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Hematology

Staffing & Productivity

Personnel management is the most expensive and complex component of laboratory administration. Labor costs typically consume 50% to 70% of the laboratory’s operational budget. Therefore, the efficient alignment of staffing levels with workload volume is essential for financial viability. “Staffing” refers to the process of hiring and scheduling the appropriate number of qualified individuals, while “Productivity” is the measurement of the efficiency of that staff. In Hematology, where workload fluctuates rapidly based on automation and patient acuity (e.g., manual differential review rates), dynamic staffing models are required

The Full-Time Equivalent (FTE)

The standard unit of measurement for human resources is the Full-Time Equivalent (FTE). An FTE does not necessarily represent one individual person, but rather a specific number of paid hours. Understanding the mathematics of the FTE is required for budgeting and scheduling

  • Defining the FTE: One FTE is equivalent to 2,080 hours per year
    • Calculation: 40 hours/week \(\times\) 52 weeks/year = 2,080 hours
    • Application: A part-time employee working 20 hours a week is a 0.5 FTE. Three employees working 12-hour shifts (36 hours/week) represent 2.7 FTEs
  • Productive vs. Non-Productive Time: When budgeting for a position, the manager must account for the fact that an employee is not available to perform testing for every hour they are paid
    • Paid Hours (Total): The total hours the employee is compensated for (2,080 hours)
    • Non-Productive Hours: Paid time where no work is performed. This includes Vacation/PTO, Sick Leave, Holidays, and Education/Training time. This typically accounts for 10% to 15% of total hours
    • Worked Hours (Productive): The actual time the employee is physically in the lab performing work
    • Staffing Implication: To cover one 24/7 workbench (8,760 hours/year), a lab needs approximately 4.2 to 4.5 FTEs: to account for the non-productive time of the staff

Measuring Workload

To determine how many staff are needed, the laboratory must quantify the work being done. Historically, this was done using the “CAP Workload Unit” (minutes per test), but modern management relies on the “Billable Test”

  • The Billable Test: The most common unit of service. It counts the reportable patient results (e.g., one CBC, one PT)
    • Limitation: It treats all tests as equal. A routine CBC takes far less effort than a Body Fluid Analysis or a complex Coagulation Factor Assay, yet both might count as “one test.”
  • Weighted Workload: A more accurate method that assigns a “weight” or time value to each procedure
    • Example: An automated CBC might be weighted as 3 minutes, while a Manual Differential is weighted as 10 minutes
    • Hematology Complexity: Workload in Hematology is heavily dependent on the Review Rate. An oncology hospital where 40% of CBCs require manual smear review has a much higher weighted workload than an outpatient clinic where only 3% require review, even if their total CBC volume is identical

Productivity Metrics

Productivity is a ratio of Output (Workload) to Input (Labor). It serves as a benchmark to compare the laboratory’s efficiency against previous years or against other hospitals (peer groups)

  • Productivity Calculation
    • Formula: \(\text{Productivity} = \frac{\text{Total Billable Tests}}{\text{Total Worked Hours}}\)
    • Target: The lab sets a target (e.g., 55 tests per hour)
  • Worked vs. Paid Productivity
    • Worked Productivity: Measures operational efficiency. Low worked productivity implies staff are standing around with nothing to do
    • Paid Productivity: Measures financial efficiency. It includes the cost of PTO. Low paid productivity might indicate excessive overtime or abuse of sick leave
  • Variance Analysis
    • Low Productivity: Indicates “Overstaffing.” The lab has too many people for the volume of work. Management may need to reduce FTEs or send staff home early (flexing)
    • High Productivity: Indicates “Understaffing.” While financially attractive, excessively high productivity leads to employee burnout, increased error rates, and delayed Turnaround Times (TAT)

Staffing Models

Managers use workload data to create a schedule that ensures coverage during peak times while minimizing waste during quiet times

  • Fixed vs. Variable Staffing
    • Fixed Staffing: The minimum number of personnel required to open the lab and maintain operations, regardless of volume. (e.g., You always need at least one licensed laboratory scientist to verify results)
    • Variable Staffing: Staff added to the schedule to handle incremental increases in volume
  • Trend Analysis: Staffing is not flat across the day
    • Morning Run: Hematology volume usually spikes between 04:00 and 08:00 due to inpatient morning rounds. Staffing must peak during these hours
    • Outpatient Window: Volume stabilizes during the day for clinic patients
    • Night Shift: Volume drops, allowing staffing to reduce to the fixed minimum
  • Skill Mix: Not every task requires the highest-paid employee. Efficient staffing utilizes a mix of personnel
    • MLS (laboratory scientist): Performs complex troubleshooting, manual differentials, and validation
    • MLT (Medical Laboratory Technician): Performs routine testing and maintenance
    • Lab Assistant/Processor: Loads analyzers, centrifuges samples, and answers phones. Shifting non-technical tasks to assistants improves the productivity of the high-cost laboratory scientist staff

Factors Influencing Hematology Staffing

Specific operational characteristics of the Hematology/Coagulation department directly dictate staffing needs beyond simple volume counts

  • Automation and Autoverification: The implementation of middleware and track systems significantly increases productivity. Autoverification allows the LIS to release 80-90% of normal results. This reduces the need for variable staffing, allowing the lab to handle higher volumes without hiring more people
  • Digital Imaging (e.g., CellaVision): This technology consolidates the differential workflow. Instead of three techs sitting at microscopes, one laboratory scientist can verify images on a monitor. This allows for staff consolidation or remote review
  • Test Menu Complexity: A lab performing specialized coagulation (e.g., Platelet Aggregation, Lupus Anticoagulant) requires lower productivity targets (more staff per test) because these manual, time-consuming assays cannot be automated to the same degree as a CBC

Justifying New Positions

When a manager requests an additional FTE in the budget, they must provide a justification based on quantitative data, not just qualitative feelings of “being busy”

  • Volume Growth: Showing a sustained trend of increased testing (e.g., “Volume is up 15% year-over-year”)
  • New Procedures: Quantifying the labor required for a new service line (e.g., “We are bringing Kleihauer-Betke testing in-house, which requires 30 minutes of laboratory scientist time per test”)
  • FTE Savings (ROI): Justifying a capital purchase to reduce staffing. (e.g., “Buying this automated slide maker will eliminate the need for the 0.5 FTE currently assigned to manual slide staining”)