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From:Bert Dotson <>
To:"Histonet (E-mail)" <>
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   The NSH appointed a committee (or working group or something) to look 
into this issue at the last convention. I am looking forward to see what 
they come up with.
   I have at various times used or helped others to use three different 
workload productivity systems. The Canadian workload system is by far the 
most flexible but it has some pitfalls that people should be aware of 
before they choose to use it. The standards we currently use here are based 
on the Canadian system. These standards are then plugged into an activity 
based cost accounting software package to produce monthly reports on labor 
efficiency (among other things). The system is also used to produce "flex" 
budgets that help us to better adjust resources when we experience 
significant shifts in workload.
   The CAP workload recording system is similar to the Canadian system (it 
should be since it was based on it). It is by far the most problematic of 
the productivity standards that I have used for two reasons: 1) It is out 
of date. The standards have not been updated since 1992 and will not be 
updated because the CAP has abandoned it in favor of their new product, 
LMIP. 2) It is very difficult to work with because there seems to be little 
logic behind which tasks are included in the standard values and those that 
are not. For example, some simple laboratory tasks such as gloving and 
degloving that are associated with a wide variety of laboratory activities 
are counted separately, while other tasks such as reagent preparation for 
special stains are included in the unit for the stain. In net effect over 
time CAP units tend to exaggerate the labor required for special stains and 
underestimate the labor required for processing, sectioning and staining 
routine H&Es. The Canadian system does much better here. It is regularly 
updated and its values contain most of the associated tasks--including an 
allowance for supervision. It also contains values for a few uncommon 
techniques like the peripheral nerve tease preparation. Neither are great 
for an immuno lab (we have "borrowed" the unit for diastase digestion for 
both enzyme predigestion and epitope retrieval and are probably 
underestimating the effort required). Both seriously underestimate the 
resources required for report transcription and distribution. Both also 
involve counting activities and offer little advice on accounting for idle 
time or paid time on days when workload is lower than average. If you add 
up all your unit values for a year and the system tells you that you need 
nine technicians and you have nine technicians you may be disappointed 
because you will most probably need ten to get the work out on time and 
avoid overtime.
   The current CAP offering (LMIP) does not suffer from this problem. It is 
more akin to acuity adjusting staffing levels used in nursing. By counting 
cost driving activities over long periods of time from lots of laboratories 
it offers suggested staffing levels for a particular volume without the 
intermediate step of telling you how long it should take to cut a block. 
The last time I was discussing this with a subscriber, the rule of thumb 
was 1000 slides per month (including a certain number of special stains) 
justified one FTE. In my opinion the LMIP is rather generous unless you 
have histotechs performing most of the gross. The LMIP does suffer from two 
drawbacks. First, the program is only as good as its participants. Second, 
it is a subscription program. In order to get the full value you have to 
subscribe--it ain't cheap.
   I have developed a personal rule of thumb for our lab of an average of 
50-60 blocks per day per technician. This includes covering frozen sections 
and gross assistance but not actual grossing or immunos). This is fairly 
consistent with LMIP and is about 80% productivity under strict Canadian 
standards. A lab that has less volume fluctuations (I can predict with 80% 
certainty that we will have between 200 and 600 blocks tomorrow--which 
means there's a 20% probability that there will be more than 600 or less 
than 200) should be able to do better. God Bless any lab that has less 
predictable volume.

Bert Dotson

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