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Our experience with a 7-day-on, 7-day-off schedule.


Five years ago, R.H.D. Memorial Medical Center faced the same financial upheaval as many other hospitals. Diagnosis Related Groups had arrived, intensifying the competition for available health care dollars. Plus we were in the midst of changing from a non-proprietary hospital to a proprietary facility.

This 425-bed health care complex serves a population of 50,000 in a Dallas suburb. The challenge, of course, was to work within the new financial constraints while meeting the lab testing needs of the hospital's 340 staff physicians.

We worked our way through the usual staff stretching alternatives, but the results were disappointing. Part-timers and splitshifters often lacked commitment. The MT registries bailed us out of the occasional staffing crisis, but the Cost was just too prohibitive for routine use.

Eventually we came back to the oft-discussed possibility of trying a 7-on, 7-off schedule. The staff was somewhat skeptical, but the plan certainly had merit. It would insure round-the-clock coverage by experienced laboratorians with no more last-minute scrambling to keep the weekend and holiday shifts fully staffed-those On hand Thursday and Friday would still be around throughout the weekend.

Fourteen laboratorians-eight technologists and six phlebotoMists-anxiously signed on. Spurred by the staff support, we devised a new laboratory schedule and prepared to make the switch. First, the new 7-7 staffers were encouraged to use up any accrued vacation time.

Participants were divided into two teams-four technologists and three phlebotomists for each of the two weeks in the 7-on, 7off rotation. (A subsequently modified version of the schedule, with two phlebotomists per 7-on, 7-off team, is shown in Figure 1.) Each 7-7 laboratorian would work seven Consecutive 10-hour days followed by a seven-day break. Six laboratorians continued on the traditional 5-2 schedule-the department head, three technologists, a clerk, and the receptionist. These staff members had to be in the lab during routine business hours,

The hospital pay period runs from Sunday morning through Saturday night; the 7-7 Staff members would begin their work week on Thursday. By scheduling 30 hours in one pay week and 40 hours in the other, the laboratory could eliminate the pitfalls of "artificial" overtime. Should overtime be necessary, employees would be paid time-and-a-half for any extra hours they worked during the 40-hour week. If a laboratorian stayed late during the 30hour week, the first 10 hours of the overtime would be paid at the base rate.

In a typical pay period, laboratory personnel work 80 hours. The 7-7 staff, however, logs just 70 hours during that same time period. The hospital offered 10 bonus hours per pay period as a trade for vacation time and holidays. With the prospect of 26 free weeks each year, staff members didn't mind sacrificing their traditional vacation time. To avoid the nightmare of scheduling holiday coverage under such a system, we simply decided that staffers would be responsible for working any holidays that fell during their seven days on.

This plan saved us untold scheduling aggravation and gave 7-7 employees an annual bonus of almost 40 extra paid hours: Consider that most of the 7-7 staff members were eligible for the maximum of four weeks' vacation, which equaled 160 non-productive hours. Add in another 64 hours for the eight paid holidays the hospital offers, and the total paid time off equaled 224 hours annually. In place of these hours, employees received 10 bonus hours per pay period or 260 nonproductive hours annually. This 36-hour difference represented money in the laboratorian's pocket. Newly hired employees received the same bonus time as long-term employees.

Unlike the traditional schedule, these non-productive hours do not require an assist from part-time help or contract Labor. Overtime is almost unnecessary. Traditional vacations and holidays have been eliminated, and thus there is no need for special overtime scheduling. However, 7-7 laboratorians are paid time-and-a-half when they must work on a holiday.

Although these staff members do not accrue holidays and vacation time, they do receive such benefits as sick days, bereavement leaves, educational days, paid time off for jury duty, and leaves of absence. If a 7-7 laboratorian were to decide to retum to the traditional 5-2 rotation, he or she would once again begin accumulating vacation days based on seniority.

The 7-7 schedule delivered as we had hoped. For starters, we saved 88 hours of technologist time each week and were able to trim nearly two FTEs (Figure 11). We did see a weekly gain in hours for the phlebotomists and the lab clerk. This increase was partially offset, however, by letting attrition eliminate the laboratory assistant position.

The staggered 10-hour shifts gave the laboratory substantial overlap, which helped ease the crunch when the workload peaked unexpectedly. First-shift 7-7 laboratorians began coming into the lab at 6 a.m., with the last 7-7 third-shifter leaving at 7 a.m. The wide selection of starting times let everyone pick the "workday" that best accommodated his or her personal circumstances.

Although we never conducted formal productivity studies, we do know that performance picked up. We were not only able to process more work with fewer FTEs, but we also brought several procedures back in-house-including thyroid profiles, some of the isoenzymes, and nearly all of the electrophoresis.

The unconventional schedule was a boon for laboratory morale. The 7-7 staff was quite contented. There was little concem about burnout and no grousing over a real or imagined lack of advancement. Instead, the laboratorians focused on their free time. Some pursued hobbies; some were able to spend more time relaxing with their families at vacation homes; and some chose to earn extra money as part-timers in other laboratories.

From a management perspective, it was a great relief to know that a certified medical technologist would be in the lab at any given time. The staff was honorbound to show up during their designated weeks, and they did. The 7-7 program's built-in shift overlap helped reduce the need to bring in pool personnel when the 5-2 laboratorians were out sick or on vacation.

Personal commitment is no doubt the reason why the system worked as well as it did. For example, the 7-7 laboratorians very rarely were ill. Whether just coming off a week-long break or winding up their seven-day work stint, they weren't inclined to stay home with a simple case of the sniffles.

Probably the biggest single drawback to this type of schedule is the adjustment staff members must make each time they return to the lab after their seven days off. First, they often see a major swing in patient acuity and lab workload from one 7-7 tour to the next. Second, the rigidity of having to come into the lab for seven consecutive days is always a jolt. However, our 7-7 staff members selected hours compatible with their personal lives and soon settled into the new routine.

A feeling of isolation is another potential pitfall. The 7-7 laboratorians on one tour had virtually no contact with their counterparts on the other rotation and only limited interaction with the traditional (5-2) laboratory staff.

The 5-2 medical technologists were important in providing continuity for the 7-7 teams. They saw most of the 7-7 staffers at one point or another during the seven days on.

The 7-7 schedule got us through some rough times. Staffing priorities change, however, and the lab now favors the more traditional 5-2 work week. What we have done is combine several scheduling options. For example, two night-shift technologists and two phlebotomists continue on the 7-7 rotation-these positions are difficult to fill and this type of schedule is a definite selling point. One of the former 7-7 technologists now works four 10-hour days; the rest of the slots are back in the 5-2 pool.

Based on our experience, the 7on, 7-off system has a lot of potential for laboratories of all sizes. It is important to note, though, 'that not all medical technologists prefer this arrangement, and not all are proficient enough as generalists to handle the demands of the workload. Certain laboratory specialties, such as bacteriology and the blood bank, would probably fare better under a more traditional schedule.

Were we pleased with our lab's performance on the 7-7 system? Absolutely. Would we use it if the laboratory's staffing needs change once again? You bet!
COPYRIGHT 1988 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1988 Gale, Cengage Learning. All rights reserved.

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Author:Andron, Thomas M.; Hunter, Garland L.
Publication:Medical Laboratory Observer
Date:Dec 1, 1988
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