Staff is the backbone of laboratories and is essential to unlocking performance and improvements in these settings. Recruitment, retention, and performance management are key processes for managing staff, which is why lab managers need to bring in the best candidates, and train and develop them for growth within the lab.

A talented staff drives the success of any lab and lab managers should know how to recruit promising candidates and conduct effective interviews, as mishires cost a lab more than an individual’s compensation. One needs to recognise that technical skills are less important than attitude. Find important traits in candidates and identify effective ways to structure interview questions to ensure successful recruitment. Let us not forget process improvement.

Intellectual capital is the unique knowledge and skills that a company’s workforce owns. A certain amount of staff turnover improves the health of the lab and infuses new energy and innovative ideas. But the turnover among value staff is costly, disruptive, and has negatively correlated with customer satisfaction.

Today’s successful businesses win with innovative ideas, products and services that originate in the knowledge and skills of staff. Staff who are satisfied with their work and company are more likely to create satisfied customers. Furthermore, when staff members feel an attachment to the workplace, they are more likely to share their positive impressions and feelings about the workplace with customers.

Nowadays, technology development and globalisation have helped people be more connected than ever. Therefore, the workplace has become increasingly diverse in terms of culture, sexual orientation, experience, personality, and more.

“One-size-fits-all” strategies for keeping good people simply do not work any longer. Companies can best improve their retention rates by crafting creative, specialised strategies for each major segment of the workforce. Younger staff are particularly interested in defining their career paths and taking jobs that will help them advance to their next jobs. They are also more comfortable with rapid change than older staff.

Older staff, despite moving closer to retirement each passing year, have extensive knowledge and rich business experience that are crucial for the lab. Thus, the lab needs to ask what they need, support flexibility, and make their work interesting.

There are many strategies for improving retention such as hiring the right people, having a good system for evaluating performance, tracking levels of retention and overall staff satisfaction, and training managers and supervisors in good communication skills so that expectations between staff can be openly established. It also helps to offer staff a career path and a career development plan, have a recognition programme that celebrates staff with excellent performance, and customise benefits and work expectations for individual staff as much as possible. However, not all staff have equal value. Performance evaluations make it possible to show the staff who adds the most value.

Performance evaluation and building development plans for staff to be ready for greater responsibility in the future is the lab manager’s responsibility. They need to clarify how lab staff contribute to its success and ensure they understand what is expected of them. Clearly defining expectations is critical to success.

Lab managers also need to know how to clearly define roles and responsibilities, key objectives for each member of staff, select the most important aspects of a staff member’s position, develop effective roles and objectives documents, and identify and integrate objectives into individual goals.

Addressing staff performance is a key role for all supervisors. Clear performance feedback for the staff to help them grow and develop is critical to the lab’s success. Lab managers need to design and create effective performance review conversations, figure out key strengths of staff members, and create proper development plans to grow high performance and repair deficient performance.

Figure 1

 Established in 1888 by H.M. King Chulalongkorn, the Faculty of Medicine Siriraj Hospital at Mahidol University is the first medical school and the largest teaching medical center in Thailand. Currently, Siriraj hospital has 2,200 beds and 10,000 outpatient visits per day. Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University consists of four units including phlebotomy unit, central laboratory, molecular pathology laboratory, and special immunology laboratory. Currently, department of Clinical Pathology employs about 160 people.

The annual turnover rate is around 3 per cent. Because of the ageing population, workload has grown. Since 2018, the annual test volume has increased to seven million tests. Sadly, our lab’s yearly test volume has declined since the COVID-19 pandemic in 2020, but this year it has increased to seven million tests, as it did before the outbreak (figure 1). Total lab automation has been implemented in the central laboratory since 2020 (figure 2). However, after the COVID-19 epidemic, the staff satisfaction survey score has dropped. (figure 3). Our staff will take two courses this year on stress management and effective communication.

Figure 3

 Since 2005 and 2009, respectively, our lab has been accredited to ISO15189 and ISO22870 standards. We recently received a College of American Pathologist (CAP) accreditation, which take effect since September 2022. Our lab was the first university hospital lab in Thailand to receive CAP accreditation. We appreciate our team’s efforts in achieving this (figure 4).

Figure 4

Prof. Kanit Reesukumal is the Assistant Professor at the Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand and will be speaking at the Laboratory Management conference at Medlab Middle East 2023.

Back to Laboratory

Are we ready for sustainability in healthcare? Dr. Naser Ammash, Chief Executive Officer of Abu Dhabi-based Sheikh Shakhbout Medical City (SSMC) says ‘yes’ but there are three primary factors both decision-makers, as well as healthcare professionals, need to consider implementing them in practice.

First is the conscious effort to deliver trusted care and improve public health without exhausting natural resources or adding to the current ecology concerns. Secondly, it is being conscious about how elements within the healthcare environment are consumed — which involves paying attention to factors such as energy, travel, waste, procurement, water, as well as infrastructure and building design. And finally, to ensure the efficient and responsible use of resources, including finance and human aspects.

“Around 80 per cent of our carbon emissions come from what we buy — whether it is food or travel — and out of this, around 65 per cent is related to the hospital and clinic setting, which includes services and pharmaceuticals. This is where we need to set our focus,” said Dr. Ammash.

At his Sustainability in the Laboratory session at Medlab Middle East ME, he shared that the healthcare industry is the fifth largest emitter of carbon in the world, setting figures at 4.4 per cent. These emissions in turn lead to co-morbidities such as heat strokes, cardiovascular and respiratory complications, which threaten human lives and affect professionals’ healthcare mission. “It is a vicious cycle that we need to address,” he added.

Data as rocket fuel for sustainability

Data science plays a big role in paving the path toward sustainability. Dr. Ammash said that we need to use data as “rocket fuel” and harness the skillsets of the new generation of workforce to move the industry forward.

“We need to focus on data governance to ensure clean and accurate data, which is very important to conduct our research studies, and have a policy in place for data collection and protection. We also need to maximise the skills of the new workforce related to data such as data scientists, AI engineers, etc.” he added. Automation and robotics will also need to be implemented to bridge staffing gaps.

Dr. Ammash also highlighted the potential that disruptors hold as new entrants in the healthcare market using Amazon Omics as an example. “These are non-healthcare professionals — tech, retailers and payers — that offer state-of-the-art digital solutions in various sectors of the healthcare industry. We must team up with them to take care of our patients,” he said.

Visit Medlab Middle East 2023 to attend thought-provoking sessions led by industry experts from across the globe.

 

 

Emergency transfusion support is an essential element of modern healthcare. Life-threatening anaemia and haemorrhage require timely red cell transfusion. Haematological support is also essential to reduce the risk of critical bleeding due to haemostatic failure. The context of this article is the organisational and clinical management of major haemorrhage which may require both. Major haemorrhage is a clinical emergency that rapidly results in morbidity and mortality.  

Common causes include obstetric emergencies, gastrointestinal bleeding, major surgery, and trauma. Mortality is high unless actively managed with early haemorrhage control and resuscitation, especially in trauma. Recent conflicts have driven a paradigm shift in the use of blood and raised expectations in the wider healthcare community. In this short article, we consider recent developments and innovations in emergency transfusion and the challenges for the transfusion community. 

Lessons from military healthcare, including the response to Mass Casualty Events (MCEs), have influenced civilian trauma practice, registries, and transfusion emergency preparedness. The principles are also applied, with modification, to other causes of life-threatening haemorrhage.  

Table 1 lists examples of clinical and organisational innovation. Clinical guidance emphasises the recognition of the patient at risk of shock, early haemorrhage control, the use of tranexamic acid, and balanced blood-based resuscitation. This approach has improved survival. The emphasis on early intervention in trauma has stimulated an interest in pre-hospital haemorrhage control and transfusion.  

Successful pre-hospital transfusion programmes have driven developments in cold chain and stock management. In addition, the challenge for the simple, speedy safe delivery of blood has driven a renewed interest in both group O whole blood and universal dried plasma. In turn, the simplification of the transfusion process enables the non-medical authorisation of blood transfusion.  

The best-known recent developments in emergency transfusion are Major Haemorrhage Protocols (MHPs). These are site-specific protocols that outline the processes, people, blood components, and adjuncts required to treat a bleeding patient. The treatment algorithms pre-specify the order and ratios of blood, components, or products used to treat bleeding in different clinical contexts. Common to all is patient safety which demands secure safe sampling and testing for blood type before transfusion. Clinical response directs initial blood-based resuscitation rather than haematological testing.  

However, subsequent treatment is ‘goal-directed’ and tailored using Near-patient testing and laboratory support. Activation of an MHP should trigger a timely well-rehearsed response; whereas over-activation is resource-intensive and may lead to blood wastage. It is a difficult call to make. Emergency transfusion is stressful for both clinical and laboratory staff. Sourcing and preparing components take time, when the clinician sees the patient in front of them and demands blood, the laboratory is often busy supporting other patients. 

The advent of MHPs and pre-hospital transfusion challenges both hospitals and blood providers. The innovations may drive blood demand including a greater proportion of ‘universal’ components such as group O red cells and group AB plasma. These components are often in short supply. Treating a single critically ill patient with haemorrhage may rapidly drain local blood stock. Multiple casualties magnify the need for blood and often trigger a surge in donors. Careful and coordinated management of both emergency transfusion demand and supply is essential.  

Dr. Heidi Doughty, Dr Philos, FRCP, FRCPath, Consultant in Transfusion Medicine. 

Managing demand requires agreed protocols and clinical commitment using the principles of Patient Blood Management (PBM). PBM interventions include reducing blood loss, timely access to surgery, optimising physiology, and tolerating lower transfusion targets. If transfusion must be prioritised, pre-prepared blood shortage plans support fair distribution of blood. The challenge for blood providers is to meet both immediate and future demand, especially following Major Incidents or MCEs.  

Transfusion support for major incidents requires organisational preparation and working in partnership to be successful. Public engagement partnership includes public first aid programmes to “stop the bleeding” and high-readiness blood donor panels. Organisational developments for the transfusion teams include the application of transfusion triage.  

The concept of clinical triage is well established in the context of multiple casualties. By analogy, transfusion triage prioritises blood allocation, sample handling and laboratory work-streams as well as donor selection. The purpose of triage is to ensure fair and appropriate allocation of resources by ensuring blood grouping and transfusion for those in most need.  

Over-categorisation uses scarce resources and limits the availability of others. We have found that providing emergency blood and advice in the Emergency Department and a focus on human factors improves blood ordering and sample handling. The International Society for Blood Transfusion and others have also highlighted the value of Transfusion Practitioners in emergencies. 

We all have a responsibility to meet the challenge of emergency transfusion, whether we are dealing with a critically ill individual or multiple casualties. Guidance is valuable. Humanitarian organisations provide the overarching framework for disaster planning for healthcare. More recently, the Council of Europe and WHO has advised on the continuity of blood supplies during emergencies. The advice reminds us of the importance of a national approach to policy and planning. However, a local level commitment is essential for timely response, organisational resilience, and data collection. The outcome data fed back to planners and hemovigilance systems should drive further service improvement, development, and research.  

Emergency transfusion is transforming. It is an exciting topic that has stimulated an enormous international academic effort. The challenge is translating this research into locally sensitive practice that balances timely transfusion with safety and sufficiency.  

 

Dr. Heidi Doughty, Dr Philos, FRCP, FRCPath, is a Consultant in Transfusion Medicine. She will be speaking at the Blood Transfusion Medicine conference at Medlab Middle East 2023.