Staffing to Workload: Indirect Effort

In my previous post, I discussed the importance of having a staffing-to-workload plan and identified three components to performing a staffing-to-workload analysis: direct effort, indirect effort, and operational needs. I went into detail about direct effort, which, in summary, is the amount of labor associated with “hands on time” with the patient, specimen, or data generated during testing. To calculate direct effort, we look at how many patients, specimens, or data results we manage, and how long it takes to process each one of them. Multiplying the two pieces of information together gets us the direct effort. However, direct effort only represents the most visible part of our labor needs; there are a couple of less visible or hidden needs. The first of those hidden needs is indirect effort.

Indirect effort refers to the labor effort with items other than the patient, the specimen(s), or the patient test results. Examples of indirect tasks include:

  • Daily calibration of the instrument.
  • Planned maintenance.
  • Performing quality control.
  • Performing proficiency testing.
  • Stocking supplies.
  • Filling out paperwork.
  • Clerical work.
  • Answering the phone.
  • Revised reports.
  • Repeated testing.
  • Test development.
  • Unplanned maintenance.
  • Reconstituting standards.

The list above is some of the more common occurrences of indirect effort, but there are certainly many more. The best way to figure out what they all are is to ask the staff doing the testing and/or perform direct observation.

Calculating Indirect Tasks

Once you have a comprehensive list of indirect tasks, you need to document how long each task takes and how frequently it is performed. In some cases, the duration or the frequency will have to be estimated because it is not a scheduled event, for example, unplanned maintenance or a College of American Pathologists (CAP) inspection.

Task Duration Frequency
Daily calibration 30 minutes 5 days per week
Weekly maintenance 60 minutes 1 per week
Stocking supplies 45 minutes 5 days per week
CAP inspection 40 hours 1 per year
Answering phone 5 minutes 30 times per day
Proficiency testing 60 minutes 2 per month

How much additional FTE (headcount) is that? First, you need to convert this to a common denominator (week, month, or year). "Year" is most useful because it tends to be the longest time period.

Task Duration Frequency Annualized
Daily calibration 30 minutes 5 days per week 130 hours
Weekly maintenance 60 minutes 1 per week 52 hours
Stocking supplies 45 minutes 5 days per week 195 hours
CAP inspection 40 hours 1 per year 40 hours
Answering phone 5 minutes 30 times per day 19 hours
Proficiency testing 60 minutes 2 per month 24 hours

Total Annual Direct Hours = 460 hours

To convert the 460 hours of indirect effort in each year, simply divide it by 2,080 hours (40-hour work week X 52 weeks), which gives us 0.22 FTE. So, if the direct-effort calculation shows we need 1.5 FTE, we would add another 0.22 FTE to get 1.72 FTE needed each day to complete the work. This is before we add in the operational needs FTE, which will be coming in the next post.

Just like the direct-effort calculation, this method assumes level loading, meaning these tasks can be flexible. If any of these items aren’t flexible and will overlap with each other or with direct-effort tasks, then they need to be added together and the FTE calculation behaves more like the critical TAT direct effort.

For example: We show that we have 3.5 FTE worth of direct-effort tasks that need to be completed. We also have 0.5 FTE of daily calibration along with a 0.25 FTE of weekly maintenance; we get 0.75 FTE worth of indirect effort on the day of the weekly maintenance and 0.5 FTE on all the other days. If the direct effort and the indirect effort need to happen at the same time, we need a temporary staffing level between 4.0 FTE and 4.25 FTE, depending on the day of the week. The alternative is to find a way to move either the direct-effort tasks or the indirect-effort tasks to a less-demanding time of day.

Monitoring the Instrument

This type of indirect effort typically affects automated assays that have little direct hands-on time with the specimen, but a close eye needs to be kept on the instrument. A single tech can monitor multiple instruments, but there is a limit to how many and what other tasks the tech can do while monitoring. The impact of this type of task is that the direct calculations would show you need 0.5 FTE, but you still need to staff a full 1.0 FTE as the instrument cannot be left on its own. The challenge would be to figure out what to do with the extra FTE and to document for what the extra 0.5 FTE is needed.


This type of indirect effort typically affects inpatient assays tied to emergent care. The laboratory always needs a "bare minimum" staffing level just in case something happens. For example, the blood bank is always open and staffed to meet the needs of patients. The direct-effort data you collect may calculate a need of 3 FTE. However, to keep the laboratory open 24 hours a day, 7 days a week, you may actually need 6 FTE from a patient safety, employee safety, and patient care standpoint. The “extra” 3 FTE needs should be documented as such, but it also means the laboratory technically has capacity to do more testing or perform other indirect tasks when not engaged in a patient care episode.

Mike Baisch

Mike Baisch is a Systems Engineer within the Department of Laboratory Medicine and Pathology at Mayo Clinic. He partners with the various testing laboratories on their quality and process improvement projects including staffing to workload, root cause analysis, and standard work & training. Mike has worked at Mayo Clinic since 2005 and holds a degree in Industrial Engineering. Outside of work, Mike enjoys cooking and sampling cuisine from around the world, home brewing, and gardening.