As the laboratory technologist shortage continues, the Swedish Hospital laboratory in Chicago has worked to strategically use both automation and non-technical staff members to help ease the burden on technical employees.
By Ann H. Carlson
In the heart of the third most populous metropolis in the country, the clinical laboratory at Swedish Hospital, Chicago, must contend with the increasing nationwide shortage of laboratory technologists1.
With only a limited number of certified technologists available for hire, managers at the mid-sized community hospital lab have had to think outside the box to continue to successfully process the 1.3 million clinical tests it receives annually. To this end, the team has worked strategically to use both automation and non-technical staff to help ease the burden on technical employees.
Susan E. Dawson, MBA, MT(ASCP), laboratory administrative director for Swedish Hospital, emphasizes the staff is the laboratory’s most important asset.
“We wanted to make sure that we were using our staff wisely and that we were reducing stress—because if you can reduce stress, you’re going to reduce errors,” she says. “We wanted to create an environment where our staff felt valued as well.”
The result is a culture that focuses on collaboration to develop the best workflows for the best outcomes.
Opening Up Communication
That spirit of collaboration dates back to the late 1970s when Swedish Hospital’s current laboratory space was first designed by James McCormick, MD. Perhaps best known as the inventor of the Cryostat device, McCormick had the revolutionary idea to create an open floor plan to foster more interaction between laboratory divisions.
“He was very forward thinking,” Dawson says. “There were no walls, so there was full communication between the folks who were processing specimens and the people who were working in chemistry, hematology, and other areas.”
Dawson credits this collaborative legacy with fostering out-of-the-box thinking to help face current staffing challenges.
“We had that mindset early on to utilize resources and people slightly differently,” she says. “Later on, when we needed to start looking at how we were utilizing people and systems, it was a little bit easier, because we didn’t have the physical barriers that other places might.”
Management also encourages open lines of communication and actively solicits staff feedback and ideas. “We have an open-door policy here,” Dawson says. “There’s nothing here that is set in stone. If you see something that you think could be better, share! We want to keep optimizing what we’re doing and have it work for everybody.”
It is no surprise then that the staff provided crucial input when the laboratory partnered with Siemens Healthineers to bring in automated systems, first in 2002 and again in 2016.
Optimizing Automation at Swedish Hospital
When it comes to onboarding automation in a laboratory, it can be tempting to simply relegate existing manual processes to the new systems and software. However, Dawson encouraged her team to take a wider view.
“We didn’t keep doing everything the same way and just have automation deliver the tubes,” Dawson says. “We turned around and said, ‘OK, we need to really reorganize what we’re doing here.’ We don’t mind change, so it’s been kind of fun. Because our people are involved in it, they own it.”
In 2016, the laboratory upgraded its automated track with the Atellica Solution, Aptio Automation, and Atellica Data Manager from Siemens Healthineers to meet demand and maximize productivity.
“Swedish Hospital needed quicker turnaround time for specific assays (e.g., TnIH, hCG),” says Martu Richards, marketing director for Atellica Instrument Acquisition, North America, Siemens Healthineers. “They needed better handling for identifying quality control (QC) issues, and they also wanted to reduce maintenance times, which included less hands-on time requirements for staff. They also wanted to consolidate their testing platforms.”
Dawson finds the Atellica Solution and Aptio Automation’s pre- and post-analytical processing modules to be particularly valuable.
“The goal with our automation line is to touch a tube once,” Dawson says.
Among many features, Aptio Automation prioritizes STAT specimens. The Atellica Solution also provides prioritization for test sampling, with the longer-timed tests going first. Quicker assays are not impeded by longer-timed assays. The system will also bring forward any samples that are clotted or unacceptable, specimens without an order, or duplicate specimens and place them in an easily accessible area for follow-up actions.
“We don’t want to work for the track; we want the track to work for us,” Dawson says. “So, we’ve taken a look at different ways that the track can make the tech’s life easier with fewer steps.”
Dawson particularly appreciates the “park” area, which is a holding zone for specimens that are awaiting results release and validation.
“That has helped us decrease the turnaround time because we’re not waiting for those specimens to be brought back out of storage,” Dawson says.
When implementing the new systems, the Siemens team came onsite for a few days to create workflows based on the laboratory staff’s ideas and priorities.
“Our Project Management team directly worked with Susan’s team on the specific rules they needed to improve their testing workflow and results management process,” Richards says.
The partnership was very much a two-way street, according to Dawson.
“There was a robust exchange of ideas back and forth on new rules that were needed, such as options for workflow counters, which allowed separation of results by discipline and priority,” she says.
Since the implementation, the laboratory has experienced better turnaround times, fewer errors, and less burden on technical staff. But that doesn’t mean that the laboratory’s workflows are set in stone. Dawson’s team encourages flexibility and an openness to change when thinking about laboratory processes—and that includes how they use automation.
“We’re always looking to see where we can improve,” Dawson says. “We first brought automation in 20 years ago, but that automation and how we utilize it has evolved over time to meet the needs of the hospital and the patient population we’re serving. It’s not one of those things where you can turn around and say, ‘This is the way it is’ and be done.”
Onboarding Non-technical Staff
In addition to optimizing automation, Dawson’s team rethought the division of labor in the laboratory to avoid overloading their technical staff.
“The tech shortage has been around for a while,” Dawson says. “Long before COVID, we took a look at our daily tasks to determine what required technical help versus what required non-technical help.”
The result was assigning non-technical tasks to para-technical staff members—often phlebotomists or, in some cases, college graduates waiting to get into medical school. These routine tasks include making phone calls, processing specimens for the send-out lab, handling add-on testing requests from physicians, splitting STAT specimens from routine specimens, and racking up urine specimens.
Para-technical staff members are also able to assist with waived tests like urine pregnancy testing. Post-analytically, these employees also handle customer service tasks, such as faxing reports to physicians’ offices or delivering non-critical results to physicians over the phone in a timely manner.
“It might sound like really simple things, but when you add up all the time that it takes to do those things and how they take techs away from doing technical tasks, it’s really nice,” Dawson says.
Today, the laboratory is fully staffed at just under 90 full-time employees, with a 2:1 ratio of para-technical staff to laboratory technologists.
“Without any walls, we have a really good conversation,” Dawson says. “The techs really appreciate the folks working in the para-technical area. There’s a good relationship back and forth because everyone understands and realizes how much help everyone is.”
This division of labor also gives non-technical staff members the opportunity to grow and learn on the job.
“It’s wonderful for them, because they do learn a lot,” Dawson says. “Our phlebotomists are dealing with patients firsthand when they’re going to collect specimens from them, and then they see the back-end as well in the laboratory. So, it is a good education for them.”
Some para-technical staff members are also able to take advantage of the Emerging Leaders program through Endeavor Health, of which Swedish Hospital is now a part. Designed for staff members with no prior management experience, these workshops help participants to develop the leadership skills they need to become tomorrow’s managers and supervisors in a health care setting.
Dawson says four of the laboratory’s employees will be enrolled in the program throughout the year. They participate in a series of workshops designed to build skillsets to manage people, budgets, and time. “They’re bringing home practical skills,” she says. “That’s the beauty of the program—to be able to apply what you’re learning now.”
Investing in employee training also builds staff loyalty and retention. In some cases, employees sign an agreement to stay on for a certain amount of time to take advantage of the training and free tuition.
Obtaining Results at Swedish Hospital
The benefits of investing in automation and para-technical staff have more than paid off for the Swedish Hospital laboratory, which processes between 1,200 and 1,300 tubes per day. Notably, turnaround times (TAT) have improved: TAT for troponin is now under 24 minutes from time of receipt to result, while CBCs are consistently around 12 minutes.
“Turnaround times have now consistently dropped and have been maintained at that level,” Dawson notes. “But I think the soft side of it, so to speak, is of the largest benefit, in terms of staffing and satisfaction. We’ve lowered the stress level, because we’re using the various capabilities of the instruments, the middleware, and the automation to reduce the number of touches. Even though the volumes have increased, the stress has come down as a result.”
Dawson says that the quality of the specimens the lab receives is consistently very high
because they are all drawn by the laboratory’s own staff phlebotomists. This helps avoid time-consuming mistakes. It is also a relief to Dawson to have so many quality control (QC) functions built into the automated system.
“If the QC has failed, the middleware will stop every patient test following that QC for that assay from that instrument,” Dawson says. “There’s no longer that fear on the part of lab management that bad results are going to get out the door. I think you end up with better morale.”
Having these fail-safes in place helps keep staff focused on the main goal of turning around quality results efficiently for the good of the patients they serve. The laboratory’s mantra, after all, is, “Every tube is a patient.”
“We remind our people that every patient is waiting for a result and to keep in mind that the patient is why we are here,” Dawson says.
Another secret to the laboratory’s success is fostering a positive attitude about change. Dawson’s team constantly lets employees know that they have the tools—and “the smarts”—to implement new technologies and processes to create better outcomes.
The best way to help a team embrace change is to be realistic about mistakes and not to expect perfection, Dawson says.
“When we change something in the laboratory, we’re expecting that things are going to work perfectly,” she says. “We’re going to see what happens, and then if we need to tweak it, change it, or throw it in the garbage, we can do that. It’s about having people be receptive and open to the possibilities. What if we try this? What if we try that?”
With more than 40 years in the field, Dawson has witnessed a lot of growth in laboratory science and management. “I’ve seen a lot of changes over that time,” she says. “It’s been an interesting ride. My biggest concentration now is setting up for and mentoring the new set of leaders who are going to be taking over.”
Dawson particularly encourages her staff to look for new opportunities in current and emerging technologies.
“There’s always going to be something new on the horizon,” she says. “What benefits the hospital? Take a wide look. Don’t be narrow. Because technology is constantly moving.”
Featured Photo: Susan E. Dawson, MBA, MT(ASCP), laboratory administrative director for Swedish Hospital (center), has used both automation and para-technical staff to optimize workflow. Photo courtesy of Siemens Healthineers © Siemens Healthcare Diagnostics Inc. 2024
Ann H. Carlson is a regular contributor to CLP.
1. Edna Garcia, Iman Kundu, Melissa Kelly, Ryan Soles, The American Society for Clinical Pathology 2022 Vacancy Survey of medical laboratories in the United States, American Journal of Clinical Pathology, 2023; aqad149, https://doi.org/10.1093/ajcp/aqad149