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An in-service training program for the nontechnical staff.

The foundation of the clinical laboratory is a skilled professional staff. Hospitals and accrediting agencies work hard to insure excellent quality of service through high-caliber technical expertise, while training and continuing education programs aim to develop and maintain these skills.

Ironically, these programs usually neglect the laboratory personnel with the least technical knowledge--phlebotomists, office workers, and other nontechnical staff members. Often, these employees have more direct patient contact than medical technologists. Those who handle the telephone system represent the entire department or laboratory to physicians, the hospital, and the outside world. Technical ignorance at this vital staff level can undermine efforts to provide quality care.

Training the nontechnical staff is a complex problem. High turnover rates for many of these jobs produce a chronic lack of experienced personnel. The lab must somehow provide continuous training for new employees without overburdening technologists or seriously interrupting the work flow.

Several years ago, as laboratory manager of 380-bed Humanan Hospital Suburban in Louisville, Ky., I tackled this problem by developing formal training programs for the office and phlebotomy staff, Since then, a number of hospitals in the 89-hospital Humana system have adopted the programs and noticed significant improvements in the nontechnical staff's morale and performance.

An effective program must encompass initial training and continuing education, in order to orient new employees and keep others abreast of technological changes. It must also address all job areas, and allow for validation and follow-up. The flow chart in Figure I maps out this plan.

Our main goal was to train non-technical staff adequately for good job performance. We formulated three objectives: to design an indoctrination program that would cover all job aspects within three months of employment; to develop continuing education that would update employees on new testing procedures; and to document all training.

We began by determining training needs, working closely with office and phlebotomy supervisors to compile an exhaustive checklist for initial orientation. First we assembled a thorough outline of all job functions and solicited input from admissions, nursing, and any other areas of interaction. Specific training responsibility for each area was then assigned to the laboratory manager or appropriate supervisor.

This agenda was followed by a training timetable. We determined the approximate time needed to master each task, basing minimum and maximum limits on past experience. Each program is scheduled for a maximum of 80 hours--the employee's first two full weeks on the job. Any tasks, such as infrequent special procedures, that cannot be demonstrated within this time should be completed by the end of the employee's three-month probationary period.

Next, we established required competency levels. Most tasks required 100 per cent successful completion. In a few cases, such as speciment collection for difficult patients, a 5 per cent margin of error was allowed.

We use a point-by-point synopsis of the proram, as well as an individual training log, to document employee participation. Figure II shows a sample record for the phlebotomy program, and Figure III displays the training timetable. The office workers' training follows a similar format; it includes goals like successfully charting patient results, learning to use the computer, and correctly crediting and charging laboratory procedures. The content of the two programs often overlaps--for instances, in the segments dealin with professional conduct and general hospital policies.

We evaluated the program by administering a comprehensive test and supplemented the results by observing job performance and analyzing feedback from Humana's system of patien questionnaires. These surveys, passed out to hundreds of inpatients and outpatients annually in each company hospital, include a section of questions on the laboratory's performance, shown in Figure IV.

We also obtained feedback on the program's effectiveness by interviewing each new employee two and four weeks after completion of training. These sessions pinpoint weak areas and uncover any additional needs or problems. The content of each meeting should be documented. After the second follow-up session, employees fill out a program evaluation (Figure V). Their comments help improve future training.

Continuing education forms the next phase of nontechnical training. Periodic CE sessions--at least eight a year--may cover problem areas or address patient complaints. They offer an important opportunity to update the staff on protocols for handling new procedures, such as specimen collection and processing for therapeutic drug monitoring.

Clerical or phlebotomy team supervisors should plan in-service schedules at least two months in advance; we often scheduled ours to coincide with monthly staff meetings. Employee attendance at each session is documented in individual training logs, along with initial training.

We relied strongly on employee input to determine CE subject matter, with gratifying results. Phlebotomists suggested presentations on anticoagulants, the glucose tolerance test, and the handling of difficult patients. Some in-services were prepared and presented by technologists, supervisors, or phlebotomists themselves. Outsiders provided other sessions, like a workshop on telephone technique offered by the local phone company.

The development of a comprehensive training and in-service program not only improves the quality of laboratory service, but also boosts staff involvement and morale. Many nontechnical workers who may see themselves in "dead-end" jobs will respond enthusiastically to an opportunity for growth, and they will appreciate the fact that management acknowledges their importance.

For participating hospitals in our system, the training program has helped reduce burnout in the nontechnical staff. New employees, who may never have worked in a hospital before, have a chance to acquaint themselves with a challenging new environment. They start their duties with the confidence that comes from being well prepared.

Moreover, programs like these can improve cost-effectiveness. Labs that adopt them can expect fewer problems and complaints, lower turnover, and a decrease in errors. In the process, they will also learn not to underestimate the importance of well-trained employees at every staff level.
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Copyright 1984 Gale, Cengage Learning. All rights reserved.

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Author:Ahrens, Jan
Publication:Medical Laboratory Observer
Date:Jun 1, 1984
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