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Blood Bank

Counseling, Disciplinary Action, & Conflict Resolution

Managing the human element is often the most challenging aspect of laboratory administration. While machines are predictable, people are not. In the high-stress environment of Blood Bank - where errors can be fatal and workload is unpredictable - conflicts and performance issues are inevitable. The goal of counseling and disciplinary action is not punishment, but correction. It is a structured process designed to modify behavior and restore the employee to a level of competent, safe performance. When that is not possible, it provides the legal framework for termination

The Principles of “Just Culture”

Modern healthcare organizations, particularly in high-reliability fields like Blood Banking, operate under the philosophy of a Just Culture. This framework distinguishes between honest human error and reckless behavior

  • Human Error (The Slip): An inadvertent action; a mistake made by doing something other than what was intended
    • Example: A laboratory scientist grabs the Anti-B bottle instead of Anti-A because they look similar and are right next to each other
    • Response: Console.: Fix the system (e.g., separate the bottles), don’t punish the human
  • At-Risk Behavior (The Drift): A choice where the risk is not recognized or is mistakenly believed to be justified. “Cutting corners.”
    • Example: A laboratory scientist skips the 15-minute incubation time on an antibody screen because “it’s always negative anyway” and they are rushing
    • Response: Coach.: Retrain the employee on why the incubation is critical (safety). Remove the incentive to cut corners
  • Reckless Behavior: A conscious disregard of a substantial and unjustifiable risk
    • Example: A laboratory scientist falsifies QC results because they forgot to run them. Or a laboratory scientist arrives at work intoxicated
    • Response: Punish.: This warrants disciplinary action or termination

The Disciplinary Process (Progressive Discipline)

When coaching fails or the infraction is serious, the organization moves to formal disciplinary action. This process must be consistent, fair, and well-documented to avoid lawsuits for wrongful termination

Step 1: Verbal Warning (documented)

  • Trigger: Minor infractions (e.g., tardiness, minor procedural deviation without patient harm)
  • The Meeting: Private conversation. “I noticed you were late twice this week. Our policy requires you to be at the bench at 0700. Is there a barrier to getting here? This is a verbal warning that attendance is required.”
  • Documentation: Even though it is “verbal,” a note is placed in the file: “Date/Time, discussed tardiness with Employee X.”

Step 2: Written Warning

  • Trigger: Repeated minor infractions or a significant error (e.g., failing proficiency testing due to carelessness, rude behavior to a nurse)
  • The Document: A formal letter stating:
    1. The Policy violated
    2. The specific incident (Facts only, no emotions)
    3. The expected correction
    4. The consequence of failure to correct
  • Acknowledgement: The employee must sign the document

Step 3: Suspension / Final Written Warning

  • Trigger: Continued failure to improve or a serious safety breach (e.g., mislabeling a crossmatch tube)
  • Action: The employee is sent home (often unpaid) for 1-3 days. This serves as a “wake-up call” to consider if they want to keep the job

Step 4: Termination

  • Trigger: Failure to correct behavior after suspension, or a “Zero Tolerance” offense (violence, theft, falsifying records, working impaired)
  • Process: Consult with HR first. The termination meeting should be brief, factual, and witnessed by a second manager

Conflict Resolution

Conflict in the lab can occur between peers (Interpersonal) or between the lab and other departments (Interdepartmental)

Interpersonal Conflict (Laboratory scientist vs. Laboratory scientist)

  • Source: Often stems from “Shift Wars” (Day shift leaving work for Night shift), personality clashes, or perceived unequal workload
  • Strategy: Mediation.
    1. De-escalate: Separate the parties if emotions are high
    2. Listen: Meet with each person individually to hear their side. Focus on behaviors, not personalities. (Not “He is lazy,” but ” The morning QC wasn’t done.”)
    3. Collaborate: Bring them together. Establish ground rules. Ask, “How can we solve this process issue?”
    4. Consensus: Agree on a solution (e.g., “Day shift will empty the trash; Night shift will file the cards”)

Interdepartmental Conflict (Lab vs. Nursing/ER)

  • Source: Usually revolves around Specimen Rejection (Hemolysis/Labeling) or Turnaround Time
  • Strategy: Education and Data.
    • Don’t argue feelings (“You guys are always rejecting our samples!”)
    • Use Data (“Our data shows 15% of samples from the ER are hemolyzed vs. 2% from ICU. Let’s look at the collection equipment used in the ER.”)
    • Joint Operations Committee: Regular meetings with Nursing Leadership to discuss systemic issues rather than fighting over individual events

Documentation: The Golden Rule

In all personnel matters, the cardinal rule is: “If it isn’t written down, it didn’t happen.”

  • Anecdotal Notes: Managers should keep a log of small interactions. “1/5/24 - Coached John on proper phone etiquette.”
  • Objective Language: Avoid subjective words like “Bad attitude” or “Lazy.” Use objective descriptions: “Rolled eyes when asked to perform task,” or “Failed to restock inventory for 3 consecutive days.”
  • Timeliness: Document immediately. Recalling details weeks later during a lawsuit is impossible