Finding Opportunity Through Uncertainty: How the COVID-19 Pandemic is Shaping the Laboratory

The global spread of the SARS-CoV-2 virus has transformed our daily lives and will have long-lasting effects on how we work and how we live for much of the coming decade. Across the nation, the American laboratory workforce has now performed more than 160 million COVID-19 test results in the past eight months, the highest in the world. This achievement comes with an intangible cost to the laboratory workforce whose work-life balance has been swayed by social distancing, work from home, remote schooling, lockdowns, supply chain shortages, and home quarantines.

On a brighter side, we now find ourselves in a new virtual world: of virtual collaboration, national meetings, interviews, and training, all of which open and expand on new ways of doing business in the clinical laboratory space. Eight months into the pandemic, let us take a moment to reflect on the challenges that we have faced as well as future opportunities that will become available to us in 2021 and beyond. 

The challenges

COVID-19 has disrupted the professional and personal lives of the laboratory workforce. In the United States, nearly half of all married couples pursue separate careers, especially among married couples with kids.² According to Census data, 69 percent of America’s 73.7 million children under age 18 live in families with two parents. The second most common family arrangement is children living with a single mother, at 23 percent.³ For dual-career couples and single parents, schools and daycare provide care to their kids during normal working hours, but due to the lockdowns, many working parents were suddenly faced with doing paid (often remote) work as well as providing care to their children.

A dual emergency of public health and staffing

In a majority of households, women had to step up to the task of providing the extra hours of homecare.⁴ The clinical laboratory workforce is overwhelmingly female (83%), works full-time (88%), and has a median age of 45.2 years.⁵ Thus, during the pandemic nearly half of our workforce (18 to 45 years) often finds itself supervising online school learning while working full-time or part-time.

The technical nature of the laboratory work does not lend itself to work-from-home, rather it is a job that needs hours of work on a laboratory bench each day. A third of our workforce is 55 years or more and thus at a higher risk of complications of COVID-19.⁵ Thus, in the midst of the current pandemic, clinical laboratories are now facing two headwinds: the need to provide flexible work schedules for younger employees while minimizing contact and working hours for the senior employees. To accomplish what needed to be done, middle managers have to constantly work on shift adjustments, bench reassignments, and pay overtime. During late spring 2020, lockdowns caused a significant drop in non-COVID-19 testing and several clinical laboratories had to furlough their staff. Thankfully, it appears that the majority of the positions have now been restored.⁶ While clinical laboratories have come under criticism for delayed COVID-19 results, we must acknowledge that despite the stress on the clinical laboratory infrastructure, none of our states had a major outage of laboratory testing. This was achieved by the thorough professionalism displayed by our phlebotomists, medical technologists, middle management, and directors. We must all tip our hats to each member of the clinical laboratory team.

Disrupting growth trajectories of future leaders

While the laboratory navigates the immediate challenges of operating during a pandemic, we must also look down the road to how COVID-19 will affect long-term success of the laboratory, especially in terms of leadership.

Young leaders need mentors and on-the-job mentorship to refine their management skills. Interaction with other team members, feedback from mentors, and planned activities with supervisors allow an individual to understand and improve the dynamics of the workplace. With the advent of COVID-19, such formative activities are either cancelled, reduced, or done via virtual means. Workplace career advancement often depends on recognition of one’s work. When almost all work is done remotely, understanding who should and who should not be credited for outcomes may become a challenge.

In recent decades, women leaders have made significant strides in rising up the management ranks of clinical laboratories. This is a very positive trend since it matches the demographics of the leadership with the demographics of the laboratory workforce. Rather worryingly, however, recent studies show that due to the demands imposed by COVID-19; mothers, senior-level women leaders, and women of color are now considering leaving the workforce or reducing their work hours.⁴ While we do not yet have any study that looks into a similar trend in the clinical laboratory space, the executive leadership of the clinical laboratories needs to be acutely aware of such trends and ensure that all young leaders, irrespective of their gender, continue to benefit from mentorship, are given credit for their work, and continue to grow on their career paths.

The opportunities

COVID-19 has changed the way we communicate inside and outside the clinical laboratory—and may be one of the silver linings of this pandemic. Before the pandemic, middle managers and leaders spent considerable amounts of time commuting to work, attending in-person interviews, and arranging in-person training. COVID-19 has forced us to rethink the need for certain in-person commitments and question their need. It is now possible to ask for someone’s time commitment without disrupting their work location.

We have also learned that virtual communication lends itself to two distinct advantages: (1) you can reach a bigger audience and are no longer confined by the size of meeting venue, and (2) you can now record the information and distribute it to individuals who could not make it to the meeting. However, we should be wary of the long-term detrimental effects of virtual meetings and virtual collaborations. Human beings are social animals and we have always depended on real-time and non-verbal cues in gauging our compatibility with others in the group. An audio teleconference erases all non-verbal cues and often replaces them with awkward silences, people speaking over each other, and misunderstood statements. We will need more time and more experience to truly understand where and how to use emails, audio teleconferences and video teleconference. Interestingly, post-COVID-19, the occasional interruption by someone’s child walking into a virtual meeting is no longer derided; rather it brings in a fresh air to a dull virtual meeting. With the right mix of tools, we will become better online collaborators, better online educators and learners, and lastly better interviewers.

Leveling the professional education playing field

Before the pandemic, attending national or international meetings in the clinical laboratory space meant arranging air travel, staying at venue hotels, and spending time away from family. The expenses of travelling to a conference could easily preclude the educational value of that conference, and this disproportionately affected younger individuals. On a global scale, research from the developing world was often neglected as presenters often needed sponsorship to travel to international meetings.

Thankfully, as regional and global travel ground to a halt, most professional societies transformed their in-person meetings to virtual meetings. The annual meeting of the American Society of Clinical Pathology was hosted online and was available for free to its members. From my perspective, this is an extraordinary value addition to ASCP membership and will save expenses for ASCP members as well as their employers. And even more important, now a medical technologist in Nairobi has the same access to ASCP’s content as her/his peer in New York. As video conferencing applications like Zoom, Microsoft Teams, Google Meet, and Skype become central to our work, there has been a ‘Great Information Flattening’ among the haves and have-nots in the clinical laboratory workforce. The world is an oyster for anyone with an Internet connection.

Altering inspections and accreditations

Depending on the jurisdiction, clinical laboratories may need to be inspected and accredited by organizations and state agencies. Before the pandemic, the site inspections required in-person visits. Following travel restrictions, accreditation bodies have implemented new programs for virtual site inspections. The College of American Pathologist’s Laboratory Accreditation Program and CAP15189 Accreditation Program have announced plans to transition to a virtual process.⁷ While it may be too early to predict if virtual inspections would become the norm, it is very likely that the frequency and duration of in-person inspections will be reduced. It is quite possible that tomorrow’s laboratory directors and managers will be inspected via teleconference calls and their documentation would be pre-loaded into a central data repository. In the long run, this will reduce regulatory burden and improve the overall inspection experience.

The post-COVID laboratory

Almost a year into the pandemic, we are still living in a world defined by COVID-19 and we continue to find new ways to adjust to the new realities. We have become more efficient as certain in-person interactions make way for their virtual avatars. The emergence of low-cost and high-convenience virtual conferences has been a very positive development, allowing for more young leaders to take advantage of educational opportunities. In these times, younger leaders may find themselves devoid of in-person mentorship, and we need to leverage the online platforms we have to fill this void. Above all, we must recognize that despite the challenges we’ve faced over the last year, a new generation of forward-looking leaders is being forged in the fire of this pandemic.

References

1. The COVID Tracking Project. (2020). covidtracking. https://covidtracking.com/
2. U.S. Department of Labor. (2020, April 21). Employment characteristics of families — 2019. https://www.bls.gov/news.release/pdf/famee.pdf
3. U.S. Census Bureau. (2016, November 17). The majority of children live with two parents, census bureau reports. https://www.census.gov/newsroom/press-­releases/2016/cb16-192.html
4. McKinsey & Company. (2020). Women in the Workplace. https://wiw-report.s3.amazonaws.com/Women_in_the_Workplace_2020.pdf
5. Garcia, E., Kundu, I., Kelly, M., Soles, R., Mulder, L., & Talmon, G. A. (2020). The American Society for Clinical Pathology’s job satisfaction, well-being, and burnout survey of laboratory professionals. American Journal of Clinical Pathology, 153(4), 470-486. https://doi.org/10.1093/ajcp/aqaa008
6. American Society for Clinical Pathology. (2020a). Laboratory data during Covid-19 pandemic. https://ascpcdn.s3.amazonaws.com/static/ISTP/ASCP_Covid-19_data_web.pdf
7. College of American Pathologists. (2020). Update: CAP inspections for ClIA-licensed laboratories, virtual inspections added. https://www.cap.org/laboratory-improvement/news-and-updates/update-cap-inspections-for-clia-licensed-laboratories-virtual-inspections-added