Effect of Staff Attitudes on Quality in Clinical Microbiology Services Ms. Julie Sims Laboratory Technical specialist Strengthening of Medical Laboratories in the Caribbean: Caribbean Health Research Council 4 th May 2007

Aims and Objectives This research study entitled ‘The Effect of Staff attitude on Quality in Microbiology Laboratories’ was performed in order to investigate the effect of an individual’s perception of laboratory climate, climate quality and job satisfaction on the quality of Microbiology laboratory service This research study entitled ‘The Effect of Staff attitude on Quality in Microbiology Laboratories’ was performed in order to investigate the effect of an individual’s perception of laboratory climate, climate quality and job satisfaction on the quality of Microbiology laboratory service

Background The area of job satisfaction is under- researched in the Caribbean region, in particular in the medical field. The area of job satisfaction is under- researched in the Caribbean region, in particular in the medical field. Microbiology was chosen as the specific area within the laboratory field because it is a subjective science, and because stringent quality control is required in order to obtain accurate results Microbiology was chosen as the specific area within the laboratory field because it is a subjective science, and because stringent quality control is required in order to obtain accurate results

Methodology  Research was conducted in twenty-one countries, with questionnaires being sent to 69 laboratories.  291 questionnaires were distributed, 194 were returned; response rate of 67% (UK response rate was 38%)

Study Materials The study utilized two self-report questionnaires The study utilized two self-report questionnaires The first questionnaire contained 3 scales: The first questionnaire contained 3 scales: Laboratory Climate Scale Laboratory Climate Scale Climate for Quality Scale Climate for Quality Scale Job Satisfaction Scale. Job Satisfaction Scale. Additional demographic questions included: Additional demographic questions included: age, current employer, gender, current grade and length of time worked age, current employer, gender, current grade and length of time worked

Laboratory Climate Scale Respondents were asked to rate their perception of laboratory climate on a five point scale from strongly disagree (1) to strongly agree (5). Respondents were asked to rate their perception of laboratory climate on a five point scale from strongly disagree (1) to strongly agree (5). The areas of laboratory climate that were examined included: The areas of laboratory climate that were examined included: supervisory style supervisory style co-worker relations co-worker relations task characteristics task characteristics employee competence employee competence layout of laboratory layout of laboratory performance-reward relationship performance-reward relationship equipment & supplies. equipment & supplies.

Climate for Quality & Job Satisfaction Scale Climate for Quality Scale Climate for Quality Scale Respondents were asked to rate their perception of the climate for quality in their laboratory on a scale from strongly disagree (1) to strongly agree (5). Respondents were asked to rate their perception of the climate for quality in their laboratory on a scale from strongly disagree (1) to strongly agree (5). Job Satisfaction Scale Job Satisfaction Scale Respondents were asked to rate their satisfaction with various aspects of their job on a scale from very dissatisfied (1) to very satisfied (4). Respondents were asked to rate their satisfaction with various aspects of their job on a scale from very dissatisfied (1) to very satisfied (4).

Analysis Statistical Package for Social Sciences (SPSS) 14.0 was used to analyze the collected data. Statistical Package for Social Sciences (SPSS) 14.0 was used to analyze the collected data. Reliability analysis was conducted on all the scales Reliability analysis was conducted on all the scales The reliability coefficients for the departmental climate section and the job satisfaction section indicated that these scales were highly reliable. The reliability coefficients for the departmental climate section and the job satisfaction section indicated that these scales were highly reliable..

Analysis Pearson’s r was conducted to determine the correlation between the dependent variable laboratory quality and the independent variables of climate for quality, laboratory climate and job satisfaction. Pearson’s r was conducted to determine the correlation between the dependent variable laboratory quality and the independent variables of climate for quality, laboratory climate and job satisfaction. A multiple regression was performed, which indicated that type of employer was a significant variable A multiple regression was performed, which indicated that type of employer was a significant variable A regression was conducted between laboratory quality and type of employer. A regression was conducted between laboratory quality and type of employer. This indicated that in the Caribbean, the perception of the type of employer may have an impact on the laboratory quality This indicated that in the Caribbean, the perception of the type of employer may have an impact on the laboratory quality

Results The employee perception was that: The employee perception was that: Ministry of Health laboratories had a higher mean laboratory quality score as compared to private authorities and regional health institutions Ministry of Health laboratories had a higher mean laboratory quality score as compared to private authorities and regional health institutions Overall, private labs had the highest mean laboratory climate score, as compared to labs under the Ministry of Health, and the regional health institutions Overall, private labs had the highest mean laboratory climate score, as compared to labs under the Ministry of Health, and the regional health institutions

Results High, positive perception of task characteristics, co-worker relations, employee competence, job satisfaction and layout of lab High, positive perception of task characteristics, co-worker relations, employee competence, job satisfaction and layout of lab Medium perceptions for laboratory climate, climate for quality and supervisory style Medium perceptions for laboratory climate, climate for quality and supervisory style Low, negative perceptions of performance reward relationship and equipment & supplies Low, negative perceptions of performance reward relationship and equipment & supplies

High Ratings Layout of the Laboratory Layout of the Laboratory Employee competence Employee competence Task characteristics* Task characteristics* Co-worker relations Co-worker relations Job satisfaction Job satisfaction *Task characteristics refer to components of the task that the employee performs and the extent to which the job allows them to use their knowledge, skills and abilities, and allows for a variety of tasks to be performed *Task characteristics refer to components of the task that the employee performs and the extent to which the job allows them to use their knowledge, skills and abilities, and allows for a variety of tasks to be performed

High Ratings Layout of the Laboratory Layout of the Laboratory Results show that the layout of the lab is important in achievement of laboratory quality. Results show that the layout of the lab is important in achievement of laboratory quality. Employee competence Employee competence The level of employee competence has implications for laboratory quality. The level of employee competence has implications for laboratory quality. Task characteristics Task characteristics These results show that task characteristics are very important in achieving a high quality in the laboratories. These results show that task characteristics are very important in achieving a high quality in the laboratories.

High Ratings Co-worker relations Co-worker relations These results show the importance of peer interactions in the workplace and that organizations should strive to promote friendly interaction among colleagues. These results show the importance of peer interactions in the workplace and that organizations should strive to promote friendly interaction among colleagues. Job satisfaction Job satisfaction Results showed that in the Caribbean, the participants’ job satisfaction level is 38.4 out of a possible score of 60, while in the UK rate was 37.3 and the USA was Results showed that in the Caribbean, the participants’ job satisfaction level is 38.4 out of a possible score of 60, while in the UK rate was 37.3 and the USA was 46.0.

Medium Ratings Climate for quality* Climate for quality* Supervisory style Supervisory style *Climate for quality refers to employee’s attitudes toward quality issues such as managements commitment to quality assurance and standards of staff training *Climate for quality refers to employee’s attitudes toward quality issues such as managements commitment to quality assurance and standards of staff training

Medium Ratings Climate for quality Climate for quality There is a relatively high positive relationship with climate for quality and job satisfaction There is a relatively high positive relationship with climate for quality and job satisfaction Supervisory style Supervisory style These positive correlations indicate the importance of the supervisory approach that is adopted by authority figures and the implication this can have for laboratory quality. These positive correlations indicate the importance of the supervisory approach that is adopted by authority figures and the implication this can have for laboratory quality.

Low Ratings Performance reward relationship Performance reward relationship Equipment and supplies Equipment and supplies Laboratory climate Laboratory climate

Low Ratings Performance reward relationship Performance reward relationship From the analysis, one can see that it is important that employees perceive that distribution of rewards is based on good performance. From the analysis, one can see that it is important that employees perceive that distribution of rewards is based on good performance. Equipment & Supplies Equipment & Supplies It can be seen that employee’s perception of the availability of equipment and supplies has a significant relationship with the variables climate for quality and job satisfaction. It can be seen that employee’s perception of the availability of equipment and supplies has a significant relationship with the variables climate for quality and job satisfaction.

Low Ratings Laboratory climate Laboratory climate It is important to note that in the Caribbean, many laboratories are not accredited, and there is limited participation in External Quality Assessment Schemes, hence no labs in this study had high laboratory quality scores and this may have affected the correlations that were produced. It is important to note that in the Caribbean, many laboratories are not accredited, and there is limited participation in External Quality Assessment Schemes, hence no labs in this study had high laboratory quality scores and this may have affected the correlations that were produced. Therefore, although laboratory quality scores were very low, laboratories may have had a positive laboratory climate and climate for quality. Therefore, although laboratory quality scores were very low, laboratories may have had a positive laboratory climate and climate for quality.

Conclusions The results show that employee perceptions are very important to the achievement of a high laboratory quality, and that activities to create a positive laboratory climate should be encouraged. The results show that employee perceptions are very important to the achievement of a high laboratory quality, and that activities to create a positive laboratory climate should be encouraged. This is supported by data produced in the UK This is supported by data produced in the UK.

Conclusions One of the most critical problems that the study revealed was the low perception of the performance reward relationship One of the most critical problems that the study revealed was the low perception of the performance reward relationship It is important in the work environment that employees perceive that when rewards are distributed it is based on good performance and not on extraneous variables such as friendship or seniority. It is important in the work environment that employees perceive that when rewards are distributed it is based on good performance and not on extraneous variables such as friendship or seniority. These rewards do not have to be monetary, since studies have shown that intangible rewards, such as praise, are valued by employees. These rewards do not have to be monetary, since studies have shown that intangible rewards, such as praise, are valued by employees. These findings are crucial towards the achievement of a high quality laboratory and therefore should be addressed. These findings are crucial towards the achievement of a high quality laboratory and therefore should be addressed.

Conclusions The results also show that employees think that there is insufficient equipment & supplies (encompasses staff) in order to efficiently perform their duties. The results also show that employees think that there is insufficient equipment & supplies (encompasses staff) in order to efficiently perform their duties. This can negatively affect the laboratory climate and ultimately laboratory quality since if employees do not think there is adequate equipment they will be able to carry out their work tasks. This can negatively affect the laboratory climate and ultimately laboratory quality since if employees do not think there is adequate equipment they will be able to carry out their work tasks.

Limitations The sample methodology was not random, a consecutive sample was used, therefore the results are only valid for this sample and there are implications for generalizing the results to all Caribbean medical laboratories. The labs used were based on accessibility and willingness to participate. The sample methodology was not random, a consecutive sample was used, therefore the results are only valid for this sample and there are implications for generalizing the results to all Caribbean medical laboratories. The labs used were based on accessibility and willingness to participate. The scales used are highly subjective. The scales used are highly subjective. No laboratory in the Caribbean has been accredited, therefore no lab could have obtained the maximum laboratory quality score. This is important to consider, since some labs may have the satisfactory laboratory climate. No laboratory in the Caribbean has been accredited, therefore no lab could have obtained the maximum laboratory quality score. This is important to consider, since some labs may have the satisfactory laboratory climate.

Recommendations A random sampling technique should be chosen. To do this one would need to acquire a comprehensive list of all laboratories in the Caribbean. A random sampling technique should be chosen. To do this one would need to acquire a comprehensive list of all laboratories in the Caribbean. From our analysis, it is clear that other factors affect laboratory quality in the Caribbean, and additional research should be conducted to identify these variables. From our analysis, it is clear that other factors affect laboratory quality in the Caribbean, and additional research should be conducted to identify these variables.

Thank You Thank You

CORRELATIONS

Laboratory Quality Laboratory Climate Climate for Quality Laboratory Climate Climate for Quality Laboratory Quality r = 0.38** r = 0.83** r = 0.30** r = 0.69** r = 0.04 r = 0.07 Diagram comparing Correlations United Kingdom Caribbean

VariablesSupervisor y Style Co-worker Relations Task Characterist ics Employee Competen ce Layout of Laborator y Performanc e Reward Relationship Equipment & Supplies Co-worker Relations0.313** Task Characteristic s0.432**0.258** Employee Competence0.304**0.413**0.273** Layout of Laboratory0.305**0.412**0.272**1.0** Performance Reward Relationship0.536**0.273**0.360**0.211**0.212** Equipment & Supplies0.421**0.276**0.403**0.329**0.333**0.408** Climate for Quality0.705**0.283**0.435**0.312**0.314**0.511**0.461** Job Satisfaction0.525**0.300**0.475**0.246** **0.453** Laboratory Quality

Bar Chart showing distribution of Laboratory Quality

Bar Chart showing Laboratory Climate

Bar Chart showing Climate for Quality

Bar Chart showing Job Satisfaction

Bar Chart showing Supervisory Style

Bar Chart showing Co-Worker Relations

Bar Chart showing Task Characteristics

Bar Chart showing Employee Competence

Bar Chart showing Layout of Lab

Bar Chart showing Performance Reward Relationship

Bar Chart showing Equipment & Supplies