workforce assessment report dhb medical laboratory workforce · workforce assessment report ......
TRANSCRIPT
Prepared by Kamini Pather
Strategic Workforce Services
Strategic Workforce Services
Workforce Assessment Report DHB Medical Laboratory Workforce
June 2016
Strategic Workforce Services – DHB Medical Laboratory Workforce 1
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Strategic Workforce Services – DHB Medical Laboratory Workforce 2
Table of Contents Executive Summary ............................................................................................................................ 3
Key Findings ........................................................................................................................................ 3
Recommendations .............................................................................................................................. 5
1. Purpose ......................................................................................................................................... 7
1.1 Background ................................................................................................................................. 7
1.2 Context ....................................................................................................................................... 8
2. Medical Laboratory Services in New Zealand ............................................................................... 9
2.1 The Medical Laboratory Workforce Defined .............................................................................. 9
2.2 Service Provision......................................................................................................................... 9
2.3 Medical laboratory service provision arrangements by DHB ................................................... 10
3. The DHB Medical Laboratory Workforce Overview ................................................................... 11
4. Current Status of the DHB Medical Laboratory Workforce ........................................................ 15
4.1 Overall Assessment of the Medical Laboratory Workforce ...................................................... 15
4.2 Rationale ................................................................................................................................... 14
4.3 Summary of the Current Status of the DHB Medical Laboratory Workforce ........................... 16
4.4 Workforce Assessment ............................................................................................................. 17
4.4.1 Service Demand .................................................................................................... 17
4.4.2 Supply ................................................................................................................... 20
4.4.3 Operational Flexibility ........................................................................................... 23
4.4.4 Operational Capacity ............................................................................................ 25
4.5 Medical Laboratory Workforce Engagement Groups ......................................................... 28
4.5.1 The National Pathology and Laboratory Round Table .......................................... 28
4.5.2 The National Laboratory and Engagement Group ................................................ 30
4.5.3 Canterbury Health Laboratories Annual User Group Meeting ............................. 30
4.5.4 Other Groups ........................................................................................................ 31
5. Operational Workforce Analysis ................................................................................................. 32
5.1 Regulatory Requirements for Medical Laboratory Workers in New Zealand .......................... 32
5.2 Changes to Registration Requirements from 01 February 2016 .............................................. 32
5.3 Workforce Description ............................................................................................................. 34
5.4 Key Service, Operational Workforce and Employment Drivers ................................................ 34
5.5 Service Delivery & Development Drivers.................................................................................. 34
5.6 Demographics ........................................................................................................................... 34
5.7 Current employed workforce ................................................................................................... 34
5.7.1 Recruitment .......................................................................................................... 34
5.7.2 Retention .............................................................................................................. 35
5.8 Training and Development ....................................................................................................... 35
5.8.1 Entry/ Transition Competency: ............................................................................. 35
5.8.2 Match to Service Requirements: .......................................................................... 35
5.8.3 Access to On-going Training (progression): .......................................................... 35
7. References .................................................................................................................................. 36
Strategic Workforce Services – DHB Medical Laboratory Workforce 3
Executive Summary
Current analysis of the DHB medical laboratory workforce has resulted in it being classified
as a ‘Transitional Occupation’. Overall, the DHB medical laboratory workforce is in a state of
transition with considerable variance between DHBs, depending on regional service
provision arrangements, workforce size and geographic location. There are a few long
standing issues around recruiting for particular areas of specialisation and rural areas;
increasing service demand; the increasing impact of technology; the changing nature of
laboratory work; and the challenges of managing issues relating to the ageing workforce
demographic. While there are emerging requirements for more flexible workforce options
there is very limited substitution that can occur, due to the lack of available substitutes that
can perform the critical functions of this workforce. No significant priorities have been
identified for the DHBs to address through the bargaining strategy.
Key findings include:
Service demand is variable between DHBs, dependent on geographical location and
the populations they service. Overall service demand is progressively increasing due
to increasing and changing population demands, as well as the success of national
health programmes requiring medical laboratory tests; with peak demand pressures
on laboratory services such as histology. Service demand and provision is also
changing within the medical laboratory context.
While there is an overall stable supply pattern, there are some emerging distribution
issues and wider issues with supply. However, these are localised issues rather than
the entire workforce, i.e. with particular areas of specialisation, management roles
and certain geographic areas. The DHB medical laboratory workforce is changing in
distribution and composition. There is considerable variation in the supply patterns
being experienced by individual DHBs. This appears to be largely dependent on
geographic location. DHBs with large urban populations are experiencing sufficient
and in some cases an oversupply of medical laboratory workers, while other DHBs
with rural populations are facing supply challenges.
There are no significant workforce flexibility issues. This workforce comprises largely
technically specialised roles with specific qualifications and scopes of practice.
Hence, there is no flexibility in terms of scopes of practice, work and areas of
specialisation. There are some emerging requirements for more flexible workforce
options for the DHB medical laboratory workforce, however there is very limited
substitution that can occur. This is being addressed through multi-skilling staff,
flexible work arrangements to enable coverage and the use of enhanced
technological capability to increase flexibility in the way work is organised.
Strategic Workforce Services – DHB Medical Laboratory Workforce 4
DHBs vary considerably in terms of operational capacity. Many DHBs are
experiencing no significant recruitment and retention issues, and there is generally
easy access to this workforce when required. However, internationally and
nationally, there are generalised recruitment and retention issues in areas of
specialisation and for leadership roles, with longer timeframes for gaining this
workforce. Additionally, DHBs with rural laboratories are experiencing difficulty
recruiting and retaining staff for rural locations. As a result some DHBs operational
environments are being affected by potential lack of this workforce, due to the
higher level of workforce specialisation required within the medical laboratory
context. The high numbers of retirements in this ageing workforce also impacts on
retention. Additionally, age related health issues can be complex to manage.
There are also issues sourcing people for management positions, i.e. with technical
skills and leadership / people management skills. This may be because this workforce
does not tend to move between laboratories due to the market being too small, and
some staff choosing not to work in the private sector. There are also MLWs of very
long tenure that are at the top of their scientific scales but do not want to lead into
their retirement years, and younger emerging staff may see the step to a leadership
role as too great. The remuneration gap between private and public sector labs for
scientific leadership positions is very large. Although private laboratories usually
have fewer leadership roles, as they do not have the mix or sub-specialisations of
DHB services, the private laboratories tend to remunerate their leadership roles at a
higher level than the DHBs.
New technology is having a significant impact on the role and increases the on the
job training required. Information technology, informatics, work flow process design,
etc. are now integral in the MLWs work environment.
The composition of the DHB medical laboratory workforce is also changing. The
proportions of scientists and technicians vary significantly between DHBs depending
on operating models and technological infrastructure. The needs of the workforce
are changing, so technical and scientific ratios are also likely to change.
There are some emerging needs for other scientist skills vs traditional medical
laboratory science skills. The ML workforce is moving from a total bench, hands on
scientists, to experts in process, automation and equipment, result interpretation,
complementary knowledge experts for referrers and patients, with specialisation in
managing laboratory information systems and bioinformatics.
Strategic Workforce Services – DHB Medical Laboratory Workforce 5
Medical laboratory science, pathology, scientific and technological advances are
moving relatively quickly so it is anticipated that there will be a continuing need to
develop and transition the medical laboratory workforce to meet changing needs.
With increased use of automated technology, laboratory scalability to meet volumes
in high volume testing areas is achievable often without investment in additional
staff.
There are some predictions that the future medical laboratory workforce may
comprise fewer scientists and more technicians due to automation as well as cost
drivers, especially within the community environment. A tertiary level research
laboratory would have a slightly difference mix. Conversely, other predictions are
that increasing automation will reduce the number of technicians required and bring
a shift in the scientist role to be more consultative.
There are issues around the lack of training funds for specialised training and for
funded ‘Trainee’ positions. Funding of Continuing Professional Development (CPD) is
negotiated. Training is needed to develop specialist skills, however funding is an
issue. It can be difficult for smaller DHBs and laboratories to keep up skills
development and CPD. Additionally, the DHB environment has a number of older
staff who are unlikely to move and free up opportunities for younger MLWs. There is
also a tension between specialist vs generalist capability development. The drive
towards specialisation could create a shortage of generalists over the long term.
Recommendations
It is recommended that the following actions be considered in relation to the DHB medical
laboratory workforce:
Quantifying and monitoring increasing service demand to ensure optimal
understanding of the operating environment, and to support proactive management
of volume changes.
Comprehensive analysis of the increasing impact of technology changes and
automation on this workforce over the long term, to support future planning.
Further enquiry into the changing nature of laboratory work, such as the emerging
need for other scientist skills vs traditional medical laboratory science skills, to
ensure that the DHBs are able to be effectively responsive to any necessary
change/s.
Strategic Workforce Services – DHB Medical Laboratory Workforce 6
Exploration of options to support long term capability development in management
/ leadership development and the areas of specialisation which are experiencing or
are likely to experience supply issues.
The DHBs review representation on the National Pathology and Laboratory Round
Table (the Round Table) to ensure effective participation, and to leverage
opportunities for addressing sector wide issues to enable a coordinated national
approach to workforce planning and development. The Round Table commenced
work in late 2015 on identifying changes in the laboratory industry and workforce
implications, as the first step to describing a blueprint to consider and plan for future
laboratory workforce requirements. This includes defining the current state for the
workforce, identifying changes in the industry, and considering the response
required to ensure the workforce is able to respond appropriately to change.
The NLEG consider narrowing its scope to focus only on addressing employment
related issues as required. With wider workforce issues to be addressed by
leveraging of the broader perspective offered by the Round Table’s workforce
development programme.
The DHBs retaining MLWs review DHB representation on the NLEG, to ensure
appropriate and proportionate representation. Somewhat proportionate
representation could occur by selecting representatives based on regional workforce
size.
Developing a long term strategy for managing the ageing workforce, in particular
managing the correlating complex age related health issues and planning for high
numbers of retirements.
Note that on 01 February 2016, the Medical Sciences Council made significant
changes to the registration requirements and scopes of practice for medical
laboratory science practitioners in New Zealand. These changes are likely to have
significant implications for the DHB medical laboratory workforce.
Strategic Workforce Services – DHB Medical Laboratory Workforce 7
1. Purpose The purpose of this paper is to provide an overview of the current DHB medical laboratory
workforce and to recommend actions for the development of this workforce, based on the feedback
received from DHBs and the workforce information data.
Workforce development is a key enabler for DHBs and has a significant impact on service delivery
and DHB outcomes. Operational advice on the DHB employed workforce is developed by the
Strategic Workforce Services team and is complementary to the strategic advice and direction
provided by Health Workforce New Zealand (HWNZ) and the operational activity of associated lead
professional groups.
The operational workforce advice provides a view of the current status of the DHB Medical
Laboratory workforce. The recommendations from the report will be presented to the lead
operational groups for consideration and further development. Elements of the advice may also
relate to employment relations issues. The report will also be provided to the Employment Relations
Strategy Group to ensure access to this information when considering strategic employment
relations advice in relation to this workforce.
1.1 Background
This advice is provided for the purpose of informing the workforce group.
Ongoing health workforce development is a key accountability for DHBs and has a significant impact
on DHB outcomes. The Workforce Strategy Group (WSG) has an operational governance role over
the 20 DHB’s workforce activity and has mandated a range of advice to ensure that annual
workforce planning via Strategic Workforce Services (SWS) is well supported. Operational advice on
the employed workforce is developed by DHB experts and is complementary to the strategic advice
provided by Health Workforce New Zealand (HWNZ).
The purpose of the operational advice is to ensure that annual workforce planning processes have
the required level of workforce analysis, wherever additional focus or information is required. It is
about improving overall accuracy of information to this group in order to allow informed decisions to
be made regarding any potential intervention required. The purpose is to identify any staffing
capacity and/or capability issues related to DHB operational delivery and/or service development
needs, some of which may be addressed through the annual DHBSS workforce workplan process.
This paper provides summary advice to the workforce group on the current status of the DHB
medical laboratory workforce. The catalyst for this paper commencement is the upcoming 2016
Medical Laboratory Workers Multi Collective Employment Agreement (MECA) negotiations with the
Strategic Workforce Services – DHB Medical Laboratory Workforce 8
NZMLWU, the DHBs and the NZBS. This information is provided for the purpose of informing the
development of a bargaining strategy in preparation for the 2016 Medical Laboratory Workers
MECA. The intent of the operational advice is to ensure that Bargaining Strategy Groups have access
to accurate information on the current status of the DHB medical laboratory employed workforce.
1.2 Context
The previous Medical Laboratory Workers MECA was settled in August 2014 and expires on 4
September 2016. A minor extension to the term of the current MECA was agreed last year to
incorporate several projects completed by the National Laboratory Engagement Group (NLEG).
There are 13 DHBs who are party to the current MECA:
Northland, Waitemata, Auckland, Counties Manukau, Waikato, Lakes, Hawkes Bay, Taranaki, Hutt
Valley, Capital & Coast, West Coast, Canterbury, and Southern.
*** Hutt Valley and Capital & Coast DHBs have contracted out their laboratory services to a private
laboratory since the last MECA was negotiated and will not be part of the 2016 bargaining.
The NZ Blood Service is also a party to the MECA.
Strategic Workforce Services – DHB Medical Laboratory Workforce 9
2. Medical Laboratory Services in New Zealand
2.1 The Medical Laboratory Workforce Defined
The Medical Laboratory Workers (MLW) workforce includes two distinct professions: Medical
Laboratory Scientists (Scientists) and Medical Laboratory Technicians (Technicians).
Medical laboratory science involves the collection, receipt, preparation, investigation and analysis of
samples of human biological material for the purpose of supporting diagnosis, monitoring,
management and treatment of diseases and medical conditions; and for the maintenance of health
and wellbeing.
Medical laboratory science comprises a number of distinct disciplines including:
Biochemistry Embryology Molecular Diagnostics/Genetics
Blood Donor Services Haematology Mortuary Practice
Blood Transfusion Services Histology Phlebotomy
Cytogenetics Immunology/Virology Point of Care Testing (PCT)
Cytology Microbiology Specimen Services
The practice of medical laboratory science also includes:
Medical laboratory management
Medical laboratory science research and development
Medical laboratory science teaching
Medical laboratory quality management
2.2 Service Provision
Current arrangements around the provision of community and hospital medical laboratory services
in New Zealand, varies considerably between DHB regions and across the country. This is due to the
mixed DHB and / or private provider service provision models in place.
Additionally, there are some regionally specific arrangements such as:
DHBs retaining particular functions or units while outsourcing all other medical laboratory services to a private provider, e.g. Lakes only retains a mortuary function at Rotorua Hospital with casual staff;
A single laboratory providing nearly all services in that region, e.g. The West Coast DHB Laboratory with support from Canterbury Health Laboratories;
Hospital laboratories undertaking some community testing, e.g. Northland DHB covers smaller rural areas without Northland Pathology collection centres such as Kaitaia; and
Community laboratories providing tests at hospital outpatient clinics, e.g. Southern Community Laboratories covers community and hospital labs for the Southern DHB.
Strategic Workforce Services – DHB Medical Laboratory Workforce 10
2.3 Medical laboratory service provision arrangements by DHB
DHB Hospital Laboratory Services Community Laboratory Services
Auckland Auckland DHB’s LabPlus Diagnostic Medlab
Labtests
Auckland DHB’s Anatomic Pathology Services -community anatomical pathology & histology
Counties Manukau Counties Manukau DHB Diagnostic Medlab
Labtests
Auckland DHB’s Anatomic Pathology Services -community anatomical pathology & histology
Northland Northland DHB Northland Pathology
Northland DHB covers areas without Northland Pathology collection centres
Waitemata Waitemata DHB Diagnostic Medlab
Labtests
Auckland DHB’s Anatomic Pathology Services -community anatomical pathology & histology
Lakes District Laboratory Services Rotorua
Southern Community Laboratories (SCL) services Taupo
Lakes District DHB operates the Rotorua Hospital Mortuary
Laboratory Services Rotorua
SCL services Taupo
Bay of Plenty Pathlab Pathlab
Waikato Waikato DHB Pathlab
Waikato DHB provides some community laboratory services for small south Waikato towns such as TeKuiti, Taumarunui, Tokoroa and Thames
Tairawhiti TLab (a joint venture between Medlab Central and the DHB)
TLab (a joint venture between Medlab Central and the DHB)
Taranaki Taranaki DHB Taranaki Medlab provides community laboratory services, anatomical pathology and histology tests.
Canterbury Health and the New Zealand Blood Service in Waikato provide specialist testing and advice
Capital & Coast Wellington SCL (owned by SCL) Wellington SCL (owned by SCL)
Hawkes Bay Hawkes Bay DHB SCL
Hutt Valley Wellington SCL (owned by SCL) Wellington SCL (owned by SCL)
MidCentral Medlab Central
Auckland DHB’s LabPlus
Medlab Central
Wairarapa Wellington SCL (owned by SCL) Wellington SCL (owned by SCL)
Whanganui Medlab Central Medlab Central
Canterbury Canterbury DHB’s Canterbury Health Laboratories SCL
Nelson Marlborough Medlab South (owned by SCL)) Medlab South (owned by SCL))
South Canterbury Medlab South (owned by SCL)) Medlab South (owned by SCL))
Southern SCL
Southern DHB operates the hospital mortuary
SCL
West Coast West Coast DHB
Canterbury DHB’s Canterbury Health Laboratories
Canterbury DHB’s Canterbury Health Laboratories
Strategic Workforce Services – DHB Medical Laboratory Workforce 11
3. The DHB Medical Laboratory Workforce Overview
Over the long term, the overall DHB medical laboratory workforce distribution has diminished due to
laboratory services increasingly being contracted out to private providers. There are currently only
11 DHBs who employ medical laboratory workers: Northland, Waitemata, Auckland, Counties
Manukau, Waikato, Lakes, Hawkes Bay, Taranaki, West Coast, Canterbury, and Southern.
There is considerable disparity in FTE numbers between DHBs and regions, as evidenced in the
tables below. Lakes DHB has only retained a mortuary service which employs casual staff, so it has
no FTE for the purpose of this report. Similarly, the Southern DHB only employs 3 FTE in its mortuary
service.
DHB Scientist FTE Technician FTE Total %
Auckland 198.1 89 287.1 28.30%
Canterbury 108.1 81.1 189.2 18.60%
Waikato 78.3 58.2 136.5 13.40%
Counties Manukau 63.3 66.4 129.7 12.80%
Waitemata 58.7 51.7 110.4 10.80%
Northland 40 20.7 60.7 6.10%
Hawke's Bay 27.3 29.8 57.1 5.60%
Taranaki 14.8 13.5 28.2 2.80%
West Coast 7.9 5.1 13 1.30%
Southern 0 3.3 3.3 0.30%
Lakes 0 0 0 0
Total 596.4 418.7 1015.1 100.00%
DHB Scientist FTE Technician FTE Total %
Northern Region 360.1 227.8 587.9 58.0%
Southern Region 116.0 89.5 205.5 20.2%
Mid-Central Region 93.1 71.7 164.7 16.2%
Central Region 27.3 29.8 57.1 5.6%
Total 596.4 418.7 1015.1 100.0%
HWIP trend analysis from 2013 to 2015 indicates that the overall number of DHB employed MLWs
has experienced 0% change and is currently 1203. Given that during this period the number of DHBs
employing MLWs reduced from 13 to 11, the unchanged headcount indicates that the number of
MLWs employed by the remaining 11 DHBs increased. This growth is largely influenced by changes in
the Northern Region, particularly the transition to Anatomical Pathology Services being managed by
the Auckland DHB.
Strategic Workforce Services – DHB Medical Laboratory Workforce 12
Strategic Workforce Services – DHB Medical Laboratory Workforce 13
The DHB medical laboratory workforce comprises 58% scientists and 42% technicians. During the
period 2013 to 2015, the number of scientists decreased by 1% to 692, while the number of
technicians increased by 2% to 511. The Northern Region has a headcount of 686, which is 57% of
the overall DHB headcount. Since 2007 the number of scientists in the Northern Region increased by
28% to 417 and the number of technicians increased by 67% to 269.
With 587.9 FTE the Northern Region currently has the highest FTE of scientists and technicians, i.e.
58% of the overall DHB medical laboratory workforce FTE. The overall mean FTE is 0.84 indicating a
high number of part time workers. The mean FTE for scientists has consistently been higher than
technicians, and is currently 0.86 and 0.82 respectively.
80% of the current workforce is female, with both the proportion of female scientists and
technicians having decreased slightly to 76% and 86% respectively since 2013.
The overall mean age is high at 46.9 years. There has been a steady increase in the mean age for
both scientists and technicians, which are currently 46.5 and 47.4 years respectively. 33% of DHB
MLWs are under 40 years; 21% are 40 to 49; 41% are between 50 and 65 years, i.e. up to 15 years
away from retirement age; and 5% are 65+ years and working beyond retirement age. The charts
below illustrate the age distribution across the two main MLW occupation groups.
41% of female and 36% of male scientists are more than 50 years old; while 45% of female and 29%
of male technicians are more than 50 years old. Currently, for both scientists and technicians 5% of
females and 7% of males are more than 65 years old and working beyond retirement age.
The difference between workforce ethnicity and population ethnicity proportions indicates under-
representation of Māori and Pacific groups and disproportionately high representation of Asians,
especially for technicians in the Northern Region. The majority of MLWs are classified as ‘Other’
ethnicity, however an exception to this national trend is the Northern Region which has a higher
proportion of Asian technicians than the proportion of technicians classified as ‘Other’.
Strategic Workforce Services – DHB Medical Laboratory Workforce 14
The annual turnover rate is 8.3%. The annual turnover rate has generally been higher for technicians
than for scientists, except between 2010 and 2012. While the annual turnover rate for scientists has
fluctuated between 6-12.5% between 2008 and 2015, the actual number of scientists leaving is
small. The overall mean Length of Service (LoS) increased to 10.9 years, and has consistently been
higher for scientists than for technicians.
In March 2014 the DHB MLW workforce was 36.13% of the overall New Zealand MLW workforce.
Since 2007 the number of New Zealand graduates registering as MLWs has been increasing, while
the number of overseas qualified new registrations has been decreasing. The United Kingdom
continues to be the major source country for scientists, while the Philippines remains the major
source country for technicians. The number of work visas issued to foreign MLWs has also been
decreasing in recent years. These trends indicate a decreasing dependence on overseas qualified
MLWs.
The key statistics suggest an aging workforce, which is changing in distribution and composition,
concentrated in the Northern region, with a higher proportion of scientists, dominant female
representation, a volatile turnover, long lengths of service, decreasing dependence on overseas
qualified workers, under-representation of Māori and Pacific and disproportionately high
representation of Asian. A detailed Workforce Information Report is included at Appendix 1.
Strategic Workforce Services – DHB Medical Laboratory Workforce 15
4. Current Status of the DHB Medical Laboratory Workforce
4.1 Overall Assessment of the Medical Laboratory Workforce
The current status of the DHB employed medical laboratory workforce was assessed by DHB sector experts using a structured screening tool. (Appendix 2)
The screening tool assigns a score to the workforce being considered according to:
Service Need The operational stability/instability of the service
Supply Demographic factors impacting on the overall availability of this workforce
Operational Flexibility Operational flexibility around this workforce for service delivery and innovation
Operational Capacity Recruitment and retention
The purpose of the screening tool is to provide an overall assessment of the workforce to highlight any pressures impacting on the workforce operationally and/or in the context of employment negotiations. The results of the screening place the workforce in one of 4 categories as shown in the figure below. Results should be considered indicative only.
Health Workforce Classification Table
Overall Classification Intervention Overall Score
Stable Occupation WATCHING BRIEF 4 < 6
Transitional Occupation SOME INTERVENTION RECOMMENDED ≥ 6 < 10
At Risk Occupation INTERVENTION REQUIRED ≥ 10 < 15
Occupation Under Pressure INTERVENTION IMPERATIVE ≥ 15
Preliminary assessment of the current status of the DHB medical laboratory workforce by sector experts has identified this workforce as a Transitional Occupation.
DHB Medical Laboratory Workforce Classification
Transitional Occupation - SOME INTERVENTION RECOMMENDED
Domain Assessment Score
Service Demand
Service demand is progressively increasing and there are some instances of demand pressure on service.
2.4
Supply There are some distribution and supply issues, but these are localised issues (i.e. with specialisations and geographic locations), rather than the entire workforce.
2.1
Operational Flexibility
There are emerging requirements for more flexible workforce options however there is limited substitution that can occur.
2.6
Operational Capacity
Some recruitment and retention issues are occurring, with slightly longer timeframes for gaining this workforce in areas of specialisation and for rural locations.
1.9
Total Score 9
Strategic Workforce Services – DHB Medical Laboratory Workforce 13
DHB MLWs FTE Distribution & Workforce Assessment Classification
DHB Scientist
FTE Technician
FTE Total FTE
% Hospital
Laboratory Services
Other DHB
Services
Community Laboratory
Services
Service Demand
Supply Operational
Flexibility Operational
Capacity Total Classification Intervention
Auckland 198.1 89.0 287.1 28.3% Community anatomical pathology
& histology services
x 3 2.5 3.5 3 12 At Risk
Occupation INTERVENTION
REQUIRED
Canterbury 108.1 81.1 189.2 18.6% x x 2 2 2 2 8 Transitional Occupation
SOME INTERVENTION
RECOMMENDED
Waikato 78.3 58.2 136.5 13.4% x x 2 1 2 1 6 Stable
Occupation WATCHING BRIEF
Counties Manukau
63.3 66.4 129.7 12.8% x x 3 1 3 1 8 Transitional Occupation
SOME INTERVENTION
RECOMMENDED
Waitemata 58.7 51.7 110.4 10.8% x x 2 2 3 2 9 Transitional Occupation
SOME INTERVENTION
RECOMMENDED
Northland 40.0 20.7 60.7 6.1% x x 4 3 4 3 14 At Risk
Occupation INTERVENTION
REQUIRED
Hawke's Bay
27.3 29.8 57.1 5.6% x x 3 3 2.5 2.5 11 At Risk
Occupation INTERVENTION
REQUIRED
Taranaki 14.8 13.5 28.2 2.8% x x 2 2.5 2.5 2 9 Transitional Occupation
SOME INTERVENTION
RECOMMENDED
West Coast 7.9 5.1 13.0 1.3% x x 1 2 1 1 5 Stable
Occupation WATCHING BRIEF
Southern 0 3.3 3.3 0.3% x Mortuary
only x Stable
Occupation WATCHING BRIEF
Lakes 0 0 0 0 x Mortuary
only x Stable
Occupation WATCHING BRIEF
Total 596.4 418.7 1015.1 100% 2.4 2.1 2.6 1.9 9 Transitional Occupation
SOME INTERVENTION
RECOMMENDED
Strategic Workforce Services – DHB Medical Laboratory Workforce 14
4.2 Rationale
Analysis of the DHB medical laboratory workforce has resulted in the classification of a Transitional
Occupation. This classification highlights that there is considerable variation between DHBs and
regions in terms of workforce size and around the private/DHB models that are currently in place.
These contextual issues make it challenging to present a national or regional assessment score with
a reliable level of validity. Therefore, the workforce assessment scores have also been examined at
DHB level to provide a more accurate analysis of each DHB’s situation in terms of its medical
laboratory workforce.
Key findings include:
Service demand is variable between DHBs, dependent on geographical location and the
populations they service. Overall service demand is progressively increasing due to
increasing and changing population demands, as well as the success of national health
programmes requiring medical laboratory tests; with peak demand pressures on laboratory
services such as histology. Service demand and provision is also changing within the medical
laboratory context.
While there is an overall stable supply pattern, there are some emerging distribution issues
and wider issues with supply. However, these are localised issues rather than the entire
workforce, i.e. with particular areas of specialisation, management roles and certain
geographic areas. The DHB medical laboratory workforce is changing in distribution and
composition. There is considerable variation in the supply patterns being experienced by
individual DHBs. This appears to be largely dependent on geographic location. DHBs with
large urban populations are experiencing sufficient and in some cases an over supply of
medical laboratory workers, while other DHBs with rural populations are facing supply
challenges.
There are no significant workforce flexibility issues. This workforce comprises largely
technically specialised roles with specific qualifications and scopes of practice. Hence, there
is no flexibility in terms of scopes of practice, work and areas of specialisation. There are
some emerging requirements for more flexible workforce options for the DHB medical
laboratory workforce, however there is very limited substitution that can occur. This is being
addressed through multi-skilling staff, flexible work arrangements to enable coverage and
the use of enhanced technological capability to increase flexibility in the way work is
organised.
DHBs vary considerably in terms of operational capacity. Many DHBs are experiencing no
significant recruitment and retention issues and there is generally easy access to this
workforce when required. However, internationally and nationally, there are generalised
recruitment and retention issues in areas of specialisation and for leadership roles, with
longer timeframes for gaining this workforce. Additionally, DHBs with rural laboratories are
Strategic Workforce Services – DHB Medical Laboratory Workforce 15
experiencing difficulty recruiting and retaining staff for rural locations. As a result some
DHBs operational environments are being affected by potential lack of this workforce, due
to the higher level of workforce specialisation required within the medical laboratory
context. The high numbers of retirements in this ageing workforce also impacts on
retention. Additionally, age related health issues can be complex to manage.
On 01 February 2016, the Medical Sciences Council made significant changes to the
registration requirements and scopes of practice for medical laboratory science practitioners
in New Zealand. These changes are likely to have significant implications for the DHB medical
laboratory workforce.
Overall, the DHB medical laboratory workforce is in a state of transition with considerable
variance between DHBs, depending on regional service provision arrangements, workforce size
and geographic location. There are a few long standing issues around recruiting for particular
areas of specialisation and rural areas, as well as managing issues relating to the ageing workforce
demographic. No significant priorities have been identified for the DHBs to address through the
bargaining strategy.
Strategic Workforce Services – DHB Medical Laboratory Workforce 16
4.3 Summary of the Current Status of the DHB Medical Laboratory Workforce
Summary of Key Service, Operational Workforce and Employment Drivers
1. Operational Service Needs
Current Changing in distribution and
12 month outlook No major changes foreseen
1 - 3 years outlook Watching brief in regards to volume increases
2. Employed Workforce Structure (Demography)
Average age Ageing workforce with an average age of 42.9 years.
Gender balance Predominantly female part time workforce with the risk of losing workforce numbers during childbearing years
3. Recruitment Current vacancies There are issues with particular specialisations and rural regions
Average time to fill No reported issues
Distribution Changing in distribution
Pressures on related workforces
No reported issues
4. Retention Factors Turnover Has been volatile but is currently relatively low
Sick Leave No reported issues
Part-time /Fulltime A part time workforce with a 0.92 mean FTE
Skill Mix No reported issues
Access to Clinical leadership
No reported issues
Clear career path No reported issues.
Development No reported issues
Workload management No reported issues
Roster management Some inconsistencies between business units
5. Ongoing Training and Development
Entry/ Transition competency
No reported issues
Match to service requirements
No reported issues
Access to ongoing training (progression)
There are issues around CPD funding
Access to training to maintain practising cert
No reported issues
Key
Working Well - no current problems, no immediate action required
Moderate Alert - action required in short / medium term
High Alert - immediate action required, extreme risk to occupation group
Strategic Workforce Services – DHB Medical Laboratory Workforce 17
4.4 Workforce Assessment
4.4.1 Service Demand
Service Demand is about the demands on a particular service and associated workforce, and it
relates to the need for service provision within the environment or context being examined.
Service demand is variable between DHBs, dependent on geographical location and the
populations they service. Overall service demand is progressively increasing due to increasing and
changing population demands, as well as the success of national health programmes requiring
medical laboratory tests; with peak demand pressures on laboratory services such as histology.
Service demand and provision is also changing within the medical laboratory context.
DHB Medical Laboratory Service Demand Ratings
Rating
1 2 3 4
Service is stable and there are no anticipated major changes to service delivery or demand in the
short term
Some instances of demand pressure on
service but the majority of the time it is stable
overall.
Service demand progressively increasing / impacting on service level or peak demand
periods increasing.
Service operating at full capacity, peaks in
service demand driving instability in service
delivery.
% of DHB MLWs
1.3% 45.6% 46.7% 6.1%
DHBS
West Coast
Southern
Lakes
Canterbury
Waikato
Waitemata
Taranaki
Auckland
Counties Manukau
Hawke's Bay
Northland
Considerations include:
Service demand is increasing and changing as technology, population needs and clinician
requirements change.
Population growth and variegation are some of the factors driving increases in service
demand. There are increasing population demands impacting on service demand. Service
demand has increased significantly for Counties Manukau, Northland and Waitemata. This
increase is due to dramatic population growth, increases in population groups with high
health needs, and a steadily increasing aging population’s needs. Auckland DHB has not
experienced remarkable population growth; however there has been significant change in
cultural diversity which has resulted in a changed demographic population. This has resulted
in service demand increasing and workload increases in ‘acute’ health issues. Many
population sub-groups are accessing secondary care rather than primary care. Therefore
there is a requirement for more complex assays. There are also issues obtaining skilled or
specialised staff to meet the changing needs. Canterbury DHB is finding that variations in the
community and population; as well as increasing and changing expectations from consumers
are impacting on service demand.
Strategic Workforce Services – DHB Medical Laboratory Workforce 18
There are changes to clinical practice which result in changes to service demand and
requirements, e.g. testing requirements and companion diagnostics.
Changes to operational requirements impact on service demand, e.g. changes to surgical
schedule or changes to collection of samples.
There are pressures around national initiatives. National health programmes and Ministry of
Health performance targets impact on service demand and requirements. The Ministry of
Health is working with the health sector to ensure patients have timely access to
appointments and tests which detect cancer and support cancer treatment. This work is
being done by the Faster Cancer Treatment (FCT) programme which aims to improve the
quality and timeliness of cancer diagnostic and treatment services for patients along the
cancer pathway. DHB medical laboratory service demand is being impacted on by the FCT
programme indicators. The Hawkes Bay DHB is experiencing severe demand pressures on
laboratory services, particularly in Histology, resulting from increasing numbers of cancer
referrals due to the success of the FCT programme. Additional pressure is expected as the
volume of referrals and medical staffing continues to increase.
The Bowel Cancer Programme is another growth area in terms of service demand. The
Ministry of Health established a Bowel Cancer Programme in 2009 to lead work aimed at
improving bowel cancer outcomes for all New Zealanders. The programme priority is to
strengthen bowel cancer services across the country to effectively meet the current demand
and increased demand in the future. This involves ensuring diagnostic, surveillance and
treatment services are working effectively and to a high standard. A four-year bowel
screening pilot began in late 2011 to determine if a bowel screening programme should be
rolled out nationally. In May 2015, the pilot was extended to December 2017.
Point of Care Testing (POCT) is also impacting on service demand, particularly in supporting
remote communities. Due to its varied nature, risks associated with POCT are higher than
those associated with testing in the environmentally controlled pathology laboratory.
Therefore, laboratory expertise is still required to support these services to ensure accurate
results.
Care areas are changing which is impacting on service demand and requirements. The
Waikato DHB’s work volumes have been decreasing recently due to the implementation of a
project which has reduced ‘unnecessary’ testing. This has been clinician driven and is based
on overseas models adapted for the local context. However, this balanced by changing
service needs which has seen an increase in demand for genetic testing and histology. This is
attributed to the new techniques available and more rapid testing, e.g. cancer markers.
The Canterbury DHB is also finding that service demand is changing and is variable
depending on specialty areas and particular services. There is increasing demand for
cytogenetic testing, which is a branch of genetics that involves analysing cells with an
emphasis on chromosome analysis for the detection of inheritable diseases. While there
Strategic Workforce Services – DHB Medical Laboratory Workforce 19
appears to be low volumes, this area of work can be labour intensive and requires specialist
skills.
Medical laboratory science, pathology, scientific and technological advances are moving
relatively quickly so it is anticipated that there will be a continuing need to develop and
transition the medical laboratory workforce to meet changing needs. With increased use of
automated technology, laboratory scalability to meet volumes in high volume testing areas
is achievable often without investment in additional staff.
New strategies are regularly being developed and led at a national level, e.g. the change of
primary cervical screening to HPV testing. Therefore, the provider laboratories have the
challenge of maintaining a workforce until new services are in place and then maintaining a
specialised workforce where some are still needed but will have less work and then
transitioning others into other disciplines. To ensure service continuity, laboratories need a
critical mass of core staff irrespective of the volumes. It is similar for technology, diagnostic
or technique changes, such as traditional cytogenetics moving to molecular techniques.
Laboratories work with staff to transition over a period of time to new disciplines.
Service provision requirements and operating hours for medical laboratories are changing
across most DHBs, as a result of service demand and the drive to be more responsive. In the
Northern Region services are now provided 24/7 over multiple sites due to increases and
changes in service demand. Other DHBs are finding that the shifts in volumes has resulted in
laboratories running evening shifts. At times there are short term pressures in some of the
more specialised areas. There has been a shift in some specialties in timing of workload
(usually later in evening) and therefore a need to match resources to this demand or the
need to shift demand. This type of service model requires a particular skill mix and changes
to the way rosters and work are organised.
There are also increased pressures in terms of the aging workforce, reducing hours and time
out for parental leave. These issues also impact on capacity for supervision.
The increased shift of care into the community is likely to lead to higher service demand at
community collection centres.
The Northland DHB experiences seasonal increases in service demand due to population
peaks during holiday periods.
The West Coast DHB services a relatively stable population. Since the singular laboratory
provides all services for the region, there is certainty of workload. A lot of the required
hospital and specialist testing is performed by Canterbury DHB.
The Auckland DHBs are finding that outsourced services sometimes have to be picked up by
DHB laboratories if schedules are behind. However, other DHBs are finding that some of
their work is being outsourced to the private sector to meet service demand, creating an
interesting dynamic.
Strategic Workforce Services – DHB Medical Laboratory Workforce 20
4.4.2 Supply
Supply is about the actual quantity and distribution of a workforce, including current demographics
and the quantity and quality of students / graduates.
While there is an overall stable supply pattern, there are some emerging distribution issues and
wider issues with supply. However, these are localised issues rather than the entire workforce, i.e.
with particular areas of specialisation, management roles and certain geographic areas. The DHB
medical laboratory workforce is changing in distribution and composition. There is considerable
variation in the supply patterns being experienced by individual DHBs. This appears to be largely
dependent on geographic location. DHBs with large urban populations are experiencing sufficient
and in some cases an over supply of medical laboratory workers, while other DHBs with rural
populations are facing supply challenges.
DHB Medical Laboratory Supply Ratings
Rating
1 2 3 4
No major distribution or supply issues, overall stable supply pattern.
Some distribution issues emerging and
wider issues with supply, but localised
issues (i.e. with a particular speciality), rather than the entire
workforce.
Distribution and supply issues increasingly impacting on wider system. Issues with
overall size of workforce available.
Significant distribution and or supply issues currently occurring, problems with small
size of available workforce. Real issues
with the pipeline supply for this workforce.
% of DHB MLWs
26.2% 61.8% 11.7% 0
DHBS
Waikato
Counties Manukau
Auckland
Canterbury
Waitemata
Taranaki
West Coast
Northland
Hawke's Bay
Considerations include:
There is sufficient supply available in terms of new graduates and technicians; as well as at
mid / intermediate capability level.
However, there are supply issues in certain areas of specialisation unique to this area of
work, e.g. tissue typing. It is difficult to source technical specialists with the appropriate
experience.
Due to the shifting landscape of medical laboratories in New Zealand over the last 10 years,
the DHB medical laboratory workforce has also been in a state of change. Over the long
term, the overall DHB medical laboratory workforce distribution has diminished due to
laboratory services increasingly being contracted out to private providers. Indications are
that this trend is likely to continue. There are currently only 11 DHBs who employ medical
laboratory workers: Northland, Waitemata, Auckland, Counties Manukau, Waikato, Lakes,
Strategic Workforce Services – DHB Medical Laboratory Workforce 21
Hawkes Bay, Taranaki, West Coast, Canterbury, and Southern. There is considerable
disparity in FTE numbers between DHBs and regions. Lakes DHB has only retained a
mortuary service with no permanent FTE. Similarly, the Southern DHB only employs 3 FTE in
its mortuary service.
The overall number of DHB employed MLWs is currently 1203. The majority are
concentrated in the Northern Region (58%) followed by the Southern Region (20.2%). The
Central Region (5.6%) has the lowest proportion of DHB MLWs, while the Mid-Central Region
comprises the remaining 16.2%.
The composition of the DHB medical laboratory workforce is also changing. The proportions
of scientists and technicians vary significantly between DHBs depending on operating
models and technological infrastructure. The needs of the workforce are changing, so
technical and scientific ratios are also likely to change.
The key statistics indicate that the DHB medical laboratory workforce is aging, changing in
distribution and composition and is concentrated in the Northern region. It comprises a
higher proportion of scientists, with dominant female representation, a volatile turnover,
long lengths of service, decreasing dependence on overseas qualified workers, under-
representation of Māori and Pacific and disproportionately high representation of Asian.
There is sufficient supply available in terms of new graduates and technicians; as well as at
mid / intermediate MLW capability level.
Since 2007 the number of New Zealand graduates registering as MLWs has been increasing,
while the number of overseas qualified new registrations has been decreasing. The number
of work visas issued to foreign MLWs has also been decreasing in recent years. These trends
indicate a decreasing dependence on overseas qualified MLWs. There are well qualified
overseas trained MLWs being recruited by DHBs, however there is decreasing reliance on
this source as there are sufficient numbers of MLWs available locally.
There are supply issues in areas of specialisation or sub-specialty. It is difficult to source
technical specialists or sub-specialists with appropriate experience and who are multi-skilled.
This is a long standing global and national issue.
There are also issues sourcing people for management positions, i.e. with technical skills and
leadership / people management skills. This may be because this workforce does not tend to
move between laboratories due to the market being too small, and some staff choosing not
to work in the private sector. There are also MLWs of very long tenure that are at the top of
their scientific scales but do not want to lead into their retirement years, and younger
emerging staff may see the step to a leadership role as too great. The remuneration gap
between private and public sector labs for scientific leadership positions is very large.
Although private laboratories usually have fewer leadership roles, as they do not have the
mix or sub-specialisations of DHB services, the private laboratories tend to remunerate their
leadership roles at a higher level than the DHBs.
Strategic Workforce Services – DHB Medical Laboratory Workforce 22
There are no issues with the quantity and quality of graduates. However, many new
graduates need to be trained and appropriately transitioned from technician to scientist.
New graduates sometimes have unrealistic expectations, i.e. they have to undergo on the
job training which they often don’t expect and are unprepared for. Supervision, training and
mentoring staff involves a significant investment of resource and takes people away from
the functions of their core role.
Technology is having a significant impact on the MLW roles, i.e. it increases the on the job
training required. Information technology, informatics, work flow process design, etc. are
now integral in the MLWs work environment. This increases the on the job training needs as
well.
There are issues around the lack of training funds for specialised training and for funded
‘Trainee’ positions. Funding of Continuing Professional Development (CPD) is negotiated.
Training is needed to develop specialist skills, however funding is an issue. It can be difficult
for smaller DHBs and laboratories to keep up skills development and CPD. Additionally, the
DHB environment has a number of older staff who are unlikely to move and free up
opportunities for younger MLWs. There is also a tension between specialist vs generalist
capability development. The drive towards specialisation could create a shortage of
generalists over the long term.
There is an emerging trend of increasing numbers of fulltime staff reducing their hours or
wanting part time work. It is difficult to recruit to cover small FTE gaps. This increase in part-
time hours also puts pressure on service provision.
In the Northern Region, the current supply picture for the Auckland DHBs is possibly the best
it’s ever been historically for general MLW roles. However, the Northland DHB is having
difficulty sourcing scientists.
In the Mid-Central Region, there are no supply issues with general MLW roles. The Waikato
DHB is experiencing an oversupply of scientists, so some are taking up technician roles due
to a shortage of scientist roles. There have been issues around some staff wanting to
increase their FTE hours to more than 30 hours per week to meet immigration visa
requirements. While the Taranaki DHB has no supply issues, the hospital laboratories are
unsettled because it is unclear whether they will move to private providers. As a result, they
are currently not able to employ permanent FTE, which can make it challenging to recruit.
The Hawkes Bay DHB is the singular DHB within the Central Region which continues to retain
a medical laboratory workforce. Distribution and supply issues are increasingly impacting on
the Hawkes Bay DHB’s medical laboratory workforce and its ability to deliver effective
services. There are challenges recruiting appropriately trained and experienced MLWs due
to the rural nature of the region.
The Southern Region has an overall stable supply pattern for general MLW roles. Canterbury
DHB has an active intern and bridging course programme with technicians being supported
Strategic Workforce Services – DHB Medical Laboratory Workforce 23
to transition into scientist roles, which also contributes to the DHBs supply. The West Coast
DHB’s workforce has been very stable with long tenure employees. They are currently
undergoing a period of change and are aiming to transform the workforce for future needs.
4.4.3 Operational Flexibility
Operational Flexibility is primarily about substitution of a workforce and the ability for other
workforces to potentially take on the roles involved. It includes specificity of skills and how
specialised particular roles / scopes of practice are in regards to delivery of required care. It is also
about how enabling or limiting a current scope of practice is on workforce utilisation.
There are no significant workforce flexibility issues. There are some emerging requirements for
more flexible workforce options for the DHB medical laboratory workforce, however there is very
limited substitution that can occur. This is being addressed through multi-skilling staff, flexible
work arrangements to enable coverage and the use of enhanced technological capability to
increase flexibility in the way work is organised.
DHB Medical Laboratory Operational Flexibility Ratings
Rating
1 2 3 4
No current workforce flexibility issues.
Some sector requirements to begin looking at alternative models of care and
roles for this workforce, as greater flexibility
required.
Emerging requirements for more flexible
workforce options. Substitution can occur,
however it may be difficult.
Requirements for flexible workforce options, but very
limited/no available substitute workforce that can perform the
critical function of this workforce.
% of DHB MLWs
1.3% 40.4% 51.9% 6.1%
DHBS
West Coast
Canterbury
Waikato
Hawke's Bay
Taranaki
Auckland
Counties Manukau
Waitemata
Northland
Considerations include:
The medical laboratory workforce comprises specialised roles with specific qualifications and
scopes of practice. There is no flexibility in terms of scopes of practice and work. There is
also no flexibility with specialisations. This works well in this technically precise context.
There is limited ability to substitute, however some work could be carried out by other
workforces, e.g. specimen collection can be done by nurses and Point of Care Testing (POCT)
is increasing. In Phlebotomy there is regular transition from nursing and other clinical areas
into this specialty.
Strategic Workforce Services – DHB Medical Laboratory Workforce 24
In terms of operational context, the various DHBs operate a number of different laboratory
teams in different geographic locations across New Zealand. The hours of operation for
these laboratories varies depending on service requirements related to location. Rosters are
managed locally.
Increasingly operational requirements are necessitating flexibility of operating hours in some
locations to meet work loads and service demand. Changes to work hours and rosters can
be difficult to execute due to the change management requirements in the collective
contracts. It can be complex and challenging to quantify what a ‘significant’ vs a relatively
‘minor’ change in rosters is, and to then reach the level of agreement required. There are
also some historical legacy issues with some staff not working weekends or working ‘school
hours’. Many DHBs are re-examining and addressing issues around how rosters are arranged
and organised.
There is the some level of flexibility in relation to terms and conditions of employment,
which can be used to create some flexibility around service provision and coverage.
However, there are diverse arrangements, silos and inconsistencies between and within
DHBs. Additionally, DHBs with low MLW FTE levels such as Taranaki, Hawkes Bay, West
Coast and Southern do not have sufficient staffing capacity for extra coverage.
Some cross training of staff is happening to enable staff to be multi-skilled to support their
rotation through functional areas. This is aimed at achieving better cross cover flexibility.
Waikato, Canterbury and West Coast DHBs are working with staff to optimise flexibility of
coverage by reorganising work and investing in training staff. These DHBs are cross training
staff to enable the rotation of staff through functional areas and thereby increase flexibility
of coverage. There is also an approach of getting staff to focus on less with a higher quality
focus. However, this approach involves a substantial investment of time and resource and
occurs over an extended period of time.
New technology is having a significant impact on the role and increases the on the job
training required. Information technology, informatics, work flow process design, etc. are
now integral in the MLWs work environment.
Technology changes are requiring and creating opportunities for more flexible work
arrangements. Waikato DHB is currently looking at using shared platforms to increase
flexibility, i.e. technology / machine platforms which require specific environmental
conditions. DHBs such as the Hawkes Bay DHB are considering automating more processes
and using POCT to increase flexibility and meet increasing service demand.
Point of Care Testing (POCT) is a new area which increases flexibility. The increasing drive for
POCT, often carried out by other health professional groups, is likely to have an impact on
the shape, size and look of the future MLW workforce. How patient care is supported within
their homes and communities with diagnostics is what needs to be considered, and what
role the MLS workforce will play in this.
Strategic Workforce Services – DHB Medical Laboratory Workforce 25
There are some emerging needs for other scientist skills vs traditional medical laboratory
science skills. The ML workforce is moving from a total bench, hands on scientists, to experts
in process, automation and equipment, result interpretation, complementary knowledge
experts for referrers and patients, with specialisation in managing laboratory information
systems and bioinformatics.
There are some predictions that the future medical laboratory workforce may comprise less
scientists and more technicians due to automation as well as cost drivers, especially within
the community environment. A tertiary level research laboratory would have a slightly
difference mix. Conversely, other predictions are that increasing automation will reduce the
number of technicians required and bring a shift in the scientist role to be more consultative.
4.4.4 Operational Capacity
Operational Capacity is about recruitment and retention of a workforce. It includes availability and
the ability to buy / bring in more of a particular workforce as required.
DHBs vary considerably in terms of operational capacity. Many DHBs are experiencing no
significant recruitment and retention issues and there is generally easy access to this workforce
when required. However, internationally and nationally, there are generalised recruitment and
retention issues in areas of specialisation and fro leadership roles, with longer timeframes for
gaining this workforce. Additionally, DHBs with rural laboratories are experiencing difficulty
recruiting and retaining staff for rural locations. As a result some DHBs operational environments
are being affected by potential lack of this workforce, due to the higher level of workforce
specialisation required within the medical laboratory context.
DHB Medical Laboratory Operational Capacity Ratings
Rating
1 2 3 4
No significant recruitment and
retention issues and easy access to this workforce when
required.
Some recruitment and retention issues are occurring, with slightly
longer timeframes for
gaining this workforce.
Generalised recruitment and retention issues for
specialised skills. Operational environment is affected by
potential lack of this workforce due to higher level
of workforce specialisation required. Longer lead times i.e. 6 months to 1 year for
recruitment.
Significant recruitment and retention issues for
specialised skills. Issues exist with gaining appropriately skilled individual. Long and often difficult recruitment
processes for gaining sufficiently qualified
individuals i.e. 1-2 years for recruitment.
% of DHB MLWs
27.5% 37.8% 34.4% 0%
DHBS
Waikato
Counties Manukau
West Coast
Canterbury
Waitemata
Hawke's Bay
Taranaki
Auckland
Northland
Strategic Workforce Services – DHB Medical Laboratory Workforce 26
Considerations include:
There are some recruitment and retention issues, and pockets of difficulty relating to areas
of specialisation or sub-specialty. It is difficult to source technical specialists with
appropriate experience who are multi-skilled, especially in new and developing areas of
specialisation. This is a long standing international and national issue. Specialist skills are
very transferable and in high demand; so specialist staff can be targeted by the specialist
global market with shortages.
There are also issues sourcing people for leadership roles, i.e. with technical skills, leadership
and people management skills. Lead times can be greater and remuneration can be a
challenge. There are also better opportunities in the private sector in terms of remuneration
levels, career progression and Continuing Professional Development (CPD). Some DHBs with
larger MLW FTE numbers have some in-house leadership capability development training
available, however it can be a challenge for smaller regional DHBs who may not have the
resources or capacity to this.
Recruiting to rural areas can be difficult, as it involves getting people to move to small towns
which are often remote. The Hawkes Bay DHB has recently been experiencing a particularly
high turnover and difficulties recruiting suitably qualified staff for its rural hospital
laboratories. This challenging recruitment environment is resulting in longer time frames for
recruitment and leaving gaps in its workforce, which is adversely impacting on the operating
environment.
The Northland DHB has historically had a low turnover among MLWs, however more
recently there has been an increased turnover among young people and migrants.
Northland DHB is also struggling to recruit suitably qualified staff for its rural laboratories.
Challenges include multiple locations comprising small sites which need to be able to
provide multiple services. It is difficult to source the experienced multi-skilled staff needed
for these sites.
The Waikato DHB is also finding it difficult recruiting for rural laboratories. As a result the
Waikato DHB has relocated some rural work and increased FTE hours to be able to attract
better candidates. The Waikato DHB has no retention issues.
Access to training and lead in time can become a retention issue. Funding of Continuing
Professional Development (CPD) is negotiated. Training is needed to develop specialist skills,
however funding is an issue. It can be difficult for smaller DHBs and laboratories to keep up
skills development and CPD. Additionally, the DHB environment has a number of older staff
who are unlikely to move and free up opportunities for younger MLWs.
DHBs are also managing an increasing number of retirements, which impacts on retention.
Additionally, age related health issues can be complex to manage.
Strategic Workforce Services – DHB Medical Laboratory Workforce 27
The high cost of living in Auckland impacts on recruitment and retention. Auckland is
particularly unaffordable for lower paid technicians. The Auckland and Waitemata DHBs are
finding that recruitment is difficult with the high cost of living in Auckland, and it is
particularly difficult to recruit technicians. Counties Manukau DHB has no recruitment and
retention issues.
Canterbury DHB has no issues with retention as there are few similar roles available in the
region. Canterbury DHB is finding that the instability in the MLW workforce due to the
increasing trend of shifting service provision to private providers, also contributes to the
workforce being very stable due to the need for job security.
The West Coast DHB currently has no issues with recruitment and retention, however this
could easily change as it has a small number of aging MLWs.
The Taranaki DHB’s medical laboratory service provision arrangements for is currently under
review. So the DHB is facing instability due to not being able to recruit permanent MLW FTE.
There are few similar roles available in the region, so they have no issues with retention.
The high numbers of females means that there are high levels of parental leave and people
not returning from parental leave, which impacts on retention.
New vetting requirements introduced under the Vulnerable Children Act 2014 can cause
delays and impact on recruitment.
Some DHBs have immunisation requirements which can result in delays as there is a
payment/cost component involved.
The recruitment process can be lengthy due to ineffective HR processes. Time to recruit can
also be impacted by time lags caused by internal processes and funding sign off.
Strategic Workforce Services – DHB Medical Laboratory Workforce 28
4.5 Medical Laboratory Workforce Engagement Groups
There are a number of forums within the New Zealand medical laboratory sector which facilitate
collaboration at a national level. The main groups of interest to the DHBs are The National
Pathology and Laboratory Round Table (the Round Table) and the National Laboratory Engagement
Group (NLEG).
4.5.1 The National Pathology and Laboratory Round Table
The Ministry of Health (the Ministry) convened the National Pathology and Laboratory Round Table
(the Round Table) in 2010, with a view to strengthening engagement within the Laboratory and
Pathology sector. The group comprises of key sector leaders from DHBs, private and community
laboratories and the Ministry. It is chaired by the Chief Medical Officer and meets at least three
times a year. The Ministry of Health provides a secretariat function for the Round Table.
The purpose of the Round Table is to provide national leadership and independent advice on clinical,
scientific and strategic aspects of the Pathology and Laboratory sector. To achieve its purpose the
Round Table is tasked with working collaboratively with the wider health sector stakeholders to
strengthen engagement and collaboration within the Laboratory and Pathology sector. It uses
laboratory information to support the efficient planning and commissioning of health services for
populations; and informs investment in new health technology and procedures. It also ensures that
systems, processes and practices are in place to provide assurance to the health service about the
quality of laboratory and pathology services and information.
a) Workforce Related Activity
The Round Table’s current work programme includes a Workforce work stream which aims to define
a blueprint for the New Zealand Laboratory and Pathology workforce. Work commenced in late
2015 on identifying changes in the laboratory industry and workforce implications, as the first step
to describing a blueprint to consider and plan for future laboratory workforce requirements. This
includes defining the current state for the workforce, identifying changes in the industry, and
considering the response required to ensure the workforce is able to respond appropriately to
change. This provides opportunities for the DHBs to leverage of a coordinated national approach to
workforce planning and development.
b) DHB Membership
In October 2015, there were seven DHB representatives who were members of the Round Table.
They represent 51% of the DHB medical laboratory workforce.
The minutes from late 2015 indicate that there were concerns regarding attendance, participation
and the level of DHB representation. It would appear that there is a need for enhanced DHB
participation in this national forum.
Strategic Workforce Services – DHB Medical Laboratory Workforce 29
At the August 2015 meeting, the Round Table discussed reviewing membership of the group, given
the relatively low attendance at recent meetings, and regular non attendance from some members.
It was agreed that a key focus would be to ensure there is appropriate high level DHB
representation, via Chair, CEO and GM Funder representation. Other membership would continue
based on usual attendees. As a result the agreed actions were to discuss having a DHB CE and a DHB
GM P&F representative with the DHB lead CE and Lead GM P&F.
It is proposed that the DHBs review representation on the Round Table to ensure effective
participation; and to leverage opportunities for addressing sector wide issues through this national
engagement group charged with responsiveness and advising on these matters.
c) Current Membership
Name Organisation
Chair Don Mackie Ministry of Health
DH
B R
ep
rese
nta
tive
s
Ross Hewitt Lab+ (Auckland DHB) 28.3% of DHB
MLWs Stephen Absalom Lab+ (Auckland DHB)
Gloria Crossley Taranaki DHB 2.8% of DHB MLWs
Carolyn Gullery Canterbury and West Coast DHBs
19.9% of DHB
MLWs David Meates Canterbury and West Coast DHB
Kirsten Beynon Canterbury and West Coast DHBs
Virginia Hope Capital & Coast DHB & Hutt Valley DHB 0
Other Sarah Prentice Northern DHB Support Agency
Pri
vate
Pro
vid
ers
Arlo Upton Labtests NZ
Mike Norriss Labtests NZ
Cynric Temple-Camp Medlab Central
Karen Wood Aotea Pathology
Peter Gootjes Southern Community Laboratories
Richard Massey Pathology Associates
Trevor English Otakaro Pathways
Pro
fess
ion
al
Org
anis
atio
ns Graeme Benny ESR (The Institute of Environmental Science and Research)
Ian Beer NZ Society of Pathologists
Michael Dray Royal College of Pathologists Australasia
Ross Boswell Royal Australasian College of Physicians
Union Deborah Powell NZ Medical Laboratories Workers Union
Strategic Workforce Services – DHB Medical Laboratory Workforce 30
4.5.2 The National Laboratory and Engagement Group
A significant aspect of the January 2012 MECA settlement was the establishment of a National
Laboratories Engagement Group (NLEG) at the national level and local engagement groups (LLEGs).
This arose from the more constructive interests based bargaining approach pursued by the parties;
and was an acknowledgement by both parties that they needed to engage differently to avoid the
industrial conflict that had previously characterised bargaining with the NZMLWU.
The NLEG’s primary purpose is to function as a collaborative means of addressing issues that emerge
during the MECA bargaining process between the employers and the NZMLWU. The NLEG has been
successfully delivering on its purpose and has been beneficial in establishing common understanding
and in addressing matters that have been difficult to advance in an industrial setting.
While there are and are always likely to be on-going differences between the parties, previous
bargaining strategy papers have acknowledged that these are not as significant as previously was the
case. Therefore, there has been a correlating decrease in issues needing to be worked on through
the NLEG. This is a positive outcome and supports the need for the NLEG to perhaps continue albeit
in a changed capacity.
The NLEG is currently re-examining its membership composition and focus. Given the apparent
reduced need for addressing key issues and intervention activity, one option would be for the NLEG
to narrow its scope to focus only on addressing employment related issues as required. Wider
workforce issues could be addressed more effectively by leveraging of the broader perspective
offered by the Round Table’s workforce programme.
a) DHB Membership of the NLEG
The NLEG should include five NZMLWU representatives and five employer representatives, i.e. 1
NZBS, 1 COO representative and 3 other DHB representatives. It is to be expected that the member
representatives of any established group will be reviewed and changed periodically.
Over recent years the distribution of DHB MLWs has decreased, while the overall DHB MLW FTE has
increased by 17% since 2007 and is currently 1015.2. Given these changes to the distribution of DHB
medical laboratory service provision, it would be timely for the DHBs retaining MLWs to review DHB
representation to ensure appropriate and proportionate representation on the NLEG. Somewhat
proportionate representation could occur by selecting representatives based on regional workforce
size.
4.5.3 Canterbury Health Laboratories Annual User Group Meeting
Canterbury Health Laboratories annually invites laboratory managers and leaders from around New
Zealand, Australia and other countries to participate in their User Group meeting. Over the years the
Strategic Workforce Services – DHB Medical Laboratory Workforce 31
meeting has moved from a predominantly scientific focus to include discussions on issues affecting
the industry’s future direction and sustainability. The Lab Meeting is recognised as providing a
valuable forum for senior medical laboratory associated people and those interested in the
pathology sector. The 2016 programme focuses on challenging current thinking to prepare for future
developments and new ways of working; including preparing the laboratory workforce as well as
developing current and emerging leaders.
This forum represents an advantageous opportunity for DHBs to participate in as it manages its
medical laboratory workforce through a landscape that is changing on a range of levels.
4.5.4 Other Groups
There are several other groups which support collaboration and engagement within the medical
laboratory sector in New Zealand, including:
• Laboratory Managers Group;
• Laboratory Information Systems (LIS) Managers Group;
• Laboratory Quality Managers Group
• Labnet (Collaboration between Canterbury, Taranaki, Hewkes Bay & West Coast DHBs); and
• Point of Care Advisory Group.
Strategic Workforce Services – DHB Medical Laboratory Workforce 32
5. Operational Workforce Analysis
5.1 Regulatory Requirements for Medical Laboratory Workers in New Zealand
The Medical Sciences Council (the Council) of New Zealand regulates medical laboratory science
practitioners in New Zealand. The Health Practitioners Competence Assurance Act 2003 requires all
medical laboratory science practitioners to be registered with the Council; and they must also have
applied for and been issued with an annual practising certificate (APC) before they begin practising
in their registered scope/s of practice. Registration applies to a single scope of practice, and
practitioners will need to apply for registration for each additional scope of practice.
Registration is a one-off process. Medical laboratory science practitioners remain on the Register for
life once registered in a scope of practice, unless they are removed. Registration on its own does not
allow medical laboratory science practitioners to practice. They must also hold a current annual
practising certificate. Applying for registration and then an APC are two separate processes that are
completed online through the Council’s website.
5.2 Changes to Registration Requirements from 01 February 2016
From 01 February 2016 significant changes were introduced, including the creation of 6 specified
scopes of practice under which medical laboratory science practitioners in New Zealand may be
registered. The new scopes of practice are listed in the following table:
Medical Laboratory Scientist Medical Laboratory Technician Medical Laboratory Pre-Analytical Technician
Medical Laboratory Scientist (Provisional Registration)
Medical Laboratory Technician (Provisional Registration)
Medical Laboratory Pre-Analytical Technician
(Provisional Registration)
Medical Laboratory Scientist
(Full Registration)
Medical Laboratory Technician (Full Registration)
Medical Laboratory Pre-Analytical Technician (Full Registration)
Newly created
Includes Phlebotomy, donor technology, and specimen preparation /services
Some of the key changes introduced by the Medical Sciences Council of New Zealand are
summarised in the following table:
Role Changes from 01 February 2016
Scientists Introduction of Provisional Registration, requiring completion of a period of supervised practice before qualifying for Full Registration.
Strategic Workforce Services – DHB Medical Laboratory Workforce 33
Medical Laboratory Technicians
A significant change for registration as a Medical Laboratory Technician came into effect from 1st February 2016. This is in relation to the Qualified Medical Laboratory Technician certificate (QMLT) as issued by the New Zealand Institute of Medical Laboratory Science (NZIMLS).
Previously Trainee Medical Laboratory Technicians worked under supervision in an appropriately accredited New Zealand laboratory for a minimum period of 2 years FTE. During that time they completed a logbook and once they had accumulated a total of 4000 clinical hours within the laboratory they could sit the QMLT examination. The QMLT certificate is only issued upon successful completion of the examination and evidence of having completed at least 4000 hours of clinical experience. At this point the Trainee applied for registration as a Medical Laboratory Technician.
From 1st February 2016, applicants must hold provisional registration as a Medical Laboratory Technician at the point of having successfully passed the QMLT examination which can be done after having completed a minimum of 6-calendar months of employment in an appropriately accredited New Zealand laboratory. Provisional registration will remain in place until such time as the Medical Laboratory Technician has been issued with the QMLT certificate by the NZIMLS. At that point they must apply for full registration in the Medical Laboratory Technician scope of practice.
Medical Laboratory Pre-Analytical Technicians (ML-PATs)
The introduction of a new scope of practice called Medical Laboratory Pre-Analytical Technician (ML-PAT).
The ML-PAT scope of practice encompasses the medical laboratory science disciplines of phlebotomy, donor technology, and specimen preparation (specimen services). While categorised as pre-analytical, the nature of the work performed within these disciplines is critical to the profession of medical laboratory science and has potential to cause harm to the public.
The Medical Laboratory Technician scope of practice used to include phlebotomy and donor technology, however specimen services was excluded from the defined parameters of the profession of medical laboratory science.
Many quality and service aspects of modern laboratories are directly impacted by the work of specimen services practitioners. Modern laboratory equipment is often loaded with samples by specimen services staff, effectively integrating this work into the analytical work flow. The potential risk of harm by this group of practitioners is significant enough to warrant their inclusion within a medical laboratory scope of practice.
There will be some transitional qualification pathways available for a short term to allow practitioners who have extensive experience in the discipline of specimen services to gain registration. Specimen services staff who perform data entry only are not required to be registered.
Sourced from The Medical Sciences Council’s Registration Guide: Medical Laboratory Science
Scopes of Practice – December 2015
Strategic Workforce Services – DHB Medical Laboratory Workforce 34
5.3 Workforce Description
5.4 Key Service, Operational Workforce and Employment Drivers
The conducting of the occupational assessment tool highlighted the progressive increase of service
demand, issues with recruiting for rural laboratories and in areas of specialisation, CPD funding and
the need for greater service provision flexibility.
5.5 Service Delivery & Development Drivers
Service demand for medical laboratory services is influenced by population growth and overall
practitioner diagnostic treatment rate uptake. Sector feedback suggests that service demand
continues to grow for DHBs due to overall increasing complexity of new diseases, changing
treatment and diagnostic practices and the increased use of technology.
5.6 Demographics
The Workforce Information Report (Appendix 1) summarises demographic data relating to the DHB
medical laboratory workforce.
5.7 Current employed workforce
As well as service driven factors, DHB requirements for the medical laboratory workforce are
influenced by the characteristics of the current workforce:
5.7.1 Recruitment
The recruitment situation is relatively stable from a macro perspective.
a) Supply
No major recruitment drives are currently occurring within the DHBs for medical laboratory
staff. While there are issues with recruiting for rural laboratories and in areas of specialisation,
there are no significant workforce shortages currently occurring.
b) Distribution
No major recruitment drives are currently occurring within the DHBs for medical laboratory
staff. While there are issues with recruiting for rural laboratories and in areas of specialisation,
there are no significant workforce shortages currently occurring.
c) Vacancies
Apart from the longstanding rural issue there are no significant vacancies occurring nationally.
Strategic Workforce Services – DHB Medical Laboratory Workforce 35
5.7.2 Retention
Retention is relatively stable nationally.
a) Workload Management:
The impact of increasing demand varies according to geographic location.
b) Workforce Mix:
No significant skill mix issues were reported by sector experts.
c) Clinical Leadership:
There is a need for this workforce to change the role it undertakes to remain relevant. As
greater automation occurs the workforce may need to add value with a more direct clinical role
or greater engagement with clinicians. There is a need for increased investment in management
/ leadership capability development.
5.8 Training and Development
5.8.1 Entry/ Transition Competency:
Sector evidence indicates that there are no issues with entry competencies from new graduates
entering the DHB environment.
5.8.2 Match to Service Requirements:
The current workforce is well matched to service requirements but the requirements will inevitably
change and the workforce will need to change with it.
5.8.3 Access to On-going Training (progression):
There are issues around the lack of training funds for specialised training and for funded ‘Trainee’
positions. Funding of Continuing Professional Development (CPD) is negotiated. Training is needed
to develop specialist skills, however funding is an issue. It can be difficult for smaller DHBs and
laboratories to keep up skills development and CPD. Additionally, the DHB environment has a
number of older staff who are unlikely to move and free up opportunities for younger MLWs. There
is also a tension between specialist vs generalist capability development. The drive towards
specialisation could create a shortage of generalists over the long term.
Strategic Workforce Services – DHB Medical Laboratory Workforce 36
6. References
1. Bennett A, Garcia E, Schulze M, Bailey M, Doyle K, Finn W, Glenn D, Holladay E B, Jacobs J,
Kroft S, Patterson S, Petersen J, Tanabe P, Zaleski S. (2014) Building a Laboratory Workforce to
Meet the Future: ASCP Task Force on the Laboratory Professionals Workforce. American
Journal of Clinical Pathology, 141(2), 154-167.
Available from: http://ajcp.oxfordjournals.org/content/141/2/154
2. Bureau of Health Professions, National Center for Health Workforce Analysis, US Department
of Health and Human Services Washington, DC: Health Resources and Services Administration.
(2005) The Clinical Laboratory Workforce: The Changing Picture of Supply, Demand, Education
and Practice.
Available from:
https://www.google.co.nz/webhp?sourceid=chromeinstant&ion=1&espv=2&ie=UTF8#q=The+
Clinical+Laboratory+Workforce%3A+The+Changing+Picture+of+Supply%2C+Demand%2C+Edu
cation%2C+and+Practice+July+2005
3. Bureau of Labor Statistics, U.S. Department of Labor. (2016) Occupational Outlook Handbook,
2016-17 Edition, Medical and Clinical Laboratory Technologists and Technicians.
Available from:
http://www.bls.gov/ooh/healthcare/medical-and-clinical-laboratory-technologists-and-
technicians.htm
4. Castaneda R. (2015) Love me tender: Lab firms in grip of contract uncertainty.Nzdoctor.co.nz.
Available from:
http://www.nzdoctor.co.nz/in-print/2015/april-2015/april-1-2015/love-me-tender-lab-firms-
in-grip-of-contract-uncertainty.aspx
5. Herd G and Musaad S. (2013) Point-of-care testing governance in New Zealand: a national
framework. New Zealand Medical Journal, 27th September 2013, Volume 126 Number 1383.
Available from:
https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2013/vol-126-no-
1383/view-musaad
6. The Medical Sciences Council’s (2015) Registration Guide: Medical Laboratory Science Scopes
of Practice – December 2015.
Available from: http://www.mscouncil.org.nz/publications/
7. Ministry of Health NZ. (2013) Bowel Cancer Programme.
Available from:
http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/bowel-
cancer-programme
8. Ministry of Health NZ. (2016) Faster Cancer Treatment Programme.
Strategic Workforce Services – DHB Medical Laboratory Workforce 37
Available from:
http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/faster-
cancer-treatment-programme
9. Ministry of Health NZ. (2015) National Pathology and Laboratory Round Table.
Available from:
http://www.health.govt.nz/about-ministry/leadership-ministry/clinical-groups/national-
pathology-and-laboratory-round-table
http://www.health.govt.nz/about-ministry/leadership-ministry/clinical-groups/national-
pathology-and-laboratory-round-table/national-pathology-and-laboratory-round-table-
meeting-minutes
10. National Health Committee (2015) An Overview of Laboratory Services in New Zealand
11. http://www.chl.co.nz/meetings
12. http://www.labmeeting.co.nz/index.html
13. http://www.labnet.co.nz/