Background: The University of Maryland Medical System, like all other medical systems, is faced with providing the highest quality care in an environment of increased demands and competition for resources. Some responses to this pressure include improved integration, coordination, and efficiency. Laboratory integration has been highlighted by our medical system as a promising area for improvement. Standardization of practices, including job descriptions, is an important step on this journey.

Methods: With the help of the Human Resources department and the laboratory directors, we conducted an assessment of existing titles and practices from across our medical system. Analysis and evaluation of job descriptions demonstrated some inconsistencies and opportunities for standardization. Discussion and dialogue allowed us to reach consensus on a standard philosophy, format, and approach.

Results: We created a system wide Phlebotomist job description, based on current practice, which reflected the needs of our medical system. We will be able to use this tool to standardize other job titles, as well as for recruitment and as a basis for retention.

Conclusion: This methodology can be easily duplicated and followed to evaluate and design job descriptions, as well as to reach consensus in an efficient and organized approach to job standardization in the laboratory.

The University of Maryland Medical System has embarked on a journey of laboratory integration for its hospital laboratories. Although this concept entails a broad range of opportunities, human resources issues continue to arise.

The University of Maryland Medical System is an integrated delivery network (IDN) with 12 hospitals and more than 1700 licensed beds, outpatient centers, and physician groups/offices, all spread throughout central and eastern Maryland. Currently, laboratory integration is focused only on hospital laboratories.

Why Should We Standardize Job Descriptions?

We have learned through multiple consulting engagements, discussions with members of other IDNs, and our real life experiences that standardization of human resources (HR) practices is vital to ensuring successful overall integration. Although we are currently limited by information technology (IT) connectivity regarding test integration, we have been working on integration in many areas of our medical system. Our System Laboratory Council, which consists of laboratory directors from all of our hospitals, meets every month to discuss opportunities. We reserve discussions for covering urgent HR topics. These meetings give us the chance to commiserate regarding the high vacancy rate for phlebotomists, clinical laboratory assistants, laboratory scientists, histology technicians and technologists, and cytology technicians and technologists; the lack of qualified applicants in those specialties; and the process to recruit and hire new workers in those positions. However, we also share the occasional true HR story one of us has experienced for the educational and entertainment value of the others.

The directors in our council believe that standardizing job descriptions across the system would be a good first step in using the basic tools of job description standardization (job analytics, identification of tasks, grouping of functions, and creating meaningful jobs) to identify our needs and to begin the discussion of equitable compensation, for use in recruiting new employees, and recognizing and retaining existing employees. We discussed potential courses of action and reached out to the corporate HR department for authorization, information, and advice.

Which Job Descriptions Should We Standardize?

Starting with a list of our combined job titles and full time equivalents (FTEs) across our medical system, we identified likely places to start. We evaluated the data based on immediate needs and potential short-term benefit. Figure 1 shows the list we compiled. This list is not entirely inclusive: it does not include all of our facilities. Also, some groups that we labeled “hospitals” represent semi-integrated groups within our system. This exercise in itself revealed a lot of useful information. In addition, we received detailed salary information (not included in this table).

Figure 1

List of combined job titles and full-time employees across the University of Maryland Medical System, Baltimore, MD.

Figure 1

List of combined job titles and full-time employees across the University of Maryland Medical System, Baltimore, MD.

We realized that job descriptions, titles, and duties varied widely. Standardization of job descriptions also would lead to standardization of titles and responsibilities. In addition, some of our organizations contain, within their job descriptions, effective examples of what used to be called career ladders (processes designed to formally progress a staff employee to a higher level of job responsibility within his/her current position; this term is colloquially considered to be severely outdated). The current term for these processes is advancement models; this term is more reflective of what we are trying to determine in our research. We understood that if we tried to standardize job descriptions using advancement models, doing so would complicate the initial process and would involve much more interaction with the HR and compensation specialists than we had anticipated originally.

So, given all the jobs and all the needs that we were examining, we decided to start with Phlebotomist as a relatively uncomplicated job description. However, we soon discovered that this job serves as a dynamic catchall for many tasks that contemporary phlebotomists perform. We also noted significant overlap in tasks with clinical laboratory assistants (CLAs), who are employed in many of our facilities. Some of our hospital laboratories do not even have a phlebotomist function or job title. Nevertheless, we needed to start somewhere. The job title Phlebotomist has a significant headcount and role in our hospitals.

How We Standardized Job Descriptions

We gathered some Phlebotomist and phlebotomy related job descriptions from across our medical system to begin our comparison. On the advice of the HR department, we did not start with the description or format used by any single hospital because doing so could lead to contention instead of consensus. Discarding the preamble, physical requirements, and other miscellaneous information, we focused strictly on the duties of the position. We discovered a wide variety in the types of duties performed by phlebotomists. For instance, most, but not all, of the phlebotomists in our health system draw blood. Some phlebotomists process specimens and perform point of care testing (POCT). A few more check insurance and register patients for outreach laboratory work. Many perform customer service tasks and call center functions. At one of our facilities, phlebotomists are responsible for starting and maintaining intravenous (IV) lines.

As laboratory leaders, we looked at all the questions and possibilities within the data. If phlebotomists could handle IV lines at one hospital, why not at the others? If some phlebotomists performed POCT or registration or had customer service duties, could our phlebotomists all perform these tasks? Was there any financial advantage or job satisfaction outcome related to reformulating basic duties? These are questions to be answered at another time. However, they are part of our thought process, and we consider them to be possibilities for future examination.

The methodology that we selected to compare and standardize job descriptions was fairly simple: we read through all the descriptions and listed them in grid format. The wording was different between the many job descriptions, and sometimes we had to determine what additional information was implied, but the essential duties were consistently similar. After determining requirements for individual hospitals, we examined the similarity of tasks. Figure 2 shows our findings.

Figure 2

Similarity of tasks among job descriptions for the same type of position across the University of Maryland Medical System, Baltimore, MD.

Figure 2

Similarity of tasks among job descriptions for the same type of position across the University of Maryland Medical System, Baltimore, MD.

We are grateful for the analytical abilities of the laboratory practitioners who created these job descriptions. The continuum of frequency of duties corresponded strongly with the tasks that we expected a “typical” phlebotomist to perform. However, the definition of “typical” has changed radically as the field has progressed. For instance, many years ago, I started out as a phlebotomist, with the central duty of drawing blood. Before long, however, I was registering patients and ordering tests via computer, fielding customer service calls, and maintaining records. The field of phlebotomy and the responsibilities of phlebotomists have grown in the past several decades. By ranking the frequency of performance of certain tasks, we derived a clean dividing line between the responsibilities of individuals with similar job descriptions.

Results

The laboratory directors discussed how to use the results of this analysis to write standardized job descriptions. We decided that including common core duties would be essential. Other duties, which were above and beyond the entry-level expectations or tasks that were unique to one of our member hospitals, would be put into another category, called additional duties. This distinction leads to a strong foundation for compensation and an advancement model. We believe that performing the standard phlebotomy duties should be a minimal expectation for this position and that compensation could be determined and rationalized equitably based on the diverse needs and conditions of institutions within our medical system.

We were interested by the fact that some common duties were missing from some descriptions and that others contained strong ideas that we believe should be included in all descriptions (ie, collection of transfusion specimens and blood cultures). We also included “appropriate responses to adverse reactions” as a required duty. However, certain tasks seemed inappropriate for the Phlebotomist job description. One facility had “logging bleeding times” included as a duty. This was the only facility still performing bleeding times. We were able to work with the medical director to get it removed from the test menu—an improvement in job standardization and a bonus for our lab utilization efforts.

The additional duties for phlebotomists, which we also determined according to local needs, could form the basis of an advancement model. For instance, an entry-level phlebotomist would meet the standard requirements. If he or she had a certain number of additional responsibilities from the higher-level category, that person could qualify for additional professional advancement. This change has budgetary considerations and requires additional thought and interaction with personnel in the HR, Compensation, and Administration departments, but the foundation for such change has been laid.

Figure 3 shows the primary duties of phlebotomists, as represented by the grid. We went back to the individual job descriptions to select the strongest verbiage but still had to round out this verbiage to encompass all the qualities we were seeking to include.

Figure 3

Primary duties of phlebotomists across the University of Maryland Medical System, Baltimore, MD.

Figure 3

Primary duties of phlebotomists across the University of Maryland Medical System, Baltimore, MD.

The additional duties were eclectic but important to the facilities in which they were standard practice or add-ons. As a group, we agreed to relinquish some further miscellaneous items and wording. Additional duties are listed in Figure 4.

Figure 4

Additional duties that were removed from the primary task in the job description of Phlebotomist for the University of Maryland Medical System, Baltimore, MD, as decided by on consensus of the research group.

Figure 4

Additional duties that were removed from the primary task in the job description of Phlebotomist for the University of Maryland Medical System, Baltimore, MD, as decided by on consensus of the research group.

In addition to discovering common and disparate duties, we also discovered significant differences in experience and certification requirements, as evidenced in the grid data. Brief discussion and rationalization, including much talk about required vs preferred duties, helped us to arrive at consensus. New requirements are listed in Figure 5.

Figure 5

New requirements for the standardized Phlebotomist job description for the University of Maryland Medical System, Baltimore, MD, as decided by consensus of the research group.

Figure 5

New requirements for the standardized Phlebotomist job description for the University of Maryland Medical System, Baltimore, MD, as decided by consensus of the research group.

The full phlebotomist job description (with the miscellaneous information added back in) is shown in Figure 6.

Figure 6

Full job description for the role of Phlebotomist, as standardized based on synthesis of job-description language for this position across the University of Maryland Medical System, Baltimore, MD.

Figure 6

Full job description for the role of Phlebotomist, as standardized based on synthesis of job-description language for this position across the University of Maryland Medical System, Baltimore, MD.

After we all agreed on the job description, we sent it back to the HR department for formatting. They styled it according to the Corporate HR format. When we received the reformatted descriptions from the Corporate HR department, our laboratory directors realized, in some instances, performance evaluations are incorporated into job descriptions in their facilities. We agreed to move forward with the standard Phlebotomist job description with the local official approval and reformatting when necessary.

Because we were satisfied with the results of this standardization process, we performed a similar analysis and standardization on the job description for Phlebotomy Supervisor.

Next Steps

Although we believe that salaries for phlebotomists are well managed within our medical system, we would like the Compensation department to reevaluate the position and to complete a market assessment for internal and external equity. A solid job description and compensation packet will serve as the basis for sound recruitment. We must also evaluate the job description for Laboratory Assistant and its other variations, to determine whether there is room for further integration and consolidation. When these positions similarly have been analyzed and standardized, we will design the career-advancement model for them, as a retention and job-satisfaction tool.

Due to the tightening labor market (aging baby boomer workforce, fewer schools and graduates, and increased specialization), we are eager to examine the job descriptions for Medical Laboratory Technician (MLT), Medical Laboratory Scientist/Clinical Laboratory Scientist (MLS/CLS), and Histotech positions, to help us with our total employee staffing and retention goals. The labor supply that we access for these particular jobs and functions is inadequate for our demand, so we must take aggressive proactive steps to staff our laboratories in the future.

Acknowledgments

The staff of the University of Maryland Medical System Laboratory Directors and Human Resources department contributed substantially to this work.

Abbreviations

    Abbreviations
  • IDN

    integrated delivery network

  • HR

    human resources

  • IT

    information technology

  • histotech

    histology technician

  • cytotech

    cytology technician

  • FTE

    full-time employee

  • CLAs

    Clinical Laboratory Assistants

  • POCT

    point-of-care testing

  • IV

    intravenous

  • CLIA

    Clinical Laboratory Improvement Amendments

  • ECGs

    electrocardiograms

  • CPR

    cardiopulmonary resuscitation

  • IV

    intravenous

  • GED

    general equivalency diploma