In the previous blog we discussed the factors that make one shift different from another, and how an awareness of these differences is important for the proper management of the workload and staffing for these shifts.
Since each shift is part of the continuum of the lab operation for that day, when chronic problems are happening on a particular shift, it is important to determine if the problems are centered within the shift, or are interrelated to the shifts that precede or follow as well.
Below are some of the many factors that need to be considered when performing a root cause analysis of problems that may occur on any shift:
Personnel
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Total workload per person
Total workload per person compared to other shifts
Training and Competency of staff working each shift
Permanent staff / shift ? or does the staff rotate to/from other shifts
Presence or availability of supervisory staff during the shift
Awareness of personality differences and conflicts between shift staff
Evaluations: are they designed for the specific tasks and responsibilities for each shift and performed by supervisory personnel who are familiar with the operations of that shift?
Policies and Procedures
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Appropriateness of instrumentation for different workloads and test menus
Shift specific policies governing routine and STAT orders, including which tests are included in each category, and expected turn around times.
Support when needed during each shift
Policies for performance of quality control, calibrations, and maintenance during each shift
Policies for test management when expected testing cannot be performed on each particular shift
Inventory control
Internal Communication
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Shared work between shifts: policies governing testing already underway when next shift begins
Availability of policy and procedure manuals, other resources on every shift.
Ability for all staff to participate in laboratory meetings and continuing education
If rotating staff: proper training for work on each shift.
External Communication
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Communication with other departments that interact with the laboratory: ER, ICU, Radiology, Respiratory Therapy, Outpatient.
Expectations of Physicians, Nursing staff and other professionals for turn around times for STAT and routine orders
Have nurses and others external to the laboratory been trained on proper specimen collection, labeling and handling?
Management
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Listen to and act on all complaints and other feedback from lab staff, physicians/nurses, and patients as soon as possible.
Proficiency Testing needs to be performed by each shift
QA each shift
Review workload changes annually to adjust staffing levels and instrumentation if appropriate.
These are not all the factors to be considered, of course, but for effective corrective actions and the maintenance of quality standards, these make a good start when getting to the root cause of chronic problems occurring on different shifts.
