1. Laura Benson Genetic Technologist South East Scotland Cytogenetics Service Western General Hospital Edinburgh

2.  Our building was large with many labs. Laid out for section-based workflow.  Fell into disrepair – urgency to move.

3.  Cyto/ Molecular/ Clinical Genetics geographically separated.  Opportunity to work closer together & integrate.  Current financial situation encouraged change.  Split between two buildings = change in workflow paramount!

4. Director/Deputy Head of Laboratory Head of Section (Principle Clinical Scientist) Clinical Scientists Genetic Technologist Trainee Clinical Scientist

5. Conventional Cytogenetics Culture Establishment and maintenance HarvestSlide Making G-Banding and Autocapture Analysis Molecular Cytogenetics DNA ExtractionPre-PCR Set UpPost-PCR Set Up Generation of Results Analysis

6. Director/Deputy Head of Laboratory Principal Clinical Scientists Clinical Scientists Trainee Clinical Scientists Laboratory Manager Senior Genetic Technologist(s) Genetic Technologists Band 4 Biomedical Support Worker Band 3 Biomedical Support Worker

7. Banding and Slidemaking QF- PCR Arrays & FISH Culture

8.  Analysis Central - Traffic light system on LIMS to manage workflow for analysis.  Pool-based analysis where cases are analysed by priority as dictated by colour assigned by Analysis Central.  Flexible analytical/reporting approach.

9. Benefits  Better cover of all work.  Makes use of team’s potential – increased morale.  More efficient.  More flexible use of time (e.g. validation of new techniques/analysis).  Training needs and inconsistencies identified.  Gained more control over working practice and training. Challenges  Initial risk of errors as change in established, repetitive workflow – staff had to think differently about how sample handling of different sections related. Pushed us to think about communication and how better to manage tasks.  Training/re-training/witness audits and technique sign off for all staff. Expect improved and more consistent quality.

10.  Automation already in place – Automated image capture, Gemini, Thermotrons, Biomek.  New techniques and technologies – SNP arrays, iGENatal.  Established staff group with a good training background able to switch between sections/techniques.

11. But…  How do we change workflow without affecting training so that quality of results are maintained?

12. Benefits  Better cover of all work.  Makes use of team’s potential – increased morale.  More efficient.  More flexible use of time (e.g. validation of new techniques/analysis).  Training needs and inconsistencies identified. Challenges  Initial risk of errors as change in established, repetitive workflow – staff had to think differently about how sample handling of different sections related. Pushed us to think about communication and how better to manage tasks.  Training/re-training/witness audits and technique sign off for all staff. Expect improved and more consistent quality.

13. But…  How do we change workflow without affecting training so that quality of results are maintained?  Identification of inconsistencies and re-witnessing staff performing techniques has created more consistent working practice and updated SOPs.  So, we will initially train using the section-based approach so that staff can gain an understanding of sample handling start to finish.

14. So we have begun training all practical staff using a fresh start:  Retrain using updated SOPs.  Quick process for long-standing members of staff already familiar with techniques.  Proposed to have all staff trained/re-trained by 6 months.  This is an investment that will ensure that when we move back to a pool-based workflow: ALL staff will be trained to the SAME STANDARD in ALL TECHNIQUES to create a DIVERSE and FLEXIBLE workforce.  Train to a standard, not a grade!

15.  We have learned that the key to delivering successful major change with minimal disruption to the service is: - Co-ordination – rotas. - Communication – weekly huddles/proactive GT meetings/weekly staff meetings. - Established staff training from rotation.  Currently two GT teams and individuals should predominantly work within their team, with flexibility to work in other areas if required.

16.  Evolution of work structure so far: - All work shared between all staff = flexibility. - The addition of new grades of staff = evolving duties for existing staff.  It is expected that these changes will release routine time for GTs to analyse.  Catalyst for further change cross-training between the Molecular and Cytogenetics departments.

17. Requirement for common database:  Integrated reporting system.  Tighter quality management.  Single sample input and patient record management.  Paperwork for processes. Standardise SOPs and shared procedures.

18. Staff Pool Trained Cyto GT team GT training in Molecular techniques GT/CS scientific development R&D for future development Training in new techniques Release Cyto GTs GT training in Cyto techniques Release Mol GTs

19. I would like to acknowledge the efforts of all staff in Cytogenetics, Molecular Genetics and Clinical Genetics in the South East Scotland Genetics Service for their contributions implementing the changes described and all of their hard work putting these changes into practice.