which the lab hired the temp and the vacancy of the trainer.

The labor pool they’ve built is based on historical volumes of how many phlebotomists, for example, had to be pulled in as temporary and for how long and at what cost. Their extensive assessments of past use of temporary staff enabled them to say they need three phlebotomists who are always in the department and move from shift to shift. “And it gives them an opportunity to work on different tasks. That way they’re trained, they stay, they are not always married to one shift.” They can apply for a shift, but they would remain in the pool, Fralick said.

The same is done for histotechnologists and CLSs, the latter of whom can work in virology, microbiology, and chemistry. “While there’s going to be training as they go from lab to lab, it’s not significant. The core foundation is there.” The labor pool helps when there are family leaves of absence, for example, and gives the staff flexibility as well.

Dr. Kong and Fralick and others look for efficiencies, too, and one way to do that, Dr. Kong said, is to “promote a culture of psychological safety, where staff feel free to bring up different ideas or to speak up when they see a problem or something that could be done better.” They see a lot and they have a lot of ideas, she said of the staff, “so it’s important to capitalize on that.”

“As we’re looking for efficiencies, they can tell you the things that frustrate them,” that they know to be a poor use of their time or to add little. “Those are things you want to find so you can change the way things are done,” said Dr. Kong, who is vice chair for medical affairs and medical director and chief of service, Stanford Health Care.