Monday, September 05, 2011

With love from me to you - Blood buddies (Musings on staff shortages & succession planning in transfusion medicine)

This blog was stimulated by the August 2011 issue of AABB News, which explores laboratory workforce shortages soon to be exacerbated as baby boomers* retire in large numbers. (*Boomers are generally anyone born between 1946 and 1965, meaning they will reach 65 between 2011 and 2030 and 60 between 2006 and 2025). I particularly enjoyed "Where have all the blood bankers gone?", the focus of this blog.

The title derives from an early Beatles song that illustrates the blog’s ‘big idea’.

Although the blog deals with medical laboratory shortages, I encourage physicians and nurses to read on and assess how the discussion applies to them since pathologist and nursing shortages are well documented. Recent Canadian examples:
Saskatchewan regulation breach linked to pathologist shortage (CMAJ, 9 Aug. 2011)s

In my area of the world, and perhaps in yours, we've struggled with a lab work force shortage for close to 20 years. See an old record I wrote about events in Alberta as they happened:

ABBB News covers many of the salient issues related to lab staffing shortages but the proffered solutions seem like treading water to me. Perhaps I'm skeptical but, as the French say, plus ça change, plus c'est la même chose.

In particular, I wish the AABB article had mentioned one of the most pertinent consequences of staff shortages and the impending exodus of the boomers: loss of expertise, especially the 'tacit knowledge' missing from text books or journals.

If tacit knowledge can be transferred, it is likely transferred by ongoing close interaction between experts with tacit knowledge and those who lack it. More on this later.

To my mind, what's needed is a big idea to supplement the series of bandaid solutions currently on offer. First, let's examine some aspects of the AABB News article, "Where have all the blood bankers gone?"

On the issue of staff shortages related to technologists leaving the profession, "Where have all the blood bankers gone?" reports that poor salary is acknowledged as the main reason people leave and offers these additional factors:

1. Stress
2. Scheduling
3. Limited potential to advance
4. Increased workload as staff numbers decrease
5. Lack of recognition as a profession

To combat these ‘drivers’, several strategies are proposed:

1. Evaluate wages & benefits

In an age where mergers are increasingly common to save entire organizations such as blood centers, are the wages of medical technologists likely to be high on management's agenda?

As noted in the round table discussion in the July 2011 issue of Journal of Blood Services Management, the CEOs who arrange the mergers seem able to keep their positions, perhaps renamed but at similar salaries (in the $300,000 to $500,000 range judging by those publicly available).

Fact is, one executive salary could likely pay for 5-10 additional technologists, thereby reducing stress and workload and helping to retain staff. Or one CEO salary could increase the annual salaries of 5 senior technologists by perhaps $50,000 each (or 10 technologists by $25,000/yr), thereby motivating them and those who succeed them to stay on the job. Similarly, one executive salary could fully pay for 60 or more staff to attend annual conferences (or 5/yr for 12 yrs). Or subsidize 50% of the cost for at least 5 people to attend for 24 yrs.
But that ain't what's happening or likely to happen, is it?
2. Engage & empower staff with learning opportunities

Good strategy, but hard to institute given today’s cost constraints.
When staff struggle with inadequate time to do the actual work, setting aside time during the work day for good stuff like journal clubs becomes increasingly difficult. Also, when staff feel devalued, motivation to learn outside of work time wanes significantly. Doesn't make it right, and is short-sighted, career-wise, (we are all responsible for our own learning), but there it is.
As well, in the current climate funding for attending conferences has dried up for all but the most senior staff. Some enlightened organizations partially fund congress attendance for one of more junior staff but this is fairly rare today.
3.. Develop career ladders for professional growth and advancement

Using USA terminology, creating special programs for MLTs/CLTs who want to move to the "scientist" level is a good idea, but how many universities are currently interested in creating NEW programs with limited enrollment? How many MLTs/CLTs can fund additional education? How many can leave work and family, even for short hands-on sessions to supplement distance education study? Some can but many cannot.
4. Create efficient work flow processes


'Lean' is supposedly not about reducing staff but about reducing waste and the need for skilled staff to do rote or manual tests so they are free to perform more skilled, interesting tasks.
Rote is one thing, but as someone who started in the profession when most blood bank testing was manual, that was one of the benefits of working in blood bank, as opposed to clinical chemistry where instruments have ruled for decades.

If Six Sigma & other lean management programs reduce waste and free up worker time, in the article’s context, lean can help reduce stress and workload and therefore act to retain staff.

But it's all pretty theoretical. Lean can assist many desirable outcomes, but has anyone seen a paper whereby, post-lean, laboratory staff retention rates are shown to improve significantly?

Who knows - maybe lean is like IVIg, the cure-all for every disorder known to humankind.....
5. Integrate automated solutions

Of course, automation has now infiltrated even the manual bastion of the transfusion service.
Like lean, blood bank instrument manufacturers promote automation as a way to free staff from routine work so they can do more interesting things. However, at the same time automation is promoted as a way to lessen the need for knowledgeable staff so that cross-trained techs, who are not transfusion specialists, can do the work. As well, manufacturers always note the number of staff that can be eliminated by their marvelous machines often named after characters in Greek mythology.
So which is it?
  • Automation enhances staff retention by freeing them from boring manual tasks and letting them do interesting things? Any studies on this?
  • Or automation helps eliminate the need for knowledgeable, specialized staff?
  • Or both? That is, automation has the potential to be totally liberating, liberating staff from boredom and ultimately from their jobs, all the while making clinical laboratories lean, efficient and error free.

The AABB article also discusses the decline in medical laboratory science training programs. From my experience in Canada, here's what happened:

  1. Governments withdrew funding from health care and laboratories in particular. See 'History of 1990s Laboratory Restructuring in Alberta'
  2. Faced with decreased funding, health care organizations instituted lab restructuring, regionalization, and automation, which led to a dramatic decrease in the need for medical laboratory technologists (and pathologists).
  3. The same trends made it increasingly difficult for laboratories to find the staff and time to train student technologists.
  4. The drop in demand, along with decreased funding for educational institutions and the inability to find adequate internship placements, led to schools closing.
  5. Move forward several years and severe shortages appear, exacerbated by the lack of training programs and non-existent internship spots, as well as the reality that skilled health professionals take years to educate and train.
Now we're in catch-up mode, as described in the AABB News article. Proposed educational strategies include career ladders (discussed above) and online education to obtain sustainable numbers with decreased cost.

Unfortunately, new or expanded programs are a hard sell in most locales, especially with the rise of automation, regionalization, and centralized testing, all designed to require fewer highly skilled staff.

Increased awareness of the profession is also discussed in the AABB piece. Although worthwhile, improved recognition for medical laboratory science as a career is such a long goal I will not discuss it here. Medical laboratory science professional associations and education programs devote much time an effort to this elusive goal.


So, while we stumble along with bandaids, the hemorrhage of knowledgeable lab staff continues and with them the tacit knowledge that cannot be found in print.

If the number of training programs and clinical placements magically increase, will there be any specialized transfusion experts left to pass on knowledge missing from textbooks and journals to the next generation? I doubt it. Not without adding a big idea to the bandaid mix.

So what's mine? I suggest an old idea that has never been fully adopted by the transfusion medicine community - a succession plan for transfusion professionals as a whole based on mentorship.

Granted, mentoring still happens informally to varying degrees some of the time but mentoring has decreased in recent years.

Mentoring is not a solution to staff shortages per se but rather an adjunct to help with succession planning for the profession as a whole.

And just because it's a big idea doesn't mean it cannot be implemented in baby steps by far-sighted leaders.


Call the mentoring program something catchy, a name that reinforces that's it's fun and unpretentious, e.g., Blood Buddies.

Employers, governments, professional associations, manufacturers. Time they 'walked the talk', don't you think?

  • Get by-in from local power brokers
  • Recruit newly close-to-retiring and retired experts willing to act as mentors*
  • Identify workplaces willing to test the concept
  • Generate topics where tacit knowledge is the norm
  • Assess mentee needs with their full participation
  • Develop prototypes and pilot projects to test the idea ("proof of concept")
  • Draft ways to evaluate pilot projects, including measuring outcomes
* Why older workers? Because they know what the current generation does not know that’s important to know. Because many are motivated to transfer knowledge as a parting gift ‘with love from me to you’. Oldie goldies have a wealth of experience to share.

Once mentoring program details are fleshed out, ask newly retired professionals (nurses, medical technologists, physicians), those with the respect of colleagues, to contribute one day a month, or whatever works for them, to pass on to the next generation what they see as the most important lessons from their careers, to include scientific, clinical, managerial, educational, and political aspects.

Solicit not just the 'big names' that speak year after year at conventions but respected professionals who have toiled out of the spotlight, the unsung heroes, as it were.

Think Global

Facilitate communication between retired transfusion professionals across the globe to discuss mentoring ideas and international mentoring sessions using the Internet.

Why not? The technology is there for free face-to-face sessions between individual and small groups.

Based on my experience, there are many experts that, depending on your country, you may not have heard of.  I know from MEDLAB-L that we can all learn from each other, regardless of profession and country.


So, what could 'Blood Buddies' look like?
  • Medical technologist, nurses, and physicians participating in interdisciplinary mentorship programs
  • Local, regional, national, and international programs
  • F2F: Series of informal, interactive workshops at local blood centers and hospitals, focused on practical aspects of key lessons learned over a lifetime. Notice I did not say presentations and topics would be co-generated by mentors and mentees.
  • Online: Individual and small group learning facilitated by Skype and similar free tools.
  • Integral components would be case studies to illustrate tacit knowledge.

Staff shortages of transfusion professionals will worsen in the coming decades. We can continue to apply the same bandaids, even though many do not appear to be working well. Best to evaluate their effectiveness to assess which ones have made a difference.

Will transfusion leaders - the powerful physician-CEOs and medical directors who run TM - do what it takes to improve staff shortages and the loss of tacit knowledge? I doubt it. Most of the talk in professional newsletters like AABB News about staff shortages is so much smoke and mirrors.

I'll know everyone is serious when

1. Post-merger, some extraneous blood center CEOs are let go and a proportion of their salaries is applied to wage raises for medical technologists or new hires or CE funding.

2. CEOs, VPs, and assorted medical directors at the top of the food chain voluntarily forego some of their salaries to make those of medical technologists more competitive (Okay, stop laughing....But as CEOs earn 5-10 times as much, or more, as technologist, why not, especially if they are serious about solving shortages.)

3. Employers, especially the pathologists who run transfusion laboratory services, actively and forcefully lobby governments to strengthen existing medical laboratory science programs

4. More medical directors donate some of their CE funding to allow technologists to attend conventions.

5. Employers designate more funds for educational initiatives for medical technologists.

6. More medical technologists volunteer to participate in CE programs on their own time.

7. Governments fund more MLS educational programs and provide funding for more clinical training placements.

Unfortunately, the 'movers and shakers' have NOT taken serious action yet and likely never will.

Call me an idealist but these are the things that concern me when reading the fuzzy thinking and hypocrisy that passes for expert opinion about staffing shortages in AABB publications. This sounds harsh, and it is. But if I wrote only nice things, readers would soon be comatose. Just like a 'goody-two-shoes' police inspector in a mystery, 'nice' has no legs.

Mentoring by near and recent retirees is a suggestion to supplement current bandaids. Mentoring addresses a real knowledge loss, one that is happening now and will continue to worsen as more people retire.

Maybe it doesn't matter that tacit knowledge is lost. We probably won't know until it's too late.

In the meantime, enjoy

Two ‘beauties’ from my 2010 post on mentoring:

As always, the ideas are mine alone. Comments are most welcome BUT, due to excessive spam, please e-mail me personally or use the address in the newsletter notice.  - see several  Comments below.

Further Reading on mentoring

  1. Saskatchewan nurses
  2. CLMA
  3. Women in leadership
  4. Beck SJ, Laudicina RJ. Passing the torch: Mentoring the next generation of laboratory professionals. Clin Lab Sci. Winter 2001.
  5. Beck, SJ, Laudicina, RJ. Mentoring tomorrow's leaders in education. Clin Lab Sci Winter 2001.
  6. Kapanka ARH. Journey to the millennium: mentoring in the clinical laboratory. Med Lab Observer, May 1998.
  7. Laudicina RJ. Mentoring for retention and advancement in the multigenerational clinical laboratory. Clin Lab Sci. 2001 Winter;14(1):48-52.