PROCESS DESIGN-

WORKFLOW AND
STAFFING

From Harmening’s Laboratory Management:

Principles and Processes, 3rd edition.
Process Design-Workflow and Staffing
“If I had to sum up in one word
what makes a good
manager,
I’d say decisiveness.
You can use the fanciest
computers to gather the numbers,
but in the end you have to set
a timetable and act.

Lee Iacocca
 Objectives
 Explain the relationship between process design, workflow, and
staffing.
 Identify the factors that must be considered when developing a
process design.
 Construct a table that contains the three phases of workflow and
discuss the components of each.
 Define Process Management and identify various process
improvement methodologies.
 Compare and contrast the written application with the oral interview.
 Develop a generic schedule using: (a) 8/80 work rule, (b) 40-hour
workweek rule, (c) Self-scheduling guidelines.
 Discuss the importance of retention in the workplace.
 Process Design

 Must be cost-effective
.
 Within organizational needs and budgets

 Be customer friendly

 Produce quality results

Flowchart

 Developed to present all possible factors

that can influence a process design.

 Global in nature.
 WHAT IS A FLOW CHART

A flowchart is a graphical representations of steps. It was

originated from computer science as a tool for representing
algorithms and programming logic but had extended to use in
all other kinds of processes.

Nowadays, flowcharts play an extremely important role in

displaying information and assisting reasoning. They help us
visualize complex processes, or make explicit the structure of
problems and tasks.

A flowchart can also be used to define a process or project to

be implemented.
Flowchart Symbols
Terminator- This symbol represents the starting or ending point of
the system.

Box - indicates some particular operation.

Document- This represents a printout, such as a document or a

report.

Diamond- represents a decision or branching point. Lines coming

out from the diamond indicates different possible situations, leading to different
sub-processes.
 Flowchart Symbols
Data - It represents information entering or leaving the system. An
input might be an order from a customer. Output can be a product
to be delivered.

On-Page Reference -This symbol would contain a letter inside. It

indicates that the flow continues on a matching symbol containing the same
letter somewhere else on the same page.

Off-Page Reference- This symbol would contain a letter inside. It

indicates that the flow continues on a matching symbol containing the same
letter somewhere else on a different page.
Flowchart Symbols

Delay or Bottleneck- Identifies a delay or a bottleneck.

Flow Lines - represent the flow of the sequence and

direction of a process.
When to Draw Flowchart?
Using a flowchart has a variety of benefits:

 It helps to clarify complex processes.

 It identifies steps that do not add value to the internal or external customer,
including delays; needless storage and transportation; unnecessary work,
duplication, and added expense; breakdowns in communication.
 It helps team members gain a shared understanding of the process and use
this knowledge to collect data, identify problems, focus discussions, and
identify resources.
 It serves as a basis for designing new processes.
Flowchart Example – Medical
Service
 Process Design

Global factors that influence process design

1. Size
2. Design of the laboratory
3. Equipment
4. Test Methodology
5. Regulations
6. Staffing
7. Receipt of Work
8. Test Priority and Accessioning
SIZE OF THE LABORATORY

 Starting The Laboratory

Starting your lab begins with a business plan that includes, in this order,
an executive summary, a company description, a market analysis, an
organization and management section, a service or product line section,
and a funding request section.

 Size – depend on the type of the laboratory and hospital set up (primary,
secondary and tertiary) or stand- alone laboratory as diagnostic laboratory.
By following the law of the Land / DOH regulations.
2. Design of the laboratory
A. Walls/Doors/Security
1. The laboratory shall be completely separated from outside
areas (i.e., must be bound by four walls).
 Having enclosed laboratories will help contain spills, keep
unauthorized personnel from entering areas where hazardous
operations are performed, etc.
These regulations apply specifically to laboratories containing radioactive materials; however,
Stanford University EH&S interprets this to include all laboratories (e.g., general chemistry
and electronics).
 The laboratory shall have means of securing specifically regulated
materials such as DEA (Drug Enforcement Administration) controlled
substances and CDC (Centers for Disease Control/ DOH Regulations)
select agents and radioactive materials (i.e., lockable doors, lockable
cabinets, etc.).
2. The laboratory shall have means of securing specifically
regulated materials such as DEA (Drug Enforcement
Administration) controlled substances and CDC (Centers for
Disease Control) select agents and radioactive materials (i.e.,
lockable doors, lockable cabinets, etc.).
 Having secured hazardous materials storage will keep
unauthorized personnel from gaining access to them.
These regulations apply specifically to laboratories containing radioactive materials
and CDC Select Agents; however, Stanford University EH&S interprets this to include
all laboratories (e.g., general chemistry and electronics).
B. Windows

3. If the laboratory has windows that open, they must be

fitted with insect screens.
 Insects, particularly flies, are known to be a potential carrier of
disease. To keep insects out of the lab, the doors must be closed
while an experiment is in progress, and windows shall be
screened if they are capable of being opened .

These references apply specifically to laboratories containing biological

materials; however, Stanford University EH&S interprets this to include all
laboratories (e.g., general chemistry and electronics).
Flooring
4. The floor must be non-pervious, one piece, and with covings to the wall. This can
be achieved by use of glue, heat welded vinyl flooring, epoxy coated concrete slab,
etc.
 Floors should be coved up walls and cabinets to ensure spills cannot
penetrate underneath floors/cabinets. Tiles and wooden planks are not
appropriate because liquids can seep through the small gaps between
them.
 These references apply specifically to laboratories containing biological and radioactive materials;
however, Stanford University EH&S interprets this to include all laboratories (e.g., general
chemistry, electronics, etc.).
5. Floors in storage areas for corrosive liquids shall be of liquid tight construction.

CCR, Title 24, Part 9, Sections 8003.1.7.2, 8003.14.1.2

Sinks
6. Each laboratory must contain a sink for handwashing.

 Exposure to hazardous materials and/or pathogenic organisms can

occur by hand-to-mouth transmission. It is extremely important that
hands are washed prior to leaving the laboratory. For this very reason,
the sink should be located close to the egress.
CDC-NIH Biosafety in Microbiological and Biomedical Laboratories (BSL 2, D.1)
Guidelines for Research Involving Recombinant DNA Molecules (NIH Guidelines)
Appendix Physical Containment-II-B-4-d: Physical Containment/Laboratory
Facilities (BL2)
NBS Handbook 92
IAEA, Safe Handling of Radionuclides

7. Laboratory sinks shall have lips that protect sink drains

from spills.
Chemical/Waste Storage
8. Chemical storage shelves shall not be placed above
laboratory sinks. P.A. Ordinance, 16.09.091
9. Sufficient space or facilities (e.g., storage cabinets with
partitions) shall be provided so that incompatible
chemicals/gases (waste and non-waste) can be physically
separated and stored.

This will be based on the chemical inventory and use projection provided by the Principal
Investigator to the project and EH&S. If the project scope cannot provide sufficient storage
the user must develop a written management control plan to include as part of their local
Chemical Hygiene Plan. Good Practice per Stanford University EH&S CCR, Title 24, Part 9,
Section 8001.9.8
 Materials which in combination with other substances may cause
a fire or explosion, or may liberate a flammable or poisonous
gas, must be kept separate. When designing the shelves, it is
important to factor in enough space for secondary containers.
Recommend that solvent storage not be located under the
laboratory fume hood, as this is a location where fires are most
likely to occur in laboratories.
 All labs should be designed to conveniently and safely
accommodate the temporary storage of biological, radiological,
and chemicals (non-waste and waste) based on laboratory use
projections. Wastes are generally stored in the lab in which they
are generated, not in centralized accumulation areas.
Furniture Design, Location, and Exit Paths
10. All furniture must be sturdy. All work surfaces (e.g., bench tops and counters) must
be impervious to the chemicals used. The counter top should incorporate a lip to help
prevent run-off onto the floor.
For example,
 Microbiological manipulations involve concurrent use of chemical solvents
such as formaldehyde, phenol, and ethanol as well as corrosives.
 The lab bench must be resistant to the chemical actions of these
substances and disinfectants.
 Wooden bench tops are not appropriate because an unfinished wood
surface can absorb liquids. Also, wood burns rapidly in the event of a fire.
 Fiberglass is inappropriate since it can degrade when strong disinfectants
are applied. Fiberglass also releases toxic smoke when burned.

These references apply specifically to laboratories containing biological and radioactive materials; however,
Stanford University EH&S interprets this to include all laboratories (e.g., general chemistry and electronics).
11. Vented cabinets with electrical receptacles and sound insulation
should be provided for the placement of individual vacuum pumps where
their use is anticipated. A one- to two-inch hole for the vacuum line hose
from the cabinet to the bench top should be provided. Good Practice

12. The lab shall have a minimum aisle clearance of at least 24 inches.
Main aisles used for emergency egress must have a clearance width of at
least 36 inches.
Clear aisles and exits are necessary to facilitate departure in the event of an
emergency. In practice, lab aisles must be designed wider than 24” so that
even with the presence of lab stools and other miscellaneous items, a
clearance of 24” is always maintained.

13. A pathway clearance of 36 inches must be maintained at the face of the

access/exit door.
14. Designated storage space should be provided for lab carts.
Location must not reduce width of corridors or aisles to less than
code-required widths. Lab carts should be secured with earthquake
restraints when not in use.
[Link] design must comply with basic ergonomic
specifications referenced in the SU Facilities Design and
Construction Standards
(Section 01310, Part A – 1.04) Good Practice

Lack of properly designed workstations can increase safety and

ergonomic risks for occupants.
16. Laboratory shelving should NOT be installed at heights and distances which require
workers to reach 30 centimeters above shoulder height and extend arms greater
than 30 centimeters while holding objects 16 kg or less when standing on the floor
or on a 12” step stool.

Good practice per Stanford University EH&S. see also information on “Earthquake
Restraints” below.

Installation of high shelving, above laboratory benches in particular, can create

several potential hazards, including, but not limited to ergonomic issues (over
reaching above shoulders and across lab benches); spill and exposures to
chemical, radiological or biological agents (e.g., dropping containers when
accessing them at high levels). If high shelving were installed, administrative
controls, which are often burdensome, would be required. A system for ensuring
safe access would include prohibition on the materials stored on shelves, limitations
on the frequency of use, availability of ladders or ladders stands, training on
ladders, etc. (See also #15 and “Earthquake Restraint” information below.)
17. The space between adjacent workstations and laboratory benches should be
5 ft. or greater to provide ease of access. In a teaching laboratory, the
desired spacing is 6 ft. Bench spacing shall be considered and included in
specifications and plans.

18. The laboratory doors shall be automatically self-closing. Such self-closing

doors are to be able to be opened with a minimum of effort as to allow
access and egress for physically challenged individuals.

19. Doors in H-occupancy laboratories shall have doors which swing in the
direction of egress. Doors serving B-occupancy shall swing in the direction of
egress if the occupant load is 50 or more. Where possible, all B-occupancy lab
doors should swing out.
20. Sufficient space or facilities must be provided for the storage,
donning and doffing of personal protective equipment used in the
laboratory.
National Institutes of Health Design Requirements Manual (December 12,
2016) Section [Link] Good practice per Stanford University EH&S

Facilities such as hooks or cabinets for lab coats, containers for safety
eyewear and/or hearing protection, must be provided so that personnel are
able to don and doff the personal protective equipment (PPE) before
entering and exiting the hazardous areas of the laboratory. PPE storage
should be separate from any storage provided for ordinary clothing.
Illumination
21. Laboratory areas shall be provided adequate natural or
artificial illumination to ensure sufficient visibility for
operational safety.

Earthquake Restraints
[Link] equipment requiring anchoring shall be anchored, supported
and braced to the building structure in accordance with CCR Title
Part 2, Table 16A-O. For example, any equipment, including but not
limited to, appliances and shelving that are 48 inches or higher and have the
potential for falling over during an earthquake, shall be permanently braced
or anchored to the wall and/or floor.
23. A channeled anchoring station for seismic bracing of equipment, named the
Universal Restraining Bar, shall be installed along all bench top/counters in
laboratories and other horizontal surfaces that house equipment. These bars
shall be installed at the back edge of the bench to minimize bench space
used.

This system will allow a bracing point for all bench top equipment and will
provide standard bracing locations for all benchtop equipment. This bar
allows for bracing of items in a way that allows them to be moved to another
location when needed, and re-braced after moving. The bar should be
adhered to the benchtop with very high bond adhesive so that no holes are
drilled.
24. All shelves must have a passive restraining system to adequately prevent
shelf contents from toppling over. Seismic shelf lips (3/4 inch or greater), sliding
doors, or mesh nets are examples. The shelves themselves must be firmly fixed
so they cannot be vibrated out of place and allow shelf contents to fall.
[Link] equipment requiring anchoring, whether installed by a
contractor or the University, shall be anchored, supported, and
braced to the building structure in accordance with the guidelines

26. Cabinets must be equipped with positive locking door latches.

Examples include barrel bolts, safety hasps, and child proof
locks. These latches will not allow the cabinet door to open
unless the locking mechanism is triggered. Magnetic or pinch
grip catches are not considered “positive locking” and hence
should not be used.
Cleanability
[Link] laboratory shall be designed so that it can be easily cleaned.
Bench tops must be a seamless one-piece design to prevent
contamination. Laminate bench tops are not suitable.
Penetrations for electrical, plumbing, and other considerations
must be completely and permanently sealed. If the bench abuts a
wall, it must be coved or have a backsplash against the wall.
Walls should be painted with washable, hard non-porous paints.

Wooden and wood finish walls or floors are not appropriate because they can
absorb hazardous and/or potentially infectious material, particularly liquids,
making decontamination/remediation virtually impossible. These references
apply specifically to laboratories containing biological and radioactive materials;
however, Stanford University EH&S interprets this to include all laboratories
(e.g., general chemistry and electronics).
28. Spaces between benches, cabinets, and equipment must
be accessible for cleaning and allow for servicing of
equipment.

Laboratory furniture must have smooth, non-porous surfaces so as to resist

the absorption of liquids and the harsh effects of disinfectants. Furniture
must not be positioned in such a manner that makes it difficult to clean
spilled liquids or conduct routine maintenance.

For example, positioning a Class II biosafety cabinet in a limited concave space might not allow
the biosafety cabinet certifier to remove panels of the cabinet when recertifying the unit. These
references apply specifically to laboratories containing biological and radioactive materials;
however, Stanford University EH&S interprets this to include all laboratories (e.g., general
chemistry and electronics).
Breakrooms
29. The design of the laboratory building must incorporate
adequate additional facilities for food storage/consumption and
personal hygiene tasks.

California Radioactive Material License, 0676-43

State of California, Department of Health Services, Radiologic Health Branch –
DOHS 2010
Stanford University Radiation Safety Manual
 Workflow
 Pre-analytical
– Everything that occurs before actual testing
– Collecting the right specimen at the right time and under the
right set of
circumstances
– Hardest to control
– Many people are involved with the process

 Analytical
– Actual testing of the sample

 Post-analytical
– Reporting the results after testing is complete
 Workflow Phases

Pre-analytical Analytical Post -analytical

Ordering Testing Interpreting
Collecting Recording
Transporting Reporting
Processing
 Process Management
 A systematic data based approach to monitoring and
improving the performance of a business.

 A management strategy that identifies opportunities for

improvement using proven problem-solving methods.
 Hiring
 Training
 Scheduling
 Retaining
Hiring
Application – A written document that lists the prospective
employee’s education, qualifications, and work experience.
Interview – The interview is the oral process used to confirm
the information in the application and to fill in any gaps.

Training

Orientation – the initial training

period.
Competency Assessment
Scheduling

Full-time employee – works 40 hours a week or 80 hours in two weeks

depending on the work rule used.

Part-time employee – regularly scheduled and works a defined number of

hours (less than full-time employee).

Per diem employee – is not regularly scheduled and has no set number of
hours.
 Scheduling Formats
 The 8/80 work rule
 The 40-hour workweek rule.

8/80 work rule

• Used by most hospitals.
• Employees scheduled to work 8 hr days.
• Each day = 3 eight hour periods.
• Covers a 2-week time frame.
• Employee works an 8-hour day and any number of days up to 10 within
2weeks.
• Limit the number of hours in the day that can be worked, but more days in a
row are allowed.
40-hour work rule
 Employee is allowed to work any number of hours per shift
as long as the total hours worked in a week does not
exceed 40.
 Employee can work longer shifts but limits the number of
days in a week to a max of 5.
 The Week is defined as Sunday through Saturday.
Laboratory Staffing

 Laboratories are open 24/7 and must be staffed

appropriately.
 In any pay period fourteen 24-hour days need to
be staffed.
 Staffing for the Average Workload

Day Shift Evening Shift Nights

■ Weekdays
Day duty – 3 technical, 2 phlebotomy 1 phlebotomy, 1 secretary
PM duty- 2 technical
Night duty- 1 tech
 Weekends
Day duty- 2 technical 1 phlebotomy, 1 phlebotomy, 1 secretary
PM- duty- 1 technical
Night duty- 1 tech
Staffing

■ Day Shift
■ Weekdays 3 tech staff needed 10 shifts = 30 shifts
■ Weekends 2 technical staff for 4 shifts = 8 shifts
■ 14 days 38 shifts cover
■ If a full time employee works 10 shifts, divide the
■ 38 shifts by 10. This = four. Four full-time people
■ are needed to provide coverage.
Staffing
■ Day Shift
■ Weekdays 2 phleb staff needed for 10 shifts = 20
■ shifts to cover
■ Weekends 1 phleb staff needed for 4 shifts = 4
■ shifts to cover
■ 14 days or 24 shifts
■ Divide 24 by 10 this equals 2.4, which means 2 fulltime people
and 1 part-time person is needed to
■ cover shift.
Self-Scheduling
Generational studies have shown that inflexible scheduling is
considered poor working conditions by the newest to the work
world.
Guidelines:
■ No one is guaranteed a specific schedule.
Retention

■ Retention of team members is well worth putting forth a good

effort, as the number of people entering the workforce
decreases.
■ Retention may be as simple as recognizing each of your team
members every day, giving praise where due, and treating the
team fairly when making assignments or counseling them.