When Leslie Rea heard that there was one seat left for laboratory medicine in a new Job Instruction training course, she wanted that seat to be hers. “I literally begged my manager and director to help me get into that course,” she laughs. “It was totally worth it.”

Job Instruction training is part of the Kaizen Promotion Office’s “Training Within Industry” and is a structured, step by step training method which teaches supervisors, educators and managers how to quickly train employees to do a job correctly, safely and conscientiously. The objective is to help develop a well-trained workforce to ensure sustainability and accountability of standard work. The method involves preparing the learner, giving a demonstration while identifying important steps and key points of a job, having the learner perform the job and ensure continual follow up until the learner is confident in the new skill.

Rea, who is the supervisor of the phlebotomy department in Royal University Hospital, implemented the Job Instruction training method in September 2012 to reduce labelling errors on specimens. To date, the department has reduced those errors by 43 per cent.

When specimens are improperly labelled, it’s the patients who are affected the most. “When a sample isn’t labelled properly or not at all, it has to be re-collected,” she explains. “This means delayed testing and therefore results are delayed in getting to the patient.” For outpatients, it means that they have to come back to the hospital to have their sample recollected. For more critical patients such as those in emergency care, a delay in getting their specimen tested could mean death. “The costs to our patients can be huge.”

Leslie Rea and Diana MacLean stand by the phlebotomy department's visual management board. The department has gone 36 days without an unlabelled specimen.

Leslie Rea and Diana MacLean stand by the phlebotomy department’s visual management board. The department has gone 36 days without an unlabelled specimen.

“Our Adverse Event Management System (AEMS) reports from July 2011 to July 2012 showed that our department had sent 63 unlabelled samples to the lab,” Rea explains. For most labs, 80 per cent of errors happen in the pre-analytical work or the work that has to happen before the sample even gets tested. “The challenge then is not only making sure that all specimens are labelled but labelled properly,” says Rea. After implementing Job Instruction training, the AEMS reports for July 2012 to July 2013 showed that only 36 unlabelled samples had been sent to the lab.

Because Job Instruction training focuses on one-on-one instruction for 15 minutes, the biggest challenge to the method can be time. “When you have a lot of staff members, finding time to train them all can be difficult.” Rea does have a bit of help though; her colleague Diana MacLean has also been trained to teach Job Instruction and the two of them are working together to train the rest of the staff.

The team has even made Job Instruction part of their huddle. “We track how many days we’ve gone error free and celebrate those accomplishments. Right now we are at 36 days without an error,” says Rea. “Of course the ultimate goal is always be defect free and if you truly follow Job Instruction, you really can’t make any errors. That’s the way the method is designed to work.”