Maximizing Lessons Learned from Past

Outbreaks to Develop a Sustainable Laboratory 
Cross-training Program

Welcome. We are glad you have joined us for day 2 of the 2024 CDC OneLab Summit. If 
this is your first day joining us, we're thrilled to have you. If you are coming back after 
yesterday, we're thrilled to have you, too.
A couple of notes about today's session. 
This and all other sessions are being recorded and are going to be posted on the OneLab 
Summit page at a later date. If you have any trouble or technical issues during the OneLab 
Summit, please email the OneLab Summit inbox for support at onelab@cdc.gov. 
We're going to give participants a few more minutes to join, and then we will get 
started. 
If you have any questions throughout today's events, please insert them into the 
Questions and Answers panel at the bottom of your Zoom screen. We'll answer questions at 
the end of each session. We've posted the link to live captions in the chat. 
Please be sure to keep the captions window open if you're using it in addition to the 
Zoom meeting window. I'll now turn it over to our OneLab Network lead, Alicia Branch to 
introduce today's theme. Alicia?
Thanks, Blanche. Today's theme is planning. We are fortunate to have Ms. Channyn 
Williams as our distinguished keynote speaker, and other subject matter experts again today 
who are ready to enrich our learning experience. I'll read our disclaimer and then introduce our 
speaker. 
Next slide, please.
I'll go ahead and just read it. "Slide decks may contain presentation material from 
panelists not affiliated with CDC. Presentation content from external panelists may not 
necessarily reflect CDC's official position on topics covered." 
I'm excited to introduce our keynote speaker today. Ms. Channyn Williams is a 
supervisor, medical technologist, and cross-training coordinator at the District of Columbia 
Public Health Laboratory with over 10 years of clinical laboratory experience. She joined the DC 
Public Health Laboratory as a medical technologist and quickly transitioned to several 
concurrent roles. 
During the COVID-19 pandemic surge, Channyn supervised the DC Public Health's 
mobile testing unit, followed by the interim laboratory epidemiology coordinator, before 
accepting her current role. Our keynote speaker for today is Ms. Channyn Williams. Over to 
you, Channyn.
Thank you for that introduction. I will actually go ahead and skip this since you kindly did 
that for me. 
Go ahead.
And we can get started. 
So cross-training — simply put, cross-training is the answer. And most people have 
actually participated in cross-training at some point in their career. And in many cases, they 
may not have known that it was cross-training or even recognized the benefits due to how it 
was implemented.
But when it is effectively intemen... — implemented, excuse me — it is indeed the 
answer to the many universal lab challenges that we have all seen or experienced at some 
point. So definition-wise — and, again, this is a little subjective — but cross-training is a 
powerful training plan lab managers can use to build a reserve of staff to prepare for future 
challenges, resolve current challenges, and optimize overall lab preparedness.
And to quickly list some of those challenges we are all so familiar with, at the top of the 
list, we have staffing issues, both planned and unplanned, and the bane of every laboratorian's 
experience — downtime. 
Then there's surge testing, where we love those high volumes of samples with those 
urgent turnaround times, and the last challenge, which is certainly not all of the challenges, but 
the last one that I'd like to talk about is the constant concern — the consistent concern, excuse 
me — with onboarding of new staff, which should ideally be completed without interrupting 
daily operations, but, as we all know, that isn't always the case.
And I know it almost sounds too good to be true for cross-training to solve all of these 
issues and common challenges. But it's important to realize that a lot of labs have already 
implemented cross-training in some way. And the key is to capitalize on your lab strengths and 
identify the most ideal method of implementation that works for your lab.
And, again, as we all know, being able to adapt at any moment in the lab setting not 
only allows for routine operations to continue without interruption, but also ensures 
preparedness. And this creates a future-ready team, which allows lab managers to easily 
maintain stability while also providing flexibility for staff. 
Now, cross-training, it isn't solely for the benefit of management or operations. It also 
creates opportunities for career development and job enhancement. And for staff, this can be 
an opportunity to enhance the skills and knowledge that they already have for professional 
development. Or it could be a chance to develop complementary skills. 
By cross-training in different units or on different assays within your lab, staff can 
showcase additional skills their current position doesn't necessarily require, but could 
potentially open doors for a promotion, such as moving from a processing role into a testing 
role, or from a testing role into a supervisory role.
And while implementation can feel overwhelming at first, once a realistic and actionable 
plan is established, the benefits will undoubtedly outweigh the cost. And essentially, cross-
training can be a lab's greatest tool. And I may be biased, but it truly is the most cohesive 
approach for addressing both wants and needs in the lab. 
Now, let's say your lab is as solid as they come. You are prepared for anything and 
everything. And if that's you, you can keep that to yourself, because no one likes a show-off. 
But you would have the ability to utilize cross-training to focus more on those staff 
wants, such as job enhancement, professional development, and the biggest want of them all, 
schedule flexibility, which we will definitely get into later. 
But going back to focusing on professional development, this chart on the screen 
captures results from a survey that we actually utilized to gauge our staff preferences for where 
they wanted to be scheduled for cross-training. Now, the first go-around for our cross training 
program, this was one of the methods that we utilized to get staff interest. And we'll talk more 
about that later. 
But a key factor to keep in mind is to coordinate training based on complementary skills 
as well as lab need. So I'm hoping you're already starting to see that this can truly be a win-win 
strategy that extends beyond the bench. But, again, we'll get into all those details. Next slide. 
So I'm sure many of you could go the rest of your careers without hearing the words 
"COVID-19 response" ever again. So I'll be brief with this one. But like many of you, here at the 
DC Public Health Lab, following the pandemic, we completed a retrospective analysis to identify 
what had occurred in regards to training, in addition to testing, but more so for our cross training program. 
We used this analysis to look at training and how we responded so we could 
essentially improve our overall lab preparedness. 
And in that analysis, we undeniably saw that a surge led to increased sample volumes 
and subsequently increasing turnaround times. Naturally, having a team built around typical 
routine testing volumes for daily operations, during surges, our trainers were required to train 
and test almost simultaneously because of these surges. 
And fortunately, training efforts did increase the number of trained staff across multiple 
units to widen our staff ability to accomplish all the testing that was needed. However, it lacked 
a concentrated focus on a lot of the pain points that staff were experiencing. And it didn't 
efficiently address overload and exhaustion, nor did it improve the turnaround time on a 
consistent basis, which does not take away from how hard everyone worked throughout the 
entire pandemic. 
But some of those pain points included those bottleneck steps that sometimes you just 
can't prepare for until it happens. And when it comes to overload and exhaustion, there were 
still instances of necessary overtime for many of our staff. And in regards to turnaround times, 
they definitely improved. However, because we still had issues that weren't fully addressed, 
and we didn't have the time to address them because of the need for so much testing, those 
turnaround times weren't always met. Next slide.
So when it came to our Mpox response, again, we did the same thing — retrospective 
analysis, and were able to see that while the training plan still wasn't the most ideal, there was 
a noticeable improvement in training efforts, which were based on lessons learned from our 
COVID-19 response. 
So with our Mpox training, we were able to double the number of trained staff in less 
than a month by pooling staff with complementary skills, which significantly improved trainer 
availabilities. Given the additional staff that were trained, it freed up our trainers to train 
additional staff as needed.
And we were also able, thanks to the additional staff and the increased trainer 
availability, we were able to implement a rotating schedule, which allowed us to assign staff to 
specific days for testing, as well as when we had higher volumes or expected higher volumes, 
we were able to create a shift within a shift. 
So we would have a team A in the morning and a team B in the afternoon. And, again, 
this team was comprised of staff across our lab who had complementary skills to train quickly 
and be scheduled for testing.
So when it came to these teams, for Mpox in particular, we had an extraction team and 
then a PCR team. And so this allowed us to significantly reduce that overload and exhaustion 
that a lot of our team was feeling, myself included. And this allowed us to have a sustainable 
schedule, which improved our overall operational efficiency. Next slide. So we touched on the 
benefits of cross-training earlier. But we'll go ahead and go into a little bit more detail for that. 
And I wanted to start with this stool analogy.
So when it comes to a stool, you have the legs that support the seat, and you can look at 
the seat as your lab or a unit or whichever need you have in your lab for cross-training. Now, 
let's say we're focusing our cross-training efforts on specific assays or a specific unit.
Well, each of these legs can represent a staff member in that particular unit. You have 
one staff member that is trained in four out of five assays. You have a second staff member 
trained in three out of five. And then you have a third staff member who is trained in all five 
assays within that unit. 
Now, if, let's say, that one staff member that is trained in all five assays, they 
unfortunately have to go on leave, you're left with two staff who aren't fully trained on all of 
your assays. And you're left trying to figure out how to adjust and adapt. 
So the biggest benefit with cross-training is that it allows for readily available support 
for critical functions or for all of the assays within a unit. And this subsequently increases 
schedule flexibility. So this prevents that overload and exhaustion from staff having to come 
together and cover all of the assays, or struggle to do so.
And having a readily available pool of staff allows you to decrease the need for overtime 
for the staff that are coming together to cover those assays. And another amazing benefit of 
cross-training is that it allows for a PTO-friendly schedule.
Cross-training also resolves common operational interruptions and delays, which we will 
get into. And the biggest benefit, especially for management, is that it increases workforce 
sustainability, which, as we all know, is critical to a fully prepared and functioning lab.
For staff, this can also promote knowledge transfer, which I'm sure some of you have 
seen in the lab. Sometimes, staff can be nervous about knowledge transfer.
They feel the need that they need to know everything, and they're the only ones that 
need to know it, when, really, it's extremely beneficial for the lab for several staff to be aware 
of all of the testing assays or specific functions. And so cross-training allows staff to see the 
benefits without feeling threatened, so to speak. 
Now, cross-training also significantly reduces the occurrence of those assay bottlenecks 
that I previously mentioned. And just to get into those with this table at the bottom, so for 
preanalytical bottlenecks, that will look like accessioning, which is a unit that a lot of people don't 
give much credit to. But accessioning is a core function for every lab that's performing any 
testing.
And with accessioning, that can look like logging samples into your LIMS or, if you're in a 
hospital, redrawing labs, sending out additional collection requests or specimen labeling. 
Having enough staff that can cover those tasks can be critical, especially during surges, as well 
as aliquoting. 
So in our lab, our accessioning unit did assist with aliquoting. And at some points, they 
were performing all of the aliquoting for our units. And one of the benefits with cross-training 
was for staff to see just how important of a function that that was and how critical our 
accessioning unit was to our lab.
And obviously, it's pretty self-explanatory when it comes to increasing the amount of 
staff available to complete that. But the more people available, the faster it gets done, and the 
less likely people are to burn out. 
Now, inventory, which we all have to focus on — this one can be broken down into 
levels. And we won't go into all of those levels. But monitoring onboard reagent levels can be a 
critical function that can be not overlooked but not focused on.
And so you could have staff that are cross-trained in a schedule specifically for checking 
onboard reagents if you're performing around-the-clock testing during surge testing or you're 
short-staffed. And so you can easily have a schedule implemented where you have lab 
assistants or certain techs in your lab that are checking for those onboarded reagent levels to 
ensure that it's ready to go for testing to prevent any delays or interruptions.
This can also include — if you don't have to worry about onboard reagents, it can also 
include sample racks, which was something that we also saw, or consumables that are 
necessary to complete testing. And while these tasks can seem a little bit tedious, they can have 
a substantial impact on efficiency and exhaustion during surge testing. And that is obviously 
something that we utilize cross-training for to improve. 
And with everyone's favorite days of short-staffing, those are also the days when you 
want to make sure you have some of those critical functions, such as inventory or aliquoting 
and accessioning. You want to have enough people available to cover that. 
Now, when it comes to some of the analytical benefits, that can look like batching 
samples. You could have batching schedules, where you have some staff that are available that 
are specifically assigned to batching samples in the morning. That way, your testing staff 
doesn't have to worry about batching and testing. 
You could have staff that are cross-trained specifically for reagent prep. And, again, you 
can create a schedule specifically for monitoring reagents. 
And I cannot stress this enough. If you are going to utilize schedules for specific tasks, 
such as monitoring inventory levels or monitoring anything that has to be utilized for testing, 
you want to ensure an efficient method for tracking and communicating this information. 
So you want to make sure everyone is aware of these levels. They're aware of what's 
going on. They're aware of the schedule. And you want to have an efficient method for doing 
that, which we'll also get into.
Now, for some of the postanalytical benefits, once testing is already completed, this can 
also be a bottleneck step, especially if, let's say, you're experiencing surge testing, and you only 
have one analyzer. So this could look like a bottleneck step for sample storage.
And you want to have dedicated roles to ensure timely and accurate storage. So this 
could be another function that you cross-train available staff for to assist. If this particular unit 
was short-staffed or experiencing surge testing, you could have a schedule for this function as 
well, which would alleviate that stress and overload on the staff from having to go through all 
those pre-analytical steps or analytical steps and then have to worry about postanalytical steps 
such as sample storage before moving on to another batch of testing.
And, again, this also — excuse me — is important because this can help with potentially 
with avoiding — losing any samples. If staff are overwhelmed, they're running around. They can 
easily misplace samples or forget where they might have left off. And so this, again, assists 
them with being able to be more in control of that testing. Next slide.
OK, so when implementing a cross-training program, here at the DC Public Health Lab, 
what we did was we utilized this six-step process in order to figure out the best way to 
implement our cross-training program. And going back to our first implementation, we utilized 
the retrospective analysis that we conducted for both our COVID-19 response and our Mpox 
responses.
However, the second go-around, we decided to implement this six-step process to avoid 
some of the issues that we encountered, which we will get into. But to go over this — and if you 
want to take a screenshot of this, we won't go into all of the details. But you want to start with 
— these core questions are where you want to start when you are planning out your program.
And you want to start with, what are the needs for your lab? Is there a general need? Is 
there a specific — are there specific needs for a particular unit or multiple units? And this can 
be as simple as just needing to increase available staff for certain assays or tasks, like we just 
went over. Or it could be to improve your current schedule.
The next question you want to consider is what needs to be prioritized. And this needs 
to be specific. This is not — when you're looking at what you need to prioritize, you don't want
to generalize this, because you want to be able to measure how effective your plan is. And 
without identifying where you need to start, you can't benefit fully from implementing cross training.
And, again, this can wear down your staff. They could lose interest. And that is obviously 
something that we don't want. 
And the next question to keep in mind is, how can you implement this? What does a 
cross-training program look like for your lab? Because this is specific to your lab. Every lab is 
different. 
And you also want to look at what you're already doing that will complement a cross training program 
without interrupting your daily required tasks. And what you're already doing 
can include something as simple as a huddle or meetings.
And you could utilize this. Since the staff are already used to it or your management is 
already used to it, you can capitalize on that since they're already familiar with that process. 
But the purpose in identifying these things is to ensure smooth implementation.
Now, the biggest hurdle when it comes to cross-training isn't quite the actual training. 
It's usually a bit of staff resistance. And we will go into more detail on that in a bit. But that is a 
critical step that you'll want to put quite a bit of effort into. And while it can be easy to just 
focus on the training aspect, you can't optimize training until you effectively address any 
resistance that you might be facing. 
And by answering these core questions, planning out what is needed for each step in 
building a solid cross-training program becomes almost effortless. Now, just to quickly go over 
these six steps that are displayed here — the first step is assessing your needs and your lab. 
And that can, again, look like I start — excuse me — start with identifying critical 
functions, identifying those pain points within your lab or your units. You want to identify 
limiting steps. And these points allow you to create a baseline of where you need to start. 
The next step would be to define your goals based on your needs assessment. And then 
you can move into designing your plan. And once you have your plan fully designed out, which 
you definitely want to make sure you focus on your timeline — and when I say "timeline," I 
mean an effective timeline and a very realistic timeline.
You also want to look at your required resources. And that's something that you want to 
have ironed out before you start. And so the next step would be to implement your program.
And, again, with implementation, that can include managing resistance. It can include 
pretraining motivation, as well as monitoring and documenting progress, which allows for 
continuous improvement. So once you've been able to implement your program, you want to 
move into evaluating your results. And this is something that you want to consistently do.
Now, this can look like surveys. This could be done through huddles and meetings with 
your training staff. But you definitely want to consistently monitor your results to ensure that 
you're on the right track. 
And lastly, you want to sustain your efforts. And this can easily be just by integrating 
cross-training into your lab culture, as well as considering updates based on your lab needs and 
staff needs. Next slide.
So just going to a little bit more detail quickly with the steps, you're starting with your 
needs assessment. So here we go back to our trusty stool analogy. Now, we see that we have —
we see that we have enough staff in our unit. However, all of the staff aren't trained in all of the 
assays.
And while that may work with daily operations, the key point to keep in mind are those 
times when you're short-staffed or those unexpected times. So first and foremost, we want to 
identify overall need first and then identify areas of the lab that would benefit from cross training.
And, again, one thing to consider and plan for is that cross-training may be needed in an 
area, but might require a not-so-simple process to implement. And so those are things that you 
want to take the time to plan out. 
Now for at PHL, with our most recently implemented cross-training program, we 
focused on one unit at a time. And by focusing on one unit, we were able to focus on that 
complicated process that this unit required, which was compliance-oriented and required 
special clearances. 
And by assessing the unit needs, we were able to look at the workflow. We were able to 
identify the limiting steps, the testing bottlenecks, and understand if we could continue any 
current solutions that we were using for any undesirable outcomes that we were constantly 
facing, or we were able to identify the need to create new solutions. 
Now, staff concerns most likely will always include burnout or just not having enough 
staff to run specific assays. And, again, if we look at our stool analogy, that can definitely be the 
point that that could be your critical function that you need to focus your cross-training 
program on. 
And, again, this can look like focusing on specific functions or an entire assay. But you 
really want to hone in on where your cross training efforts need to be focused. It isn't always 
optimal to focus on every aspect at the same time. You really want to prioritize where you need 
to start. Next slide.
OK, so defining your goals — you want to base your goals, obviously, on your needs 
assessment. And I'm sure many of you are familiar with SMART goals. But this can be the best 
way and most efficient way to do so. It allows you to stay on track with the needs assessment 
that you completed. And it allows you to create realistic, actionable goals.
So you want to be specific. And you want to ensure these needs — excuse me, these 
goals — are specific to your lab's needs. And this includes both staff needs and testing needs.
You want your goals to be measurable. You want to ensure that you are utilizing efforts 
that allow you to efficiently measure your progress and allow you to make any changes as you 
go along.
You want your goals to be realistic. I know you can be — excuse me. I know that I can be 
a bit overzealous at times when it comes to identifying goals. But you really want to be realistic 
to ensure a successful implementation. 
And next, you want to make sure your goals are relevant. Do your goals align with your 
lab values and your mission statement? Do they align with how your daily operations typically 
run? 
And lastly, you want to make sure your goals are time-based. You want to set realistic 
but ambitious deadlines. And this can clarify task prioritization as well as demonstrate the 
benefits of cross-training.
If you set these goals and you have a realistic deadline that you are meeting, this will 
subsequently increase motivation and staff cooperation, which undoubtedly is necessary to 
successfully implement a program. 
Now, when you're looking at your expected results, you want to focus on increasing 
available staff for a specific assay if your issue is increasing the number of trained staff. And 
with your goals being obtainable without interrupting current operations, this allows you to 
prioritize where you're going to start.
And going back to your schedule, if improving your staff coverage plan is your priority, 
you want to account for short staffing on any given day, right? You want to account for 
maintenance days. You want to account for conferences, if that is a requirement within your 
lab, or a staff desire.
But in order to obtain those goals, you want to ensure you're not placing any additional 
strain on your staff in order to meet these. So, again, that goes back to ensuring you're 
prioritizing and defining sustainable goals. 
So just to go back — I know we were touching on staff goals. But just to go back on 
testing goals really quickly, a lot of times, when it comes to testing, turnaround time is the 
priority. And when it comes to turnaround time, obviously, there are a lot of factors go into 
that. 
But the number of staff trained and competency-assessed for a specific essay — assay, 
excuse me — or certain steps in the process, this can include those pre-analytical, analytical, 
and postanalytical examples that we discussed. And, again, if your priority for cross-training is 
testing, that is where you want to focus at first if that's a priority. And then you can move into 
your next priority. Next slide.
So designing your cross-training plan — again, you want to make sure your timeline is 
achievable. Are all of the units and staff on the same page? Does your cross-training schedule 
align with the current operational schedule? 
And I know, sometimes, when you're trying to plan out a training plan, it can get lost in 
the sauce, so to speak when you get overwhelmed. And you want to make sure that — you 
want to prioritize your operations. You don't want to allow cross-training to interrupt what you 
have going on, because this is, again, how you lose your staff interest.
Now, the next point when it comes to your timeline that is something that we needed to 
refocus on with our second go-around of cross-training is the allotted time frame. We want to 
make sure that it's appropriate for training. 
Now, the first go-around, we were a little overzealous with it. And there were times 
when we didn't meet those deadlines. And so this second implementation, by focusing on one 
unit, it allowed us to meet all of those deadlines, which, again, created interest from our staff. 
They wanted to cross-train. They did not feel overwhelmed. Our trainers did not feel 
overwhelmed.
And one of the ways — as you can see on the screen, one of the ways that we were able 
to do that, to ensure that, was by sending out a survey to our unit managers. And we wanted to 
double-check first before creating the schedule. We wanted to collaborate with them. We 
wanted to double-check that our cross-training plans aligned with their daily operations.
And so by giving them this ownership in the plan, it allowed us to easily collaborate and 
implement a plan that had almost no resistance from our unit managers the second go-around, 
whereas, the first go-around, we kind of just shared what the plan would be and without 
considering the managers' concerns or needs. 
Now, when looking at required resources, again, you want to look at your available 
training staff. You want to look at your staff coverage for trainers and the trainees' units. And 
you don't want to schedule a trainee for cross-training if that's going to cause their unit to be 
short-staffed, right? You want to ensure that your trainers aren't going to short-staff their unit 
by focusing on training a cross-training tech.
And quality assurance is a big factor when it comes to training, as we all know. So you 
really want to make sure you are planning out what that looks like for your lab. You want to 
ensure, if you need to create any modifications to your training checklist or your competency 
documents, that you are taking care of that before implementation.
That way, once you start with your training, you have all your documentation ready to 
go. And that is just one less thing to worry about, and you can continue with a smooth 
implementation.
Now, prerequisites and criteria — that's essentially just you're looking at training, 
experience and skills, as well as trainer experience and ability to train, which is a big one. Not 
everyone is able to train, and that is OK. So you really want to ensure that your trainers are 
comfortable with training, they know how to train, and they know how to assess a successful 
training plan. 
They want to be able to see where there are issues if they need to focus on specific 
points to ensure successful training for whoever is training in that unit. 
And lastly, the feedback and support mechanism is also an important factor when 
designing your plan. How are you collecting and assessing this feedback? And, again, for us, that 
also looks like a survey.
So we would send out — we sent out a survey to cross-training techs. And we also 
checked in with them weekly. So we utilized huddles, and we utilized these surveys — and they 
were simple questionnaires — or just conversations weekly to check in with our cross-training 
staff.
And this allowed us to ensure that we were on the right track, that our schedule still 
worked with their home unit, so to speak, and that we were still meeting those deadlines and 
goals that we had set for our cross-training program. Next slide.
OK, so when implementing your program, the first step is always — well, not always —
but the first step usually is managing resistance. Sometimes this is a foreign concept, so to 
speak. It's something that your staff or management aren't familiar with or used to. And you 
want to ensure that they are fully supportive of this program because staff buy-in is critical.
You want to allow unit managers and trainers to participate in the planning process. 
And, again, that looks like sending — that could look like sending out a survey to gauge where 
they are, to gauge their concerns, to gauge the available time frames that will work with their 
unit to host another staff member for training in their unit. 
And you want to actively solicit this feedback and monitor progress throughout to 
ensure that you are modifying your cross-training program to consistently align with the unit 
operations where the cross-training is occurring.
You want to prepare your trainers. So this can look like just explaining the process from 
start to finish, as well as clarifying what their role and required tasks will be.
And this can be documentation, resolving any scheduling conflicts, communication, and 
you want to address all concerns before implementation. And, again, when we go back to staff 
buy-in, showing that you are readily addressing concerns, and that is also a priority in 
conjunction with training, will allow your staff to feel comfortable with moving forward. It 
allows them to want to participate. 
And when you're addressing these concerns, again, this can look like pretraining 
motivation. You want to use this time to build anticipation and to build interest. And lastly, you 
want to monitor progress and document continuously. And, again, we went into this, but this 
can include utilizing key performance indicators to allow you to monitor performance. And so 
you can actively see what is working, what is not, are you meeting your goals.
Now, when you're monitoring progress, maintaining training checklists that are 
modified for your cross-training program can be extremely beneficial. It allows you to have a 
clearly defined tracking system, and it allows you to see where you are meeting your marks, as 
well as where you might need to make some modifications. 
And this can also be simply done with a logbook or some sort of register, right? When 
you're checking in with your unit managers and your trainers or your trainees, you want to have 
some sort of centralized location where you are documenting any communications, any issues 
that were resolved, because this allows you to continuously improve your program as you go 
along. Next slide. 
So when it comes to creating a schedule, you want to keep it consistent. The first go-around, 
this was something that we kind of modified as we went along, whereas the second go-around 
was significantly improved.
And as you can see on the screen, so what we utilized this time was our Outlook 
calendar. And so what we did was, whenever cross-training was scheduled for a specific team 
member, we would send out a calendar invite to their unit manager, their unit supervisor, the 
trainer — the trainee, excuse me — and the trainer, so that everyone was on the same page 
and aware of when cross-training was occurring, and we utilized the same times on the same 
days.
Now, we had to stick with two-to-three-hour windows across two to three days weekly. 
And while that doesn't seem like a lot of time, we were able to accomplish every training goal 
that we had identified. We broke down our training program to focus on a specific workflow, 
and we were able to break down that workflow within these training windows.
And, again, we were able to do this by collaborating with these unit supervisors and 
managers to stick within the ideal training windows that our supervisors told us that worked 
with their unit. And next, we established an efficient mode of schedule dissemination. And, 
again, that is this Outlook calendar. 
It was simple. It was easy to follow. And it sent out automated reminders. So it avoided 
that instance of the schedule not being shared with everyone. 
And, again, it aligned with agreed-upon time frames, and we stuck to those time frames. 
So that also made it easier on us to ensure that all aspects of the training program were being 
implemented on the days that they were supposed to. 
Now, there were days when we had to reschedule due to staff being out or unavailable. 
And because we were utilizing this efficient and digital mode following the schedule, we were 
able to easily move the training programs — excuse me, the training session — to another day, 
or sometimes to another time on that same day. And that was simply by checking in with the 
supervisors, managers, trainers, and the trainee.
And next, we want to focus on evaluating results. So when it comes to evaluating your 
results, you want to ensure continuous evaluations are occurring. And in order to make any 
modifications as you go along to make it a little bit easier, again, short weekly huddles or Teams 
meetings are an ideal way to accomplish this, right? 
It avoids having to think back on what happened or potentially miss any issues that or 
concerns that might have been brought up. And, again, you can easily do this by collecting and 
analyzing your data. And this can look like comparing your projected training numbers to what 
your actual training numbers are, or looking at your training and competency document 
completion. 
Are you meeting your deadlines? What issues are occurring? And by collecting this as 
you go along, and having these short — or long — weekly huddles or meetings, it allows you to 
address it as it happens.
And, again, you want to make sure when you're looking at your cross-training goals, if 
you are not meeting any of your goals, you want to look at the corrective actions that are being 
implemented and if they are effective, because if they aren't effective, this can cause your 
program to be brought to a halt. Or, again, it can become overbearing on your staff.
And, again, when it comes to collecting feedback, you want to — oh, next. Can you hit 
next? Thank you. And next one more time? Thanks — perfect. 
When it comes to collecting feedback, you want to assess participant satisfaction, right? 
Again, cross-training, while it's beneficial for improving your lab preparedness, you want to 
ensure your staff are satisfied with the program in order to ensure smooth implementation. 
Did your trainers feel adequately prepared and supported? Did your trainees feel 
confident in their abilities to perform newly acquired skills? Are your unit managers and 
supervisors satisfied with the implemented training schedule? Again, these are all points that 
you want to keep in mind and constantly improve on, which is easily done when you're 
continuously collecting feedback and addressing these concerns. Next?
OK. So once you've implemented your program, and you see that you are on track for 
meeting your goals, and you've successfully completed your first program, or your first version 
of it, you want to sustain these efforts. And that can look like integrating cross-training into 
your everyday operations. 
This allows for continuous improvement. This allows for preparedness, which is the 
overall point in cross-training. And by highlighting the success, this allows you to integrate it 
into your lab culture, right?
And examples of highlighting success can look like the number of staff that are 
attending conferences. Again, if you're unable to allow staff to attend conferences that they'd 
like to attend for professional development, and cross-training efforts have allowed that to 
occur, that is something that you want to highlight. That is something for people — for your 
staff to be proud of, right? 
Another example of success could look like an increase in PTO approvals. And it can also 
look like — it can also be demonstrated through a decrease in the number of callouts, right? 
Staff are human. If they're constantly overworked or feel exhausted, they call out. That's 
something that we can't avoid.
However, when you cross-train and you prepare for this — excuse me — it decreases 
the need for staff to call out. They won't feel like — they won't feel overwhelmed or exhausted. 
And another way to sustain your efforts — and, again, this can be subjective, but you can 
reward your staff for their efforts. 
And this can be as simple as an award for your trainers for their participation and their 
dedication. And I'm going to tread lightly with this one. But it could look like lifting schedule 
restrictions or limitations.
And I say I tread lightly because a previous job, we were limited to one person per day, 
no matter what, for PTO, which took a toll on our staff, myself included. But if, after 
implementing cross-training, you're able to allow a fully flexible schedule which increases the 
amount of people that are able to take PTO, this can be a huge success that will reinforce staff 
interest and cooperation. And next? 
Excuse me.
And, again, going back to our trusty stool analysis, once you have your readily available 
reserve of staff that fill those gaps that you've identified in your needs assessment, you have a 
fully covered unit, right? No matter what the case is, whether you're short-staffed, whether 
you're surge testing, by preparing for anything that could come up, it allows you to operate in 
the most optimal way, and efficiently. And proper reinforcement yields optimal preparedness. 
Next slide.
And just quickly, this is just a look at a schedule that we created following cross-training 
within one of our units. 
Now, you could have — and this is just an example, but this was a way for us to easily 
plan and disseminate a schedule that all of our units that had staff that had cross-trained in this 
unit, they were able to see when their team members were scheduled, and they could work 
around it. And we could also make any necessary changes as needed and just disseminate this 
to everyone that needed to receive it. Next slide.
Essentially that is cross-training in a nutshell. I do apologize for all the issues that we 
encountered. But I did want to — and I know I kind of breezed through it.
But I did want to end it with a quote by Jim Crapko. And it said, "If you continue training 
the same way you've always trained, don't expect to get better results." And this is something 
that we kept in mind for this second go-around of cross-training to remind us that it's OK to 
make modifications. Continuous improvement is only beneficial to our lab preparedness, which 
was our optimal goal. 
So I want to thank you all for your patience and your attendance to this, and I can 
answer any questions.
Thank you so much. We'll take a few minutes to answer as many questions as possible. 
If we do not get to answer your question today, we'll do our best to respond via email. If you 
didn't submit your question anonymously, if you have any questions after today, please feel 
free to email the OneLab inbox at onelab@cdc.gov. So let's see what's the first question.
OK — two issues, OK. This person says they have two issues that I have seen come up 
with cross-training is people have not wanted to be trained or they want to be trained — they 
want to be compensated for the extra work that they have to do now with the already heavy 
workload. The other issue is staff not wanting to train or be patient with staff who are learning. 
How did you handle these issues? 
OK, so with the first point, compensation was definitely a big point that was brought up. 
And I think what we decided to move into, as opposed to hammering it into the staff's brains 
that this is for the benefit of the lab, you just should just want to do this because you work 
here, what we had to do was compromise, right?
And, again, for staff, a lot of times, that can look like, while compensation isn't always 
something that can be modified, unfortunately, but how you can compromise is what all staff 
would like is PTO, right? 
Cross-training can allow for a more flexible schedule, which, again, when you're short-staffed, 
or when people just need a break, when you have a readily available pool of staff that 
are cross-trained, anytime anyone needs a break, they can easily take that break without having 
to sacrifice the break that they need because there isn't coverage. 
And for the second point — can you remind me — fully — the second point? 
Oh, they have it. So I guess it's the trainer doesn't have the patience to train the staff 
who's the learner. 
Another valid point. And, again, I think to reduce the instance of that happening, when 
you're scheduling or assigning staff to a unit for cross-training, you want to make sure that 
you're assigning them to a unit that's complementary to their skills, or, if it's not necessarily 
complementary to their skills, it's a new skill that they are ready to move into. 
And, again, going back to that pre-implementation motivation, support your trainers. 
Discuss what the plan is going to look like. Cover any potential issues that they may run into, 
again, which can be having patience.
Remind them the benefit that cross-training will bring to them in their unit. And, again,
just support them throughout the process. Have an open line of communication. And create an 
environment where they feel safe for bringing up these issues. 
And just honestly, collaboration is — and compromise. Collaboration and compromise 
are the two biggest factors for pretty much any concern when it comes to cross-training. 
OK, let's see. The next one — I'm assuming they meant — I'll say, "Are there any 
functions in your LIMS that makes cross training difficult or you hit a bottleneck with? How can 
LIMS assist with cross-training in more efficiency?"
Can you read that again? 
They have "LIS," but I don't remember you — L-I-S. But I don't remember you saying 
anything. I remember you talking about your LIMS system, so I'm assuming they meant maybe 
the LIMS system? Maybe they'll — maybe they'll type in what they meant by this question. 
OK.
Let's go to the next one. They want to thank you for the presentation. They would like to 
know how you identify staff eligibility for the cross-training program.
Sure. So one of the ways that we were able to do that was by looking at the assays that 
we were going to focus on for cross-training. And we were able — we wanted to identify staff 
who might have had previous experience on a certain instrument or a certain part of the 
process that we were going to focus our cross-training efforts on. 
And if it was a staff member who necessarily did not have that experience, they may 
have had similar skills, or they had skills that were essentially a prerequisite to what the 
cross training was going to focus on.
So, again, you want to look at complementary skills, but you also want — if that's not 
the case, you also want to look at those prerequisites. You want to make sure that the trainee is 
ready to learn that new skill if it's new, as well as the trainer being able to identify the readiness 
of that trainee and modify the training plan as necessary.
OK, let's see, then, this one. "Is it better to try and develop a trainer or to move on to 
another person to do the training?" 
Whoa, that's a dicey one. I think supporting your trainers is always going to be the most 
ideal option. You've already identified this person to be a trainer, right? And to ensure interest 
and in collaboration and support for your implementation, for your cross-training 
implementation, you want to support them.
You know, if they are struggling with that process, see how you can help. See why they 
are struggling. It may not be a skill issue. It may be something different that you can support 
them through. They 
may just need a confidence booster, or they just may need some ideas that kind of help 
them think outside the box, or just a little bit of assistance to identify the best workflow for 
whatever the circumstances are. But, again, I definitely think that you should always start with 
supporting them. And then, if you identify that that support isn't necessarily enough, rather 
than just replacing them, I think you work with them to figure out the best method. 
Maybe you can assist them by having an additional trainer. They work with another 
trainer. But you definitely want to always support them first. And, again, if you do need to find 
a new trainer, find a way to still include that first trainer if they are still interested in doing it, 
because you definitely don't want to discourage anybody.
Right. This is a good one. They thank you again for the presentation. They're just curious 
to know, how would you support a staff member that would like to cross-train from the bench 
to a leadership role whenever there is an internal opportunity with an open position?
That's a good one. I think, to support — so while that's not — depending on the 
organization, that's not always an option, right? But that could look like — excuse me, 
introducing them to online e-courses to learn leadership skills, to learn how they can assist their 
supervisor, they can take on more responsibility. 
And, again, I know compensation is a big thing. But if this is a staff member that really 
wants to progress and move up, sometimes — and I've done this personally — sometimes, you 
have to give a little bit to get what you want. And, again, for my experience, which is why I 
brought up the e-courses, what I did while moving into a supervisor role wasn't always a 
possibility. 
What I did was I assisted my supervisor with certain responsibilities and certain tasks, 
which, again, significantly enhanced my professional development and allowed me to move 
into a supervisory role.
Oh yeah, they did mean the LIMS, the LIMS system. This was the same person. Hold on 
just a minute. We found another one. This person wants the quote.
Oh, they want the quote at the end? 
Yeah.
Oh, sorry. It was by Jim Crapko. And his last name is spelled C-R-A-P-K-O. And the quote 
was, "If you continue training the same way you've always trained, don't expect to get better 
results."
And I think this is — I chose this quote because it was a great reminder for both 
managers and staff, but more specifically managers, to remember, you know, you have to 
collaborate with your staff. And if you have a management style where you typically just tell the 
staff what to do, it can be to your benefit in allowing them to have some sort of ownership in 
the planning or the process. 
And, again, you can control that. But it can be very beneficial to changing the way you 
implement your training.
Yeah. I think this one's a good one. "When you have cross-training where staff revolve 
every six months to a year, wouldn't it be difficult to constantly cross-train when staff would" —
I guess, with consistent staff turnaround? 
Definitely. And in that instance, that is a bigger problem. However, before you can even 
implement a cross-training program, you want to focus on why that staff turnover is so short. 
What is causing staff to leave? Why aren't they staying? What can you do to encourage 
them to stay? And, again, if you need cross-training in order to fill those gaps when staff are 
leaving, again, that starts with identifying why staff are leaving. 
What is causing them to leave? How can you prevent that? How can you prevent more 
staff from leaving? And how can you fill those gaps without overloading your current staff that 
are staying? But, again, that's a bigger problem.
Yeah. We'll take one more question, and I think this is a good one. This person's — she's 
actually a LIMS manager. And she said, "How do we cross-train or select a tech to train where, 
at work, it might be seen as favoritism or pre-selection?"
So did you experience any — where people felt like they were — there was some 
favoritism in the person that you were choosing? 
I don't think it was — we necessarily faced the issue of favoritism. But I think, well, for 
this question, when revolving around LIMS, again, you want to consider any prerequisite skills. 
You want to look at complementary skills.
And, again, let's say you have a staff member who doesn't necessarily have those 
prerequisites or skills, and they actively would like to cross-train on your LIMS. Start with — you 
don't necessarily have to count them out, right? You can start with getting them familiar with 
those prerequisites in order to eventually cross-train in LIMS while you're focusing on someone 
who currently has those skills. 
And so you're not discounting them. You're focusing on that cross-training need for your 
LIMS while also still providing an opportunity for others who may not necessarily have the 
prerequisite skills, but you're still assisting them with getting to that point. 
I want to thank you so much for sharing your experience and knowledge and passion. It 
definitely shows how laboratories can actually use this same plan to develop their current staff 
and to address the laboratory workforce shortage, and also plan for future public health threats 
through cross-training. So thank you so much, and I look forward to seeing you again. 
Absolutely. Thank you so much for the opportunity. It was an absolute pleasure and 
honor. And, again, thank you for your patience.
You're welcome. Back to you, Blanche.