Solution: As part of lab efficiency improvement, Accumen’s Schedule Excellence is a way to evaluate site and department schedule quality based on hourly volumes, minimum staffing, and bench level productivity goals. Schedule Excellence implements the right staff, working at the right bench, at the right time, at an ideal productivity, to ensure accurate test results that meet service requirements. Adjusting to an optimal schedule is a long-term journey which requires time and targeted improvement efforts. However, the benefits are quantitative scheduling with staff aligned to volume for a balanced workload, improved productivity, and reduced time spent creating schedules.
Benefit: To deploy the Accumen Schedule Excellence model, hourly volumes by lab department are obtained from the Lab Information System (LIS), as well as current site schedules. By assigning a productivity benchmark or improvement target, the model then reveals an optimal schedule which aligns hourly staffing to hourly volumes as well as increases productivity toward goal. Leaders and teams can then evaluate scheduling opportunities based on gap analysis between current and optimal schedules. In tandem with process improvement, executing changes to improve schedule performance will then increase site and department schedule quality. Schedule Excellence outputs are continually monitored over time.
Solution: There are many nuances and challenges with everyday lab scheduling, and staff schedules can easily become status quo due to the time involved in creating them. However, staffing schedules should be reviewed periodically to ensure they meet the needs of the lab. Through Accumen’s Schedule Excellence, it may come to light that the current staffing schedule presents opportunities to better align staffing to volumes, to improve productivity, or both. At that point, Accumen’s Schedule Builder tool reduces the time and frustration of creating department schedules. It offers many advantages over the paper- or Excel-based schedules that lab leaders commonly utilize.
Benefit: Accumen’s Schedule Builder is an interactive tool that considers department schedules, laboratory volumes by day and hour of day, and productivity improvement goals. These factors are combined to create a model similar to Accumen Schedule Excellence, but the staffing schedule is dynamic. Accumen experts first manipulate individuals’ proposed schedules to arrive at an ideal schedule at the employee level that both aligns with hourly volumes of laboratory work as well as maximizes productivity. However, the tool is meant to be collaborative. With training, department leaders can also manipulate schedules to arrive at multiple schedule options.
Solution: Labor oversight or talent optimization committees for laboratory are crucial for several reasons. During times of scarce labor resources, it is important to optimize the use of the staff available. Keeping staff working at the “top of license” or certification is also key, through best use of lab assistants. This committee typically consists of a team of lab and hospital leaders who, along with Accumen strategic advisors, establish the structure and cadence of the committee, review and assess distribution of labor, discuss variances, and work toward optimizing the talent pool within the organization.
Benefit: Due to significant cost pressures on labs, it is important to capitalize on the time/labor savings of any process improvements through labor optimization. First, comparing current productivity to lab industry benchmarking standards provides a high-level view of how the lab measures up to its peers. By then assessing the processes and performance of the lab, the Accumen team of expert trusted advisors can identify improvement opportunities and make recommendations to create efficiencies. Development of operational efficiencies paired with restructuring the assignment of duties can then right-size the labor pool based on the needs of the business, all while maintaining quality and service.
Solution: Minimum staffing levels in laboratory refer to the minimum number of qualified staff who are needed to provide quality patient care while ensuring the safety and well-being of patients, staff, and community. This includes operating and maintaining the lab’s functions, ensuring that tasks are performed safely, and meeting the lab’s objectives. Minimum staffing can vary depending on factors like facility size, type of testing, level of automation, and special regulatory requirements. Staffing needs may also vary across different shifts or days of the week to ensure continuous coverage. Maintaining minimum staffing levels is crucial to ensuring successful operations of the lab.
Benefit: Adjusting schedules to fit the needs of the lab and of the staff can be daunting. Accumen’s team of experts uses various tools including conducting time studies, comparing them to the number of tests performed per hour, and, together with leaders, determining the minimum number of qualified staff needed in each area, each hour of the day. This is particularly valuable in times of staffing crisis, as well as weekends and holidays. By incorporating minimum staffing numbers into productivity assessments, the team will avoid falsely identifying an opportunity to reduce labor, which could have resulted in impact to quality or accuracy.
Solution: Inpatient specimen collection refers to the process of obtaining samples from patients who are admitted to a hospital or other healthcare facility, for laboratory testing contributing to diagnosis and treatment. Collections can be carried out by trained healthcare professionals including nurses or phlebotomists who must follow specific protocols to ensure proper labeling, handling, and transportation of specimens for accuracy of test results. Collection ownership has often been debated within the medical field. Should nurses own bedside collections to ensure timeliness, or should dedicated phlebotomists round to minimize specimen integrity issues? Which model yields the most benefit to the organization?
Benefit: With an aim to improve both quality and service while decreasing costs, Accumen assesses current state inpatient collection processes by reviewing metric performance, staff feedback, onsite observations, and spend analyses. After careful consideration, Accumen determines the best specimen collection ownership model for patient care, one unit at a time. Recommending that to leadership, experts can also assist clients with implementation and change management.
Solution: Changes in the laboratory industry have led to a necessity to rethink how the traditional laboratory is structured to remain competitive in the marketplace. Labs must become more efficient through optimizing both workflows and the skill mix of the team. As laboratory scientists remain difficult to find, it is important to review how the lab functions and to consider new ways of operating.
Benefit: The Accumen team utilizes a series of tools to assess the laboratory, including review of turnover rates of technical and non-technical staff, workflows, and cross-training opportunities. The team also analyzes current tasks performed by lab assistants, compares that against identified needs, and identifies recommendations to provide a higher level of training for lab assistants. This improves efficiencies and allows technologists to work at “top of license.” Recommended duties will consider any state-specific requirements.
Solution: The metric of productivity is a measure of a unit of work as compared to a unit of time. Productivity may be evaluated differently in every hospital department. It is highly complex to measure staff productivity in laboratories for several reasons, and laboratory testing is so unique that it should not be subject to hospital-wide targets. Variability of test mix will cause large differences in productivity and cost. Assessing productivity at the department level will demonstrate where there is room for improvement. Best practices or key strategies can then be implemented to improve staff performance.
Benefit: Accumen’s productivity dashboard reports three metrics over time – worked FTEs, testing’s billable CPTs, and productivity of tests per worked hour. It is key to assess the performed work of a location rather than its billed work, and to do so by department. Capturing performed work is a truer picture of productivity than billed work, and departmental-level analysis is important because test mix varies significantly between departments. Additionally, a laboratory’s productivity can be compared to other laboratories using Accumen’s lab benchmarking tool, which runs on Accumen’s databases and is continuously updated to ensure the most current industry benchmarks.
Solution: In healthcare a float pool is a group of professionals who are available to work at various locations. While float pools are commonly associated with nursing and direct patient care, the concept is not as prevalent in laboratory settings compared to clinical units. However, lab staffing needs are increasing due to both volume and complexity of testing, and so it’s worth noting that the lab setting may benefit from variations of float pools as a staffing model. Float pools can allow for more cross-training and flexibility among lab personnel, address temporary staffing gaps, cover absences, and accommodate changes in workload.
Benefit: Collectively, the Accumen team has deep experience with multiple lab labor float pool models. Sometimes all sites may budget several FTEs to the pool (employees are only in the pool and do not have a “home” job), or employees may keep their “home” job as well as enter the pool to pick up additional hours for incentive pay. There are also hybrid models, and there are pros and cons to each. Implementation requires expertise on the key requirements and considerations in order to be successful, such as competencies, governance, reporting structure, recruitment process, and site standardization.
Solution: Work Sampling is a technique for determining the proportion of time spent by coworkers in various defined categories of activity. It is important as it permits a quick analysis of the opportunity to enhance job tasks or to reduce waste or idle time.
Benefit: Lab team members are observed as they perform tasks within their normal workflows, and the activities are categorized as Value Add, Incidental/Required, Waste/Rework, or Idle/Vacant. These categorizations are time-stamped, and the data generated provides valuable information while assessing workflows, team productivity, individual productivity, workload balance or imbalance, and scheduling opportunities.
Solution: Whether it be within or across different lab departments, within or across different job codes, cross-training staff increases flexibility and can reduce costs by leveraging internal talent. Learning how to do additional jobs or tasks also allows employees to become more professionally well-rounded. This applies to both technical and non-technical staff.
Benefit: Accumen utilizes a Cross-Training Matrix tool to identify and evaluate the current state of cross-training by bench, shift, FTE status, and individual co-worker. This is effective for identifying any gaps, and the team then develops a cross-training plan to be executed over time. A recurring review and update of cross-training status can also be implemented for continuous improvement.
Solution: Employee engagement can be defined as the degree to which employees invest their energy toward positive organizational outcomes. An Employee Engagement Assessment is an in-depth effort to understand the complexities encountered in the relationship between an organization and its most valuable asset – its employees. Employee disengagement can lead to high turnover rates as well as negative impact on morale, productivity, culture, safety, and financial performance.
Benefit: The Accumen team performs employee engagement assessments in the lab as well as supports implementation of solutions. This may include working with lab leadership to provide mentorship, education, or other personalized tools to support a meaningful strategy toward improved employee engagement.
Solution: It is important to understand the chain of command, reporting structure and the responsibilities of members within the organization. The intent of this assessment is to evaluate and provide a roadmap for effective optimization of laboratory organizational structure. Completion of the roadmap should result in elimination of duplication in duties between roles, appropriate skill mix among lab leaders, reduced waste in administrative processes, standardization among healthcare system locations, a more cost-effective organizational structure, the ability to function operationally in new ways with fewer resources, and/or increased flexibility in scheduling to handle short-staffing through lower tier leaders working the bench.
Benefit: The Accumen team performs a gap analysis regarding task allocation to laboratory leadership, time constraints, consistency of roles, and overall span of control. With information gathered, a comparison of the current state with a recommended future state provides recommended next steps for the organization to take.
Solution: Within laboratory, personnel span the educational continuum from high school graduates to associate/bachelor degreed professionals and beyond, in order to meet regulatory requirements and the knowledge base needed to provide quality patient care. In todays’ limited workforce environment, it is important to provide career pathways and options for laboratorians which will allow them to grow and advance skillsets. While benefits to the employee are many, effective career ladders have also been proven to strengthen the organization itself. Career ladders have been shown to be an effective means to improve productivity, morale and employee engagement, staff retention, and succession planning.
Benefit: It is imperative to clearly differentiate roles within the laboratory based upon educational requirements, experience levels, certification, licensure needs, and performance expectations. Creating a career ladder program is a highly collaborative process between laboratory leadership and human resources professionals. Accumen works closely with this collaborative team to review current structure, existing job descriptions, and future-state goals for success. The Accumen team brings extensive experience in implementing career advancement programs in the laboratory and tailors recommendations appropriately for the scope and size of the laboratory department or a laboratory system.