Staffing to Workload in Phlebotomy Areas: Indirect Effort

In the previous post, we began a staffing to workload exercise in a phlebotomy area. We started with the direct effort tasks such as blood draws, container hand-out, and patient rooming. In this post, we will now focus on the indirect effort tasks that are needed to support the direct effort tasks.

Indirect Effort

In phlebotomy, indirect effort is defined as "the tasks performed that don’t involve the patient or the patient’s sample." These tasks typically include, but are not limited to:

  • Ordering supplies.
  • Putting away supplies.
  • Managing the outdating of supplies.
  • Daily and weekly cleaning of the phlebotomy areas.

As with indirect tasks that are performed elsewhere, how long it takes to perform them and with what frequency they are performed need to be identified. As our direct effort is being calculated at the day of week and by every 15 minutes of the day, we need to calculate our indirect effort the same way.

We will return to our example of a Tuesday in the outpatient phlebotomy area. On Tuesdays, we perform the following indirect tasks:

Table 1: Tuesday Outpatient Phlebotomy Indirect Effort.

It should be noted that when a task takes longer than the 15-minute interval, there are two options in documenting it:

  1. The first scenario is outlined in the Discard Outdated Material task in Table 1. The task takes 25 minutes and is performed by one person, so it takes the individual one full 15-minute interval and 10 minutes of the following interval.
  2. The other scenario is outlined in the Restock Patient Desk task in Table 5. The task takes 20 minutes but can be performed by more than one person at the same time.
Figure 1: Tuesday Outpatient Direct and Indirect Effort.

Staffing Estimation

There is now enough information to generate an estimated staffing plan. The intent of this estimate is to establish good faith figures to allow us to see where we will encounter overstaffing and understaffing situations, plus allow for the inclusion of operational-needs planning. In Figure 1, we have a peak staff need of 3.1 phlebotomists and minimum need of 0.1 phlebotomists. The chart below outlines where the overstaffing or understaffing scenarios will occur when staffing one, two, or three phlebotomists in the outpatient area:

Figure 2: Tuesday Outpatient Staffing Options.

With one phlebotomist staffed, the outpatient area will not achieve the objective of collecting all patients who present and not have them wait more than 15 minutes. In fact, the area wouldn’t be able to serve all of the patients even with extended wait times. This would drive patient dissatisfaction, delays in care, and undue stress for the phlebotomy staff.

With three phlebotomists staffed, the outpatient area will consistently achieve the objective of collecting all patients who present and not have them wait more than 15 minutes. However, this comes at a phlebotomy staff utilization "price" that would be about 50%, increasing the phlebotomy labor costs by one-third ($15 per draw instead of $10 per draw).

Having two phlebotomists staffed appears to be the best compromise, as it raises our overall staff utilization to about 80%, and it achieves our objectives most of the time. There are some understaffing concerns during the late-morning period and some overstaffing concerns during the afternoon that will still need to be addressed, but overall, it is the best starting point for us to complete the staffing-to-workload analysis.

Summary

Indirect-effort tasks are often overlooked when accessing the staffing of a phlebotomy area, but they are critical in maintaining the services provided. The nice part about these tasks is that, sometimes, they can be moved to a different time of the day or even a different day all together. This can help us to smooth out the demands being placed on the phlebotomy staff. It can also give us the flexibility to handle abnormally high patient-demand situations by knowing which tasks can be pushed out.

The next blog post will continue with the analysis by outlining other operational needs in a phlebotomy work unit.

Mike Baisch

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.