For Blood / Biologics

Retraining Employees: When Once is Not Enough
by Lynn A Emmert, M.Ed., MT(ASCP)SI





Most supervisors would agree that their staff wants to do a good job and that their employees do their best to meet the demands of the highly regulated blood bank industry. But occasionally management has to deal with employee performance that falls short of expectations. This issue becomes increasingly important if the employee has committed an error more than once, in spite of attempts to correct the problem. Such situations usually require more than just counseling; it is the responsibility of the supervisor to ensure that the staff members working for him or her are capable of performing their duties accurately. The regulatory/inspection agencies, such as the FDA, AABB and CAP, require documentation that employees are adequately trained for their duties and documented proof of retraining, if required, as a corrective action in an error situation.

"The regulatory/inspection agencies, such as the FDA, AABB and CAP, require documentation that employees are adequately trained for their duties..."

When confronted with the possible need to retrain an employee, the questions each supervisor should ask are:

  • What is the cause of the recurring errors?
  • How can the cause be appropriately addressed?
  • If retraining is required, how should it be designed and documented?

Using root-cause analysis, the effective supervisor will review the organizational, environmental and human factors that may have contributed to the error. Many times the source of the error is not the employee but rather a poorly designed process, inadequate equipment/space, or a badly written standard operating procedure (SOP). Until the source of the error is determined, the employee should not perform the specific procedure identified in the error investigation.


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Mandatory training and discipline, even after a pattern of repeated errors, is an ineffective and often counter-productive strategy for the prevention of recurring errors. In an organization that encourages self-reporting of errors, you need to use care to ensure that staff members do not fear reprisal for their actions. Retraining should not be used as a disciplinary tool. Regular communication between the supervisor and the employee in regard to his/her performance on the job is an important part of employee success. This includes both under-performing employees and those employees whose performance is at satisfactory levels or better. The use of both constructive and appreciative feedback can be a powerful tool for improving employee performance.

Be sure that your organization has a method so that employees can report concerns about current SOPs and policies or can request their revision. It can be very frustrating to be expected to follow procedures that are not up to date or that are erroneous.

After thorough evaluation of the situation, if training is required, careful planning of the retraining program is the next step. The retraining goals should be clearly stated and should include the specific outcomes expected. The goals need to be communicated to the trainee, trainer and any other supervisory personnel involved. In planning the retraining program it is also wise to determine the steps that will be followed should the trainee fail to meet the stated goals. Prior to training, the trainee should read the plan, have the opportunity to ask questions about the training plan and sign-off to indicate she/he has read and understands it. Again, communication with the supervisor about the plan is the key to its success.

An important factor in designing a retraining program is the choice of the trainer to be used in the process. The trainer needs to be sensitive to the situation of the trainee, but s/he also must keep in mind the goals of the retraining and the needs of the organization. When working with a newer employee it may be wise to use a different trainer than the one that provided his/her initial training; a fresh perspective can be helpful and prevent any bias.

The trainer can begin by asking the trainee to perform the procedure to demonstrate his/her current knowledge. Using the same samples or scenarios that were found in the error situations can be useful to determine if the employee makes the same mistakes during the observation. The trainer can note any procedural discrepancies and correct them. Often errors are the result of inadvertent changes to procedures made over time by the employee, which have resulted in incorrect outcomes. Long term employees may create their own short cuts that they think are appropriate but result in errors. There may even be situations where a trainer has passed along bad habits to a new employee.

The training plan may include required re-reading of procedures and/or policies involved in the error. Reading should be documented in the manner your organization uses for new/revised procedures and policies. Written tests of knowledge may be appropriate and can be administered on paper or through an on-line learning management system.

If necessary, the trainer may demonstrate the procedure or sections of the process to the trainee to be sure he/she is familiar with the steps required. Once the trainer is satisfied that the employee knows the procedure and can successfully perform it, the trainee should demonstrate competency by successfully performing a battery of samples or complete the process successfully a specific number of times. The trainer may continue to observe trainee performance. Completion of the training plan should include assessment of the trainee by the trainer and/or supervisor. Your department should have assessment tools for new trainees which may be adapted for the specific retraining situation.

If the employee is still unable to demonstrate competency, you need to rule out factors that may be hampering his/her performance, such as problems related to disabilities, language issues, or vision. If other factors are found, work with your HR department to determine the best way to handle the situation. Special accommodation may be needed.

If no extenuating factors are identified, and the employee is unable to successfully complete the plan, it's time to work with your HR department to determine if the employee has been hired into the appropriate position. This should include a review of the trainee's complete performance history. Your human resources representative can explain your organization's policies for such situations and assist you with the necessary steps to re-assign or terminate the employee.

Documentation of the retraining is made simpler when using a quality management system, but whether captured in a database or on paper, there should be management oversight of the outcome of the retraining. The supervisor should review all the training materials to ensure that all training goals have been met. The trainee, trainer and supervisor need to verify the completion with a signature, either electronic or on a hardcopy. Retraining documentation is stored with the employee training records; copies of the retraining documents may also be required for the corrective action record. If the retraining is not successful, documentation should also be retained as part of the employee file.

Upon completion of the retraining and any other corrective and preventative actions, it is necessary to determine the effectiveness of your efforts. Your organization should have a method to systematically review the results of the actions taken. The review of the performance of the retrained employee is the supervisor's responsibility. Obviously you need to ensure that the error does not reoccur, but review of any other performance issues is important as well.

The keys to a successful retraining situation are adequate communication and documentation; both are crucial to ensure that the employee is ready to return to his/her job. Although retraining situations can be stressful, thorough preparation and consistent supervisory follow-up most often lead to improved employee performance.

Reference

Emmert, L., Oen, E., Winkler, T. Errors and Non-Conformances: How to Document and Retrain. AABB Audioconference # 084567, Feb. 6, 2008.

Lynn A. Emmert is Project Manager/Training Coordinator for the Quality Assurance and Regulatory Affairs department at Puget Sound Blood Center in Seattle, Washington. Her previous position at Puget Sound Blood Center was as Supervisor of Technical Education for the Transfusion Service. She has been an Instructor for the Medical Technology Programs at the University of Washington and Rush University and the Medical Laboratory Technician Program at Shoreline Community College. She is an active member in the AABB and American Society for Training and Development (ASTD).

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Additional Information
"A National Biovigilance Network,"
http://www.dhhs.gov/bloodsafety/presentations/WhitakerAABBACBSA0806.pdf