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Creating a Positive Work Environment

Laboratory Evolution

As a Director of Laboratory Service at a Critical Access Hospital facility in rural Montana, I must be proactive and involved. I have been a member since it was ASMT in both Montana and Washington; I am also a member of the Clinical Laboratory Management Association. These are the first places I go when we are reviewing our strategic plan or when we are faced with an issue that we have not found a solution for.

We were having a great deal of turnover with our phlebotomists, and as laboratorians we know 46 to 68 % of lab errors happen in the pre-analytical phase. If we could not find a way to stabilize this department, it was only going to be an opportunity for error rates to increase. I researched what other facilities were doing and attended workshops that addressed this same problem. While other facilities provided in-house phlebotomy training and offered numerous variety of incentives to ensure longevity, this was not quite right for our facility, but it was enough of an inspiration to show me that I just needed to work with what I did have available in our area.

Our facility collaborated with the local college to provide a phlebotomy program that included having the students take the nationally recognized testing at the end to become a certified phlebotomist. Our laboratory then participated in their externship process, which allowed us at no financial cost, to have the student do their externship to see if they would be a good fit for our team and also if we were a good fit for them.

We were still facing the issue of taking time to work with them, train them, and then after a year having the larger hospitals entice them away for an additional dollar an hour. Our facility had recognized this issue with many of our front line staffing positions, registration, ward clerks, dietary, and housekeeping, so they had been working to develop a tiering process for career advancement. Once the majority of our phlebotomy team was officially certified, our Technical Supervisor of Phlebotomy and I worked on new job descriptions for a Phlebotomist, Certified Phlebotomist I, Certified Phlebotomist II, and Certified Phlebotomist III. Moving them from Phlebotomist to Certified Phlebotomist I, gave them a little over a dollar increase as well as opportunities to continue to grow and move up the chain.

Just one small area of improvement we have been able to measure our success, is in our blood culture contamination rate, taking it from 6% to 1.4%. I was not an easy process, but after two years we feel we have created a very positive working environment for this vital section our laboratory team.

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