Human resources planning: Building a case for cross-training.
Economic forces and technological advances of the last 2 decades have changed the way laboratories organize and deliver their services, resulting in the rapid development of interlaboratory consolidation in the form of core laboratories. Many laboratorians are concerned that these changes will adversely affect the quality of services offered and have expressed their fears of being downsized or de-skilled from their current jobs.
Traditionally, laboratories were organized into a central laboratory with internal departments such as chemistry, hematology, immunology, microbiology, and transfusion medicine. In larger facilities, employees were assigned to a specific area and specialized in that area.
In today's environment, however, employing specialists often does not offer the flexibility needed to staff the core laboratory, especially in facilities that require economic improvement. In response to the combination of economic necessity, technological progress, and flexible staffing requirements, laboratories are looking for more generalists (i.e., cross-trained medical technologists and technicians). Some technologists view the move to generalist training as a de-skilling process rather than an opportunity. Laboratory managers are mandated to do more with less, which has exacerbated their difficulties in developing and maintaining cross-training programs. The challenge for managers is to deal positively with changes affecting their staff members and to develop realistic crosstraining programs that include plans for ongoing competency.
To define the key issues and steps in establishing cross-training plans, I sought the input of those colleagues and former clients who had successfully developed and implemented such programs in their laboratories. These facilities are located in community hospitals, large urban hospitals, and integrated delivery systems (IDNs). I conducted an informal survey to answer the questions enumerated in the following list; those answers, combined with my own experience, helped me compile the information offered here.
1. What were the decision factors that made cross-training necessary?
2. What were the critical elements (e.g., staff buy-in, job responsibilities, communication plans, scheduling, etc.) that affected core laboratory staffing and cross-training decisions?
3. How did you identify the technologists and/or technicians who were to be cross-trained?
4. What were the successes and/or failures of your cross-training program?
5. How did you maintain the competency of cross-trained staff members?
What is cross-training?
A generalist is trained to perform routine laboratory testing within multiple specialties. As the term implies, a cross-trained individual has been trained to move from one specialty to another. In today's laboratory, cross-training generally means teaching lab workers who have become specialized on one instrument or in one area to become competent at routine testing procedures in at least 2 or 3 other specialty areas. The term "cross-training" can also be used on a larger scale, as with an IDN, in which staff members must be cross trained to work at multiple sites within the IDN, such as a hospital laboratory, a physician office laboratory, or a reference laboratory.
In general, my survey concluded that approximately 30-35% of the dayshift personnel were cross-trained; 80% of the evening-shift staff were cross-trained; and 97% of the nightshift employees were cross-trained. The 30% of laboratory managers who secured cross-training for technical specialists were from smaller community hospitals, not an unusual finding because technical specialists and managers from those facilities generally perform a higher percentage of bench-work than their colleagues in larger urban or academic hospitals. In addition, a technical specialist in a small community hospital might have technical oversight responsibility for multiple specialties.
One general practice appeared to be that microbiology technologists and technicians were not cross-trained and did not rotate out of their area; however, most laboratories trained individuals to rotate into microbiology to assist in routine procedures, with the exception of culture evaluation. Approximately half of the respondents cross-trained their staff members in transfusion-medicine routine procedures.
The primary reason indicated for cross-training was to develop a core laboratory to include the development of a centralized, highly automated laboratory of chemistry, hematology, and immunology.
Other reasons for cross-training included mandatory downsizing of staff, a need to increase flexibility within the laboratory or across sites, staff attrition without employee replacement, and the flattening of the department management organization by consolidation of supervisory responsibilities and elimination of supervisory personnel.
Developing a plan
When laboratory managers contemplate a cross-training plan, they should consider several critical factors. Of these factors, the 2 most important are communicating with staff members and employee acceptance of the plan. A successful cross-training plan must include a communication process--lab personnel should be informed of the why, who, what, when, and how many of the process.
Other factors might include (1) any costs or savings associated with a cross-training plan, such as the expenses of required resources, the cost of maintaining competency, or the savings potential related to flexible staffing; (2) staff job descriptions; (3) the physical layout of the laboratory; (4) overall employee attitude; (5) a schedule for a cross-training plan; (6) competency plans for newly trained employees; and (7) intercampus logistics (for an IDN).
The scope of diagnostic services that the laboratory provides for its patients and physicians will contribute to the decision about which test procedures staff members should be cross-trained to perform. In addition, each laboratory ought to review its individual needs and expectations to determine the areas in which such training needs to occur. In general, within the core laboratory, lab workers are cross-trained to perform the highly automated procedures that require rapid turnaround time.
As a cross-training plan is developed, understanding and addressing potential roadblocks or threats is important. Major obstacles might include turf issues within the laboratory and resistance by staff members, as there are usually individuals within laboratories or any organization who have difficulty accepting and dealing with change. As previously stated, a clear and constant communication process must be in place to help employees accept the transition. Even with communication, however, there still may be those who cannot accept change. Being aware of this in the initial stages will help lab managers deal with resistance as the process continues.
Implementing a plan
When actually putting a cross-training plan into practice, laboratory managers might want to look at some of the key factors that can make or break a new program.
Changing productivity. Laboratory employees, as they are going through the process of retraining, will be working outside their comfort zones. This may result in reduced productivity, longer turnaround time, and frustrations among personnel.
Training discontinuity. One threat to any plan is backsliding caused by intermittent starts and stops in the training. It is very important to move forward once a plan is in place. Cross-training will fail if the process starts and stops too often, and a well-developed work plan with timelines will keep the process on track. The lab manager must be aware of and identify the necessary resources to complete the initial training on schedule. It is too easy to say, "We are short-staffed and very busy today. I just don't have the time to train."
Physical restrictions. The physical layout of the laboratory also must be considered because it can affect the cross-training plan. Resources associated with facility renovations and/or reconfiguration might be needed to alter the layout of the lab to accomplish the plan's objectives.
Searching for candidates. All of the laboratories that responded to my informal survey indicated that at first they had sought volunteers for cross-training who had expressed a desire to learn or re-learn new procedures, who wished to expand their job skills, or who wanted to become more marketable in this. changing field. Only after seeking volunteers did these labs post new job descriptions identifying the areas of cross-training. A few hired recent graduates who had the generalist skills necessary to perform routine procedures.
Viable personality traits. Another key to a successful program is whether employees possess the desired personality or work traits. Such characteristics might include the willingness to learn new skills; an acceptance of the necessity for cross-training; a facility for teamwork; the ability to prioritize work; strong communication skills; technical experience; self-motivation; flexibility; an aptitude for customer service; a sense of humor; and the ability to think independently and resist peer pressure.
The usual reason for failure in a cross-training program is poor planning--approaching it without understanding and without keeping in mind all of the previously mentioned factors. Backsliding because of a lack of commitment is another significant reason for failure and causes interruptions in the training plan, which results in a deviation from the timeline. Interruptions and delays could also result in lowered morale. To avoid failure, a fallback plan should be developed; being able to change the course of action should be considered during the planning stage. This will allow lab managers to move forward even though the unexpected has occurred.
After the cross-training program has been completed, all of the newly educated employees must remain competent in the areas for which they were trained. The key to maintaining competency is ensuring that staff members continue to rotate into cross-training areas on a regular basis to preserve their skills.
Respondents to the survey indicated that this can be accomplished well by preparing a master schedule for the whole laboratory rather than developing a schedule for each area of specialty. Competency procedures currently in use for laboratory personnel can be easily adapted to the needs of the cross-trained staff.
As lab managers consider how to justify cross-training, they might want to develop and present this information to their administrators in a business-like format. The written business proposal or cross-training plan should include:
* background information explaining why cross-training is necessary;
* the issues, critical factors, and major considerations in approaching the plan;
* the positive and negative aspects of cross-training;
* an outline of the costs and savings;
* a fallback position if a mid-course adjustment becomes necessary;
* a training schedule;
* a timeline; and
* a competency plan for newly trained employees.
It is important to include an evaluation of the entire cross-training process within the timeline. This will allow lab managers to determine if their program has been successful.
Successful outcomes of a cross-training program can include many benefits, such as the improved efficiency of personnel, improved relationships among staff and between shifts, improved staff morale, increased standardization across specialties and campuses, increased flexibility, and expanded skills for laboratory staff members.
Developing the plan is tedious, and it requires a team effort, but the rewards are great.
Judy Lien is Senior Management Consultant, Superior Consultant Company, Inc., Southfield, MI, and Secretary, CLMA: Leadership in Clinical Systems Management.