“We don’t have an overabundance of qualified technicians and technologists,” says Jamie Boone, BS, MT (ASCP), assistant director of lab services, Medical Center Laboratory, a service of Jackson-Madison County General Hospital (affiliate of West Tennessee Healthcare). “But what helps us deal with the shortage is our association with the local community college, Jackson State, which has one of the oldest lab training programs in the country, and we also work with the University of Tennessee, which sends students here to train. A lot of our employees come via that route.”
But finding people with advanced skills is sometimes an issue, she says. “We recruit by advertising nationwide in magazines when we have special needs. We’ve had times when people didn’t want to come to our area. We’ve offered sign-on bonuses, but that’s not the case now.” Boone says being connected to other institutions as a training site costs time and money, but it’s worth it.
Chris Aukerman, lab manager for St Vincent Mercy Medical Center, a member of Mercy Health Partners in Toledo, Ohio, says St Vincent has a premier clinical laboratory science (CLS) program, which ranks second in the nation in Board of Registry scores. Karlyn Lange, CLS program director, conducted a study to determine the ages of St Vincent’s lab workers versus the national average, and found that the number of retirements justified the facility’s tech programs. Five graduates of this year’s class and the affiliate programs plan to stay at Mercy Health Partners laboratories, Aukerman says. These include St Anne and St Charles, two additional Mercy Health Partners hospitals in Toledo. A few graduates return to facilities in their hometowns. “We’re one of a very few programs left; so many have been closed,” she says.
Back in the 1990s, when hospitals faced difficult financial times, the programs were ended, which proved to be a negative strategy in the long term, Aukerman says. She notes that for mentoring purposes, it’s good to have synergy between older staffers and younger ones.
At Century City Doctors Hospital in Los Angeles, Laboratory Director Sarina Rodriques, CLS, MT (ASCP), DLM, also finds it necessary to advertise for techs. That’s despite the fact that the cutting-edge, hotel-style, luxurious hospital adjacent to Beverly Hills and catered by Wolfgang Puck attracts a high-level clientele, and employees are excited about the prospect of being around celebrities, she says.
Because of its connections with medical-technology educational programs, St Vincent has fewer recruiting problems, but rural and East and West Coast hospitals are struggling with shortages, according to Aukerman. “Our median age here is 49. Long-term, we anticipate a shortage of techs; therefore, we need to plan strategically for automation upgrades in clinical lab and anatomic pathology. Progressive technology may improve our efficiency and fewer medical technologists may be needed,” she says.
Once Boone gets qualified clinical lab workers, she does all she can to keep them. There’s a career ladder within, and employees are encouraged to finish their degrees with tuition reimbursement, loans, and scholarships if they agree to work at the facility for a specified length of time. Besides management positions, there are technical career advances possible through education (a Master’s degree or ASCP specialist certification) and acceptance of more responsibility.
Aukerman says the shortage of techs will be even greater in the future. “We have a med tech program here, but several years ago many programs closed because of poor financial performance. However, our program pays for itself when you consider the educational reimbursement from Medicare. It’s great to have an internal program that provides us with staff.”
Hiring the Right People
There are good rules of thumb to follow when hiring lab staff. Just ask JP Kilbourn, PhD, who began working in labs in 1958. She is a former lab director for Public Service Laboratories and for Consulting Clinical & Microbiological Laboratory Inc.
Even before today’s computerized background checks, there were still ground rules to follow that apply today, Kilbourn says. “I wanted med techs who were licensed with the state and people who were certified with ASCP, or if they were to be non-medical contract employees, they needed to have baccalaureate degrees.”
To alleviate certain concerns, she checked references. “With references, look for damning with faint praise. Just because a reference is glowing in some respects, be aware of what isn’t being praised,” she says. “When applicants present published work, pay attention to how many co-authors were involved. With only two or three authors, the applicant was more likely to be involved. With a raft of co-authors, less involvement is likely.”
Aukerman notes that St Vincent, located in the central city, has a strong Catholic, faith-based mission of service to others. The facility brought in StuderGroup® consultants to help it find the right people, and that has contributed to the low turnover rate.
She says the facility has to identify those who are certified and have the necessary qualifications and the right attitudes. Service operational excellence teams created standards of work behavior, standardizing such things as how to answer the phone and greet patients. In interviews and in the application process, Aukerman shares St Vincent’s mission and its values—compassion, human dignity, service, justice, sacredness of life, excellence—with applicants.
Managers are extensively trained on how to hire. Training includes behavioral interviewing techniques, role play, and standards of behavior. In the hiring process, applicants are asked, “Do you agree and can you work within the framework of our mission, core values, and standard of behavior?” Most say yes, but some are just not the right fit. Candidates are first interviewed by a manager and team leader. Results of the interview and reference checks are reviewed. Those with the basic requirements and potential are passed on to a peer interview with frontline employees trained in interviewing. About three people do the interviewing—two from that department and one from an outside department. The panel interviews the candidates, rates them, and has the final say on whether candidates are offered a position. “Staff have a lot of say. All new hires go through a 90-day probationary period. During that period and all throughout their employment with St Vincent, we try to reinforce positive behavior and job performance. In addition, I also conduct a 30-day interview to ask the new employee how it’s going, to give my assessment, and to ask what needs to be achieved,” Aukerman says.
She says if a facility invests heavily on the front end, there are fewer problems at the back end. It’s all about finding the right person for the job. Some who aren’t right for St Vincent may be great for another lab.
This kind of screening is done throughout the institution. Once hired, employees are rated annually. These ratings address technical performance as well as behavior and attitude. Aukerman says the middle performers are the bread-and-butter, solid workers, while high performers are overachievers and highly motivated. The low performers are the ones whose job performance is below where it needs to be to accurately do their job. The aim is to either “help those employees move up to the middle or, in some cases, that job and the organization may not be the best fit for either the employee or St Vincent,” she says. Aukerman acknowledges that this is delicate; the tech’s problems might be because of personal issues, and an employee assistance program is there, free of charge, for personal, family, and career counseling. However, the problem may be merely that the employee is in the wrong job, she says.
“We have to find the right staff to begin with,” Aukerman says. “There’s a lot of investment of time and effort, but we’d rather do it this way than put out fires on the back end. Historically, health care workers are accustomed to being reactive—we’re all about fixing things when it comes to patients—but we should be proactive about a situation before it becomes a problem. There has to be a balance; resources are limited, and there’s less reimbursement than before.
“One of a hospital’s most important resources is the people who work there. This culture values patients, employees, and doctors, and we must invest in our workers,” Aukerman says.
With short supply and high demand, people do leave, and Boone says it’s a struggle to keep them and make the job attractive. Another problem is that there is a large body of knowledge involved in becoming qualified to do lab work, and the curriculum is difficult. There also may be fear of contracting disease in the lab, a concern with all medical jobs. The computer industry has hired many people who might have been interested in lab work, but Boone notes that labs are highly computerized, with robotics and automation. It is a health care information business, and the word is being put out in high schools that the lab profession is a good choice for computer-oriented students. Boone also adds that television series such as CSI help. Although the clinical lab isn’t involved with forensics, having a medical lab degree helps in getting into forensics, and it is a way to get training and to support oneself financially if forensics is the goal.
Such advanced fields as biotechnology and biometrics are also bringing people into lab work. And many Internet training programs are now available for med tech students, making distance learning an option. “There may be 50 students present physically in a class, but 350 online. If we don’t have the programs, we won’t have the students, so this is a way to keep the programs viable,” Boone says. She currently has several job openings for which she is trying to attract people from the local area.
Boone works closely with the human resources (HR) department on hiring, ensuring that applicants’ credentials are legitimate. This is followed by interviews in the lab using a team interviewing process to make sure applicants understand the facility’s culture. Applicants are shown around the lab. “If we extend an offer, they already know what our lab is like. We’ve had good success with the team lab interview approach.”
New hires get a 90-day probationary period, a no-fault zone. If the new hire leaves within that period, it’s not on record. Evaluations are done at 30, 60, and 90 days, then at 6 months and 1 year. “We work with them if there are problems, and they have opportunities to cover issues at regular meetings with our executive director. We’re very open as an institution, and we survey employees regularly,” Boone says.
In the HR department at Century City Doctors Hospital, cognitive and personality assessments are used to judge candidates, and the successful ones are referred to managers for interviews. There, candidates are told that the hospital lab is fully automated and state of the art. “We have a model that’s both high-touch and high-tech,” Rodriques says.
“If an applicant made it through the screens, I know they’re capable, so I look for experience in blood banking, hematology, and other core areas,” Rodriques says. “But I also look for other things. I want them to be bright, articulate, and willing to interact with the doctors and nurses,” she says. CLS staff are truly playing the roles of clinician-technical supervisors because there are very few of them. This environment forces them to use all the skills they learned in training programs.
But despite the attractions of Century City Doctors Hospital, there’s no abundance of candidates from which to choose. Rodriques says she heard about bright, motivated people who wanted to move ahead in their careers, “so I took a chance on them. But it’s hard to get supervisory-level personnel. I look for those with potential and train them in what they need, and I’m tolerant as they learn.”
Retention is difficult. New hires think working at her hospital is glamorous, but the reality is that they’re working 10-plus-hour days and weekends, Rodriques says. Techs want time with their friends and families and weekends off, and they are always on the lookout for jobs with better work schedules, she says. Rodriques has had to increase salaries by 30% in order to keep techs. She has created two-weekends-on, four-off scheduling, and has hired another graveyard-shift tech to give the current tech fewer days and 10-hour shifts. “I’m more flexible in accommodating time off or vacation requests, or if a tech has to leave early for an appointment,” she says.
Attrition is part of the shortage problem, Boone says. There will be more people retiring over the next 7 to 10 years than are coming into the workforce, as well as low enrollment in training institutions throughout the country. “However, we’re seeing a slight increase, partly because of HR bills that help labs.” But despite the graying workforce, being connected to school programs “has saved us,” Boone says. However, the challenge is then to keep the personnel, through career advancement and other incentives.
The personnel shortage gives techs leverage, so Boone says her facility has to be a place where people want to come to work. “We’re doing exciting things here—new technologies and new processes. We have automated for more efficiency because we have fewer personnel. We have streamlined and Leaned our processes that actually make large volumes of work easier to perform and reduce the burnout often seen with stressful work.”
Gary Tufel is a contributing writer for Clinical Lab Products.