Gearing Up for Change

Laboratories are under greater pressure than ever before to increase efficiency, but the challenges they face are also unprecedented. Reduced funding, altered payment models, escalating costs – all of these obstacles (and more) stand in the way of patient care, placing a significant burden on lab infrastructure and resources. But institutional hurdles aren’t the only ones to overcome. The social and digital media explosion means that patients themselves are more aware of emerging trends and services, with everything from health apps to self-testing becoming increasingly commonplace. What does that mean for us? Today, we have to meet the demands of better-informed customers – with greater expectations around personalized care –  who also present the challenge of complex conditions and multiple co-morbidities with ever greater frequency.

The concern that laboratories may not be able to cope with demand is growing. In the United Kingdom, for example, pathology pressures are now the subject of national newspaper headlines. One major cancer charity recently warned that laboratories are at tipping point; that soon, they may not be able to test the volume of samples they’re expected to receive. Will that create knock-on delays in cancer care? Many people fear so, and unless our resources increase at the same rate as our workload, they may be right.

Patients aren’t the only reason demand is increasing. New healthcare growth areas – genomic medicine, new techniques in disease screening and monitoring of chronic conditions, point-of-care testing, and more – are asking more than ever of the 21st-century pathologist, and I anticipate that the situation can only escalate. At the same time, though, skilled human resources are dwindling, not only because of budgetary constraints, but also because of the recruitment challenges pathology faces worldwide.

The urgency to modernize

Despite many years of calls to consolidate pathology services for increased efficiency, laboratories around the world still operate in much the same way as they always have. But now, the rising tide of pressures has created renewed urgency to modernize – starting with the acquisition of the tools and systems we need to make changes happen. Why are laboratories so slow to adapt to diagnostic and technological advances? And with change management skills a rare resource in public pathology services, what can we do to make sure labs are keeping up?

The first step is to make sure we know what our goals are. Laboratories need to maximize their existing resources, improve turnaround times of results and reporting, and reduce the costs of testing. These may seem like fairly obvious targets, but attaining them demands a detailed understanding of workflows and procedures; we need to understand and tackle our own cost drivers and efficiency gaps. Current inadequacies in workflow visibility – often the cause of bottlenecks and delays in reporting and analysis – must be addressed if we want to shift our business objectives and allocate the right resources to speed up service.

One key skill we’ll need to acquire is the ability to detect low-value tests, so that we can limit the number we perform. To get there, we need to give labs the power to ensure that patients receive the most appropriate testing right from the start. There is an urgent need for clinical context in the laboratory to help evaluate the appropriateness of tests, as well as for clinicians to have decision support so that they can avoid requesting inappropriate tests in the first place. Getting such services in place at the very beginning of the testing process should reduce pressure down the line. Clearly, the laboratory needs to step out of the “back office” and create a more clinically engaged service – one where pathologists and clinicians collaborate to decide which patients need which tests.

The transformation process

The whirlwind of factors, each requiring a tailored response, has made managing a laboratory extremely complex. As a result, legacy laboratory information systems (LIS) are no longer able to keep pace – to be effective in the modern lab environment, they must be able to support the logistics, measurement, planning and analytics we need to relieve staff burden, prevent bottlenecks, and provide business intelligence to support further transformation and consolidation.

Recently, we’ve seen a surge in the number of healthcare initiatives drawing on lean principles – including in the laboratory, where they’re being adopted in response to increased demand. Why are lean strategies so important? They aim to reduce variations, eliminate waste, streamline workflow, and provide the means to improve service delivery – all vital characteristics for the “new generation” of pathology service provision. But as with any major change, adopting a lean approach invariably comes with organizational resistance, fears of job loss as efficiency increases, and the cultural challenge of moving away from long-held beliefs about how services should be delivered. For these kinds of changes to be accepted by pathologists on the ground, labs need to provide evidence of success – something legacy systems have not been able to do.

Beyond the LIS

A new breed of information system is emerging that will allow laboratories to evaluate the success of transformation initiatives, monitor compliance, and capture and analyze data to improve decisions for both patient testing and long-term strategic planning. If laboratories can measure improvements in turnaround times, costs, and the quality of test results, they can demonstrate the increase in operational efficiency to stakeholders and create a service thoughtfully designed to improve healthcare.

To that end, pioneering service providers are now starting to use laboratory business management systems (LBMS) to help them measure performance and gain an understanding of the costs, patient requirements and workflow needed to cope with unprecedented healthcare pressures.

(For an example of these systems, see Figure 1.) I expect that, as the advantages of this entirely new generation of IT platforms become better-known, labs around the world will begin using them to support laboratory processes and to track the data they need to manage their work effectively – and to implement evidence-based transformation initiatives.

Why do we need such business-oriented laboratory technology? Modern service-level agreements demand improvement and require governance to monitor that improvement. LBMS platforms can capture and analyze the necessary data to show compliance (see Figure 2). They help the laboratory to transform from a reactive testing service into a far more proactive part of the healthcare environment.

Diminishing resources, growing costs

In many parts of the world, pathology is receiving smaller and smaller slices of the healthcare budget. At the same time, costs – fueled by intensifying workloads and increasingly varied and expensive diagnostics – continue to rise. To respond, we need to start making changes to our services, and evaluating those changes against efficiency improvements and measurable clinical outcomes. I’d like to see laboratory results integrated into electronic patient records and used to inform clinical decision-making; in my opinion, that would go a long way toward minimizing unnecessary testing, targeting interventions, and optimizing overall patient care.

I don’t think it’s an exaggeration to say that the need for change is urgent. But that doesn’t mean we should rush full steam ahead into those changes; we need to harness the right information and provide the right results to ensure that we’re making the right changes to the right services at the right times.

Emerging laboratory business models can help with that – but only if pathologists are ready to step up to the plate. What can we do right now to help facilitate improvements in patient care? Be open to new information; be ready to adopt new technologies; and, most importantly, don’t be afraid to participate in the process of choosing and implementing change. It’s our willingness to get involved that puts the best possible patient care within our grasp.