I agree with Tim on this issue.  We still do the old CAP units for
everything we do and the staff gets productivity feed back every two weeks.
The whole department rotates 8 different positions for 2 weeks each.  So
they also get private quarterly reports along with an acceptable standard so
they know how they are doing.  All staff has been appreciative of the
information and know that it is to their benefit to keep these statistics.
We have not had a problem obtaining approval for additional positions as the
workload increases.  Although sadly enough we do have problems finding
qualified histologists.  

Karla Carson
Regional Pathology Manager
Mercy Health Care Sacramento
Phone 916-453-4494
FAX 916-453-4397
e-mail kcarson@chw.edu <mailto:kcarson@chw.edu> 

		-----Original Message-----
		From:	Morken, Tim [mailto:tim9@cdc.gov]
		Sent:	Friday, February 23, 2001 6:44 AM
		To:	'Histonet'
		Subject:	RE: productivity standards (long)

		Bert wrote: 
		<I disagree that simply looking at labor utilization versus
workload may be 
		used for staffing decisions because such a decision making
process invites 
		technicians and supervisors to "game" the system.>

		If you count minutes to show workload I guess people could
claim more time
		spent than acutally was used. That's why, for staffing
justification, I
		always used only the hard numbers of work produced by the
lab (never by
		individual tech). I kept databases of all countable work
done - blocks made,
		H&E slides, IHC slides, unstained slides, and even wasted
cuts that were
		thrown out (they did work to make those too!), whatever
could be counted.
		That sort of data cannot be argued against and when I can
show that we did
		30 percent more work with the same number of people it is
much easier to ask
		for more positions, especially if you can document yearly
increases with no
		plateau in sight.

		From my experience, no tech is going to cut extra blocks or
slides, or do
		extra special stains, or whatever, to boost the lab output -
they are busy
		enough with the work requested!

		As to whether it is worthwhile to do this, nobody is going
to listen to
		complaints about being overworked unless you can prove it,
so in that sense,
		doing this helps your lab, and helps the people working in
your lab.

		Tim Morken
		Atlanta

		-----Original Message-----
		From: Bert Dotson [mailto:amdj@duke.edu]
		Sent: Thursday, February 22, 2001 4:33 PM
		To: Histonet (E-mail)
		Subject: Re: productivity standards (long)


		One must first ask the obvious questions: (1) what is the
purpose of the 
		standards? (2) how will they be used? (3) how will
performance relative to 
		the standards be measured?

		There may be a number of purposes behind the decision to use
some sort of 
		standard that I am unaware of but in my experience they
really come down to 
		two. Standards are set up to measure laboratory performance
or to measure 
		individual performance. The first instance should be less
controversial so 
		I will tackle it first.

		   Measuring laboratory performance can be used for cost
accounting, 
		setting staffing levels, benchmarking against
peers/competitors or any 
		combination. In these instances, it is very important that
the standard be 
		tied to some relatively universally acknowledged
measurements or the data 
		are meaningless.
		   On this continent we have two such systems that are
up-to-date and 
		widely used and one that is hopelessly out-of-date and still
frequently 
		used. The two current standards are LMIP measurements from
the CAP and 
		Canadian workload measurement system. The hopeless one is
the old CAP 
		workload values that are still used by some but reflect none
of the 
		technological and market-place changes (automation, wider
availability of 
		ready-made reagents, shift from pathologist gross to
technician or PA 
		gross...) that have occurred over the past 10 years. The
LMIP is a 
		subscription system that carries a healthy price-tag but
roughly measures 
		the amount of output (slides) that can be expected from an
average FTE over 
		a period of time. This works out to about 1000 slides per
FTE per month 
		inclusive of a certain percentage of special stains etc. The
Canadian 
		system assigns a number of units of effort (minutes) to each
technical 
		task. The numbers of each task performed are then counted up
and multiplied 
		by the unit and you have an approximation of the level of
effort required 
		for a given lab. This system is much more versatile for cost
accounting and 
		for laboratories that perform a lot of specialty tests or
have 
		significantly different mix of workload from those in the
LMIP (all 
		research labs). The Canadian value to produce one finished
H&E slide from 
		one cut and blocked tissue (but not processed) is nine
minutes.
		   No system can be perfect and there will be justifiable
variations from 
		lab to lab. Canadian standards are based on actual
time-studies in 
		laboratories and contain small increments of overhead
activities and 
		step-function costs such as supervision and processor
changing. Larger 
		laboratories can perform better because they spread these
activities over a 
		larger specimen volume. LMIP is simply not suitable for
research settings 
		because it is based on actual clinical laboratories
performance over longer 
		time-spans (thus accounting for some fluctuations in daily
workload). So as 
		Tim Morken pointed out, these measures must be put into the
context of the 
		specific lab and its performance versus these measures over
time. I 
		disagree that simply looking at labor utilization versus
workload may be 
		used for staffing decisions because such a decision making
process invites 
		technicians and supervisors to "game" the system. Academia
and the 
		government are notorious havens for such "gaming behavior."

		   The use of "standards" for assessing individual
performance is a real 
		problem. A government study (post office or census, I can't
find the 
		reference) in the '50s examined the performance of card
punch operators 
		when given various performance expectations. The study found
that those 
		that were given specific expectations in terms of the number
of cards to be 
		processed seldom reached the expectations (regardless of the
actual number) 
		and experienced significant stress when they did so. Those
who were not 
		given expectations soon surpassed the productivity of those
that were and 
		experienced no stress--go figure.
		   If you must provide quantitative measures of employee
productivity (as I 
		must thanks to policies beyond my control) be VERY careful.
From almost six 
		years now of experience with this I can tell you there is no
good way to do 
		it. The best method I have used is a multivariable
regression that allowed 
		me to identify individuals whose presence in the lab
significantly impacted 
		total laboratory productivity. The powers that be found that
method too 
		complicated (they didn't understand it). Currently each
individual keeps 
		track of the number of blocks they cut and embed and these
are monitored 
		over long periods of time to control for differences in
daily assignments 
		and workloads. This is less than adequate but it does tend
to give a more 
		realistic picture and stifle some of the negative behaviors.
		   I can provide a few pointers for those establishing a new
system or 
		modifying an old one:

		Do Not set a standard "X blocks per hour." There is no way
to properly 
		monitor this unless you intend to stand over the techs with
a stop watch 
		and an abacus all the time. If you only monitor sometimes
then performance 
		when you monitor will be significantly different from when
you don't. You 
		will be measuring ability and not productivity. I disagree
to some extent 
		with the statement someone made that some techs are more
talented. Many 
		poor performing techs are capable of cutting at rates close
to those of the 
		better techs. They just don't.

		Do Not count blocks over short periods of time (days or
weeks). You do not 
		have an unlimited supply of blocks. Those one person cuts
are those another 
		person doesn't. You will create block hogs.

		Do have behavior and quality measures in addition to
productivity. If 
		productivity is the primary basis for deciding compensation
or continued 
		employment, poor quality and counter-productive behaviors
will abound.

		I've tried to be brief but given the amount of time I have
wrestled with 
		this issue it is difficult. And it is silly. Everyone in the
lab knows who 
		is not pulling their weight--just introduce peer evaluation
and avoid all 
		this busy work.

		Bert Dotson