American Association for Clinical Chemistry
Better health through laboratory medicine
May 2011 Clinical Laboratory News: Trends in Recruitment and Retention

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May 2011: Volume 37, Number 5


Trends in Recruitment and Retention
How Can Labs Thrive Despite the Staffing Shortage?

By Bill Malone

Training programs closing down. Baby boomers preparing to retire. Budgets being cut. Many signs point to the worrisome prospect that the staffing shortage labs have lived with for years has now become the new normal. But despite the lack of qualified workers, labs still have to get the job done and maintain quality testing. This dilemma has driven them to take up creative strategies to find, screen, and retain employees as recruitment becomes more challenging. Many have found that they can thrive in the face of a dwindling supply of qualified medical technologists (MTs) and medical laboratory technicians (MLTs) by emphasizing professional development and team-oriented management approaches. Others are tackling their long-term staffing problems by investing in the education of the next generation of workers.

According to Denise Harmening, PhD, labs have to reorient their thinking and focus on developing their staff in order to compete with other organizations—and even with other jobs in healthcare. “Labs that are successful in recruiting and retaining have professional development programs that create opportunities for their employees to strive for,” she said. “If you cultivate the scholarship of your people, you will cultivate productivity—we know that educated, knowledgeable employees give you more. Unfortunately, too many organizations only focus on the numbers of tests performed and not on a nurturing environment, and in turn, may create a stressful and negative workplace.” Harmening is an adjunct professor in the department of clinical laboratory sciences at Rush University in Chicago, Ill., and president of DH Publishing & Consulting.

Teaming Up for Retention

As hard as it may be to find qualified laboratory professionals, retaining staff can be equally daunting as more and more opportunities open up in other fields for those with lab training. “The younger lab professionals are not staying in the field as long as people like myself. They may work in a lab five years and then move into a more lucrative—and less stressful—position in industry or somewhere else,” Harmening said. “There has been a tremendous expansion of the areas in which these trained individuals have transferable skills; so they have a lot of options to get out of the lab if they want.” For example, some lab professionals have taken jobs in medical malpractice departments of insurance companies or as clinical trial coordinators, because they have a unique portfolio of meticulous skills that are in demand.

“Retention is as important, if not more important, than recruitment because once you get a good person, you want to keep them,” said Dave Glenn, CEO of Pathology Services in North Platte, Neb. “And the most important element in retention is the employer-employee relationship.” Glenn is also a consultant serving 18 hospitals and more than 50 clinics in Nebraska, Kansas, and Colorado, and clinical coordinator for the North Platte Community College MLT program.


Top Tips for Retaining Lab Staff

According to the experts, retaining good employees is more important—and more difficult—than ever. In part due to the shortage of qualified personnel, labs also face competition for lab professionals who are being lured away to other lucrative careers outside of the lab.

Here are some tips from veteran lab managers.

  • Offer opportunities for professional development—continuing education programs to expand or enhance skills, and support for medical technicians who want to earn bachelor’s degrees.
  • Give employees authority to solve problems creatively, not just responsibility when things go wrong.
  • Entrust some management duties to teams—scheduling, process improvement, and even interviewing new staff.
  • Work with your human resources department to develop more attractive recruitment packages such as sign-on bonuses or tuition forgiveness.
  • Get involved in local medical technology training programs—become a clinical rotation site, or connect with students before they graduate. Some labs have hired technicians part-time as they work toward their bachelor’s degree, or invited full-time students to sign employment offer letters as soon as they begin their education.


At Pathology Services, Glenn developed an organizational approach called shared-management work teams, where employees function as mostly self-directed cells of three-to-eight people with two leaders per team. This tactic has solved the thorny issue of scheduling—a notoriously trying part of lab management and a subject where it’s difficult to keep everybody happy. Under Glenn’s system, each team has the responsibility of preparing its own schedule. “We lay out what hours need to be covered, and how many people we need here during those times, and then we leave it up to the teams to schedule it any way they want,” Glenn explained. “Allowing them to schedule themselves and be happy with their schedule actually works much better than my dictating a rigid rotating schedule that forces everyone to go through a lot of hassle to make any changes.”

The lab has a fairly high number of employees with young children, who often end up splitting shifts so they can attend school functions or sporting events. Most teams get together around the 15th of each month and start working on the next month’s schedule. Some use electronic spreadsheets, while others just use a basic calendar and start penciling it in. “This is based on the needs of the employees, and they know their needs best and that what goes around comes around. It also gets me out of having to beg people to work at the last minute. Here they’re asking their friends and coworkers to cover, each person knowing that if a colleague covers for them, they’ll have to cover for that person later,” Glenn said.

The teams not only work together, but also help select new hires for their respective teams. They control their own budgets for purchasing, too. “We not only give them the responsibility—which most labs give their employees—but we also give them the authority. The only authority they don’t have is to fire someone. They have to bring me into that. And on that, I’ve never disagreed with them yet,” Glenn said.

Giving teams responsibility and authority not only improves job satisfaction and retention, but also enhances lab processes, Glenn emphasized. “If you want to solve a problem, go to the people that are on the bench dealing with the problem. They know what the solution is. But often they’re overlooked by administration. Unfortunately, I think the larger you are, and the more levels of middle management you have, probably the poorer management you have. I believe that the more you involve the people in the trenches, the better they’ll be able to fight the battle that needs to be won.”

Katheryn Inglis, laboratory manager at St. Elizabeth Medical Center in Utica, N.Y. for 26 years, attributes the low turnover rate at her lab to a similar management approach she calls PACIT—process action continual improvement teams. “These teams get our staff involved in evaluating processes, getting their opinions, and making decisions. If they’re involved in making the changes, you get buy-in, and they know they’re making a contribution,” she said.

Her teams deal with specimen receiving and other processes, and are made up of bench technologists, technicians, and clerical staff.

However, really improving retention actually starts with the interview, Inglis noted. “Over the years, I’ve learned I can get a good feel for whether a person is really interested in staying or not from the interview if I ask the right questions” (See Box, below).

Holding on to excellent employees in the lab is even more important with the lack of qualified candidates, Inglis emphasized. She also warned against labs expecting automation to solve all their staffing problems. “Certainly, automation does help.

We have work cells now, robotics, and autoverification with a lot of our tests,” she said. “It allows the techs to focus on the abnormal things that really need their attention, but it does not replace them.”


Interviews that Work

Even though many labs struggle to find qualified candidates, they still want to be selective about who they hire. Taking a strategic approach to interviews can be one way of finding the best candidate. Unfortunately, many lab managers have little training in this area, said Kathryn Inglis, who has been the laboratory manager at St. Elizabeth Medical Center in Utica, N. Y. for 26 years.

“You have to learn as you go, and you learn from your mistakes. Unless you take management courses, you’re not taught these skills,” she said. “Now with the scarcity of applicants, sometimes people make the mistake of settling for someone who isn’t quite what they want. And that really isn’t the best way to go. I’ve learned that if your instincts say this person may not be up to your standards, don’t hire, or you’ll regret it.”

Over the years, Inglis has fine-tuned her interviewing techniques, and focuses the discussion on integrity, honesty, and teamwork. “I ask them to give me examples about when they were part of a team, working with people of different backgrounds, and how they interacted with them, and how they made changes,” she said. “I also ask every applicant, ‘what’s your definition of integrity?’” Inglis looks for signs of achievements in past positions, patterns of stability, and significantly, what the person does to keep learning. She also asks technical questions about the specific job she’s filling, including giving interviewees a technical test based on the work they’ll be required to perform.

“People need to take the initiative for continuing education,” she said. “For some people it’s a career, but to others, it’s just a job. You want the people who look at it as a career. I’ve also learned that if someone is very negative about previous jobs, they’re going to be negative about your job too. That negativity is a red flag.” Questions that reveal an applicant’s commitment to professional development include, what would you most like to accomplish if you get this job? how does this job fit in to your overall career plans? and where do you see yourself 3–5 years from now?

Interviewing also involves making sure that the interviewee truly understands what the job entails, Inglis emphasized. “Do not sugar-coat it: if they’re going to have to work off-shifts, be sure they understand that so that they know what your expectations are.”

Many organizations also employ various models of group interviewing. This not only streamlines the process so that candidates don’t have to go through multiple interviews, but also helps interviewers be more objective. Corinne Fantz, PhD, co-director of the core laboratories and director or point-of-care testing for Emory Medical Laboratories, described a method called targeted selection that applies a committee approach. Committee members use a standard set of questions, most of which are situational, such as ‘tell me about a time when you had to discipline an employee and how it turned out.’

“With each situational question, the interviewees have to say what happened, what their role was in it, and then the outcome. We’re looking for three pieces of the story,” Fantz said. After the interview, the committee reviews each question, the score each member gave the candidate, comes to a consensus, and finally ranks the interviewee on a point system.

Seasoned managers also emphasized that what appears to be poor performance in an interview does not necessarily mean that person could not be an excellent employee. “There are drawbacks to this kind of situational interview style,” Fantz said. “Some people are better at answering questions, and yet their technical skills aren’t necessarily up to par. So, you have to be really careful on getting lulled into thinking that just because this person is a really good communicator, that they’re going to be a good fit for that particular technical position.”

Younger laboratorians have become better at these verbal skills over the years, contended Rosalee Allan, senior vice president and chief operating officer of the Spokane, Wash.-based PAML reference lab. “I can remember years ago when I interviewed medical technologists, those were some of the hardest interviews because you would have to drag answers out of them, but it would give you no indicators whatsoever about their technical abilities,” she said. “This has begun to change, though. I look at the medical technologists that are coming out of the schools today, and they’re more verbal, and very capable of getting up and giving presentations or performing really well in an interview.”


Offering Opportunities for Growth

In addition to adopting a team management approach, labs can also help attract and retain excellent staff by engaging employees individually with a supportive path for job enrichment and promotion, say seasoned lab managers.

“Providing a variety of additional learning opportunities may be one reason why it is competitive to get a medical technology position here,” said Corinne Fantz, PhD, associate professor of pathology and laboratory medicine, Emory University School of Medicine, Atlanta, Ga. “These people went into healthcare to make a difference in the lives of patients, yet they find themselves working in the basement of the hospital with little connection to patients beyond the large volumes of specimens and results. This is one reason why we offer a variety of educational programs. In addition to traditional faculty and pathology residents continuing education lectures, we also invite patients and their families to visit the lab and share their stories to get staff excited about what they do.” Fantz is also co-director of the core laboratories and director of point-of-care testing for Emory Medical Laboratories.

Fantz wrote about Emory’s experiment with patient visits in CLN’s quarterly Patient Safety Focus (April, 2010). “The experience created a palpable sense of community in the lab. For weeks following these sessions, we got comments from employees saying how good the experience had been. Our employees’ focus returned to the patient,” she wrote. Fantz is now looking to repeat the program routinely to lift staff’s spirits and help them reconnect with patient care.

At Pathology Services, due to the shortage of medical technologists, Glenn has taken to offering full tuition reimbursement to MLTs who want to work toward their baccalaureate degree and earn MT certification. “Especially now that you can get MT degrees online, it makes it very easy to get those classes extended over three or four years and earn a degree. I’ve had one complete it already and a couple of others working on it,” Glenn said. “I think it’s very cost-effective for our lab, because we already have proven players who now want to continue their education, so we’re getting by cheap just paying for the tuition. So far it’s been proven successful—we haven’t lost anyone yet because we educated them.”

The burgeoning arena of online education gives more labs a chance to provide continuing education to their staff, noted Harmening. “There really has been an explosion of online curriculums. The majority are designed for people already working in a lab with an associate’s degree who want to advance their body of knowledge,” she said. “Some of us who’ve been in the field might be a bit skeptical of an online program, but I know it can be done, because I know students in these online programs do pass the certification exam.” Harmening has authored books on lab management, hematology, and blood banking, and also helped develop AACC’s Clinical Laboratory Leadership and Management online certificate program.

Part of the reason that more labs do not offer robust professional development programs comes from a disconnect between organizations’ human resources departments and the lab, according to Harmening. “I think human resource departments need to be more creative in their recruitment packages,” she said. “Part of the responsibility is on their shoulders to be sure that they have competitive salaries, and offer something that will develop the personal attributes of their employees so that they can enhance productivity and scholarship, and promote an environment of lifelong learning.”

Grow Your Own

Beyond enriching staff with continuing education and other professional development strategies, Glenn advises labs to work creatively to build up new students in training programs as a method of screening and recruiting new employees.

Created almost single-handedly by a technologist in the early 1970s, North Platte Community College’s MLT program has given Pathology Services a steady stream of new, local graduates to choose from. Although there was a time when it was much more difficult to find hospitals willing to accept students for their clinical rotations—a critical limiting factor in the number of students the college can matriculate—Glenn said the tide is turning. “For those hospitals that see taking a student as a great opportunity and get their administration to buy into it, the labs found that they liked hiring someone they already knew as a proven player. It cuts down on training, as well as wondering about having the right fit. That’s why I think the best recruitment strategy is to grow your own. Hospitals that are too short-sighted to put out the money to support the clinical rotations are shooting themselves in the foot and will pay the price many times over by not getting good, qualified people that will stay around.” Hospitals offering clinical rotations almost without exception hire the students they train, he added.

James Peele, PhD, director of clinical chemistry for Baptist Medical Center in Jacksonville Fla., is investing in a similar strategy. Peele realized not only that recruitment had become more difficult, but also that many of his star employees with 30 or more years of service would not stay around forever. “We have been very fortunate that the staff here has been very stable,” he said. “On the other hand, sooner or later we will start to see turnover, and my fear is that when it happens, it’ll happen en masse instead of in ones and twos.”

Now Peele has joined a collaborative effort among Baptist Medical Center, Mayo Clinic in Florida, and Shands Jacksonville, an academic medical center associated with the University of Florida Health Science Center, to launch a new MT program. They hope to start enrolling students in 2012. “Hospitals have now recognized that the only way they’re ever going to get qualified people in the long haul is to set up training programs where students can do their clinical rotations through sponsoring hospitals,” Peele said. “The hope is that several years down the road, this will pay dividends when we start to see people retire and our staff shortage becomes more acute.” At least for now, Peele and other experienced lab professionals will volunteer their time to teach, and the program has commitments from the labs involved to help in training.

Emory has found success with similar tactics. With its new medical technology program, students who work in the lab for 2 years after they graduate receive full tuition reimbursement. All 11 students have been hired into medical technology positions, with 10 of them hired internally, said Fantz. “We tell the students that while they’re here, they might as well consider this a job interview, because they’re on display to this lab during that whole rotation,” she said.

Under a U.S. Department of Labor grant to Minnesota, the University of Minnesota’s Center for Allied Health Programs has several projects underway that could become models for other states to improve training programs and help more labs take in students as a recruitment strategy. Over the past 5 years, the Center has increased the number of clinical laboratory science students graduating from training programs in the area from 25–30 per year to 60. One major area of focus has been helping more hospitals sponsor students for their clinical rotations. A new project called Student Max will use specially designed software to place students with hospitals, streamlining the process for both the training programs and participating labs.

Through this matching service, hospitals make commitments to take students up to 2 years ahead of time. “We hope that this program helps alleviate the last minute panic that we often have,” said Janice Conway-Klaassen, PhD, director of clinical laboratory science at the Center for Allied Health Programs. “For instance, this summer, we have 55 students who need a clinical experience either during the summer or following fall semester, and we’re really clamoring for the last 15–20 spots right now. Our worst bottleneck to increasing the workforce is that the hospitals are not willing to take more students—and yet they keep asking us to produce more.”

Also in the works are several web-based training modules, including one for lab preceptors on how to work with students during their clinical rotations and a refresher course for MLTs that can speed their entry into baccalaureate-level programs. The Center for Allied Health Programs is also working with a consortium of stakeholders in the state to develop a competency-based model curriculum map aimed at developing both 2- and 4-year graduates with a more consistent level of skill and education. This should help preceptors better prepare for students-in-training and make it easier for more hospitals to take them.

With the innovative ways that labs and educators have begun to approach professional development, labs have an opportunity to prepare for the next wave of changes in the workforce, said Glenn. “I don’t think that people realize that the staffing shortage really is coming, because we’ve been saying it so long that it’s like the boy crying wolf. But there will come a time, probably within the next five years, when we’ll see a precipitous drop in the number of Baby Boomer medical technologists still in the field. And this can be a wonderful opportunity for the younger people who want to advance their careers in lab medicine.”