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Developing a more effective training program.

AS LABORATORIANS, we strive for excellence. We want only the most sophisticated instrumentation available; our quality control programs are designed to ensure the utmost accuracy of test results; and the procedure manuals we write are detailed and complete. Even labs that have chosen not to be accredited by CAP or JCAHO are developing quality control programs and quality assurance programs, as well as subscribing to proficiency testing programs.

Why then do we spend so little time concerning ourselves with the training of new employees? It's one of the clinical laboratory's most important tasks. The quality of our work is at stake, as well as our efficiency. Our patients are not content with mediocre care. Nor are our physicians. Why then do we seem to be content with producing mediocre employees?

* Barriers to effective training. Without question, training is time-consuming, and most of us have plenty of other things to do. Patient workload must always come first, and when our workloads are heavy, training becomes a low priority.

Training can also be intimidating. Not only are we tested by the new employee on our own job knowledge, but the new employee may question the effectiveness of the way we do things. "Because we've always done it this way" isn't the right answer when a new employee asks questions.

Another barrier to effective training may be the abilities of the new employee. Many educational facilities have discontinued their laboratory programs, creating a shortage of qualified candidates. The programs that remain have been forced to economize or to accept students with less ability than may be desired. Graduates entering the job market, therefore, need more extensive on-the-job training than in the past to bring them up to speed.

While hiring graduates of a formal medical laboratory training program may still be preferable, many laboratories are exploring hiring high school graduates as testing personnel. Under CLIA |88, a high school graduate with appropriate training is permitted to perform tests of moderate complexity, but such an employee's lack of college-level education will likely impact the extent of on-the-job training needed.

Even when the new employee is educated and experienced, training on the laboratory's policies and procedures, computer system, and specific types of instrumentation is necessary. When a position is filled, we are often so desperate to have the new employee working on his or her own that we cover only the absolute minimum during the training period, hoping that the rest will come with experience. In the short run, we have a functioning employee filling a needed position. In the long run, however, we've not only shortchanged the employee, we've jeopardized the quality of the work we produce.

A final barrier to effective training is the common practice in small and medium-size hospitals of rotating personnel through the various laboratory sections. This may be the best way for the laboratory to maintain flexibility, but it makes it difficult for the employee to keep up to date on the rapid changes that may be occurring in each section. Thus, an employee with minimal working knowledge of a section may be responsible for training a new employee. In addition, a variety of people may act as preceptors within a specific section, affecting the continuity of the new employee's training and allowing important information to fall through the cracks.

* Negotiating the barriers. How do we overcome these barriers to effective training? Ideally, a single preceptor should be assigned to a new employee, and ample time should be allotted to discuss a procedure before it is performed. The new employee should observe the preceptor performing the procedure, and then be allowed to practice it under the watchful eye of the preceptor until proficient. The new employee should have time to master each procedure before moving on to the next.

But this scenario, unfortunately, is not realistic. With Stats and continuously ringing telephones, there is a need to perform multiple tasks simultaneously, and employees are not often able to devote their entire workday to training.

We should recognize that we cannot eliminate most of the barriers to effective training for the lab setting. There are only so many hours in a workday, and the workload of most hospital labs is not likely to subside anytime soon. It is doubtful that we will succeed in changing the attitudes toward training held by some of our employees, nor will we be able to change the abilities of incoming employees. Because we cannot eliminate these barriers, we must negotiate them and handle them in the most efficient way possible. A laboratory orientation checklist can be a tremendous help.

* The orientation checklist. Our laboratory recognized the need for an orientation checklist many years ago. The checklist that was prepared included specific tasks that the new employee should be trained to perform during his or her training period. It was dated and initialed by the person responsible for demonstrating each procedure to document that the training took place and to instill accountability for the proper performance of the procedure once the training period was over. This system worked fairly well for several years, but as our laboratory grew and increased in complexity, it became clear that some modifications were necessary.

We recognized that different levels of competency might be necessary for different tasks, depending on the position to be filled by the new employee and on the nature of the task itself. It was unrealistic to expect that all new employees would become competent in all listed tasks during the course of the training period, so the checklist itself might be misleading in terms of the actual competency of the new employee.

We also recognized the need for the checklist to be completed concurrently with the new employee's training, rather than at the end. Because it was likely that a new employee would be assigned to more than one preceptor while training in a particular section, it was important that a preceptor be able to determine which tasks had been completed, which ones had been partially completed, and which ones had not been covered at all by the previous preceptor.

The system we developed is based on establishing a minimum level of competency for each task or procedure listed on the checklist. The levels of competency are defined on the front sheet of each section's checklist (Figure 1), both for the preceptor and for the new employee so that there's no question about expectations during the training period. The checklist itself is detailed, providing the preceptor with a guide to follow during training. In this way, the new employee's training is not dependent on either the preceptor's level of knowledge or on the test mix experienced during the training period. Items on the checklist are categorized to provide organization and a logical flow to the training (Figure 2).

* Using the checklist. An orientation checklist for each section of the laboratory is given to the section supervisor prior to the date the new employee begins training in that particular area. The section supervisor assigns a current employee to act as preceptor for the new employee during each day of his or her training period. This person knows in advance that a new employee will be training in the section and, therefore, has the opportunity to prepare. Preparation may be as simple as gearing up mentally for the training or as detailed as reviewing specific procedures, reference ranges, critical values, etc.

Each preceptor writes his or her initials in the space corresponding to the level of competency achieved by the new employee on a particular day of training. It's possible that level 1 ("discussed") will be achieved on the first day of training, and level 2 ("observed") on the second day, with level 3 ("performed") being completed on subsequent days of training. It's also possible, as Figure 2 indicates, that some procedures may only require discussion, in which case levels 2 and 3 do not apply. Since different levels may be achieved with different preceptors, it's important that each preceptor review the checklist prior to the day's training and keep it up to date by recording each level of competency achieved.

At the end of the training period, the section supervisor reviews the checklist to make sure minimum levels of competency have been achieved for all procedures, and indicates acceptable completion of training by initialing and dating each procedure under "Supervisor." If the supervisor decides that training is acceptable for the employee even though the indicated minimum level of competency has not been achieved, an explanatory note is provided under "Comments."

Upon completion of the checklist, the section supervisor reviews it with the new employee to make sure the new employee agrees with the levels of competency achieved. The new employee and the section supervisor then sign and date the first page. The completed checklist is maintained in the employee's file and is reviewed verbally with the employee annually at the time of the employee's performance appraisal to ascertain that the employee continues to feel competent to work the section. Actual employee competence is further verified by ongoing proficiency testing.

* Benefits of the checklist. The benefits of this system include greater consistency in training, improved accountability, and more realistic expectations. Training is much less intimidating to the preceptor because he or she knows exactly what is to be covered. And it is far less likely that important information will fall through the cracks for new employees.

The most important benefit, of course, is having in place a system that produces more effective employees. Well-trained employees produce quality work, ultimately leading to quality patient care. And isn't that what it's all about?

Barriers to effective training

Time Workload Multiple preceptors Preceptor's job knowledge Attitude of the preceptor Abilities of the new employee Need for training to be completed quickly
COPYRIGHT 1993 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Hargrove, Catherine A.
Publication:Medical Laboratory Observer
Date:Sep 1, 1993
Words:1631
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