Laboratory Rubrics

Laboratory workers are lucky. Every result leaves an objective trail of lot numbers, expiration dates, storage conditions and quality control. As a manager charged with performance assessment, this can make your job easier. Documentation is complete or not; controls are acceptable or not; a result is reliable or not.

But what about subjective measures? Bench organization, responding to complaints and problem solving are a few examples of valuable employee skills that affect quality but are difficult to assess beyond opinion. Using rubrics, you can develop objective criteria to measure less tangible yet vital qualities of your employees.

Competency Assessment
Technical supervisor responsibilities for high complexity testing include “Evaluating the competency of all testing personnel and assuring that the staff maintains their competency to perform test procedures and report test results promptly, accurately and proficiently.” Methods include:

  • direct observation,
  • monitoring recording and reporting of results,
  • review of documentation,
  • testing unknowns and
  • assessment of problem-solving skills.1

Competency assessment is integral to performance appraisal, a process in which you as the manager document behavior compared to preset standards.2 The more objective the criteria, the more transparent the process of assessment and the better chance of employee success. For example, results of blind sample testing can be compared to known- or peer-established values.

But there is much more to laboratory work than numbers and work logs. The overall complexity of laboratory testing that includes interpreting physician orders, patient instruction, sample collection and preparation, and dealing with problems as they arise in the best interest of the patient cannot be quantified. It is impossible to write procedures for every contingency. Multitasking, particularly in emergencies, is crucial to patient care. These qualities make or break professionals in the field, so a fair assessment benefits the profession.

A rubric, traditionally a heading in a section of legal code or religious sacrament in red (from the Latin for red ochre, an ancient pigment), has described student scoring grids since the 1980s.3 A typical rubric is a two-dimensional grid with performance areas on one axis and a scoring metric on the other. They are used to grade student behavior in multiple dimensions and clarify objectives, arguably increasing the likelihood of a quality outcome.4 By defining criteria and gradations of quality, teachers are using rubrics to save time and help students understand their own and the work of peers, from elementary to university levels.

Table 1 illustrates a simple rubric for grading written reports. In this case, the criteria are objective (e.g., three or more spelling errors is poor). Scores can be tallied and an overall score, which can be weighted, determined. In this example, criteria for success is acceptable or better: performance meets expectations. Thus, a rubric instructs the student and guides the instructor.

TABLE 1: SAMPLE RUBRIC–WRITTEN REPORT ASSESSMENT7
Performance Area
Poor
1
Acceptable
2
Excellent
3
Spelling mistakes on the report
3 or more
1 to 2
0
Grammar mistakes on the report
4 or more
2 to 3
0 or 1
Punctuation mistakes on the report
4 or more
2 to 3
0 or 1

This example is typical of analytic rubrics, which often specify criteria to meet each score within the cells of the rubric. While analytic rubrics take time to create, they can provide useful feedback on performance strengths and weaknesses. The other common type of rubric is holistic, which considers an overall rating. Holistic rubrics tend to measure what can be demonstrated (outcomes) rather than elements of a task.5

Laboratory Applications
Rubrics are another tool to communicate expectations to employees and comprehensively grade performance. A rubric can be designed to grade a process that is only measured in part by sample testing. Transfusing blood, for example, encompasses patient identification and specimen collection to administration of components; a rubric can describe and grade this process. Critical steps in this process (e.g., reading and grading serological reactions) can be weighed.

While rubrics can provide a fair and consistent way to measure performance that includes measurable criteria, they can take time to develop. But depending on your staffing and workload, they can save time, too. For example, if many generalists rotate through a work area, a rubric can communicate expectations and grade performance equally, helping those techs maintain competency. This can be especially useful with complex procedures that are less often performed, such as transfusion reaction workups or body fluid analysis. Pros and cons of using rubrics are summarized in Table 2.

TABLE 2: PROS AND CONS OF RUBRICS8
Pros
Cons
  • Assessment is more efficient
  • Assessment is fair
  • Expectations are spelled out
  • Improved performance through consistency
  • Developing rubrics can be complex and time-consuming
  • Precise criteria can be difficult to articulate
  • Rubrics may need significant revision before use

Continued on page 2 …

Practical Example
Consider a practical example for competency assessment, transfusion of crossmatch-compatible packed red cells. This encompasses a range of laboratory processes and critical steps that proficiency testing does not completely measure. A rubric provides a description of the process for new employees and students, a way to connect policies and procedures, and a tool to assess competency.

Developing rubrics is an open-ended process that can be overwhelming. It can be difficult to know how many steps, how many scoring categories, and how much detail to include. For purposes of this example, the following are considered:

  • Performance areas–include critical steps in the process where fatal flaws can occur or where individuals are directly observed.
  • Scoring categories–unacceptable (poor) and acceptable are defined, but a third category of behavior that might represent a suggested change in policy (e.g., new telephone communication) is included.

According to one online educational resource, it’s important that change in quality from score point to point be consistent and that descriptors are clear. Parallel language is recommended to describe each level of performance. Depending on the nature of the assessment, consistent language should be used (e.g., following written policies and procedures).6

TABLE 3: EXAMPLE RUBRIC – TRANSFUSION OF CROSSMATCH-COMPATIBLE PACKED RED CELLS

Performance Area

Poor
1
Acceptable
2
Excellent
3
Patient wristband identification
Specimen is collected before wristband attached
Wristband is attached before specimen collected
Wristband is attached before specimen collected and identity verified by second tech
Specimen order verification
Specimen label is not compared to order prior to testing
Specimen label is verified against order prior to testing
Specimen label is verified against order prior to testing and other sources
Serological testing
Steps are not followed in the written procedures
All steps are followed in the written procedures
All steps are followed in the written procedures, and problem-solving skills are demonstrated
Unit selection
Unit(s) are not selected according to policy
Unit(s) are selected according to policy
Unit(s) are selected according to policy, and overall inventory control is considered in selection
Communication at completion
Transfusing RN is not telephoned when the unit is ready to transfuse
Transfusing RN is telephoned when the unit is ready to transfuse
Transfusing RN is telephoned initially to determine urgency and telephoned at appropriate steps, including when the unit is ready to transfuse

This simple rubric illustrates some of the critical steps that may be included in competency assessment. While additional steps and scoring metrics are possible, additional documentation may include a weighing factor to emphasize different steps, a total score, and responsible individuals who were observed. Rubrics can always be made more complex, so it may be best to start simple.

A consistent approach reaps rewards. You might choose a format similar to the examples in this article, something more complex, or a simpler “Pass/Fail” scale. A consistently applied template will help communicate your expectations to employees, making it easier for them to meet performance goals, improving patient care.

Scott Warner is lab manager at Penobscot Valley Hospital, Lincoln, ME.

References

  1. Code of Federal Regulations. 42CFR493–Part 493–Laboratory Requirements. Available at: http://frwebgate1.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=woomNP/1/2/0&WAISaction=retrieve. Last accessed Dec. 10, 2011.
  2. Performance appraisal. Available at: www.businessdictionary.com/definition/performance-appraisal.html. Last accessed Dec. 10, 2011.
  3. Rubric. Available at: http://dictionary.reference.com/browse/rubric. Last accessed Dec. 10, 2011.
  4. Marcotte M. Building a better mousetrap: the rubric debate. Available at: http://faculty.ccp.edu/dept/viewpoints/w06v7n2/rubrics1.htm. Last accessed Dec. 10, 2011.
  5. Types of rubrics. Available at: http://condor.depaul.edu/tla/Assessment/TypesRubrics.html. Last accessed Dec. 10, 2011.
  6. Rubrics and scoring. Available at: http://pals.sri.com/guide/scoringdetail.html. Last accessed Dec. 10, 2011.
  7. British Columbia Institute of Technology. Creating a rubric. Available at: https://helpdesk.bcit.ca/fsr/teach/teaching/ja_createrubric.pdf. Last accessed Dec. 10, 2011.
  8. Advantages and disadvantages of rubrics. Available at: http://demo.4vqzl21.remote.schoolcenter.com/education/components/scrapbook/default.php?sectiondetailid=5128. Last accessed Dec. 10, 2011.

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