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

Performance improvement projects at the institutional level, while hard to find time for, create visibility for the lab, she said, and “if done correctly, they give time back to you because you find ways to decrease waste.” If there are no institution-wide programs, she said, “you can create that type of opportunity for change within your own area.” In the Stanford laboratories, one such project empowers front-line staff to lead small improvement projects coached by lab supervisors and managers. They use an iterative process. The problem is identified; a walk-through takes place to see what’s being done and to get a full understanding of the issue; and the goal, the drivers, and potential changes are documented.

“Then it becomes iterative,” Dr. Kong explained. “You try a change and you see it fails. You try another change until you identify the one that really works. Then you go back and make sure it’s effective,” all while involving the staff. “Because then they’ll start to understand that, yes, doing the thing is stupid, but to effect change takes work and it can’t be done with the flip of a switch.” Once they’re engaged, they’re good at helping to find solutions that work for them instead of being imposed on them, she said.

One improvement project at Stanford involved the transfusion team, “to hold off on crossmatching blood until call slips are reviewed. This saved 86 FTE weeks,” Dr. Kong said, “almost two FTEs of work. And it’s amazing when you start to look at how you’re doing it because they were pulling and reshelving blood products that were not being used.” It also reduced blood wastage, she noted, because “you’re not pulling things off and decreasing that time to use.”

In immunohistochemistry, they moved from paper orders to electronic orders for special stains. They did the same for FISH and other molecular test orders, and the latter shortened the molecular test turnaround time by six days, Dr. Kong said. Instead of faxing requests that would sometimes get lost, “it was a simple change that took a long project led by a pathologist to be able to figure out what would work best.”

Look at the number of submitted blocks, she suggested. “If you can reduce that, you reduce histology work, staff time to file slides, and the time you spend to read all that glass.”

For recruitment and retention purposes, Stanford implemented career ladders in recent years for CLSs, histotechnologists, cytogenetic technologists, and bioinformaticians, and they aim to expand it to others, Fralick said. “Not everyone wants to advance, but for those who do, this gives them a path forward,” she said.

A governance committee consisting of medical directors, managers, and supervisors from AP and CP laboratories meets twice yearly to review the applications of employees who seek promotions. The application has multiple elements encompassing people, quality, safety, service, operations, and improvement, “with quality and improvement weighted higher than the other areas,” Fralick said, and a letter of recommendation from the employee’s supervisor is required.

“There’s a long list of criteria and they can say, I’ve done this and this is when I did it, and they provide supporting documentation” for the committee. “We say, ‘This person needs to get promoted,’ or maybe we go back and request additional documentation. Sometimes we say, ‘No, you’re not ready. Let’s hold you until next time,’ so there are rejections but it’s rare.”

As a CLS, an employee can go from staff to senior to reference technologist, for financial gain and to take on more advanced tasks such as test validation and development. For all staff, whether they prefer to stay where they are or apply for a promotion, “we try to keep the work exciting, so everyone at every level will stay engaged,” Fralick said.

To retain pathologists, Stanford implemented time-limited director roles, Dr. Kong said, “because especially in academic institutions you see people leave because they want to be a director of their service but they don’t see opportunities for it at their own institution.” A director at Stanford who is in the role for five years can be renewed for another five, and during those additional five years would identify a successor and prepare them to take over. “It creates opportunities for people to move into those positions so they don’t have to go to another institution to advance their career,” Dr. Kong said, adding, “It also means better transitions.”

The outgoing director doesn’t “go off into the sunset,” she said, noting there are other roles they can move into.

As part of this program they are creating a leadership training program for pathologists who are interested in moving into a leadership role. “It’s important to create that opportunity for growth at all levels,” she said.

Sherrie Rice is editor of CAP TODAY.