Committed to Improvement, Committed to Change

You’re the head of one of the biggest pathology departments in the UK. What are the major challenges?

Dealing with an increasing workload without a matching increase in staffing, while maintaining quality, is a constant problem. Although we’ve improved productivity significantly, it’s getting close to breaking point now.

We’re running at nearly full capacity, so if anything goes wrong, we don’t have the wiggle room we used to, and with a large department, there is always at least one person absent, for one reason or another. The options of outsourcing specimens or using locums both have significant disadvantages.

I keep banging on about the fact that clinical appointments need to have proper consideration of laboratory impact. We need to get the message across that we can’t provide an ever-improving and -increasing service if they don’t put something into it.

Is anything being done to deal with mounting pressures?

I think that the central planning of training has been about as successful as central planning was in the former Eastern Europe! As well as insufficient numbers, the recent low national pass rate of the Part 2 FRCPath was creating a backlog of trainees that weren’t able to become consultants – I’m very glad to see that improving. However, the numbers are not keeping pace with growth in demand, so we need to find other, more imaginative solutions to the staffing problem. One important thing we’ve done in Newcastle is to embrace the roles of biomedical scientists and advanced practitioners: as well as performing something like 80 percent of our cut-up, we have several enrolled in the BMS reporting pilot. It’s good to have pathology consultants focus on what only they can do, and let other people do the rest.

Has digital pathology technology made it into your service?

We’re actively looking at it. I feel it’s reached a sufficient level of maturity to be usable, and there are clearly reduced costs for slide storage, delivery and retrieval, as well as potential productivity advantages – networking across a region being a key one, which we’re currently trialling at the moment. I also like the patient safety aspect: we have an excellent specimen tracking system that minimizes errors in the laboratory – but when cases land on my desk, there’s nothing to stop me picking up the wrong slide! Anything to reduce the likelihood of such errors is very attractive.

How do you improve efficiency now and going forward?

I believe that our lab is one of the best in the country in terms of efficiency; we’ve really embraced Lean processes and created a culture of service improvement – Dave Evans, Laboratory Manager, and Terry Coaker, Histology Operations Manager, provide superb leadership in this area. There’s constant monitoring of different aspects of work of the department; when we notice something going wrong, we promptly investigate and address the problem. It’s now the way we work.

Weekly “huddle” meetings with the consultant staff have proved useful; short, frequent, informal meetings improve communication and enable quicker decision-making. It also helps specialists realize that their problems are not unique when they see the stresses across the whole department.

Two things have priority for me in the future: 1) better integration with genetics – I’d like to see pathologists at the hub of tissue diagnosis using all the relevant modalities; and 2) to re-establish better links with research – molecular diagnosis is an excellent starting point, because that’s where a lot of translational research happens. My ultimate vision is of an institute with cellular pathology, research and genetics in one building, which has proved so successful elsewhere. If the pathology market is opened up to competition, it’s difficult for a teaching hospital to compete on the straightforward stuff – but we can do advanced diagnostics that other places can’t, and I think that’s where we should position ourselves.

What’s rewarding about your role?

I enjoy successful service improvement projects – when something tedious becomes trivial, or when you cut through the Gordian knot of something problematic with a simple, elegant solution. It’s great when people start coming up with ideas themselves, overcoming the classic mantra of “I’m too busy to think about why I’m too busy.” I’m very pleased that, as a department, we have relatively unqualified people coming in and being recognized and nurtured – that’s great. You need to have a culture that recognizes the potential in everyone, regardless of position. I’ve also learnt that service improvement works best when you listen to as many people as possible.

What’s the secret of running a successful high-volume pathology department?

I wish I knew! It often feels like you’re just limping from one crisis to another – you think, “Well, it didn’t all fall apart, so that’s good.” Like other departments, I’m constantly amazed how much we have managed to achieve with significant, sustained problems in staffing, but I’m also aware that we can’t carry on like this indefinitely.

Most of the good things we’ve done have been because of a commitment to service improvement. For example, a significant reduction in turnaround time was achieved simply by articulating the goal and making everyone aware of it.

The four main things that keep me going are: 1) a sense of humour; 2) a thick skin; 3) constitutional optimism; and 4) a tolerant wife! Not necessarily in that order...