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The many faces of productivity measurement.

The many faces of productivity measurement

The much maligned and misunderstood CAP Workload Recording system really took it on the chin from laboratorians in the December 1989 issue of MLO. Survey results on productivity and subsequent comments in the letters column failed to show an understanding of how the system works. They also displayed little appreciation of its value as an effective clinical laboratory management tool.

Since CAP has never claimed the system is perfect, why do laboratory managers expect it to do everything for them? And why aren't managers learning how to make it work to their full advantage? Mastery of the workload recording system allows managers to take control of their productivity data and, therefore, have a greater opportunity to influence staffing and policy decisions. Knowledge is power: Full understanding of the system developed by lab professionals for lab professionals puts the manager in the driver's seat. * Use the system properly. Forty per cent of those surveyed by MLO said they did not find the system to be effective. Negative comments focused on the lack of units for non-workloaded tasks and the need to maintain the system to satisfy administration. Even those who used it for staffing didn't know how to analyze decreased productivity data when changing from manual to automated methods.

The answer is simple. If your number of units per hour decreases in a department that has just been automated, you will now need fewer staff members to produce the volume that was previously performed on manual equipment.

Even more surprising to me in the MLO report was the low number (18 per cent) of respondents who use the system to monitor employee performance. Why? Perhaps the reason is a lack of specific performance standards for sections, shifts, or, in the case of supervisors, individuals. To apply workloading to employee performance, however, you must be sure the data are accurate. A team approach to production works best. * Homegrown technique. Many labs have circumvented the supposed CAP deficiencies by setting up their own systems based on billable tests or raw counts. These approaches can be more detrimental to the lab than the CAP system. Neither route discriminates on the basis of complexity of tests or testing methods. Using billables, which do not reflect repeats, standards, controls, or specimen collection, can skew your data. In addition, if a panel is being billed as one test but includes many, your results will be inaccurate. If you continue to keep manual counts of these tests, you won't reduce your paperwork at all.

These minor operational adjustments can be accommodated by instituting the CAP recording system in your laboratory as it is meant to be useed. * Bonus. Failure to use the CAP non-workloaded activities formula is the major error managers make in regard to productivity management. The formula not only allows you to assign specific hours to all those administrative duties, paperwork, and extraneous service-driven activities but also attaches a dollar figure, translated into FTEs, to them. You can use that figure to show the administration what you are really doing in the lab and the cost of doing it.

The methodology for capturing standard non-workloaded activities is described in the CAP Workload Recording manual. You should also take the time to evaluate service-driven and other external activities that have a major impact on the efficiency of your operations.

The following questions should provide some insight into your operation, as appropriate: * How much extra staffing do you need because you are a Level I trauma center? * How do the requirements of your speciality clinics, such as oncology, affect your ability to batch tests? * Do some VIP physicians make unreasonable demands for turnaround times or special tests at any hour? * Do your Stat and ASAP orders - if you're still accepting ASAPs - exceed 20 per cent of your volume, forcing you to staff the laboratory for maximum rather than for minimal to optimal coverage?

If you answer yes to these questions, you are performing a disservice to your staff, patients, and hospital by not assigning workload units to these activities. Merely using the measured CAP units (units per paid hours and units per worked hours) will not tell the whole story. By using the non-workloaded data, you will provide your administration with a much better understanding of how certain medical staff and administrative policies alter your staffing level in ways that the comparative data may not show. You might also eliminate some interdepartmental problems by pointing out tasks you are forced to do that would better be handled by other departments. * Survey performance. Use the data internally to see whether your systems and operations are performing efficiently. Do your non-workloaded activities fall within the identifiable range - from 20 per cent for an average community hospital to 30 per cent for a large teaching hospital? Does the time that is devoted to basic administrative duties exceed two to three full-time equivalents? What other activities represent suspiciously large amounts of labor time? Once you have measured these as well as all other duties, you can begin to ask why some may be so high. Analyzing the data will help you resolve longstanding intra- and interdepartmental problems. * Outcome. Gathering the data you need will not be a major burden to the laboratory. Once an initial time sampling of one to two weeks has been accomplished and annualized and apparent outliers have been verified, the data need be checked only periodically unless a major change occurs in operations.

When I am conducting laboratory operations reviews, I ask management to collect the non-workloaded data for analysis. I find that they are usually astounded by the results. In addition, administration is impressed with a report that attaches dollar signs to specific areas for which the lab has requested extra staffing. Scrutinizing the figures at the bottom line helps administrators to become more sympathetic to laboratory concerns.

Administration is even more pleased when the laboratory initiates appropriate changes in its delivery of services or suggests ways in which other departments might change to help reduce lab staffing.

Either way, laboratory management demonstrates a sophisticated and knowledgeable approach to administration of their department by producing irrefutable and convincing figures. The CAP Workload Recording system is not to be feared or unjustly criticized as falling short of expectations but rather to be appreciated and forged into your own personal management tool.

Annamarie Barros, M.A.

The author is a management consultant and educator; director of Health Management Analysts, Los Gatos, Calif.; and laboratory operations adviser, Ernst & Young, Great Lakes Region, Cleveland.
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Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Apr 1, 1990
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