The COVID-19 pandemic has contributed significant operational challenges to the laboratory’s mission to deliver high-quality, accurate diagnostic test results in a timely manner. Within a few short months, significant changes have been made to testing procedures, procuring personal protective equipment (PPE), and balancing staffing loads. Laboratory leaders have had to adopt new ways of thinking and managing to navigate the changes. Regardless of the solutions to complex issues, laboratories must not lose sight of their productivity goals.
The lab administration of our multi-state, non-profit-healthcare system realized it was necessary to adapt to the changing dynamic of a national emergency. First, to meet the need to increase testing, the Molecular Scientific Director led her team in designing, constructing, and staffing a new dedicated molecular lab that would offer antigen testing to our providers and the public. (At one point, the lab was utilizing four different instruments to produce COVID-19 test results.) The new testing capability was critical in addressing the demand caused by the need to end the statewide lockdown.
Procuring and Making Supplies
An immediate and ongoing challenge was obtaining enough supplies to support testing and protect staff. The supply acquisition experiences of our laboratory were similar to the stories told across the nation. Everyone was competing for the same items, and there was not enough inventory to go around. Just like many other healthcare systems, our administration asked staff to make their own masks to conserve the system’s limited supply. Getting enough PPE to our staff and frontline workers continues to be a priority for the system.
After the laboratory increased testing and addressed the lack of PPE, the system administration tasked the laboratory to review staffing and develop a plan to achieve assigned productivity goals. (It should be noted the productivity goals were created during pre-pandemic times.) In short, the laboratory needed to decrease the number of paid FTE hours.
In their mission to maximize all available resources, the administrative laboratory directors reviewed staffing in each laboratory and identified obstacles, some unique to the pandemic, that negatively impacted productivity:
1. Elective surgeries were canceled in all hospitals. Only Tier One (emergency) surgeries were approved.
2. The loss of testing for other types of patients reduced revenue.
3. Across eighteen laboratories, many positions were unfilled. (Pre-pandemic, the laboratories were not operating with full staffs, and each lab manager was notified the contracts of temporary techs would not be renewed at the end of their contract.)
4. Some staff were on FMLA (Family and Medical Leave Act) and would return to the workforce.
5. Some employees would begin FMLA.
6. Not all testing personnel were trained in multiple testing areas.
With this information, lab administrators began to develop a plan to address the expected staffing shortages and increase productivity.
There are over 800 employees in our laboratory system spread across eighteen laboratories with different types and levels of staffing issues. The goal was to develop a plan allowing employees from low volume laboratories to help cover the laboratories experiencing staffing shortages.
Historically, the system tried to have employees work in different laboratories with different CLIA numbers. However, the project was not fully embraced due to the training requirements of our accrediting body. Standards written by the College of American Pathologists (CAP) require each employee to train at each site despite instrumentation standardization throughout the system.
Fortunately, in response to the COVID-19 crises, CAP issued guidance to assist laboratories during the pandemic. The most significant personnel guidance change for a laboratory system was that testing personnel did not need to be trained at each site if instrumentation is standardized throughout the system. Competency must be conducted at the intervals specified by CLIA ’88 (Clinical Laboratory Improvement Amendments), but trained employees can begin working almost immediately.
The new CAP guidance allowed the laboratory to quickly develop a procedure for sharing employees between lab sites with different CLIA numbers. The lab administrative directors would coordinate the sharing of employees. Managers would need to contact a director at least 48 hours prior if they had a shift they were unable to cover. As this would be a manual process, the directors asked for longer lead time for planned employee absences requiring extended coverage.
the system is comprised of laboratories spread across two states,
there is still the problem of finding coverage for laboratories
utilizing high-cost temporary employees that will not be replaced.
If there are permanent staff willing to travel to other distant
sites, the laboratory will still need to pay for transportation,
housing, and meals in addition to the employee’s salary. However,
the additional expenses may be reflected in other financial columns
rather than productivity.
The COVID-19 pandemic is pressuring the laboratory to adapt to unique testing demands and also hard-to-fix staffing problems. The laboratory surmounted the problems of testing and PPE, but staffing and productivity remain a challenge. Technologists and technicians are essential to laboratory operations and are costly to replace.
A manual process was developed to help maintain staffing across the system; however, a digital, automated system would vastly improve the process and allow the laboratory to respond more efficiently to coverage issues in the future. Labs may find that innovative ideas, processes and systems developed during the pandemic may be carried over into the future for operational improvements. Changes to existing or new systems could end up helping bottom-line productivity, a welcome outcome from a national crisis that has stretched us all.
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