The roles of medical laboratory scientists and technologists are pervasive in all areas of the clinical laboratory, including chemistry, hematology, immunology, microbiology, and transfusion medicine, among others. In the blood bank, these core laboratory staff are responsible for the full range of laboratory tests—from simple prenatal blood tests, to more complex diagnostic tests for diseases such as diabetes and cancer or tests for antibody identification. Accordingly, an entry-level MLS is likely to have exposure to many different disciplines within the laboratory and in order to find the best fit for future advancement, it is important to recognize what skills are required to best manage the operations of that discipline.
Pursuing a management position in the clinical lab generally requires an advanced degree or specialist certification, and taking on additional responsibilities should be encouraged for those seeking advancement. However, while development of education and technical expertise is certainly necessary, as we progress to increasingly more senior management roles, we face new responsibilities, many of which have nothing to do with our technical expertise. Further complicating matters, often there is little training available to develop these management skills.
As with other areas of the clinical laboratory, the operations behind running a blood bank have undergone profound changes in recent years. Simply put, we are compelled to provide the freshest blood products and accurate test results to physicians in the shortest amount of time, yet with fewer staff. Blood banking, along with many other aspects of health care, has become a business and in order to execute daily tasks using less time and money, it must be approached as such. A key initiative in increasing efficiency is the adoption of automation into the blood bank. For example, in our facility, after performing extensive research and watching several demonstrations of automation equipment, the blood bank staff provided feedback to both myself and our blood bank pathologist, and we decided to purchase a fully automated blood bank analyzer to automate all routine blood testing including grouping, cross matching, and antibody screening.
Benefits of Standardization
Training our technologists to operate and become comfortable with automation was initially a challenge for blood bank management, as our staff was used to manual processes. However, once the blood-testing automation became part of daily use, it has ultimately reduced the amount of stress brought on by additional time constraints in our lean staffing environment. To help enable training on the new equipment, one technologist on each shift was designated to be a key operator who could answer questions or troubleshoot the instrument in the absence of the supervisor. These operators were extensively trained one-on-one and assisted in training the remaining blood bank technologists alone or in groups of two depending on work schedule. Each technologist was then given a written competency exam and had to perform sample testing on several specimens prior to being acknowledged as a trained operator. We now perform CAP automated testing every six months to maintain competency.
Of particular benefit, automation in the blood bank has allowed us to standardize several work processes across shifts and now allows the operators to initiate the analyzation process and then leave the machine to multi-task on other more specialized job functions, such as processing units received from the blood center, issuing units to the nurses or operating room staff, and performing required quality assurance monitoring. Automating processes such as cross matching also provides the supervisor with the ability to review and audit the steps that result in any questionable outcomes, at the same time using that audit process as a teaching tool for all staff.
Focus On What You Can Control
Adding automation to the blood bank has enabled our staff to better manage workflow and increase productivity, but there are other aspects of this department that we have less control over; namely, the skyrocketing costs of blood products. Blood products have historically been the most expensive line item under the blood bank’s budget, but in recent years, expenditures have soared even higher as the processes of acquiring, testing, and delivering blood become more expensive. For example, a unit of red blood cells from a local supplier can range anywhere from $200 to $400 or more, depending on the amount of additional testing that needs to be performed on it. Containing and managing the blood products budget should be a area of focus for the hospital laboratory as a whole, given that the cost of blood products frequently occupies the second highest line item on the entire laboratory’s fiscal budget, second only to the cost of total laboratory labor. Some of the best methods for controlling the blood products budget involve networking with other blood bank supervisors, attending state and regional blood bank meetings, and talking with blood bank suppliers. Performing cost-savings analyses on the impact of switching blood suppliers and/or suppliers of blood bank reagents can reap significant savings. These are the two biggest areas where blood banks can save money, without impacting FTEs.
Involving Staff Creates Ownership
Among the more significant challenges in leading a successful laboratory department is creating a management persona for oneself. A successful lab manager must have strong communication skills with all relevant staff, listen actively to staff complaints and issues, be an effective problem solver, and be able to perform in times of crisis. These four skills are key attributes every blood bank supervisor must possess. Furthermore, do not forget to praise your employees for a job well done. Working through difficult antibody identifications, such as when a reaction does not match a specific antibody profile, can be a difficult process. It sometimes becomes necessary to perform additional antibody panels before interpreting which antibody(ies) are evident. This may involve incubating the tubes at different temperatures, changing additives, or adding additional drops of plasma. Referring to the antibody resolution procedure helps technologists to develop good problem-solving skills and obtain a higher level of confidence. In all cases, successfully troubleshooting problems in the blood bank deserves acknowledgement.
As the department leader, it can be easy to get caught up in the management hierarchy and forget to consider the perspective of your rank and file staff. When problems arise, listen to your staff; often they will come up with a successful solution to the situation given their active, every-day involvement in the work. Recently, we realized we were running out of storage space in our blood bank refrigerators. Our staff suggested we condense the specimen racks to gain back the space, which proved feasible, so we implemented a new specimen storage protocol. We find these types of issues can be resolved much more efficiently when staff are encouraged to participate in problem solving. Typically, when a problem arises, the first reaction is to find a solution. Instead, I would recommend the first reaction should be to ask a question. With this approach, your staff is encouraged to share in the problem solving and bring solutions to the table.
One certainty in laboratory management is that no matter how much planning is done ahead of time, something will eventually go wrong. When a crisis hits, it must be dealt with calmly, quietly, and efficiently, but keep in mind, you may not have all the answers and knowing when to ask for help is an important management skill. As a new blood bank supervisor on the job for only six weeks, I received a call on New Year’s Day informing me that my plasma freezer had failed. The temperature was rapidly rising and the freezer contained over $5,000 worth of plasma products. We had no backup freezer and while we could have requested boxes of dry ice from our blood supplier, the products would have begun to thaw before the dry ice arrived at the hospital. Clearly, it was time to ask for help. I spoke with the lab director and she mentioned that our chemistry department had a freezer that could maintain the required -18ºC necessary to ensure the integrity of the plasma. This quick thinking provided a stopgap measure until our freezer could be replaced, thereby saving the products.
More recently, I received a report that our platelet rotator had permanently malfunctioned during a weekend shift. While the rotator was over 15 years old and there was already a line item in the budget to replace it, this did little good at the time. Platelets must be constantly agitated during storage, but since there was no immediate need to transfuse them, the platelets were promptly returned to the blood center. The real problem arose later when an ER physician ordered two units of platelets for his patient. While discussing this problem with one of my technologists, he suggested using our serology card test rotator to rotate the platelets until they needed to be transfused. Again, this real-world thinking averted a patient safety crisis.
A key responsibility of management is to evaluate and implement process improvements, and while the necessary technical knowledge may exist to implement such changes, selling those changes to the staff is a very different challenge. It is important to remember that when we choose change it can be exhilarating, but when change is imposed upon us, our initial response may not be so positive. Change can be difficult for everyone because it usually involves stepping out of one’s comfort zone. Therefore, gaining staff acceptance is more likely to occur by encouraging staff participation in all aspects of the change. When we implemented the new automated blood analyzer in the blood bank, initial training was provided for all staff. After that, the technologists relied on each other to complete their check-off lists. After a few months of running the analyzer, the technologists became proficient with the process and were able to recognize, first hand, the benefits of automation in the blood bank.
Taking the Good with the Bad
Among the more difficult tasks of blood bank management—a rather universal issue—is dealing with unacceptable job performance during employee evaluations. There is no real training available for this part of the job. However, the onus is on the manager to unravel the obstacles preventing the employee from performing as expected. Setting reasonable goals for employees is essential and every employee should understand what is expected of them, and know the consequences should they fail.
Successfully managing a blood bank requires open and continual communication between the supervisor, the staff, and related clinicians. This involves fostering a significant level of trust. The blood bank supervisor must trust that departmental staff will work competently and efficiently, mitigating all margins for error. A wrongly labeled blood type or incorrectly identified antibody screen can have serious repercussions and lead to devastating results for patients. Maintaining close ties to the tenets of those positions over which you have authority can go a long way in ensuring the effectiveness of your own job. As is often the case in decision-making and problem solving, finding the best solution depends less on your technical knowledge and more on your understanding of the problem.
Deborah Baudler, MS, MT(ASCP)SBB, is the blood bank supervisor at Jefferson Regional Medical Center in Crystal City, Missouri. She received her BS in medical technology from University of Wisconsin-Oshkosh, her MS in clinical laboratory science from the University of North Dakota-Grand Forks, and has a specialist in blood banking certification from ASCP. Debbie has spent most of her professional career working in hospital laboratory blood banks, including four years at the Florida Blood Alliance in Jacksonville. She also is an adjunct faculty member in the SBB program at Rush University in Chicago.
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