4. QSE Personnel Management

People are the most valuable resource of any healthcare organization. The quality of results reported through the laboratory is a direct result of the quality of the employees who provide these results. Any Quality Management System is dependent on the employees who fulfill its intent to be successful. Policies, processes and procedures are required to make sure that the employees of the organization are qualified and properly trained, and that the organization has high quality measures in place to retain them. According to CLSI^[1] there are several policies, processes and procedures in place in any organization to address the requirements of the QSE Personnel.

Policies that are needed to state intent and direction for the organization include:

• Job qualifications and job descriptions with specified responsibilities
• Orientation and training of new staff
• Competency assessment requirements for personnel after the initial training has been completed
• Continuing education and professional development requirements
• Performance evaluation
• End of employment
• Personnel files

Processes that bring the intent of policies to life include:

• Developing job descriptions
• Determining and documenting the particular education needed for each job, training needed, skills and experience necessary to successfully perform the required duties
• Orientation process
• Determining appropriate training programs
• Providing programs for competence assessments – initial, ongoing, and remedial
• Supporting continuing education programs and processes for assessing professional development
• Developing standardized, effective performance evaluation process
• Implementing a process for handling the end of employment
• Organizing processes to look after personnel files effectively

Procedures that provide step by step instructions on how to carry out the necessary processes:

• establishing job qualifications and writing job descriptions that specify the duties and responsibilities of each job position
• verifying the qualifications, education, and credentials of job applicants
• conducting staff orientation programs
• developing training manuals and programs for staff
• conducting and documenting training and competency assessments
• performing employee appraisals
• recording continuing education and professional development activities
• returning all facility-owned property to exiting staff
• creating and maintaining personnel files

Job qualifications

Job qualifications and job descriptions are very important aspects of this process. It is important that the qualifications for every position in the organization are clearly articulated. The job qualifications should include the education required for each job, the amount of training, skills and previous experience needed, and the appropriate certification and/or licensure requirements. In Nova Scotia, all practicing Medical Laboratory Technologists must have passed the national CSMLS certification examination and must also be licensed to practice in the province of Nova Scotia.

Job descriptions are written in such a way as to clearly identify the duties required of each employee. The job description document defines and provides a baseline for the performance tasks of each category of employee. In the clinical laboratory those categories consist of clerical staff, Medical Laboratory Assistants (MLAs), Medical Laboratory Technologists (MLTs), Technical Specialists (who are experienced MLTs), Management positions and Laboratory Director. Depending on the size of the organization, there may also be Laboratory Scientists, who have qualifications at the PhD or pathologist level.

The job description should provide the basis for job posting information and should set the tone for performance review criteria. It identifies the level of qualification required for the position and is used in setting up questions for the interview process. A copy of the job description should always be reviewed with any new employee when they start to work. It holds both the manager and the employee in positions of accountability. Simply stated, the job description serves as a tool to remind employees of the many responsibilities they have within the position they have been hired for.

The sections of the job description should contain the following information:

• The name of the organization
• The job title
• A position summary which identifies the new employees reporting status
• Essential functions and duties
• Authority level
• Internal and external relationships
• Working conditions
• Qualifications and experience required
• Certification and/or licensing requirements

Orientation

Orientation provides new employees with their first introduction to the organization when they begin their employment. The orientation includes an overview of the organizational vision, mission and values and also introduces new employees to the processes around such things as fire safety, organizational chart, accreditation, and other details of the overall organization that every employee should become familiar with. There should also be a second orientation to the actual laboratory work area where the new employees are introduced to staff, shown the safety features of the laboratory and given an overview of the functional makeup of that work area. At this time they should receive an introduction to the Quality Management System in that laboratory and any requirements of the QMS that new employees are expected to become familiar with.

Training

Training to use the equipment and perform testing using the standard operating procedures of the workplace follows orientation. Depending on the complexity of the particular section of the laboratory the employee is being trained to work in, the training may take anywhere from several weeks to several months. The employee must be trained on the use of equipment and to follow standardized testing procedures. Once a new employee has had the opportunity to learn and practice their skills, a competency assessment is required to get the employee signed off so that he or she can begin working independently.

Competency Assessment

Once an employee has been trained and is working independently in the laboratory, there are still continuing requirements to make sure the employee continues to maintain their competence to work in that particular section of the laboratory. Generally, competency assessments are performed on selected test procedures on an annual or bi-annual basis. Because there are so many different procedures performed in every section of the laboratory, competency assessments are usually performed on a select group of significant procedures. It is the responsibility of laboratory management to ensure that all the employees working in their areas maintain the skills and competencies for the work they perform.

Competency assessments take many forms. Written tests are often the first step used to ensure that the employee has the knowledge needed to successfully complete the procedure and interpret the results correctly. Then actual performance is measured by watching an employee complete a given procedure. Finally, the test results obtained are reviewed against known results. If the test results correlate with the known results, the employee would be deemed competent in that procedure. Monitoring on an ongoing basis is also an important part of competency assessment and can be achieved through reviewing controls and proficiency testing results of tests performed by individual employees and by reviewing work records and reports on a random basis.

Sometimes, an employee may need to have some remedial training and then have the competency assessment repeated. It can be easy for experienced employees to pick up bad habits – short cuts, changes to SOPs, etc. – so having some refresher or remedial training helps them to get back on track and to maintain standardized testing among all employees working in a specific area.

Continuing education and Professional development

Professional development and continuing education are two major components of managing personnel in any quality system. In the Medical Laboratory Technology profession, they are also important requirements of licensure. All MLTs must work on improving and maintaining their professional competencies as part of the requirements to keep an active license.

Why would this requirement be important to a working MLT?

Continuing education is provided by employers to train staff on new equipment or procedures, to enable them to participate in committees or work groups in the laboratory, or to represent the laboratory in organization wide projects. There are also sessions offered such as Lunch ‘n Learn, Grand Rounds, Journal Club, Interesting Cases, and others that provide employees with opportunities to learn about specific aspects of laboratory medicine. Opportunities also come up occasionally for select employees to receive enhanced training in a particular area such as key operator training, safety specialist for the lab, or training on a new instrument or methodology being introduced to the laboratory. Special tasks such as writing SOPs or representing the laboratory on hospital wide committees may also provide an opportunity for continuing learning opportunities.

Can you list some of the organization-wide committees an MLT might be asked to participate in?

Employees need to have opportunities to learn and develop over their careers if they are going to remain competent, committed workers. There are several different paths a medical laboratory technologist may choose to pursue in career development – research, technical specialty, management or administration, and education are all possibilities. Depending on where their particular interests may fall, MLTs could move through one or more of these career paths over the course of their career.

Some of the types of opportunities that are offered to employees for professional development within the organization include courses and/or workshops in:

• Team building
• Leadership development
• Change Management Leadership (Change Agents, Champions of Change, etc)
• Non-violent Crisis Intervention
• Communication for Health Care
• Financial Management
• Generational Differences
• Dealing with Difficult People
• Conflict Resolution

There are also some opportunities for employees to volunteer with their professional associations that provide opportunities for professional development. The CSMLS offers a national conference annually that MLTs and MLAs are encouraged to participate in, either by volunteering to work at the conference, to give an oral or poster presentation, or simply to attend the event and benefit from the variety of workshops and presentations that are available. It is a wonderful opportunity to meet members from other labs across the country and to exchange ideas, discuss common issues, and simply to meet new people.

The CSMLS also offers opportunities for MLTs and MLAs to volunteer with the organization. There are several different committees where members are offered the opportunity to submit their applications and there are focus groups and task forces convened to receive input of particular issues or questions that arise. There are Exam panels for each certification exam discipline and representatives from across the country are invited to participate in those. As well, because the CSMLS is a member-run organization, the Board of Directors is made up of member volunteers. Each year, there are positions on the BOD that come up for renewal and members are invited to apply. Then an election takes places among the membership to choose the successful candidate from among those who applied.

The Nova Scotia College for Medical Laboratory Technologists, the regulatory body for MLTs in Nova Scotia, is also a member-run organization that requires input from members to operate effectively. The NSCMLT has volunteer committees for such things as Profession practice, Advocacy, and Marketing and Communication. The membership of all these committees are made up of members from across the province. The Board of Directors of the NSCMLT is also a volunteer position. Members apply to fill the spots and then an election is held at the Annual General Meeting to choose the members from the candidates. Being part of the professional organizations is a very way that MLTs can learn and develop in the profession but it is also an important way to give back to the profession and to impact on how both organizations are run.

Although it is not always possible for the employer to support every professional development opportunity financially, there is a responsibility on the part of both the organization and the employee to continue to look for opportunities to learn and grow. Sometimes independent activities are pursued by an employee who wants to enhance future career opportunities. Examples of these types of activities may include taking courses that are offered by organizations such as the Canadian Healthcare Association, Safety or Quality Management courses outside the organization (certificate and /or diploma options), or degree completion and advanced education in Healthcare Administration, Business, or a scientific specialty. In Nova Scotia, graduates of the MLT program can complete a Health Science Degree with 2 more years of study at Dalhousie University.

Performance Review

There are a variety of different types of reviews but all performance reviews (also known as performance evaluations or performance appraisals) are intended to ensure employees receive feedback on a regular basis about their ongoing performance. Regardless of the type of evaluation performed, an employee typically meets with his/her immediate supervisor to go over the review and to then set goals for the upcoming year. If the employee has performed well and there no problem areas identified, the goal setting usually revolves around developing new competencies or taking a continuing education course that may be of interest to the employee. Depending on the employee’s career aspirations, they may want to study about management principles or they may wish to develop expertise in some technical area of the lab. By working with the immediate supervisor, a plan can be established to go forward.

If there have been some problem areas identified with the employee’s performance, these are reviewed with the employee at the meeting and an action plan is developed to help the employee improve performance going forward. The action plan would set out a specific path to follow to lead to improvement and will identify the measures of improvement that will be expected within set time frames. Both the employee and the supervisor contribute to the plan so that it is clear what the goal(s) are that the employee is striving to accomplish. Although, performance deficiencies are often addressed at the performance review meeting, there should be no surprises for the employee at this meeting. Issues with performance should be addressed as they arise and the employee should be well aware of any problems when they occur.

Once a performance review is completed, both the employee and the supervisor sign off on the review and on any actions that have been identified for improvement, whether it is along the line of continuing education/professional development or an action plan for performance improvement. Both the employee and the supervisor get a copy of the signed review. The supervisor’s copy is placed in the employee’s file and is tagged for follow-up. One of the main features of the performance review is that the review is kept strictly confidential by the employer so no one other than the affected employee is made aware of the outcome. Monitoring performance is an ongoing process and open communication between the employee and the immediate supervisor must be fostered so that both the employee and the supervisor are aware of the level of performance that is being achieved.