David Ricketts, Head of Laboratory Process Improvement at Health Service Laboratories, explains how reviewing and redefining a role led to a more stable workforce and a reduction in errors.
Increasing workloads, slow adaptation of technology within trusts and other healthcare providers, high staff turnover and staff joining sample reception as a springboard for a career as a biomedical scientist is a familiar story across the country. It is acknowledged that the sample reception area [SRA] is the engine room of any pathology service and an error made in reception can lead to a misdiagnosis and that may take many senior management hours to resolve.
The SRA at the Halo building, in the heart of London, supports The Doctors Laboratory arm of the Sonic Healthcare UK pathology service. The Halo building is a state-of-the-art pathology facility, spanning 14 floors. The SRA department has just under 100 staff and provides a multidisciplinary service processing over 6,000 samples per day. The SRA covers a 24/7 service across all disciplines.
At the end of October 2017, the SRA department moved into the Halo. After a period of adjustment, the processes within the department were reviewed to look for opportunities to improve the workflow and service. This review revealed several issues that are common to all SRA departments. The staff were working incredibly hard, however, despite these efforts, targets were not always being achieved. There was a high staff turnover, which meant the department was managing a high workload while constantly recruiting and training new staff.
Once the title was agreed, there was discussion around what a career pathway would look like
The review took the processes back to basics and removed some working practices that had been historic, streamlining others and looked at how technology could support the service. This improved performance, but the key issue of high turnover continued to frustrate the service and impose a significant training burden on SRA. Morale was being negatively impacted by many of the new staff and some of the existing staff focusing on how to get a job in the analytical laboratories to progress their aspirations to become biomedical scientists.
The executive team was meeting weekly looking at SRA and there was a real top down commitment to understand how we could address recruitment and retention. A small group was tasked to come up with a plan.
The challenge was to find a way for getting staff into reception with the skills we need, engage with them and to have SRA as a career choice, rather than a stepping stone to elsewhere. The solution to this was to propose putting a professional career pathway in place for the SRA department. This had to be attractive in terms of remuneration, development and stability. The end goal was to produce a career pathway which enabled the business to recruit staff that see SRA as their main career and reduce turnover and allow a more focused training plan, rather than a reactive one.
The first challenge was, what job title is representative of this important function. The term Medical Laboratory Assistant (MLA) already describes a wide cross section of highly valued laboratory staff, which lacked the sense of identity needed for SRA as the objective was to redefine it as a specialist service in its own right. The term decided on was Sample Reception Processing Officer (SRPO), which was in part looking at the old MLSO title and captured the role and responsibility of the department.
Once the title was agreed, there was discussion around what a career pathway would look like. There needed to be progression and this progression had to be measurable. The pathway would require funding so there had to be a benefit to the organisation for supporting this. The current departmental structure was MLA staff, team leaders a deputy manager and the overall manager. The thought was to expand this to a six-stage pathway, with the first three levels having automatic progression once set criteria have been met and the last three levels requiring suitable skills and competitive interviews to obtain.
The first level allowed for recruiting staff, using a competency assessment which had the skill-sets needed for a career in SRA. The training in the first year focused on becoming competent in one area of SRA and fulfilling mandatory training requirements as well as supporting cooperate objectives. This also allows an assessment if the member of staff is suitable for the job and the job is suitable for them. Once the staff member has met the requirements to progress, normally at the one year mark, then they become SRPO2, which is recognised with increased remuneration. The level 2 staff are expected to complete part 1 of the certificate of achievement, focusing on the SRA modules. They will also begin to expand their competence across more than one work cell within SRA. Once this is complete, normally at the second year mark, then they progress to SRPO3 with increase remuneration. The objective is that by level 3 the staff are well-rounded and experienced and can move to any task in SRA. Training now focused on individual needs. To progress to management roles, staff will need to compete for vacancies and further training is a combination of business and personal needs.
The project is now a year in, turnaround times have vastly improved, meeting the client-focused goals. The pilot training for level 2 certificate of achievement portfolios has now started, which will be rolled out fully once the department has understood the requirements to train the SRPO2.
Importantly, staff turnover has reduced by 94% (Six staff in nine months) allowing for a stable workforce and a subsequent reduction in errors. The staff are happy, the executive is happy and the clients are much happier with the service. The system will now be monitored to ensure sustained success before being rolled out to other SRAs within the business.
Feedback in quotes
John Zapata, SRA manager: “The new structure helps me to allocate tasks and rosters with a clear understanding of skill sets. It allows me to implement more effective training”
Nermeen Yassein, SRA Team leader: “The new career pathway helps with staff retention, I am no longer spending all my time training new starters but can focus on my team’s needs”
Oznur Sakar, SRPO3: “ I feel like I have more career progression, this opens up training opportunities, I am able to make this my long term career pathway”