Taking care of staff and product supply: the pillars for better outcomes in phlebotomy

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“Keeping the patient safe is our top priority,” says Robert E. Del Guidice, Clinical Administrative Director for Diagnostic Laboratory Services at a large cancer centre that has recently ranked as one of the best US hospitals for cancer [1]. The Diagnostic Laboratory Services sees 800,000 patients per year where a blood specimen is collected. How have their phlebotomists, lab technicians and directors adapted to meet a new landscape in the wake of the pandemic and staff shortages?

Robert’s hands-on, gregarious personality is well suited to his role as Clinical Administrative Director. The job requires feet on the ground as Robert walks the clinics and corridors in regular contact with clinicians and phlebotomists, and their patients, taking the pulse of the centre and its satellite clinics.

His deep involvement with the health of department’s day-to-day operations and outcomes extends to the profession itself; initiating a regular program for local community college students to train and enter the profession.

Life was great. Didn't know it, but it was ...

“I had developed a phlebotomy externship program. An 18-week paid externship for new phlebotomy graduates to cultivate a pipeline of qualified candidates to fill our vacancies. Life was great. Didn't know it, but it was. We had sufficient supplies. We had sufficient staff,” says Robert. And then came the pandemic, bringing shortages in its wake.

“Staff recruitment was not very good because the pool of candidates dried up fairly quickly. We weren't able to do in-person interviews. We started to learn about Zoom. And [there were] a lot of staff resignations, because now their children were not able to leave the house to go to school. There was home schooling. They had to be home with their children.” And of the staff that remained, Robert ensured that job security matched their dedication and skill:

“Keep them all employed, keep them on payroll, keep them all busy. We wanted to treat the patients and each other with respect and kindness. And we wanted to be accountable.”

Recognizing the sacrifices the profession demanded translated into concrete gestures;

“I had to increase wages to recruit, I've done market adjustments to increase salary; and good pensions and pathways to becoming a specialist.” The centre reliably scores among the best in the US for cancer care, patient satisfaction and employee satisfaction [2] as a large national employer. Robert is glad his externship program for local community college students is back on track. And this is amid a new normal of scarcity and enormous price increases.


How the hospital has negotiated price and scarcity since the pandemic

“These patients need care. And if you don’t treat the patients, you don't get revenue, you can't sustain a business. That's the model” says Robert, summarizing his conversation with purchasing executives at the centre. While the supply chain has stabilized somewhat, the pandemic has yielded a few hard and fast lessons. Extrapolating that to the size of the community that this organization serves would mean a lot of unhappy people. “Bad marketing” as Robert simply puts it, mindful of his high patient satisfaction goals and the scores the centre regularly logs [3].

Like the majority of large administrations, a rigorous culture of safety was already in place and Robert explained that to the administration:

“I said: I’m going to have explainable, inevitable variations in supply and product availability; I can explain why I spent more money, and nobody questioned that.

We wanted to drive accountability — that was one of our overarching goals for surviving the pandemic, and we did survive, we survived fairly well.

There's a lot of pressure on all hospitals to stabilize, our purchasing executives have a mandate to really reduce the amount of expenses.”

As a significant decision maker in purchasing, Robert has had direct contact with the regional CEOs of manufacturers and distributors. Suppliers that have been able to forecast and stabilize their supply chain are favoured:

“One CEO of a manufacturer communicated directly with me, what the company plans were for expansion to sustain the supply once we were out of this pandemic. Their materials suppliers are working with their production on being cost-effective. My supplies have started to come back in, we are doing well now.”

In this series of articles, we shall bring a larger focus to these prevalent issues of supply, and how organizations like the MDAnderson Cancer Center continue to stabilize and strengthen their delivery of core services to their patients, maintaining the health of their staff while adapting, optimizing and planning for the future.

Safety and value, it’s in our blood

Protecting patients, clinicians and accuracy are topics to be covered in more detail here in the coming months. To ensure you don’t miss out, subscribe to the series here.

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