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When techs ask: 'What else needs to be done?' When a supervisor is too busy to explain, a written outline of extra tasks enables technologists to lend a helping hand.

Many of the miscellaneous tasks that fall to supervisors can be performed just as well by employees. Yet overworked supervisors often don't delegate. It seems easier and faster to do it themselves than to try to explain these tasks to someone else.

I solved this problem by preparing a supervisory handbook. Its 15 pages of detailed instructions enable any technologist to perform unfamiliar tasks with minimal monitoring. Now, when the workload lags, technologists turn to the handbook to see what needs to be done.

Their assistance is invaluable. We have only seven FTEs to provide round-the-clock laboratory coverage at our 73-bed hospital. As a result, I put in a full day at the bench besides handling the usual supervisory responsibilities. The handbook allows me to keep abreast of a very full schedule and also creates managerial learning opportunities for the bench staff.

All of us are generalists, so any technologist is qualified to handle such extra assignments as quality control in different areas of the laboratory. The handbook is organized so that whoever is free--usually during the afternoon slowdown between 1 and 3 p.m.--can see what's next on the list of things to do.

Our laboratory's small size enhances communication and allows me to check progress on the various work assignments from the bench. But the handbook approach could be as beneficial in a larger laboratory, on a section-by-section basis.

The little guide grew out of a two-year project to draft the laboratory's first set of written policies and procedures, one of my first tasks as supervisor. During this time, both the laboratory staff and workload doubled as we expanded the in-house test menu, and I found it even more of a challenge to stay on schedule.

While I worked my way through policies and procedures for the five sections--chemistry, hematology, bacteriology, urinalysis, and the blood bank--I kept finding miscellaneous supervisory tasks that the other staff members could handle. The problem wasn't a lack of cooperation. Technologists didn't like sitting around with nothing to do during a slow spell. They were happy to help when I asked for a hand, but they did need guidance.

For two months, I jotted down every single job I performed that was neither regular benchwork nor absolutely supervisory. My handwritten notes ultimately grew to 15 typed pages of "what else needs to be done in the lab each month."

Beyond the laboratory, I was spending a lot of time attending hospital meetings. That made it even more difficult to complete my share of the benchwork. When I spoke with the committee heads and reviewed appointment minutes, I found that laboratory representation didn't require my attendance at all meetings. I offered my seat on the infection control and safety committees to an interested technologist, who also fills in on other committees whenever I am on vacation or have a scheduling conflict. My committee time dropped by 50 per cent. Lab input is at the same level as before, though it is possibly more enthusiastic.

The handbook opens with inventory. It notes items on standing order, when to expect the orders, and what they should contain. I also listed supplies that are obtained from somewhere other than the central storeroom. For example, the pharmacy department reorders Rh.sub.0 (D) immune globulin and plasma protein fractions.

The quality control section tells technologists where to mail data for QC in each of the five disciplines. It includes addresses, toll-free telephone numbers for questions, and the due dates. The information and an envelope for mailing are invariably on my desk several days ahead of schedule, giving me ample time to review the data.

On a page about malfunctioning equipment, I listed the names of the service representatives along with the instruments serviced, toll-free numbers, and the type of contract we carry--full-service or preventive maintenance only. Also written out is the preventive maintenance schedule and where to send Stat specimens in the event of a major breakdown.

With this information readily available, technologists have become more interested in instrument maintenance. I am now called in as a last resort instead of being summoned at the first sign of trouble with an instrument.

Workload recording is always a challenge. The handbook told technologists where to find all the sources of workload data. We have standard worksheets, of course, but some kinds of tests do not appear on them. For example, the list of patients drawn for paternity testing is in a drawer in the chemistry department. Totals on alcohol tests are taken from a notebook kept with the breath analyzer. Thanks to these and other workload recording signposts, every one of the technologists is willing to do the biweekly tallying.

Our community blood bank has its own method of charging for transfusions, and it was a mystery to some in the laboratory. The handbook displays photocopies of properly filled-out charge slips and explains where copies must be sent.

The are about 30 handbook sections in all. Here are some of the others:

* Lab Copies tells technologists how long the various test records must be kept and where in the laboratory to find the older slips. I'm not interrupted by questions about what can be thrown out, and technologists don't have to dig through the medical records dungeon.

* New Employee Information lists the preemployment tests that must be performed for different hospital departments and specifies where the results should be sent. New laboratory employees, for example, require an anti-HB.sub.S.Ag test, a color blindness test, and the PPD skin test for tuberculosis (performed annually thereafter), while kitchen workers need a stool culture. This section also includes a reminder to orient new employees to the safety manual and disaster plan.

* Credits provides instructions for obtaining credit on unsatisfactory, defective, or contaminated products. When unpacking laboratory supplies, technologists routinely note the condition of the shipment and check for outdating. If media arrive spoiled or a shipping container is badly damaged, they are able to start the paperwork right away.

* Outpatient Reports details where copies of results must be sent, depending on whether the specimen comes from a hospital outpatient, nursing home resident, clinic referral, or county home health care patient or is part of a preoperative workup for another hospital. Outpatient testing accounts for one-third of our workload, and each of these areas has its own set of reporting requirements.

* Time Cards itemizes all the dos and don'ts from the personnel office. For example, overtime pay must be initialed by the supervisor, and certain forms must be submitted for vacation and sick days. It's also important to make sure everyone signs in and out during the two-week pay period. I still have to scan and initial all the paperwork, but now someone else is able to prepare the forms and flag any errors.

* Work Schedule lays out the rotation for weekends, holidays, and call and gives each technologist's status as a full-time or part-time worker in terms of FTEs. Here again, there's a form to submit for vacation requests and another for low-census staffing adjustments. Technologists can handle much of the routine paperwork.

*Send-Outs lists commonly ordered referred tests that oru primary reference laboratory does not perform. It does notes which specimens or tests go to which laboratory and where to find special send-out forms, addresses, and charges.

* Pathology helps us keep track of the laboratory's five pathologists. Because of our small size, the hospital has a contract with a pathology group to service the lab three days a week. This section spells out who comes to our hospital on which days and where they can be reached the rest of the time. It also explains how to locate current and past pathology and autopsy reports.

Twelve monthly sections at the end of the handbook are my biggest time-saver. Each section contains a copy of every form the laboratory must file at the end of that month. When all the other handbook tasks are taken care of, a technologist can flip to, say, the June section and see what reports are pending.

New temperature charts, quality control sheets, and preventive maintenance sheets are among the monthly reports. Quarterly assignment sheets--pipet calibration and timer and thermometer checks, for example--are in the January, April, July and October sections. Semiannual review sheets, including those for the antibiotic susceptibility ratio, are filed in the January and July sections. Budget forms follow the January material, and inventory paperwork comes after April. Annual calibrations are scattered throughout the year to balance the workload.

Although there haven't been any major snags, delegating inventory responsibility didn't work out too well. Technologists were often too busy to guard against a drop in supplies below the minimum level, so inventory is back in my domain for the time being. I am developing a new system in which technologists prepare a weekly shopping list, and I think it will prove effective.

Whenever a new product goes on standing order, or the laboratory switches vendors, or the blood bank changes its charging policy, I update the handbook accordingly. In addition, I review the entire text at least quarterly to make sure no operational changes have been overlooked.

The handbook saves me an hour or more every day, so I'm better able to cope with my bench and desk assignments. Some of the technologists seem to take on more extra tasks than others, and each tends to stick to a particular set of tasks. Everyone is very good about pitching in. Although I generally know who's doing what, I keep an incident notebook as an aid in preparing notebook as an aid in preparing performance evaluations.

I knew the manual was a success when I returned from a vacation and, for the first time, didn't lose an entire day sifting through a sheaf of phone messages, problems, and questions. The rest of the hospital discovered my secret at a recent management session. At the break, virtually all the department heads rushed back to their divisions to make sure everything was under control. Needless to say, they were surprised when I didn't do the same.

I said this wasn't necessary because I knew that the technologists, with some help from the handbook, were handling everything just fine. And they were.
COPYRIGHT 1985 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1985 Gale, Cengage Learning. All rights reserved.

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Author:Nass, Janet M.
Publication:Medical Laboratory Observer
Date:Jun 1, 1985
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