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How rotation can help boost productivity; developing well-rounded laboratory generalists through a hands-on rotation system is one solution to less staff and more workload.

How rotation can help boost productivity

A versatile staff is more efficient, satisfied, and productive than one that is strictly specialized, we discovered.

Our 250-bed hospital laboratory, with its 28 full-time employees, is large enough to be departmentalized during the day. On the night shift, however, one technologist draws and performs all testing. In the past, certain staff members used to cover vacancies on the night shift; one person frequently took on weekends and holiday nights. But this casual arrangement wasn't always reliable, and day shift technologists had to work occasional weekend evenings and nights covering all sections of the laboratory.

Those of us who are specialists during the day, however, needed special preparation to act as generalists. For example, I worked in chemistry all day. When faced with histology work at night, I had to know which of the array of preservatives to use and which procedures could not wait until morning. To keep us up to date on procedures in every section, the lab established a flexible staff development plan that requires all technologists to rotate through other sections.

Early in 1983 the laboratory supervisor began planning a system to carry out this goal on a regular basis. We developed the rotation system for another reason as well: staff reductions that seemed likely in the near future would force day shift personnel to cover other sections during evenings and nights. Of course, a more versatile staff would enhance productivity on the day shift too.

It took about four months to target the activities to be covered and produce a rough draft of the flexible staffing plan. The goal was to equip every staff member to work with confidence wherever coverage was needed. There were two main objectives for the staff: Know how to operate instruments used on weekends and for Stat analysis on all shifts; and become familiar with each section's collection and handling methods, procedures, and policies for routine and send-out specimens.

Our plan called for technologists to identify what they need to learn and go to those sections for training. In many cases that means every procedure in every other section. They rotate through urinalysis, chemistry, special chemistry, hematology, histology, blood bank, microbiology, immunology, and the front office (since we occasionally use the CRT there to record outpatient information).

Section heads responded enthusiastically to the plan draft and added ideas. They listed problems and daily maintenance requirements of instruments used for Stat work in their departments and all possible procedures that might arise on evening and night shifts. Technologists in each section also made recommendations for training.

On the advice of the section heads, we added "diesel check" to the draft plan. Once a month during the night shift, the hospital schedules a test of its auxiliary power system by shutting down main power. Certain instruments must be turned off before the changeover to prevent damage; others must be warmed up afterward before they can be used. Diesel check consists of learning how to prepare the lab for the system test--or for a real power failure.

After these consultations, the lab supervisor drew up a second draft. The evening supervisor reviewed it, added her suggestions, and confirmed that evening and night shift employees knew how to run the instruments listed.

Our final draft of the plan included a checklist of basic requirements for employees to follow as they rotate (Figure I). The list is the same today except for the addition of a new chemistry analyzer and elimination of the hematology stain. When a technologist completes each area rotation, the section head signs and dates the checklist.

The plan went into effect in May 1983, requiring one rotation a year. It stressed hands-on instrument experience from start-up through operation and maintenance to shutdown, and not just verbal review. Section heads work directly with rotating personnel or assign someone else to do so.

Under the system, technologists rotate during slack periods, which have grown more common as the hospital's admissions and lengths of stay have dropped. Technologists coordinate rotations by checking with both section heads, and those too busy to rotate are not penalized.

There is no time limit for completing rotation in a single section, but the rotation should include all items on the checklist. In fact, we did not include the staff development plan on performance evaluations, although that may change if experience shows that technologists are not being adequately trained across all sections on their own. Evening and night shift staff, who already work in all areas, are exempt from rotation, but the evening supervisor must verify their proficiency.

At first, not all employees were enthusiastic. Some thought rotation was a waste of time and postponed it; others contended that they'd never recall every procedure in a section they rotated through 9 or 10 months ago. Others, however, were eager to close the knowledge gap that results from being entrenched in one specialty.

Six months later, a staff cut left us without the technologist who worked the night shift on weekends and holidays. By April 1984, his replacement was no longer able to cover every weekend, so it was decided to have all staff members take turns working the weekend night shift once every six months.

With that announcement, something interesting happened: More staff members began rotating. Many took notes while running instruments and performing procedures as reference aids for their own stint on the night shift.

The plan required an extra measure of effort. Some technologists in busier areas had trouble finding time to rotate and felt obliged to finish all work in their own section first. Teaching medical technology students and running Stat tests also interrupted the blocks of time needed to learn the ropes in other sections.

Before taking on the solo night shift, a few technologists requested evening shift assignment, when other staff members are available for assistance and support. The requests came primarily from microbiologists, who hadn't worked in other areas in years. Now, after more frequent night shift duty, they are far more confident working alone.

Everyone on the day shift has now completed three or more full rotations. I once finished the tour in four months. Urinalysis took only one day; hematology, under two days. Other sections demanded more time. Although participation in the staff development program is not rated on performance evaluations, technologists turn in the checklists after a full rotation for recording in their continuing education files.

These days, we have fewer slack hours. Work is more evenly distributed throughout the day, not just during the morning rush. As a result, spare-time rotation takes longer because we must cover most areas in small increments. Technologists due for a night shift assignment often ask a colleague to cover their work stations so they can finish rotating.

Because we rotate alongside a section's regular employees, inexperienced hands don't slow down the work flow. We try to take refresher tours in a section when its test load is light so we can work at an easy pace without compromising quality.

The program appears to have improved turnaround time on evening and night shifts. We've developed renewed respect for our colleagues in other sections. Even during the day shift, teamwork is smoother because the staff is competent across all disciplines. For instance, our chemistry technologists draw blood for blood gas measurements, and their work used to back up in busy, short-staffed periods. Now technologists from other sections step in to help when we're behind schedule. Thanks to adequate coverage, the day-long supervisors' meetings held four times a year in every section are fully attended and uninterrupted.

The experience of a full rotation has boosted my confidence enormously when I cover the night shift. This is especially true in the blood bank, where I don't often venture. I know what's expected of me and what can go wrong--and I know that when I need to brush up my skills, management offers a standing invitation to do so.

The rotation program is working well despite a slow start. The line-by-line checklist prevented chaos during its introduction, and we can easily revise the checklist when procedures and instruments change.

Now day shift personnel generally make a smooth transition to night work. Once employees make a full rotation, we have two ways to help us remember what we have learned. First, we can take refresher courses; and second, we now receive night shift assignments more than once a year.

Looking ahead, we hope to see technologists using spare time to learn procedures that aren't part of the night shift workload, such as RIA testing in special chemistry. Those who just wish to observe specialized procedures have management's encouragement.

The growing need for generalists makes this rotation system increasingly crucial to our success. After another staff cut in October 1985, we opened a reference lab for local physicians that added to our workload. As night shift coverage and day shift interdependency become more common, we appreciate the results of staff development more than ever.
COPYRIGHT 1987 Nelson Publishing
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Author:Miller, Kim
Publication:Medical Laboratory Observer
Date:Jan 1, 1987
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