Lab administrators' role in retaining professionals.
Recruitment efforts have been undertaken nationwide by a variety of professional societies and individuals to address the severe personnel shortage in the clinical laboratory field. Since most efforts concentrate on recruiting students in high school and junior high school, we should begin to see results in the next five to 10 years. But what about the next two years? What about next month or next week--or tomorrow morning?
Short- and long-term answers to stanching the "bleed" of professionals from the field are in the hands of laboratory administrators. I define administration as a team of pathologists and medical technologists working together to direct a laboratory. The makeup of this team has been successful for many years in meeting the daily challenges of managing clinical labs and producing high-quality results. These efforts, however, are currently threatened by the inadequate number of people entering the field. The administrative team faces perhaps its greatest challenge of the 1990s: recruitment and retention of laboratory professionals.
* Zero in. While recruitment is the duty and responsibility of every laboratorian, administrators should focus mainly on retention and image-building strategies. In this endeavor, supervisors, managers, and pathologists must be committed to making retention their chief priority. Every decision made by management has some impact on retention.
The key areas to address in promoting retention include employee compensation; career ladder development; image building; work environment, including both the physical plant and nonphysical aspects of the lab atmosphere; management of the individual staff member, including fulfilling employee needs; and incentive programs.
* Climate survey. Our lab is located in a 871-bed tertiary-care teaching hospital with active trauma and transplant services. Because I was interested in finding out how employees felt about their work environment, I decided in 1987 to conduct an anonymous climate survey among all 230 members of our laboratory staff. The response rate was 60 per cent. Figure I lists some of the questions we asked.
Distributing a survey carries the responsibility to make changes. If you are not committed to making a difference in the areas cited as problems, don't conduct a survey.
A large majority (92 per cent) of our respondents cited salary as their No. 1 job dissatisfaction. The next two most important factors were lack of opportunity for advancement and lack of subjectivity on performance appraisals. Our laboratory director took these results seriously. We embarked on an intensive effort to achieve two goals: to increase levels of employee compensation and to introduce a career ladder. We were successful on both counts.
* Hiking salaries. Improving compensation levels requires a lot of homework, the ability to persuade, and persistence. The lab manager who wants to upgrade staff salaries must gather a great deal of information, as described below.
* Climate survey. Asking current staff to rank sources of dissatisfaction is almost sure to demonstrate that salaries are a major source of disgruntlement.
* Turnover and vacancy rates and costs. It is critical to determine current and past turnover rates and to calculate how long it takes, on average, to fill each vacant position. In our case, I estimated filling each market-impacted position, such as that of a medical technologist or cytotechnologist, costs at least $20,000.
I arrived at this amount by calculating the cost and time of all the factors involved in filling a position: advertising, processing applications, overtime paid while the position remains vacant, interviews of applicants by the human resources department and lab management, and training and orientation of the new employee. Using this estimate, you can determine the annual cost of laboratory turnover for your institution.
Through exit interviews, clearly document reasons for turnover. Determine the monthly vacancy rate in the laboratory as well as the impact of vacancies on services--a delay in turnaround time for Pap smears, for example.
* Market survey. Knowing the job situation in the surrounding area will help you establish which positions are market-impacted--that is, the ones for which demand exceeds supply. Call institutions similar to yours to learn entry-level starting salaries for MTs. Ask how much weight is given for experience and what the maximum hiring rate is for the pay scale in which technologists are placed.
Laboratory management should choose the hospitals and institutions to survey. They are more likely than the human resources department to know which facilities compete with yours for staff.
* Salary survey. Perform a salary survey of the other degreed allied health professionals within your institution. The results may reveal substantial inequities that could be used in an appeal for equity within the hospital.
* Cost of projected raises. Determine how much the desired rates would cost your hospital. An important factor: To what extent does your institution wish to compete against neighboring ones? In our case, we wanted our salaries to be in the top 10 per cent of those offered by nearby facilities.
* Position descriptions. Describing in detail the medical technologist's role in the lab helps to establish the laboratorian as a professional. Focus on critical areas of job performance, especially as related to patient care, such as those listed in Figure II.
Review the National Labor Relations Board definition of a professional employee. When writing position descriptions, incorporate statements compatible with that definition. This step may be useful for job classification, especially in union negotiations.
* Productivity statistics. Use the CAP Workload Recording Method to document lab productivity. Gather data to show that your laboratory is a revenue producer for the hospital and is controlling costs in the nonsalary area. In recent years, the lab has been viewed as a cost center when in fact it is still the major revenue producer in the hospital.
Once all information has been accumulated, powerful persuasion by the laboratory director is the final step in inducing hospital administration to increase compensation levels. The lab director's ability to bring this issue to the forefront is a significant factor in achieving the desired results.
At our institution, such efforts paid off big: We obtained a 24 per cent increase in compensation rates for every position in the department, including supervisors. Note: Do not increase MT entry-level salaries without raising all steps of the pay scale in all job classes. Doing so would antagonize current employees and impede retention.
* Career ladder. Developing a career ladder is the next key area to address in promoting retention. In many laboratories, opportunity for advancement has traditionally been limited to a few management positions. Technologists were not rewarded sufficiently for technical competence and expertise. The career ladder we developed, illustrated in Figure III, permits upward mobility both for individuals skilled in management, who can progress to supervisor, and for technical specialists and experienced technologists who prefer to remain in a nonsupervisory capacity but wish to advance in their careers just the same.
In developing our system, we realized that most of our assistant supervisors were really technical specialists. Therefore, a title change was appropriate. The lab should provide an adequate number of positions for technical specialists in relation to the total number of FTEs. At our complex lab, we have 20 technical specialists on a staff of 230 FTEs. The many specialists who have no desire to advance to supervisor can be rewarded for their technical expertise.
* Automatic move up. The most important advantage of our career ladder in retaining technologists for the first five years of employment is a guaranteed promotion to senior technologist after three years of service at our institution and two years of above standard performance as an MT. Staff members must attend two continuing education programs a year to be considered for promotion.
Our goal in this regard is to make a majority of technologist positions those of senior techs. Important responsibilities can then be delegated to these experienced technologists. The quality of the work we produce will improve as retention and the level of staff experience increase. Lab administrators who wish to institute a career ladder must be prepared to justify the cost of automatic upgrades by explaining to hospital administration the financial benefits to be derived from decreased turnover and increased quality and job satisfaction.
* Building status. Open recognition of MTs as professionals within the institution is critical to their job satisfaction. Hoe can this be accomplished? One way is to increase the visibility of lab professionals on committees and in other activities within the institution. Routinely demonstrating a professional attitude and communicating positively with other hospital staffs will bring laboratorians into the limelight.
The high quality of service provided to consumers--patients, physicians, nurses--will substantiate the quality of the professional as a provider of that service. Involvement in QA is instrumental in enhancing others' recognition of laboratorians as fellow professionals within the institution.
Pathologists play a key role in upgrading the image of laboratory professionals to the medical staff. Pathologists' daily interactions with physicians who use the lab provide many opportunities to boost the status of laboratory professionals. Pathologists may wish to include technologists when discussing cases with other physicians, for example, crediting the technologist for his or her role in diagnostic testing. Highly effective are statements such as this: "Andrea Jones, our cytotechnologist, was the one who picked up on this abnormality and brought it to my attention, Dr. Smith." At appropriate times, the pathologist may explain to clinician colleagues the critical role played by cytotechnologists and other specialists in the lab.
The laboratory director is responsible for insuring that the laboratory and its professionals are highly visible to the hospital administration, and their accomplishments recognized. Lab directors can accomplish this by perpetuating the lab's active involvement in decision-making activities in the hospital and by positioning the laboratory properly, with a direct line of communication to top administration. It helps if the laboratory director is in a strong position of power. Serving on key committees in the institution will help the director bring the lab to the attention of others and garner support.
* Happy home. In the laboratory, rising costs--and, quite often, managerial indifference--may cause problems in the work environment to be overlooked. In a job market as competitive as medical technology, this practice is fatal to retention efforts. Although the physical environment may be more difficult to control than the nonphysical environment, every attempt should be made to provide an adequate level of comfort and safety. Management must respond to all safety concerns, however trivial they may seem. Much more important to job satisfaction is the emotional atmosphere. Is it supportive and nurturing or does it stifle professional growth and development? Does it welcome or discourage employee suggestions and active involvement in decision making?
Because continuing education funded by the institution is fundamental to employee satisfaction, make every effort to improve CE funding. Be innovative. For example, ask each pathologist and vendor to donate to the cause, explaining how important it is. Pathologists may be willing to donate money to keep the staff happy. Surprisingly few vendors are ever approached, yet most have the resources to provide programs and speakers for the benefit of the laboratory employees--and are eager to cooperate.
* High-quality crew. As many technologists responding to our climate survey indicated, laboratorians want to be part of a professional team producing a top-notch product. Hiring team players and developing team-building strategies often improve the spirit in the laboratory. The professionalism of the team has a profound effect on retaining current employees and on whether students currently training in the lab will remain in the field.
Recently some clinical laboratories have reacted to the MT shortage by hiring noncertified workers to be trained on the job. This practice is devastating to the retention of certified laboratorians, who wish to work on a professional team. QA efforts are integral to producing a product in which employees can take pride. Unless they feel that they are contributing to a top-notch operation, many lab professionals will leave.
* What makes them tick? Laboratory administrators and supervisors can improve retention by learning to manage and appreciate each employee as an individual. Labs possess a wide mix of employees, each with a personal value system and a unique set of motivators. Different "triggers" stimulate younger and older employees. Various management styles are required for different employees. The majority of MTs require little direction or supervision but a great deal of challenge and recognition. They want to work independently and grow professionally. Let them!
Most technologists value the opportunity to be involved in such nonroutine activities as QA, teaching students, research and development, committees, troubleshooting, computer work, and CE. Scheduling off-the-bench time for these activities will reduce tedium and provide a challenge. Rotating these responsibilities gets everyone involved and heightens job satisfaction.
Finally, recognize the individual employee as a person first and as a professional second. By acknowledging the employee's contributions both within the laboratory and outside it, you will foster a feeling of commitment and loyalty to the institution.
* Incentives. It is vital to reward excellent work habits and skills and provide motivation for future performance. Incentives may take the form of monetary or nonmonetary compensation. Monetary rewards for outstanding work habits or contributions may consist of year-end or one-time bonuses.
Incentives may also be incorporated into a merit raise system if the benefit is great enough to motivate employees. Properly designed and administered performance appraisal systems with standards create incentives toward improved performance. Merit raises for above average and exceptional performance should be high enough to serve as an incentive. Merit raises, promotions, and the opportunity to participate in additional CE are fine ways to show appreciation and respect.
Laboratorians have been undervalued economically and professionally for many years. Administrators, now faced with severe recruitment and retention problems, must develop multifaceted approaches to address retention issues and to provide salaries and working conditions that will draw qualified candidates to the profession and keep them. This effort will require teamwork on the part of pathologists and MTs as well as their sincere commitment to make the clinical laboratory a desirable place to work and grow.
Michele L. Best, MT (ASCP) is director of laboratory quality assurance and human resources in the department of pathology, Washington Hospital Center, Washington, D.C.
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|Author:||Best, Michele L.|
|Publication:||Medical Laboratory Observer|
|Date:||Aug 1, 1990|
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