# Presentation: 008571

## Personnel

- Thanyanan Chaowanachan, MS
- Laboratory Chief
- Thailand MOPH - US CDC Collaboration (TUC)

**Notes:**
Good morning. I am going to talk about personnel issues this morning.  During the presentation, we will present an exercise for you to think about and then we will discuss the exercise.  While I am not an expert on personnel matters, I have worked in laboratories for many years and have been a supervisor in the TUC laboratory and the acting director of the laboratory for the past two years.  Having the right people doing the work is the critical element for quality laboratory work.

## The Quality System

**Occurrence Management**

**Information Management**

**Notes:**
All 12 of the elements of the Quality System are important, but without the properly trained personnel, the other components of the quality system cannot be properly carried out.  For example, if we have laboratory personnel who have not had appropriate training to understand the principles behind an immunological test, such as enzyme-linked immunosorbent assay (EIA), then it would be difficult to expect them to understand how or why to control the test or how to troubleshoot the test.  Similarly, everyone associated with a component of the quality system cycle (from collection to reporting) must have proper training to assure accurate testing.

## The Problem 

-              One of your senior techs who has been the person responsible for reading malaria smears has been temporarily re-assigned by the MOH to another province to assist with the back log of reading malarial smears.  Another tech from your laboratory has not been able to report to work due to an illness.  That leaves 2 techs who must now read malarial smears, even though they have not done so since their initial training several years ago.
- What must you do to ensure that the techs are competent to process and read malarial smears?

**Notes:**
In addition to being sure staff are adequately trained to perform tests, it is important to assure that individuals who are responsible for supervising the laboratory have management training.  Let’s look at this scenario and be thinking of how you might handle this problem while I go through the rest of the presentation.  We’ll come back to this exercise later on. (READ SLIDE)

ANSWERS:
Have techs had proper training for reading malaria smears?
Are there written procedures and reference books for performing the work?
Are there positive and negative control slides to “test” the tech’s ability to stain and read smears?
What ongoing procedures are in place to be sure tech’s are doing work properly? (e.g., re-checking procedures)

## The Laboratory Staff

- YOU ARE:
- The most critical part of the quality system
- The laboratory’s greatest asset
- An important partner in patient care
- YOU ALSO:
- Bring your integrity and professionalism to the healthcare community

## Success or failure of quality system is dependent on the laboratory staff
Knowledge and skills
Motivation
Commitment

- Knowledge and skills
- Motivation
- Commitment

**Notes:**
So assuring quality laboratory work is dependent not only on technical training, but is dependent on the motivation of individuals and on their commitment to the profession of laboratory science.  Motivation and commitment can only come about if the laboratory management and leadership create an atmosphere of respect for the work and for the individuals performing the work.

## Personnel Management

- Job qualifications
- Job descriptions
- Orientation and training
- Competence assessment
- Continuing education
- Performance appraisal
- Documentation

**Notes:**
The specific activities we implement to assure we have the right people doing the work include (READ SLIDE):

## Job Qualifications

- Often established by the Ministry of Health
- Levels of education and training
- Advanced degree
- Degree
- Non-degree, formal technical training
- Bench training

**Notes:**
Start by writing down  the qualifications for the work being performed.  Do staff require a degree, a diploma, or is this a laboratory assistant position that requires only on the job training?  Does the individual need any experience or is this a job that requires no experience?
Qualifications influences salary, levels of responsibility the individual will have in the laboratory.

## General Skills and Abilities:

- Problem solving
- Organizational skills
- Communication
- Written and oral
- Mathematical
- Manual dexterity
- Color vision

**Notes:**
Here are some particular skills that could be noted among job qualifications (READ SLIDE).

## Job Descriptions

- Specify responsibilities and duties
- Reflect education, training and experience
- Incorporate activities or  tasks to be performed
- Competency based
- General skills
- Specify QA responsibilities

**Notes:**
Again, it is critical to WRITE DOWN the responsibilities of the job. Anything put in writing should be developed as a draft, reviewed by another member of the management team, and finalized.  This is not work that is done in a few hours or a single afternoon.  Write it – think about it – discuss it – and then, finalize.

Job descriptions should include (READ SLIDE):

## Laboratory Personnel –  QA Responsibility

- Assist in implementation of the QA program
- Generate data and provide day-to-day documentation
- Should receive training in QA procedures
- Attitude toward QA should be part of annual performance appraisal

**Notes:**
We have said several times that quality assurance is everyone’s responsibility, so be sure to outline the individual laboratory employee’s responsibility within the QA program (READ SLIDE)

## Orientation and Training

- General orientation
- Organizational information
- Facilities
- Safety information
- Personnel Issues
- Ethics / confidentiality
- Benefits
- Emergency contacts
- Scheduling

**Notes:**
Orientation is an introduction to the laboratory’s operations and is something that is often not done in an organized way in many laboratories.  A newly hired person needs to be introduced to appropriate staff and to understand the organizational structure, 
needs to be familiar with the physical setting, needs to know from the job description where the “tools” are that they will need to do the work – e.g., how do they get glassware, reagents, etc. , be provided safety information, and other information such as emergency contacts and confidentiality that might be included in an  employee handbook.

## Orientation and Training

- Introduction to the laboratory’s operations
- Overview of the Quality System
- Responsibilities
- Technical procedures
- Initial competency assessment

**Notes:**
What training will be required.  Regardless of the experience, it is important that supervisors can assure new technologists or technicians can actually do the work and that is best provided through a documented training program. These are four critical elements to consider in orientation and training programs for employees (READ SLIDE).

## Competency
Having the essential abilities to perform specific tasks.  Tasks involve procedures throughout the specimen process
Competency Assessment
Any system in place for measuring, documenting, or otherwise determining whether employees are able to do their job. 

- Having the essential abilities to perform specific tasks.  Tasks involve procedures throughout the specimen process
**Competency Assessment**
- Any system in place for measuring, documenting, or otherwise determining whether employees are able to do their job.

**Notes:**
What do we mean be a competency assessment.  We all want “competent” staff, but how do we measure and document competency.  Well, it isn’t really difficult.  First, let’s define what we mean by competency and competency assessment. (READ SLIDE)

## Competency Assessment

- Two approaches
- New Staff
- Current Staff

**Notes:**
(READ SLIDE) For example, new Staff should not report patient results until successfully trained.
Testing for new staff may need to be more comprehensive.

## Competency Assessment	Methods

- Directly observe test performance
- Periodically review completed work
- Give previously analyzed specimens for testing
- Provide written exercises to assess:
- Problem solving skills
- Knowledge
- Interpretation

**Notes:**
Directly observe of test performance 
Whoever observing must be familiar with the test
Developing and using checklist would be helpful
Include specimen handling, processing, and testing

Periodic review of completed work -
 blind specimens, proficiency testing specimens, preventive maintenance and QC records
Monitoring the recording and reporting of test results
Many skills could be observed during an assessment
Testing process including customer service

Written assessments
problem solving skills

## Establishing a Competency Assessment Program

- Establish an assessment plan for each employee
- 1.  Prepare schedule – frequency and what tests or processes
- 2.  Determine assessment method (s)
- 3.  Assign staff responsibility for conducting assessment
- 4.  Document  and evaluate results
- 5.  Take  remedial or corrective action

**Notes:**
Prepare schedule
	Initial competency for new hires 
	Subsequent frequency will need to be determined

Test chosen  - May not be practical to assess everything they do.  Different test, e.g., test performed less frequent, but still must remain competent to perform.

More than on assessment method may be chosen depending on the capability of the lab and the complexity of the test
 If you are doing direct observation, be sure the assessor is competent on the specific test

Document and evaluate results
Assessment records become part of employee permanent file
Other factors related to the test may influence poor performance
Reagents, supplies, equipment, poorly documented procedure

## Establishing a Competency Assessment Program

- Document your competency assessment program
- Written plan
- Included in laboratory’s quality documents
- Periodically reviewed
- Used for continual improvements
- Communicate the plans to the staff

**Notes:**
Document results using standard forms that should be developed ahead of time
Communication
Important to staff because of sensitivities of self confidence and abilities
Not used to intimidate staff
Used to improve lab operations  
Fully understand the plan before its implemented

## Sample Assessment Checklist

| COMPETENCY ASSESSMENT |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|   |   |   |   |   |   |   |   |   |   |   |   |
| ANALYST NAME |  |   |  |  |  |  | TITLE |  |   |  |  |
| EVALUATION PERIOD |  |  |   |   | TO |   | DATE DUE |  |  |   |  |
| METHOD/PROCEDURE |  |  |  |   |  |  |  |  |  |  |  |
|   |   |   |   |   |   |   |   |   |   |   |   |
| READING OF PERTINENT PORTIONS OF THE |  |  |  |  |  |  | YES | NO | N/A | COMMENTS |  |
| PROCEDURE MANUALS |  |  |  |  |   |   |   |   |   |   |  |
|   |   |   |   |   |   |   |   |   |   |   |   |
| DIRECT OBSERVATION |  |  |  |   |   |   |   |   |   |   |  |
|   |   |   |   |   |   |   |   |   |   |   |   |
|   | Safety policies followed |  |  |  |  |  |   |   |   |   |  |
|   | Preparation of work area |  |  |  |  |  |   |   |   |   |  |
|   | Work area neat and organized |  |  |  |  |  |   |   |   |   |  |
|   | Follows policies, procedures and rules pertaining to assignment |  |  |  |  |  |   |   |   |   |  |
|   | Preparation/handling of specimen |  |  |  |  |  |   |   |   |   |  |
|   | Preparation/handling of reagents |  |  |  |  |  |   |   |   |   |  |
|   | Preparation/handling of QC |  |  |  |  |  |   |   |   |   |  |
|   | Preparation/handling of instrument and maintenance activities |  |  |  |  |  |   |   |   |   |  |
|   |   |   |   |   |   |   |   |   |   |   |   |
| Knowledge of criteria for acceptable specimen |  |  |  |  |  |  |   |   |   |   |  |
| Knowledge of action if specimen is unacceptable |  |  |  |  |  |  |   |   |   |   |  |

## Corrective Action Plan	

- Written plan understood by employees
- Outlines specific steps to be taken
- Training, reassessment
- Details resources needed
- Includes timeframe
- Consequence for failure

**Notes:**
Details resources needed
Consider results of evaluating poor performance
		May be problem with the method, QC,

## Poor initial orientation or training
Problem with the specimen 
Problem with the equipment                              
Poorly  written procedure 
No documented procedure 
Difficulty in dealing with change –
“We’ve always done it this way”

- Problem with the specimen
- Problem with the equipment
- Poorly  written procedure
- No documented procedure
- Difficulty in dealing with change –
- “We’ve always done it this way”

**When performance fails, consider:**

**Notes:**
If performance is not up to expectations, you should examine why that is.  Is it because of (READ SLIDE)

## Continuing Education

-  “An educational program that brings participants up-to-date in a particular area of knowledge or skills”

**Notes:**
Continuing education is essential. (READ SLIDE) Individuals who do not participate in continuing education have only the knowledge they learned while getting their degree, diploma or certificate.  Laboratory science uses technology that moves quickly and without continuing education, it is impossible to keep up with new technology.

## Why Continuing Education?

- Important in achieving good laboratory quality
- Individual personal goals
- Nothing stays the same!
- New tests
- New instruments
- New clinical programs and drugs

**Notes:**
READ SLIDE

## Innovative ways to obtain / deliver Continuing Education

- Make it someone’s responsibility !
- On-site seminars
- Journal clubs
- Case of the month
- Videos
- CD’s
- Internet opportunities

**Notes:**
As with most jobs, unless the work is assigned and unless someone takes responsibility for overseeing, it doesn’t happen.

## Local Resources for Continuing Education

- QA Committee
- Clinicians
- Nurses
- Pathologists
- Infection Control
- Epidemiologists

**Notes:**
Remote locations should encourage others from major cities to participate locally

## Performance Appraisal

- Assessing overall job performance
- Factors to evaluate:
- Technical competencies
- Efficiency of accomplishing work tasks
- Observance of safety rules
- Timeliness
- Communication skills
- Customer service

**Notes:**
Peformance appraisals come from the observations made in previously mentioned slides – you have the written job description – is the person performing that work well; how do they respond to training – does their performance improve or are they able to perform new tests in the manner trained.  

Timeliness
	Take personal responsibility for work - dependable	
	Show up on time
	Take appropriate time breaks/lunch periods

Communication skills
	Attitude
	Interpersonal relationship skills

## Communicating with Employees

- Points to remember:
- Emphasize positive traits
- Consider personal issues
- People are motivated differently
- Be direct in discussing deficiencies

**Notes:**
Communicating results of Competency Assessments and Performance Appraisals can be challenging

Consider personal issues
Chronic vs. temporary problems

People are motivated differently
Reaction to Incentives vary  - Consider different approaches

## Documentation:  Personnel 

- Personal details
- Employment details
- Resume
- Post held and dates
- Authorized areas of testing
- Terms and conditions of employment

- Job description
- Continuing education records
- Competency assessments
- Personnel actions
- Work injury records

**Notes:**
Personnel actions
	Promotions, awards, special recognitions, and disciplinary actions

## The Problem 

-              One of your senior techs who has been the person responsible for reading malaria smears has been temporarily re-assigned by the MOH to another province to assist with the back log of reading malarial smears.  Another tech from your laboratory has not been able to report to work due to an illness.  That leaves 2 techs who must now read malarial smears, even though they have not done so since their initial training several years ago.
- What must you do to ensure that the techs are competent to process and read malarial smears?

**Notes:**
In addition to being sure staff are adequately trained to perform tests, it is important to assure that individuals who are responsible for supervising the laboratory have management training.  Let’s look at this scenario and be thinking of how you might handle this problem while I go through the rest of the presentation.  We’ll come back to this exercise later on. (READ SLIDE)

ANSWERS:
Have techs had proper training for reading malaria smears?
Are there written procedures and reference books for performing the work?
Are there positive and negative control slides to “test” the tech’s ability to stain and read smears?
What ongoing procedures are in place to be sure tech’s are doing work properly? (e.g., re-checking procedures)