Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
PSA Testing Procedures
7.10 There is reason for optimism that the biochemistry section has put its troubled
past behind it and is moving forward. Implementation of the
recommendations in paras 8.1 – 8.16 will go a long way to ensuring that the
community can have confidence in the quality of biochemistry services at
Gisborne Hospital.
Staff requirements
7.11 It is not possible to provide a quality service from a small laboratory with the
same cost-efficiency that can be achieved by larger units. The most expensive
resource is staff, but unfortunately both the number of staff and the level of
training and expertise required to provide a reliable service is not directly
related to the smaller workload they may be expected to handle. This is why
past and present staff members saw the necessity of gaining private work to
ensure viability and maintenance of expertise in the laboratory.
7.12 It can be difficult to attract or retain experienced and well-trained staff in a
laboratory where opportunities for promotion and professional development
are limited. Long-term resolution of the situation will require an active
commitment to building a focused and competent team.
7.13 The primary requirement of any hospital medical laboratory is to have
sufficient, well-qualified and experienced staff to provide a 24 hour/7 day
service to the hospital. When there is a large pool of staff, as found in a
moderate or large laboratory, there is less difficulty in matching the staff
numbers to the peaks and troughs of the workflow. As the size of the
laboratory decreases, a limit is reached of the minimum number of staff
required to fill the roster to provide a 7 day service, with this limit becoming
independent of the workload being handled.
7.14 This in itself leads to unavoidable “inefficient” employment of staff at certain
times of the day, when the workload is low. The temptation for management
is to reduce the cost of staff to an absolute minimum, to keep the staff
“efficiently” busy, even if this means that at times the staff are working under
considerable stress to cope with peak workloads.
7.15 Under-staffing, either in terms of numbers or seniority, almost inevitably leads
to a gradual reduction in the quality and reliability of the service the laboratory
can provide. The need to “get the results out” means that quality factors in
their widest sense (quality control, training, continuing education) have a
lower priority and are usually the first activities to be reduced. The risk of
system failure is thus increased.
7.16 A small laboratory working in geographical isolation has the same need as any
other laboratory for an adequate number of well-qualified and experienced
staff, with sufficient time to perform routine work with minimal stress, as well
as time to undertake relevant continuing education, updating of practical skills,
and continual reviews of analytical methods and quality issues.
7.17 It appears that the biochemistry section of the laboratory had been working
under increasing staff restraints for some time. Some of this may have been
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