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Turnover rate for clinical lab managers: 20%.

Turnover rate for clinical lab managers: 20%

As fewer students enter the clinical laboratory field and seasoned technologists leave it, the medical technologist shortage has inspired considerable concern and analysis. Hard data on turnover at the top of the lab ladder, however, have largely been lacking.

The purpose of this article is to rectify the lack of data on turnover among lab managers. Data here were obtained by polling labs in Nevada, Oklahoma, Utah, Washington State, Wisconsin, and the northern half of California. The findings were not encouraging: Turnover among hospital-based laboratory managers is running at a surprisingly high 20 per cent.

This project evolved from a graduate course I taught in Atlanta for Central Michigan University. After the graduate students working with me - Bradley, Brigowatz, Ketchersid, and Knudsen - had planned the study format, they returned to their respective states. Peter Peek, a student of mine at the University of Oklahoma, Oklahoma City, subsequently signed on. Knudsen volunteered to collect data for Nevada as well as for northern California. * CEO turnover. As a former hospital chief executive officer, I have monitored turnover trends in the executive suite for several years. Published articles have reported a high rate of turnover among all top hospital executives: 30 to 44 per cent.[1] A later study found turnover among CEOs of 20 to 27 per cent.[2] According to a recent study sponsored by the American Hospital Association, the American College of Healthcare Executives, and the accounting firm Heidrick and Struggles of Chicago, nearly one in four CEOs changed jobs between 1986 and 1987,[3] the year before our study. Determining what that 24.2 per cent turnover rate had meant for their labs was one motivating force for our study. * Methodology. Our goal was to ask lab people at all the hospitals in our respective states whether a lab manager had been replaced during a 12-month period in 1987-1988. We prepared and mailed a questionnaire and included postpaid envelopes. The 1988 American Hospital Association Guide[4] served as our mailing list. Each state coordinator financed his or her own mailing costs. Because California has well over 500 hospitals, we decided to limit the survey there to the roughly 200 facilities located north of San Francisco.

Data requests were addressed to the lab manager at each institution. Responses were returned to their respective state coordinators and then forwarded to my office in Oklahoma for tabulation and analysis. The response was phenomenal. In Oklahoma, for example, 123 (88 per cent) of 140 questionnaires were returned. Of Washington State's 119 hospitals, 79 (66 per cent) are represented. The 444 questionnaires returned formed the basis of this study.

After the last of the questionnaires had arrived at my office, I set up a sheet for each state and separated the data according to the following classifications:

[P]Turnover. The first order of business was to determine whether each hospital had, in fact, lost and gained a lab manager between 1987 and 1988. I kept the questionnaires from the 89 labs that had seen changeover in the managerial ranks and set the rest aside.

[P]Ownership status. Next I analyzed turnover based on who owned the hospital. The AHA Guide lists the following ownership categories: city, county, city/county, community, church, investor, Federal/state, and other, such as regional groups.

[P] Bed size. The study's third classification involved the number of beds maintained for inpatient use. The data were separated into three groups: 1 to 100 beds, 101 to 200 beds, and more than 200 beds.

The results may not be statistically significant, since the sample was limited to six Western and Midwestern states. These states, however, are considered progressive in their health care programs and thus may offer an interesting preview of coming trends for the rest of the country. It should be noted that the data did not reflect any multiple turnover; if any of the labs had had two or more new clinical laboratory managers between 1987 and 1988, the turnover rate would actually be higher than this study demonstrated. * Worst in the West. Hospital laboratories in the far West had the most managerial turnover in the study (see Table I). Nearly half of the Nevada hospitals represented in the survey had replaced their lab managers; so had almost 30 per cent of the hospitals in northern California.

Table : Table I

Turnover by state
 No. of labs No. of labs
State canvassed with new managers Turnover
California(*) 101 29 29%
Nevada 17 8 47
Oklahoma 123 27 22
Utah 42 4 9
Washington State 79 11 14
Wisconsin 82 10 12
Total 444 89(20%)

(*)Data included hospitals north of San Francisco only.

In Oklahoma hospitals, 22 per cent of the respondent lab managers had moved on. Washington and Wisconsin fared better, posting turnover rates of 14 per cent and 12 per cent, respectively. Laboratory managers in Utah were the least mobile; only 9 per cent had left during the 12-month period studied.

The CEO turnover rate for that year was 20 to 24 per cent nationwide. Thus it is safe to conclude that laboratory managers were slightly more inclined than CEOs to stay put, at least from 1987 to 1988. The most job-hopping among chief executive officers took place, again, in the far West. * Hospital size. The study found that the smaller the hospital, the greater the turnover of lab managers. More than half of all hospitals that had lost a laboratory manager between 1987 and 1988 had fewer than 100 beds (Table II). Twenty per cent of the hospitals reporting turnover in the managerial ranks had 101 to 200 beds; the remaining 30 per cent of turnover took place in hospitals with more than 200 beds.

Table : Table II

Turnover by hospital size
State <100 beds 101-200 beds >200 beds
California(*) 7 8 14
Nevada 4 1 3
Oklahoma 20 4 3
Utah 3 0 1
Washington State 5 3 3
Wisconsin 6 2 2
Total 45(51%) 18(20%) 26(29%)

(*)Data included hospitals north of San Francisco only.

The turnover rate of lab managers in smaller hospital labs echoes the findings of earlier studies of CEO departures from comparably sized facilities. Turnover in the top ranks, however, decreased as the number of hospital beds increased. * Hospital ownership. Not-for-profit community hospitals lost the most managerial staff, accounting for nearly one-third of all hospitals hiring a new lab managers during the study period. As Figure I indicates, the turnover rate in these "hometown" hospitals was double that experienced by all other participating facilities. This finding was particularly disturbing in that employees of small community hospitals tend to have strong local ties and would thus seem less likely to leave.

Fortunately, the situation in small labs is less bleak than it appears. The high rate of turnover in these labs is somewhat skewed by the data from California, where 57 per cent of the community hospitals reporting a change in the managerial ranks were located. Factoring out the California data brightens the picture for community hospital labs in the other states polled.

Studies of CEO migration indicate that investor-owned hospitals are most likely to replace top administrators. This trend may reflect the bottom-line approach favored by profit-oriented institutions. Many of these CEOs probably transferred to other hospitals within large corporate chains.

The questionnaire mailed to the 119 hospitals in Washington included a piggyback question asking respondents to cite reasons for any turnover in lab managers. The question was added in conjunction with the Washington State Chapter of the American Society for Medical Technology, of which Ketchersid is president. * Reasons. The news on this front is that there isn't any. "Politics" was offered as the leading reason lab managers had left their jobs. "Don't know" was the next most common response. Other causes of turnover included economics, competition - and death. As suspected from the start, no single explanation exists for clinical laboratory managers' departure.

Nevada respondents were also asked to shed light on this growing phenomenon. Half of the eight who reported the loss of lab managers attributed their departure to retirement, death, or job pressures. The other half said that the staffing change followed the lab manager's termination or the laboratory's reorganization. * A few conclusions. Although many consider a 20 per cent turnover rate much too high, it is lower than the departure rate of other health care professionals. It's important to remember that some managerial turnover is a good thing, especially to eliminate incompetence or burnout.

We should all be concerned by the high rate of turnover in key administrative positions. We must now worry about the dwindling numbers not only of rank-and-file lab workers but also of their top supervisors. Turnover, which is always distressing - not to mention costly - becomes even more so as the legions of new grads to replenish the ranks grow thin.

The brunt of the problem will fall squarely on small rural hospitals. Losing a laboratory manager is tough enough, but when that person also represents 20 or 30 or even 50 per cent of the entire lab staff, the impact can be devastating. Since roughly half of the hospitals in the United States have fewer than 100 beds, the problem warrants our serious attention.

[1] Wilson, C.N., and Mazzara, B. Executive turnover in the Sun Belt. South. Hospitals 55(4): 26-27, July/August 1986. [2] Wilson, C.N., and Meadors, A.C. Executive turnover. South. Hospitals 56(2): 30-32, March/April 1988. [3] American College of Healthcare Executives; American Hospital Association; and Heidrick and Struggles, Inc. Hospital CEO turnover. Healthcare Executive 4(1): 42-45, January/February 1989. [4] "American Hospital Association Guide to the Health Care Field." Chicago, American Hospital Association, 1988.

Dr. Wilson is associate professor and director, center for Health Administration and Promotion, Department of Health Administration, University of Oklahoma City, Bradley is laboratory manager, Brigham Young University Student Health Services, Provo, Utah, Brigowatz is laboratory senior section head, Beaver Dam (Wis.) Community Hospitals, Ketchersid is laboratory manager, MultiCare Medical Center, Tacoma, Wash. Knudsen is laboratory manager, Tahoe Forest Hospital, Truckee, Calif, Peek is assistant laboratory director, South Community Hospital, Oklahome City.

PHOTO : Figure I Turnover by who owns the hospital
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Author:Wilson, C. Nick
Publication:Medical Laboratory Observer
Date:Sep 1, 1990
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