Laura BensonGenetic Technologist

South East Scotland Cytogenetics ServiceWestern General Hospital

Edinburgh

Our building was large with many labs. Laid out for section-based workflow.

Fell into disrepair – urgency to move.

Cyto/ Molecular/ Clinical Genetics geographically separated.

Opportunity to work closer together & integrate.

Current financial situation encouraged change.

Split between two buildings = change in workflow paramount!

Analysis Central - Traffic light system on LIMS to manage workflow for analysis.

Pool-based analysis where cases are analysed by priority as dictated by colour assigned by Analysis Central.

Flexible analytical/reportingapproach.

Benefits

Better cover of all work. Makes use of team’s potential

– increased morale. More efficient. More flexible use of time (e.g.

validation of new techniques/analysis).

Training needs and inconsistencies identified.

Gained more control over working practice and training.

Challenges

Initial risk of errors as change in established, repetitive workflow – staff had to think differently about how sample handling of different sections related. Pushed us to think about communication and how better to manage tasks.

Training/re-training/witness audits and technique sign off for all staff.

Expect improved and more consistent quality.

Automation already in place – Automated image capture, Gemini, Thermotrons, Biomek.

New techniques and technologies – SNP arrays, iGENatal.

Established staff group with a good training background able to switch between sections/techniques.

But…

How do we change workflow without affecting training so that quality of results are maintained?

Benefits

Better cover of all work. Makes use of team’s potential

– increased morale. More efficient. More flexible use of time (e.g.

validation of new techniques/analysis).

Training needs and inconsistencies identified.

Challenges

Initial risk of errors as change in established, repetitive workflow – staff had to think differently about how sample handling of different sections related. Pushed us to think about communication and how better to manage tasks.

Training/re-training/witness audits and technique sign off for all staff.

Expect improved and more consistent quality.

But…

How do we change workflow without affecting training so that quality of results are maintained?

Identification of inconsistencies and re-witnessing staff performing techniques has created more consistent working practice and updated SOPs.

So, we will initially train using the section-based approach so that staff can gain an understanding of sample handling start to finish.

So we have begun training all practical staff using a fresh start:

Retrain using updated SOPs. Quick process for long-standing members of staff

already familiar with techniques. Proposed to have all staff trained/re-trained by 6

months.

This is an investment that will ensure that when we move back to a pool-based workflow:ALL staff will be trained to the SAME STANDARD in ALL TECHNIQUES to create a DIVERSE and FLEXIBLE workforce.

Train to a standard, not a grade!

We have learned that the key to delivering successful major change with minimal disruption to the service is: - Co-ordination – rotas.- Communication – weekly huddles/proactive GT meetings/weekly staff meetings.- Established staff training from rotation.

Currently two GT teams and individuals should predominantly work within their team, with flexibility to work in other areas if required.

Evolution of work structure so far:- All work shared between all staff = flexibility.- The addition of new grades of staff = evolving duties for existing staff.

It is expected that these changes will release routine time for GTs to analyse.

Catalyst for further change cross-training between the Molecular and Cytogenetics departments.

Requirement for common database:

Integrated reporting system. Tighter quality management. Single sample input and patient

record management. Paperwork for processes.

Standardise SOPs and shared procedures.

Staff Pool

Trained Cyto GT team

GT training in Molecular

techniquesGT/CS

scientific development

R&D for future development

Training in new

techniques

Release Cyto GTs

GT training in Cyto

techniques

Release Mol GTs

I would like to acknowledge the efforts of all staff in Cytogenetics, Molecular Genetics and Clinical Genetics in the South East Scotland Genetics Service for their contributions implementing the changes described and all of their hard work putting these changes into practice.