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How a hospital and university jointly recruit MTs-to-be.

This state university plugged into the PR program of a nearby hospital to recruit high school students for its undergraduate MT program. The hoped-for result: future laboratorians.

If there's an area in this country that isn't having trouble finding medical technologists, we haven't heard about it. The shortage is most critical in rural communities-particularly in the southeastern United States, where our institutions are located. Hospitals now realize they must make life in the lab more attractive to halt the exodus.

The typical catch-up measures are a symptomatic solution, not a cure. To preserve an endangered species we can't do without-the MT-we must continually replenish the ranks. Our two institutions, a hospital and a state university in the same town, joined forces two years ago to do just that via a unique recruitment program targeted at high school students. Early returns indicate that it's working.

*How we started. East Carolina University, in Greenville, N.C., has 14,000 students. The clinical laboratory sciences department is in the School of Allied Health Sciences. The allied health, nursing, and medical schools comprise the university's Division of Health Sciences.

The CLS program is accredited for 16 students. Seniors spend four days a week in a hands-on lab rotation and return to campus and classroom on the fifth day. In recent years, CLS enrollment has dipped as low as seven students, but the situation is improving: Eleven entered the program in September 1988. At press time, it was too early to know how many would enroll in 1989's junior class, but we had high hopes. PreCLS student numbers were also unknown.

Also in Greenville is Pitt County Memorial Hospital, a 560-bed regional facility that serves as the primary teaching hospital for ECU's Division of Health Sciences. This past spring, the laboratory and its 200 employees completed their move to 40,000 square feet of brand-new lab space, and the hospital was recently approved for 150 more beds.

In mid-1987, both institutions were definitely experiencing a "people pinch." The school's enrollment was dwindling; the laboratory faced a major expansion and a certain shortage of workers. In November of that year, ECU faculty, alumni, and hospital laboratorians decided to launch a recruitment drive to attract more CLS students and provide the hospital with a pool of prospective personnel.

Our joint recruitment strategy differs from previous solo efforts in several ways. Most notably:

It is a cooperative effort. The hospital and university are just five miles apart, and the faculty and staff have always had a good relationship. Each institution has diligently recruited for itself, but never with a comprehensive campaign stressing both education and employment. Joining forces brought a new dimension to efforts on both fronts.

It uses resources efficiently. At the time we decided to work together, the hospital was starting an extensive radio and billboard campaign to attract health care professionals in many disciplines. Our two-pronged student-employee program builds on the hospital's theme, "Health Professions Make an Impact on Life." Both facilities freely share staff, services, and expertise. Careful coordination makes the most of our limited human resources-especially important because time is tight for both the faculty and the lab staff.

It targets a specific audience. Rather than try a shotgun approach to public awareness, we decided to zero in on high school students, preferably sophomores and juniors, who had not yet made firm career plans. Pitt Countyhome of ECU and PCMH-is an agricultural and industrial area of 100,000 people. The student population at the county's five high schools totals 4,500.

Our hospital has strong ties to the local community. Many of these young people we are trying to recruit were born at PCMH. The prospect of obtaining an affordable college education nearby and the expansion of local employment opportunities are big selling points. In addition, the hospital is a major presence in the Pitt County economy. It makes sense to tap the hometown resources and Labor pool to strengthen that economy.

It incorporates suggestions from focus groups. Our individual (and less successful) recruitment efforts had been based on what the faculty or hospital administrators thought would attract applicants. As our joint campaign evolved, we welcomed suggestions from educators, lab administrators, recent graduates, laboratorians, and public relations specialists-and some of these suggestions were eye-opening. The hospital's marketing staff also went directly to the source, polling high schoolers for ways to bolster the appeal of health professions and to glean advertising ideas.

It represents an ongoing commitment. Earlier one-shot measures temporarily eased a staffing crunch but did little to reverse the growing shortage of qualified medical technologists. We wanted to invest our limited time and energy in efforts to find local solutions to a local problem-over the long haul.

Planning sessions to meld our talents and expertise were essential. First, faculty members, ECU alumni, and PCMH laboratorians took a hard look at the CLS program. This early brainstorming yielded several solid suggestions. Some have been implemented, and others are still being considered for the future.

A simple shift in course prerequisites, for example, opened the CLS program to a wider range of transfer students. Sophomores traditionally took a cell physiology course to fulfill their biochemistry requirement and then moved on to general microbiology the next year. A little homework on our part revealed that almost all colleges of any size have a microbiology course but many do not offer cell physiology or blochemistry. By rearranging the sequence of these courses, we expanded the pool of prospective candidates for admission.

* Booklets and a billboard. With such logistical concerns squared away, we turned our attention to developing recruitment materials that would speak to our target audience of teenagers. Stuffy college brochures simply would not do, and this is where we began to trade expertise. The educators submitted copy, which was of college catalog caliber, to a media specialist in the School of Medicine who jazzed it up for a younger crowd. We drew on what the high school students had told us in focus sessions and threw out those "boring pictures of people peering into microscopes." We learned that teenagers are impressed by computers and white lab coats with street clothes undemeath, so that's what we gave them. The result was a colorful eye-catching poster and a breezy brochure.

The high school students gave high marks to billboards and radio spots for their effectiveness in reaching the teenage market. For the last year, billboards proclaiming the hospital's message"Health Professions Make an Impact on Life"-and providing a toll-free telephone number to call for information have been positioned on major roads around Greenville. We supplied copy to a local rock station, where a DJ translated the message into an appealing "rap." The marketing department's most ambitious endeavor was a music video showing teens dancing in a school hall way. Using local youngsters as our actors guaranteed high viewership on local television stations, plus media coverage.

* A made-to-order career day. Both the educators and the administrators agreed that traditional high school career days were a complete waste of time. In a few minutes, one must make a pitch to a large group of kids, most of whom are far more interested in hearing from the stewardess or computer programmer to follow. In response, the hospital launched its own career day, inviting 100 students who were recommended by local science teachers and counselors. The first two annual PCMH career days have been a big success, and we're thinking about offering the program twice a year to meet the growing demand for a glimpse behind the health care scenes.

True to our commitment to reach this youthful audience, the day begins with a health care version of "What's My Line?" After the onlookers discover there are other health care professionals besides doctors and nurses, they select two departments they would like to see in person. We were thrilled when 26 of our 100 young guests asked to visit the lab, where the technologists took pains to get the kids involved in the hands-on tour.

Lunch was a pizza party in the cafeteria concluded by drawings for movie tickets, cassettes, and other teen-targeted prizes donated by local businesses. Students spent the afternoon visiting display tables and chatting with representatives from the various hospital departments and from the university.

* Out in the field. Although the school's role in our hospital career day is a supporting one, university staff take charge of field recruitment. Throughout the academic year, ECU lab educators from the CLS program's unofficial speakers' bureau visit high school science classes and clubs to talk up health care professions in general and the laboratory in particular. This gives us a chance to reach small groups of highly motivated students. As always, we keep the programs relevant. Topics currently of great interest include AIDS and cholesterol testing.

The contributions of high school science teachers are critical to our success. We reciprocate by lending them expensive reference books and donating outdated microbiology media and chemistry and blood bank reagents. This largesse costs us nothing and pays long-range dividends by reinforcing the students' interest in science.

ECU faculty members make a point of meeting with community college representatives to assist them in advising potential transfer students. Our department chair reviews the catalog offerings, talks with science teachers, and suggests which of their courses might ease their students' transition to our program. Whenever possible, we bring along a graduate of the school in question to talk to students considering a transfer to ECU. We leave copies of a list of people at the university to contact for additional information.

When the admissions materials for an ECU applicant indicate an interest in science, the appropriate department is notified. High school students who retum special postcards bound into ECU brochures then receive a letter and information sheet describing our program. Underclassmen declaring themselves as heading for preclinical lab science are assigned to an advisor in the CLS department. The early numbers of interested students are encouraging. A growing number of freshmen and sophomores has expressed a desire to enter the science field.

* Our program could work for you. None of us can escape the technologist shortage. Yet the communities likely to be hardest hit happen to be in the best position to duplicate our success. Many small rural towns have community colleges nearby. Such institutions may be a vast untapped source of future laboratorians-if you take the time to venture onto the campus for some serious public relations work.

The best resource for hospitals and universities to combat the shortage crisis Is to share our skills. Educators are pros at grabbing the students' interest and revving them up for an intensive onsite sales pitch at the hospital. Hospital personnel, in tum, can promote a budding interest in health care and help convince students to enroll in a medical technology program. If all goes well, many will return to the hospital as badly needed health care professionals. At least, that's our plan. In a few more years, we'll know just how well it's working.

Since two of the most vital concerns of the private laboratory are the quality of work produced and the time needed to produce it, we are always looking for ways to improve both. The former is fairly well assured here in Canada, where the Government's Laboratory Proficiency Testing Program regulates quality control standards. Turnaround time thus becomes a competitive selling feature of paramount importance. Yet at our lab, this feature needed considerable improvement.

Our reference laboratory has a customer base of 2,500 to 3,000 physicians, 20 nursing homes, and 10 to 12 referring labs. Our satellite operations include approximately 25 licensed blood drawing facilities throughout the greater Toronto area. The substantial volume of our workabout 2,000 tests a day-was causing a bottleneck at data entry.

The problem wasn't with specimen and test requisitions, which were being processed quickly enough. The real backlog was a two-hour delay from the time we received the specimen until testing began. In fact, most of our work ended up being processed in batches even though our lab is equipped with random-access analyzers.

* Seeking a solution. Having defined the problem, we began to look for a way to allow immediate entry of test request data. One attractive solution was to obtain a piece of equipment called an optical mark reader. We had read about ways to integrate these devices with PC-mainframe interaction and some light bulbs went off. This seemed to be an excellent solution.

Naturally, any change of this magnitude requires a tremendous amount of planning and communication on all levels. Initially the idea was developed behind closed doors by a small group. We started by exchanging some preliminary ideas about whether the optical mark system could work for us. Having decided it might well be feasible, we moved on to actual design of the form we would need.

We then presented our plan to the Operations Group, our middle management forum, who received the idea enthusiastically. Once they had decided certain minor points-whether to list tests alphabetically or by frequency, for example (the former)-the idea was approved by the next rung up in the hierarchy, the Laboratory Upper Management Group.

A crucial ingredient for success, we felt, was to obtain the full support of those who would be most closely involved in operating the system. These workers included our specimen handling department and phlebotomists at our satellite facilities. We prepared a video and routed it to phlebotomists at our various locations, This video explained why we were implementing the optical mark system and how to fill out the special forms it would require. We solicited viewers' ideas on how to ease the transition: Would it be better, for example, to fill out the forms when each patient first comes in or after the blood has been drawn?

Once everyone was in tune, the form finalized, and the equipment ready to go, we underwent a period of intense testing from July through October 1987. In November, the day finally arrived to begin the first run.

* Initial trial. Rather than starting the new program in all our locations at once, we brought in a few at a time at scheduled intervals . This slower process allowed us to correct certain problems, such as adjusting the wording on the forms, before using the system on large volumes of work.

One particularly attractive feature was ease of transition: The system could be used simultaneously with our old one for a while. We did this for one month. Since the inherent benefits of the optical mark system made our old one seem dim by comparison, we had full support when the changeover date arrived in January. By that time we were registering test data as quickly as a cashier can process a lottery ticket.

Once the system was in full swing, it reduced our turnaround time by one to two hours. To understand the impact of the transition, we will explain how we had operated before.

*Former protocol. Personnel at our satellite centers used to assign a number to each test request and specimen. For each, a number code determined by the Ontario Health Insurance Plan was entered on a requisition formwe call the forms "reqs"-provided by OHIP. These codes, which cover more than 500 different tests, are used by all Canadian physicians. Once a physician has signed the form, it becomes a legal document entitling a laboratory to perform the test.

It was crucial for our personnel to be very familiar with the codes; otherwise, they would have had to refer to coding books continually. Because this system had many opportunities for mistakes and miscodes, several verification steps had to be taken throughout the course of processing.

Our company-run courier depanment delivered specimens and test reqs to the main lab. There, specimens were verified according to information on their labels. A manual coding check was included in this step. The specimens were then available for processing and the reqs ready for data entry.

At entry, the information from the OHIP test req was transferred to our system by two screens of data: one for patient demographics and one for test codes. Up to 40 tests could be keyed in for one req, and there were 50 reqs per batch.

Once keyed, each batch underwent another verification stepthis one by duplicating entry to eliminate the possibility of miscodes. The system highlighted any discrepancies by pointing out possible keying errors. Total time involved for data entry was 40 minutes per batch and 50 minutes for verification.

Due to the time lag, some departments then began testing. The specimen's test identification was transferred to a hand-generated worksheet and later matched to computer-generated worksheets for result entry. Although we discouraged this procedure, we sympathized with the reason for it. Technical departments would otherwise have had specimens waiting around for data to be entered and verified.

*Our new system begins. One of the first steps in instituting the optical mark system was to research and test the reader itself. We started by designing a preliminary form that listed the various tests we provide, "bubbled in" (filled in) the open circles beside the names of the tests we wanted, and ran it through to see whether it matched the work requested.

Designing the form was the longest and toughest part of the project because it involved incorporating so many tests. Complicating things further was that each department wanted a different format for its section of the form. We ended up listing a separate selection of tests alphabetically under each department, even though this resulted in some duplication.

The model of optical mark reader we purchased was the smallest in a line of goods produced by the chosen manufacturer. The p. ice was about $1,600 in U.S. dollars. As it happens, the type of machine we chose is rarely used in laboratories; it's used most often by educators, for test scoring. For our purposes, however, the model was excellent. The device can read 600 documents per hour-far more than enough for the 1,800 documents we process each day, with plenty of room to grow.

We decided to purchase two readers so that we would always have one available for backup. Both were connected through an A-B switch to a personal computer, which collects data from the reader. The information is then downloaded from the PC to our mainframe. The PC stores data that has been run through the reader. An emulation board allows data to be transferred to the minicomputer that runs the laboratory's main system.

Specimens, reqs, and optical mark cards (we use the term "card" interchangeably with "form") are prepared by our satellite collection centers and brought to our central location by courier. Upon receipt, the specimens and reqs are placed together in transport containers and routed to the processing line. The cards are channeled to the optical mark reader.

A lab worker runs the cards through the optical mark reader. The specimens and reqs are verified for specimen requirements, accession number, patient information, and specimen integrity. While the manual specimen manipulations are being carried out, the optical mark reader is loading patient name, accession number, and test reqs into the computer, generating worksheets. Figure I shows a sample of our form and explains the scanning procedure step by step.

The lab assistant who oversees the optical mark reader is responsible for answering the various edit checks and correcting errors as they arise. This position has become one of the most demanding in the processing flow; in fact, the staff have affectionately dubbed it "the hot seat." All staff members in specimen handling rotate in that post weekly. To do so, they must have a thorough understanding of reader operations and troubleshooting. A side benefit is that they have all attained a solid grasp of how samples and requisitions progress from raw form (test request) to finished product (a report of test results for the physiclan who sent the request). Such a comprehensive understanding of the process enhances the staff's knowledge overall and makes them more aware of what their coworkers' jobs entail.

Once a report has been printed, optical mark cards are kept for five days. A summary report indicating what tests were generated by the reader is kept on file for one month. After this time, such information can be accessed from our minicomputer. This storing process is needed to identify any testing errors that may have resulted from a wrongly shaded bubble or a misread optical mark card. Fortunately, both errors, happen very rarely. In fact, our record since we instituted the optical mark system is even better than our previously respectable one.

* Success. The optical mark system enabled us to eliminate bottlenecks by providing a more rapid form of test entry than anything we had done before. In addition, the specimen handling department, which had previously served only to verify reqs, now has an additional responsibility: running the reader. All workers in that department are now computer literate and using sophisticated machinery. This in turn has given our lab assistants greater self-esteem and improved morale.

Plans are under way to include bar code labeling in the specimen handling department. The simultaneous processing line will make it possible to connect the coding directly to the optical mark system. The simultaneous processing line will permit labeling. This procedure will be an extremely valuable addition in that it will help identify any problems in a given test run before the work has left the department.

We also intend to use the optical mark reader to automate entry of urinalysis and microbiology results. Results in paragraph form can be generated by keying in the corresponding number.

As time goes on, benefits we never anticipated continue to crop up. We can now load the system even when the main laboratory computer is down, for example, because the PC can function independently of the mainframe. An additional advantage is that new staff members don't have to spend two to three months memorizing those 500 codes, as they used to. Within three days they become an integral part of the staff and are pulling their own weight.

We have been pleased and satisfied with the results of the optical mark system. Learning to look not only at the newest and most expensive technology available but also at other options marked a step forward for us. We feel a great deal of pride in finally implementing a system to automate requisition entry-a process we formerly considered impossible.

What we didn't do In our quest for a solution to our work flow problems, we investigated many approaches. The following didn't work for us, but would be useful in other situations-smaller labs, for example, or larger ones with fatter budgets. *Direct data entry. We could have had workers in our satellite locations enter data in our computer directly via remote terminals. This procedure would have been ideal: As the specimens were making their way to the lab through the courier department, the patient demographics and test data would already be in our system awaiting their arrival. We had to abandon the idea, however, because the cost and logistics of implementing such a plan were beyond our budget. Other disadvantages included the need for extensive personnel training, unrealistic space requirements, possible slower response time on the main computer, and the necessity to retain a coding system we had hoped to abandon.

* Optical character readers. Manually typing each test code and using an optical character reader to enter requisitions via bar codes was another choice. The test codes would have had to be typed onto the requisition for the machine to scan. Once again, equipment outlay-placing type:writers at all our locations, training phlebotomists to become typists-made this an invalid alternative. In addition, we would still have had to deal with all those codes.

Another possibility was to equip every satellite location with a personal computer on which the staff would key in information. This had some of the same problems as our second option.

* Templates and wands. We considered a process whereby a plastic template containing bar codes is placed over each test requisition, which is then read with bar code wands. Because so many tests are involved, however, this system was not feasible for us because the bar code labels would have had to be so small as to be virtually unreadable.

*Miscellaneous rejects. We considered using automated handwriting scanners, but they were not accurate enough for our purposes. Another idea was to install bit pad tablets, in which a button is keyed to register a specific test. The large number of codes squelched this possibility, since we would have needed a massive bit pad to accommodate all 500plus of them.

Partial keying-entering only enough information needed to generate a worksheet-was a strong contender, but less efficient than the optical mark system, our final choice.
COPYRIGHT 1989 Nelson Publishing
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Title Annotation:medical technologists
Author:Chamness, Madge S.; Johnson, Debra R.
Publication:Medical Laboratory Observer
Date:Sep 1, 1989
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