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Staffing to Workload in Phlebotomy Areas: Minimum Staffing Levels

Over the course of this blog series regarding staffing to workload in phlebotomy areas, we’ve discussed how direct, indirect, and operational needs affect the staffing levels. This final post in the series will focus on the topic of minimum-staffing levels, which can override the calculated staffing needs by adding staff to meet potential demands.

Minimum-staffing rules come into play for work units that have to provide services requiring quick response to on-demand situations. In health care, the most visible form of this scenario is the Emergency Department (ED). There may be times when there is very little patient need for the services the ED provides, but the area still needs to be staffed in order to meet potential demands. This quick response to on-demand service needs has a trickle-down effect on all of the support areas like phlebotomy and laboratories. The ramifications of this is having staff on site and ready to respond, but not always having something to respond to. The table below outlines a scenario where the patient demand for phlebotomy services is very low, but there is a potential need for phlebotomy services to support emergency situations, thus creating a minimum-staffing situation.

In the example above, the phlebotomy area is overstaffed from 1 a.m. through 6 a.m. by about 5.3 hours (adding the Overstaff Levels), which is roughly equivalent to ¾ of a full-time employee (FTE). Based on our staffing analysis, if the calculated staffing needs came to a total staffing level of 5 FTE, we now need to add that ¾ FTE to account for the minimum-staffing requirement, giving us an actual staffing level need of 5.7 FTE.

Now, this time of day would be a prime candidate for those indirect tasks we identified in our staffing analysis to be performed. That said, it's not always possible to move all of those tasks, so we may end up with having staff on site with nothing much to do, unless there is an emergency situation.

Additionally, the example set the minimum-staffing level requirement at 1 person. However, there may be instances when that number needs to be higher to be able to provide the service being requested (handing out blood units may require a two-person check) or if there is a staff safety issue or concern if only one person is around.

Summary

Minimum staffing level needs can affect our staffing-to-workload plan by adding staff members who weren’t directly calculated by our direct effort (patient care), indirect effort (support tasks), or operational needs (PTO, FMLA, etc.). It only comes into play when there is a potential patient need and our calculated staffing levels are below the minimum-staffing requirement. Without this adjustment accounted for in our final staffing levels, we can create issues when serving patients during emergency situations and adding stress on the work unit trying to support it. Being able to explain what this need is and where it comes from is important in the communication to leadership who review staffing needs, as it appears counterintuitive to hire additional staff when there is “no need” for them.

In health care settings, we need to be good stewards of our resources. Overstaffing has the benefit of being ready for just about any scenario that can happen, but it drives up the cost of health care. Understaffing has the benefit of bringing the costs down in the short term, but it may lead to long-term costs by causing care delays and longer hospital stays. Finding the balance between over and under staffing (right staffing) is what the intent of a staffing-to-workload assessment is, helping us to be good stewards.

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.