Clinical Microbiology Newsletter Vol. 24, No. 9 May 1,2002

Shortage of Laboratory Professionals: Recruitment and Retention Strategies Donna MacMillan, BS MT(ASCP), MBA, Massachusetts General Hospital, Boston, MA

The statistics of personnel shortages in the laboratory professions and the factors contributing to the shortage have been well described. The laboratory profession must recognize the significance of these developments and implement a coordinated strategy to reverse the trends. This article explores several national and regional strategies and describes our efforts at a major teaching hospital. Colleges, hospitals, and industry must develop a coordinated strategy to improve the entry of new workers, retain those in the field, and, most importantly, increase the visibility of their role in health care.

Introduction

The indicators of staffing shortages in the laboratory profession, as well as the underlying factors that have con- tributed to the shortages, are well docu- mented. As the number of baccalaureate programs in medical technology declines, the pool of qualified applicants contin- ues to grow smaller (I), The national vacancy rate for medical technologist positions has increased from 10.2% in 1998 to Il. 1% in 2000 (2). A number of trained medical technologists have left the clinical laboratory to pursue careers in related tields that are perceived to offer greater flexibility and professional growth, a better work environment, higher salaries, or less job-related stress. In addition, as the general population ages, more experienced technologists are retiring and fewer new graduates are available to replace them (3).

In the 1990s conventional wisdom held that managed care would reduce reimbursement, resulting in a consoli- dation of hospitals and thus eliminating

Mailing address: Donna MacMillan, B.S. MT(ASCP), MBA, Administrative Director ofclinical Laboratories, Massachusetts General Hospital, Boston, MA 02114. Tel.: 617-726-8887. e-mail: dmacmillan@ partners.ovg

the need for a large laboratory work- force. Although these assumptions have not yet held true, they continue to impact staffing in a number of ways. Many lab- oratory professionals have left the field to seek employment in seemingly more stable and higher-paid (Fig. 1) sectors, such as biotechnology, basic or applied research, sales, and education. Others have turned to related professions as physician assistant. At the same time, under pressure to reduce the cost of patient care, many hospitals have closed their hospital-based medical technology training programs, which were per- ceived as non-productive costs or as educational programs that were not essential to the core operation of a hos- pital. The market factors are not unique to the specialty of laboratory medicine. Staffing shortages are, in fact, more critical in a number of other allied pro- fessions (Fig. 2). To some extent, the national focus on the shortage of skilled nurses has limited the ability of govem- mental and professional organizations and hospital leadership to allocate resources to those allied professions that were not thought to be involved in the direct care of the patient.

Recently, however, there has been renewed attention to the importance of

timely and accurate laboratory results to the overall care of the patient. This newfound awareness is due in large part to the release of major survey studies like the Institute of Medicine’s report “To Err is Human,” the implementation of quality assurance benchmarks for patient management (such as the HEDIS standards), and the development of new and newsworthy technologies.

The laboratory profession as a whole should recognize the opportunity presented by these developments and implement a broad, coordinated strategy to reverse the trend of staff shortages. This article explores several aspects of a strategy and examines some of

In This Issue

Shortage of Laboratory Professionals: Recruitment and Retention Strategies . . . . . . . .65

Clostridium perfringens-Induced Massive Intravascular Hemoiysis Complicating the Course of Colonic Carcinoma . . . . . . . . . . . . _ 69

A Case Report

NCCLS Update . . . . . . . . . . . . . . . .71

Clinical Microbiology Newsletter 24:9,2002 0 2002 Elsevier Science Inc. 0196-4399100 (see frontmatter) 65

the efforts at Massachusetts General Hospital (MGH), a major academic teaching hospital.

National Efforts Many national organizations are

educating government leaders on the critical shortage of qualifted laboratory personnel and the direct impact this will have on the quality of health care. The powerful presence of several national laboratory organizations in the nego- tiated rule-making process completed earlier this year has provided an oppor- tunity for industry leaders to work with government leaders on key issues and to present a broader picture of the fac- tors impacting laboratory operations.

Testimony has been given to a vari- ety of House and Senate subcommittees responsible for education or health care. The American Society for Clinical Pathology presented vacancy and wage data of laboratories to the House Energy and Commerce Subcommittee on Health. The American Hospital Association appeared before the Senate’s Aging Subcommittee of the Health, Labor, and Pensions Committee. One piece of legislation, the Medical Labo- ratory Personnel Shortage Act of 2001 (Shimkus H.R. 1948), has been intro- duced to amend the Public Health Service Act and will provide incentives in the form of scholarships and loan repayment programs to students in medical laboratory programs.

In addition to seeking legislative relief in the form of training grants and staffing requirements, national organi- zations are formulating a coordinated strategy to address the issues that arise from the shortage of skilled technolo- gists. Two “Summits on the Shortage of Clinical Laboratory Personnel” were held this year, and participants drafted a plan to gather data and educate the general public on the relationship of the laboratory professional to the patient’s primary health care provider. This effort will serve several purposes. First, with more information, the public will

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Source: Salary.com, April 2000 data.

Biotech Chemist

Figure 1. Comparative salaries in relatedfields

0% 5% 10% 15% 20% 25%

Source: American Hospital Association Special Workforce Survey, June 2001 (4).

Figure 2. Comparative vacancy rates

encourage their elected officials, rewarding option for a long-term employers, and health care providers professional career. to ensure that there is consistent access Unlike the nursing profession, in to high-quality laboratory testing for which one or two national organizations all patients. Second, as the visibility can conduct a focused information and of the role of the laboratory increases advocacy campaign, there are numerous in the public arena, students will be established national organizations that encouraged to consider the field as a represent various aspects of the labora-

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66 0196-4399100 (see frontmatter) 0 2002 Elsevier Science Inc. Clinical Microbiology Newsletter 24:9.2002

tory profession. These summits provide an excellent start to a coordinated effort to enhance the profession’s visibility. The most significant challenge for this coalition is to develop a model that measures both the value of the labora- tory’s contribution to patient care and the impact of a staffing shortage on the quality and outcome of patient care.

Regional Efforts At first it may seem counterintuitive

to consider local and regional strategies to address personnel shortages in labo- ratories. The reality is that different institutions are competing for talented professionals in the same evaporating pool. We need to find ways for local organizations to work together on long- range initiatives. That is the only way we will be successful in ensuring the quality of the laboratory profession and the quality of services provided. A major obstacle to cooperative recruitment to the profession is the fact that existing salary structures are generally non- competitive with similar jobs in related fields. Students attracted to the health care industry will gravitate toward other opportunities in which professional growth and compensation are more attractive. This problem should not stop local organizations from finding ways to work together to implement regional versions of national strategies. The for- mation of local consortia of hospitals, for example, may expand the available resource base for initiatives and shift the emphasis from a single hospital experiencing a shortage to a regional trend in the workforce.

Improving the visibility of the pro- fession in the community and educating young students about career opportuni- ties in the laboratory profession are the two most powertul long-range strategies to expand the profession. Local consor- tia of facilities will need to launch this campaign and create opportunities for

Many local chapters of the national organizations are hosting meetings to review aspects of this issue. One of the most productive aspects of these meet- ings occurs when managers share their ideas on both recruiting and retention. It is important to explore successes and failures, since an effort that is not successful in one setting may be trans- formed into a successful initiative in another.

enhancing the visibility of the profession. These efforts will be successful at the local level if the names of specific organizations are connected with the information and the direct impact of shortages on health service in the com- munity is shown. Informational news stories about the role of the laboratory in routine and specialized health care can also heighten the public’s aware- ness. This is already happening in select settings. For example, the growing con- cern about bioterrorism and the public interest in the safety and availability of the blood supply are well-recognized topics in the contemporary press. Stories can be specific to laboratory activities or employees, designed around unique clinics or hospital services, or around diagnostic approaches to a specific dis- ease (such as strep throat, cholesterol, prostate-specific antigen, and diabetes).

High school students get much of their career planning information from teachers and school counselors. Labora- tory managers and leaders in local medical technology schools should collaborate with science teachers to share their resources and expertise in a variety of classroom settings. Local and national meetings of teaching organizations can be opportunities to offer continuing education experiences for science teachers and raise the profile of the wide range of opportunities in the health care profession. Many hospitals are forming relationships with high schools to provide opportunities for students to explore a variety of jobs in health care while they develop basic work skills. Another model enables entry level employees to complete their college education while working and gaining valuable laboratory work experience. These programs could be affiliated with local colleges that offer medical technology programs and with local health care employers that can offer scholarships or work-study assignments.

The impact of a shortage of medical technologists reached a critical point at the MGH approximately 18 months ago as a result of many factors. Not only Boston but most of New England was at nearly full employment. Inpatient and outpatient activity was growing an aver- age of 10% per year. Increased efforts

Organization Strategy - MGH

to reduce the length of stay in the hos- pital and the emergency department resulted in growing expectations that the laboratories would continue to improve service and add new technology while staying within budget. Because of these reasons, our ability to complete irnpor- tam performance improvement initiatives was hampered by low staffing levels. We were challenged to accomplish the daily workload. The natural response was to request additional technical posi- tions to meet the growing demands of the service. The broader question posed was whether the solution was to add new positions or to till positions already approved and retain the technologists already on staff.

A market survey of salaries demon- strated that our hourly and differential structure was not competitive with local facilities. There was little organizational support for sign-on or retention bonuses as supplemental tools to relieve the shortage. It was clear that we needed to work with hospital management not only to improve our salary structure but also to implement broader organi- zational initiatives to address our short- and long-term staffing needs. These initiatives would focus on retaining our trained staff as well as recruiting new employees. Implementation started with the basics-stabilizing our workforce- and then moved to longer-term efforts.

The Clinical Laboratory Division developed a recruitment and retention plan with initiatives in three categories (wages, roles and responsibilities, and education). The keys to the plan were to improve the salary base for the techni- cal staff, as well as their job content and work experience. We felt this would put the hospital in a more competitive posi- tion to recruit and would likely help retain the staff already in the organiza- tion. Presentation of the plan to senior management focused on the impact of chronic staff shortages on the quality of care and the costs associated with maintaining the operations during the staff shortage. The data included our vacancy rate over time, the estimated time to fill a vacant position, the costs to recruit, and the costs to maintain the service while a position is vacant. While the analysis and discussions with hospital leadership continued, we reported the issues and our progress to the technical staff. This was done both

Clinical Microbiology Newsletter 24:9.2002 ir) 2002 Elsevier Science Inc. 0196-4399100 (see frontmatter) 67

in staff meetings and by letter. It was very important for the staff to realize that our recruitment and retention issues were being addressed and, specifically, what to expect in a possible salary adjustment package.

Our wage initiative is based on a career ladder that encourages employ- ees to improve their competencies and bases their future salary adjustments on how successful they are. By implement- ing the career ladder after the analyses, we now have a set of benchmarks to monitor our staf?ing status and hiring process over time. This allows us to make adjustments to the salary model with a more logical approach. Finally, the process of discussion with senior management put the issues of labora- tory staffing on the hospital agenda. Laboratory leadership will keep the effort visible by moving forward on what may be viewed as qualitative, but equally important, initiatives developed in the recruitment and retention plan.

The challenge is to implement these initiatives while keeping our focus on daily operations. It is hard to break into this cycle with new approaches to labo- ratory work while completing essential cross-training is still a short-term issue. Our first approach to identifying achievable opportunities was to survey the technical staff for their ideas. This engages them in the process and gener- ates new ideas beyond the original plan. We entered into this process with the commitment that the input (both posi- tive and negative) would be reported back to the staff.

Initiatives currently being evaluated include:

Flexible work hours

Even in a large teaching hospital, there are many laboratory settings or shifts where a flexible work schedule can be implemented. These can include a laboratory that operates only on single shift or weekend work packages that allow 32 hours per weekend.

Off-hour differential pay

In many hospitals, there are two dif- ferent pay scales, one for nursing staff and one for all other staff. Recruiting for the off-shifts could be facilitated with a more competitive differential scale.

Hiring process

Hiring begins with a visible and organized recruiting process. We are

working to build a budget dedicated to recruiting laboratory personnel. Our goal will be to provide the candidates with a positive recruiting experience and “sell” the organization to the applicant as much as the applicants are “selling” themselves to us.

Raising the profile of the laboratory in the hospital and in the health care system

Hospitals have spent the past few years concentrating on maximizing productivity in operations. This has led to a perception of loss of professional involvement for laboratory staff. Labo- ratory leadership can find many oppor- tunities to demonstrate the laboratory’s contribution to the organization. This will re-establish the laboratory’s credibility and instill pride in the technical staff.

Extend the career ladder to entry-level staff

The laboratory can create career paths for Clinical Laboratory Assistants to gain the education and skills needed to qualify to become Medical Labora- tory Technicians. We can leverage our senior, experienced employees to teach the candidates. These opportunities build loyalty among the staff and take advantage of the extensive technical knowledge within our system.

Hospital and laboratory leadership may face broader, more difficult deci- sions. It may be necessary to critically review laboratory service commitments to ensure that they are reasonable and sustainable if the shortage is not eased. This will require discussions with key users who rely on the laboratory service. However challenging this might be, the discussion is preferable to having one or more sentinel events because of failures within the labora- tory operations. Similarly, laboratory leadership must review all work pro- cesses and, where possible, move to as much automation as is reasonable. This automation may be as basic as maximizing laboratory information system and analytic capabilities to allow positions to be deployed in areas where automation is not possible. Finally, leadership will need to review its commitment to previously developed outreach initiatives and partnerships. The challenge will be to balance poten- tial lost revenue and economies of scale

against the high labor requirements to maintain such services.

Conclusion

There are many articles, books, and seminars on methods to improve recruitment and retention in any opera- tion. The optimal and preferred goal for any organization is to retain existing employees who have the knowledge base to maintain quality and respond to the changing needs of the organization. All approaches are based on the theory that salary alone does not serve as a long-term “satisfier” for most employees. This is especially true for professional employees. The more successful models focus on two key points. First, employ- ees must have confidence in their lead- ership to work on their behalf and on behalf of the well being of the service, In addition, employees expect ongoing communication from their leadership on the status of the organization, their strategies, and expectations for the staff, as well as opportunities to participate in managing their portion of the operation. Second, employees must be motivated to expand their careers, develop new skills, and engage in the laboratory ser-

vice. They need opportunities to expand their role, without feeling as though they are merely taking on more work. They require recognition of their contributions and accomplishments.

There can be no single solution for resolving the staffing needs in the clinical laboratory profession. The pro- fession is at a crossroad. Collectively, we must develop strategies that will improve the entry of new workers into the field, retain those already in the field, maximize their effectiveness, and most importantly, establish the role of laboratory workers in the health care team.

References

I _ Klipp, J. Who wants to work in a lab? Med. Lab. Observer. August, 2000:25-29.

2. Ward-Cook, K. and S. Tannar. 2000.

3

Wage and salary vacancy survey of med- ical laboratories. Lab. Med. 32: l24- 138.

Kellar, D. and K. Gryniewski. MLO’s National survey: MTs and MLTs respond. Med. Lab. Observer. July 1999 (suppl.): 17-20.

4. AHA special workforce study. American Hospital Association, Chicago, 2001 www.aha.orglworkforceiresourcesffactS heetB060S.asp.

68 0196-4399100 (see fmntmatter) 0 2002 Elsevier Science Inc. Clinical Microbiology Newsletter 24:9,2002