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Using schedule rewards to boost productivity.

In our 120-bed hospital, we developed an unusual method to recognize individual effort by laboratory employees.

Before it was tried out for six months, some staff members tended to avoid performing their share of work ordered and totally ignored non-urgent tasks. With the new method, these same employees performed more than their share of work promptly and also rushed to complete non-urgent tasks. This increased the productivity of phlebotomists by 38 per cent and bench technologists by 43 per cent.

Our idea was to measure the productivity of individual technologists and phlebotomists; then we would give the top producer in each employee category the first choice of available shifts when we prepare the next monthly schedule. The second most productive employee would get second choice, and so on down the list to the least productive person, who would have to take the remaining shift.

Since many laboratorians have strong preferences for the shifts they want to work, this is a big incentive to become as productive as possible. Our hospital laboratory is staffed 24 hours a day, 365 days a year. The day shift, Monday through Friday, is generally popular, while nights and weekends are generally unpopular.

The most junior staff members automatically draw the undesirable shifts at most hospitals. That discourages them and deprives them of valuable day-staff feedback on their progress. Our approach can overcome these problems.

The yardstick we use, productivity, is the sum of all useful work done in the laboratory divided by the time it takes the staff to do the work. The problem is that test orders from doctors tend to pile up at times and slow down to a trickle at other times. Employees, however, can perform many tasks during slack periods, such as cleaning instruments, calibration, keeping track of inventory, entering test charges, and filing.

Our incentive plan made these tasks (some of which had been performed by supervisors) available to employees as a means of filling up their lulls. No one could thereafter claim, as a reason for low productivity, that there was nothing left to do in the lab.

To determine how well each employee was doing, we started with the College of American Pathologists' workload recording method. Distortions result when the CAP method is used to measure individual productivity, since the workload units for a laboratory test include time spent on clerical and administrative tasks. To assign the whole value to the technologist who performs the test makes that technologist look more productive than he or she really is.

On the other hand, the CAP method does provide a relative workload value for each test, and to set up a new set of values from scratch would be a tremendous undertaking. Using the method is a valid way to compare a group of laboratorians, since the same (though somewhat inflated) values are applied to all.

For our incentive plan, we augmented the CAP method with estimated values for cleaning, calibration, and the other administrative components of each test.

The extra bookkeeping was not burdensome. Since technologists initialed lab slips and logs for all the tests they performed, it was easy to identify their work and compile the data. We multiplied each test by its CAP value and added on credit for administrative tasks, using estimated values based on crude time-and-motion studies in our lab.

At the end of the month, the assistant laboratory supervisor tallied the daily scores and divided the sum by the number of hours worked to determine each staff member's productivity. She also prepared the monthly schedule, which is posted 30 days in advance. For the February schedule, she used December productivity levels, asking the highest producer to pick the shift preferred and working her way down the list until the schedule was set.

As we noted, the day shift, Monday to Friday, was the overwhelming favorite. The top phlebotomist took that assignment each month, and the runner-up had to work the evening shift. The three most productive technologists were guaranteed a daytime schedule, while the other two had to choose between evening and night hours.

With a staff our size, it took the assistant supervisor about 90 minutes to compute daily individual productivity and another two hours at the end of the month to total the scores. She used a pocket calculator, but a computer program could provide the same information in considerably less time. In any event, the increase in individual and overall productivity had far greater dollar value than the managerial time taken to perform the computations. No dollar value can be placed on another outcome: the considerable improvement in general morale.

Statistics from the incentive program were impressive. There were five bench technologists when the program started and four when it ended; their collective productivity rose 43 per cent, as we mentioned earlier. The two phlebotomists raised their productivity by 38 per cent, which also bears repeating.

In addition, the program helped even out individual workloads, as we had hoped it would. For example, prior to the six-month trial, the top producer among our technologists performed 45 per cent more work than the low producer, By the end of the trial, the spread had shrunk to 11 per cent.

In terms of our modified CAP workload units, the laboratory had a daily net gain of more than 2,200 units (2,300 minus the 90 minutes spent on program statistics each day).

There were several other benefits. To start with, laboratory personnel had complete control over this system of reward and punishment. Anything that has to be approved by administrators outside the laboratory, such as merit raises, will at a minimum greatly delay rewards, and may be totally ignored.

The privilege of picking one's hours is a major morale booster. It is also more important than extra money to some employees, once they attain a necessary salary level.

Finally, the incentive for higher productivity lets each employee know that he or she is valued as an individual, not merely as part of the laboratory team.

We did not experience a downside to this unique scheduling system. There are potential problems, however. For example, laboratorians could become so competitive that they would cease to function as a team. Morale could drop, and the work of others could be sabotaged if someone became desperate enough.

Work could also become sloppy, or data could be faked, as employees seek as much productivity credit as possible. And some might find the stress too great to handle, though most laboratorians cope well with moderate stress.

Our productivity-scheduling incentive can be an effective alternative to overtime or additional staffing.
COPYRIGHT 1989 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989 Gale, Cengage Learning. All rights reserved.

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Author:Hooper, Anne D.; Simons, Wanda; Stevenson, Martha
Publication:Medical Laboratory Observer
Date:Jan 1, 1989
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