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Solving problems and making decisions Essay


As the Head Phlebotomist at the RD&E Wonford site I oversee the day to day running and supervision of 32 members of staff. 20 staff members are contracted, working between 12 and 37.5 hours per week and the remainder are bank workers working on an ad-hoc basis when required. Daily we have a minimum of 15 phlebotomists working throughout the site. The role of the phlebotomist is primarily to obtain blood samples from inpatients and outpatients as requested by the doctors and clinical staff. To do this, requests are placed on an order communication system known to us as Medway. To access Medway every phlebotomist has their own laptop installed onto a portable trolley which is then wheeled from ward to ward. A daily minimum of 12 laptops require a WiFi signal to operate whilst the remaining 3 laptops are continuously hard wired into static modem ports. The department has a total of 19 laptop packages.

Present Situation (Analysis of the problem)

A daily problem facing the Phlebotomy team is with information technology. This includes hardware, software and human nature. Hardware –  The laptops are made up of a “package” which includes the laptop itself, the primary and secondary batteries required to enable it to last wirelessly for the 4 hour shift worked, the small label printers required to print patient identifying labels for each blood sample bottle and the chargers for both the laptop and the printer. Each of these laptop packages were purchased in 2011. Some components are now beginning to fail owing to their age, the heavy use they get and occasionally because they have not been treated or looked after as per the recommended suppliers guidelines. When one of the elements of these packages fails it declares the whole package unusable.

Software –

Each laptop has a minimum of Medway and WiFi software loaded to enable the phlebotomists to carry out their work. WiFi is dependent on many contributing factors to enable it to operate satisfactorily. These have been confirmed by the operating systems department within the RD&E and include physical obstructions, network range and distance between devices, signal interference and restrictions, signal sharing usage and load, poorly deployed antennas and the local environment (4Gon, 2014). All of these can and do affect the performance of each laptop causing them to slow down significantly and occasionally freeze and stop working altogether. Medway is also a very slow running programme which causes delays.

Human nature –

The phlebotomy team range in age from 23 to 69. Their ability to use I.T equipment is vast in range. Many of the phlebotomists has difficulties resolving I.T issues that others may find simple, for example changing passwords and logging into programmes. More complex issues that a phlebotomist may experience include identifying a WiFi issue or why a screen has frozen and how to rectify this. A lack of patience, understanding and confidence from the Phlebotomists is a restricting factor as this often causes additional problems when incorrect icons or buttons are pressed in frustration. If a phlebotomist is unable to operate every element of their laptop package for any of the above reasons they are then unable to continue their job until the problem is resolved. This often means a single phlebotomist will have stopped working for around 30 minutes each time a problem occurs.

This delay causes an impact on their colleagues both physically and on morale. It also has an impact on the patients who will have a delay on having their blood taken and tested which, in some circumstances, may mean further procedures or treatments are delayed or in exceptional circumstances, cancelled. By solving this problem the phlebotomists would be able to carry out their duties with more confidence. Staff morale would be much higher as they would have equipment fit for purpose they could use without any issues. There would be no delays in patient treatment meaning the flow of patient care would be uninterrupted. There would be less time spent contacting the I.T service desk to report problems which would reduce their workload. If this problem is not resolved the department will have no working I.T equipment.

Staff morale reduces which promotes frustration, conflict and sickness within the team putting pressure on the service we supply. The RDE Foundation Trust has created a contingency plan (Appendix A) which would be implemented to ensure the service did not stop as this is not an option. Testing blood is a compulsory part of diagnosis and treatment. The contingency would include using paper forms to record blood sample requests although this would create a significant impact on the labs, causing further delays and more staff would be required to complete the workload adding financial pressure. The process would also be open to patient identification errors causing possible fatal errors in diagnosis and treatment. A contingency plan is a very short term work around it is not a solution.

Investigation and identification of possible solutions to the problem Phlebotomists regularly contact me to complain about a wide range of IT problems. To begin accurately identifying and logging the problems concerned I created a small questionnaire (Appendix B) and asked each phlebotomist to complete it with as much information as possible each time a problem occurred. These were completed and collected over a period of 1 month to capture as many types of problems as possible. This information is then collated onto a spreadsheet (Appendix C). From this I identified how the main problems are grouped into the following categories:

Hardware – Faulty printers

Software – Medway errors, Wifi errors, Screen errors, Windows security errors Human – Password errors, Generic log in errors, Wifi errors, Screen errors

Table 1 – Shows the types of problems, the frequency and the category based on the information collated.

Immediately from the information gathered I can see that many problems cross multiple categories. Out of the 19 laptops and users 47% have experienced problems with 26% experiencing more than one problem across multiple categories. There were 15 problems identified which could have been caused by either category. The amount of possible causes equals 27 across all categories. The highest amount of problems are possibly caused by software issues at 44%, human problems follow at 33% and hardware problems at 22%. On average 47% of laptops with problems that have 27 possible causes a mean average of 3.37 problems experienced each over the 1 month period.

The mode average of people experiencing the same problem regardless of the cause is 2. The median average of all problems experienced regardless of the cause is also 2. Solutions to resolving these problems would be to replace or repair existing ageing hardware and to retain a small level of equipment items such as batteries and chargers in stock for immediate replacement. Replacing or updating existing software programmes. A solution to resolve the human grouping of problems is staff training.

Problems that require help from the IT service desk will be their responsibility although, the generic log in problem could be avoided with staff training. By reporting these problems to the I.T service desk we can ask more specialised engineers to look into why, specifically, the WiFi regularly fails. A solution to the software grouping of problems is harder to find as the trust has purchased software that it feels is sufficient for its purpose. Staff training could help with some problems experienced in this area.

Evaluation of possible solutions

I have chosen to use the Benefit – Cost analysis (CBA) tool (Jules Dupuit 1804-1866) to evaluate the solution options as follows:

Replace or repair existing ageing hardware and stocking replacement items
Staff morale would increase if equipment is fit for purpose.

Sickness absences due to stress would decrease saving money on replacement bank staff.

The department would be able to make use of all the equipment available to them specifically during busier periods and for staff training.

The equipment would be safe.

Smaller faulty items could be replaced immediately maintaining continuity of use.

Delays on taking and testing samples would reduce resulting in few or no delays with patient treatment/procedures.

Phlebotomists would not need to contact the I.T service desk as often so reducing their workload.

Contingency plan would not need to be implemented saving time, money, staff stress and treatment delays. Sickness absences have financial and health implications to other phlebotomists and the department.

The department has a total of 19 laptop packages. The financial cost to replace all the equipment would run into thousands of pounds which we do not have the budget for.  The I.T service desk engineers are not always able to resolve problems immediately and can sometimes take several weeks owing to their workloads.

Suppliers are not always able to provide replacement equipment.

If we retain a small number of replacement items it would be the responsibility of the Head Phlebotomist to identify which item is faulty and if it could be repaired first adding to their workload.

Lack of space to store additional replacement equipment.

Replacing or updating existing software programmes
Staff morale would increase if software is fit for purpose.
Confidence would increase boosting interest and competence.

Sickness absences due to stress would decrease saving money on replacement bank staff.

Delays on taking and testing samples would reduce resulting in few or no delays with patient treatment/procedures.

Phlebotomists would not need to contact the I.T service desk as often reducing their workload.

Contingency plan would not need to be implemented saving time, money, staff stress and treatment delays. Sickness absences have financial and health implications to other phlebotomists and the department.

The I.T service desk engineers are not always able to resolve problems immediately and can sometimes take several weeks owing to their workloads.

Software programmes are purchased by the trust and cannot be replaced easily. WiFi is implemented through the whole trust and is so widespread it’s not easy to identify where the problem may have started.

Time and funding is required to enable the systems teams to identify what area of software is causing the problem and resolve it.

Disruption to ward areas whilst investigations are carried out.

Staff Training
Phlebotomists would be more confident in identifying problems and resolving them improving competence, interest and morale and reducing sickness absences.

The delays in time taken resolving problems would reduce making phlebotomists more efficient and cost effective.

Phlebotomists would not need to contact the I.T service desk as often reducing their workload.

Delays on taking and testing samples would reduce resulting in few or no
delays with patient treatment/procedures. Time needed away from normal duties to attend training for trainers and trainees.

Reducing the confidence of some phlebotomists who aren’t computer literate and may feel pressured into attending training above their ability.

Some problems are erratic and happen infrequently meaning phlebotomists are likely to forget how to resolve them.

Overall, the overwhelming benefit in finding a solution is to ensure there is minimal or no delay in the treatment of a patient. Using the cost/benefit analysis (CBA) I feel the first course of action to resolving this problem would be to implement staff training. Although the benefits only just out way the costs 4 to 3 my reason for this is that we would see faster results as it could be implemented immediately with less personal and financial cost than replacing or repairing existing hardware or software as detailed in the CBA. There would be regular time needed away from normal duties, maybe up to 1 hour per month per phlebotomist and trainer. This could be incorporated into their regular hours at quieter times or bank staff could be used to cover the minimum time requirement. Although it is difficult to calculate an exact financial cost saving I believe that it is fair to assume that as less people and equipment would be involved in implementing staff training the financial burden would also be less.

Also, as detailed in the CBA, phlebotomists would be more confident in identifying problems and could become more competent and interested in resolving them themselves. This would mean an immediate resolution in some circumstances reducing time wasted especially when contacting the I.T service desk. Secondly I would look at replacing or updating existing hardware and stocking replacement items. Although in the CBA the benefits out way the costs 8 to 6 the benefits are expensive. Stocking replacement items such as batteries and chargers is almost an essential although each battery is in excess of £90 and each charger up to £60. I believe it would be reasonable to only stock a couple of each at a time. This would enable any of the more easily replaceable faulty items identified to be replaced immediately without further delays.

The more complex laptop faults would still need to be directed to the I.T service desk. These will take longer to resolve and would involve input from an I.T engineer. I can see from appendix c that some faults are still ongoing from before October 2014 when the information in the spreadsheet was collated. Finally in resolving this problem I would look at replacing or updating existing software programmes. The CBA shows the benefits are equal to the costs. The reason I have put this last is mainly because the decision surrounding the purchase of software is made at a much higher management level. Because of this I have no influence over its capability nor do I have the power or expertise to recommend an alternative.

Although issues regarding problems or faults within a software programme are encouraged to be reported it is much more likely that the programme will not be replaced for some time owing to contracts and fixes are only possible if the supplier is able to do so. We can log all software/WiFi problems to the I.T service desk. I believe these calls are then passed to the systems support team for resolving either themselves or via an external source. Software programmes are costly and, I believe, often purchased with a minimum contract term making them the most difficult and expensive thing to replace or update when looking at resolving my problem.

Recommend implementation plan to solve the problem

The following is a table of events detailing what needs to be done. It plans how decisions will be communicated, by whom and by when. This helps to identify the order in which steps need to be taken to resolve issues and time frames to ensure efficiency.

What has to be done?
Who is responsible and/or involved?
How will this be communicated?
When should it be done?
What is needed?

Discuss the requirements of the phlebotomy service with I.T and explain the importance of rapid resolutions. Head phlebotomist, Phlebotomy manager, I.T helpdesk manager, service engineers Head phlebotomist to arrange and chair a meeting with I.T with clear expectations of what is required. By the 18th
November 2014.

All involved to attend the meeting. Minutes to be taken. Head phlebotomist to arrange a follow up meeting 1 month later to review if expectations have been acknowledged and in progress. Order a minimum of 2 of each laptop and printer batteries and chargers for stock. Head phlebotomist to get authorisation and budget code from Phlebotomy manager Head phlebotomist to email I.T with relevant information.

Budget code for funding. Approximately £420.00

Head phlebotomist to email I.T on 18.11.14 if these items have not arrived and confirm delivery date. Delivery expected by 30.11.14 Discuss ongoing issues and communicate outcome of I.T meeting to the phlebotomy team. Head phlebotomist, Phlebotomists and Phlebotomy manager

Head phlebotomist to arrange and chair a department meeting. Immediately after the I.T meeting has been completed. End of a morning shift 11.30am All phlebotomists working that day to be present. Minutes to be taken. Overtime may need to be paid if meeting goes beyond contracted hours at 12pm Deputy head phlebotomists to check that the minutes have been signed off by all phlebotomists within 1 week of the department meeting. All ongoing issues to continue to be logged.

Questionnaires (appendix B) to be completed daily

Deputy head phlebotomist to maintain a good supply of questionnaires. Time within shift to complete them. Head phlebotomist to review these daily and report to I.T service desk immediately if unable to resolve. All problems identified to be logged by Head even if resolved. Phlebotomists, Head phlebotomist, I.T engineers

I.T service desk form on intranet to be completed by Head phlebotomist or telephone I.T service desk if urgent.

As and when issues occur
Time. If resolved by Head phlebotomist then explanation/training given to phlebotomist to show how. If resolved by engineer then explanation of how to see if Head could resolve in future. Daily conversation and email between phlebotomist, Head phlebotomist and engineer to ensure problem permanently resolved or in the process of being resolved. Regular monthly training with phlebotomists on how to look after equipment and easy steps on identifying and possibly resolving reasonably simple issues.

Head phlebotomist, phlebotomists, I.T engineers

Head phlebotomist to arrange and chair a team meeting to discuss requirements and identify any one to one training. 3rd Wednesday morning of each month before start of shift at 7.50am. Time to complete the meeting and any training required. Head and deputy head phlebotomist to be competent and confident in I.T to answer questions and assist with training. Head and deputy head phlebotomists to liaise with any team member that had questions or needed training within 2 days of the meeting to ensure phlebotomist is now confident and understands how to resolve some issues.

Regular feedback to relevant areas regarding outcome of each stage above Phlebotomists, Head, phlebotomy manager, I.T engineers, systems engineers, project managers Head phlebotomist to email phlebotomy manager, I.T and systems engineers with clear concerns or positives. 5.3.15, 5.7.15, 5.11.15 (quarterly) or more often if problems persist. Time to construct the email. Contact details for each person. Relevant constructive feedback including any positive information. Head to ensure email has been received by requesting read receipt and that any actions required from previous quarterly email have been completed or in progress. Any new actions must also be acknowledged.

I have also transferred the above information on to a Gantt chart to help monitor and review my implementation plan. This is because the relation of task to time is more immediately obvious and very simple to follow.

There are ways in which this can be reviewed using the CPA (Critical care path analysis) or PERT (Program evaluation and review technique). The benefit of using CPA within the planning process is to help you develop and test your plan to ensure that it is robust. CPA formally identifies tasks which must be completed on time for the whole project to be completed on time. It also identifies which tasks can be delayed if resource needs to be reallocated to catch up on missed or overrunning tasks. PERT is a variation on Critical Path Analysis that takes a slightly more realistic view of time estimates made for each project stage. Often tasks are given unreasonable time frames and this option allows flexibility (Mindtools, 2014). Monitoring and review techniques that are appropriate for my problem include meetings and questionnaires.

Team meetings held monthly within the phlebotomy department wll ensure that each member of staff remains confident and competent in their role to assist in resolving the problems that we all experience. Staff will be able to ask questions regarding their concerns and abilities and the head and deputy phlebotomists will be able to identify specific needs that they can help to build up. It should be easy to identify phlebotomists who are struggling with their problems if they are experiencing the same issues regularly however with monthly support these should decrease. Department meetings held with the I.T service desk and engineers every quarter will ensure they are aware of the significance of the problem and the need for it to be resolved as efficiently as possible.

I.T will be made aware of the impact of the problem if there are delays in resolving the problem for example ultimately the delay in patient diagnosis, treatment or discharge home. I.T will also have the opportunity to advise if the amount of calls made to them by phlebotomists has reduced. They will be able to explain the progress in resolving a problem and why there may be delays or recurrences.

They can also advise of expected dates and times of resolutions. Questionnaires (appendix B) completed daily detailing problems would also be a good way of monitoring and reviewing the problem. I would envisage in 2 months the problems detailed on the questionnaires should become less frequent and severe realistically reducing to problems only fixable by I.T engineers. Phlebotomists will be able to explain what has happened, if they have tried to resolve it using techniques they have gained in their training and reasons why they may have or have not worked.

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