Patients' expectations of healthcare are rising. An endless evolution of social and digital media is driving greater awareness than ever before of new technology and treatment options now available.
The possibilities for patient engagement is unprecedented, but clinicians and healthcare workers are now faced with new service delivery demands from an increasingly complex landscape of rising co-morbidities and better informed customers.
Laboratories certainly feel resulting pressures. Healthcare growth areas ranging from genetic profiling, through to new techniques in screening for diseases and monitoring chronic conditions, almost invariably depend on laboratory testing.
Laboratories are also challenged by the number of stakeholders they deal with. These may include healthcare workers, institutions, environmental agencies and, increasingly, patients accessing their own results as part of personalised medicine.
To meet the shifting demand in work type and service, laboratories have had to adapt and become more efficient. At the same time funding models have changed to emphasise patient benefit and better outcomes over traditional models of cost. There is a new need for operational efficiency that must be met despite challenges that may include shrinking budgets, escalating input costs and pressure on existing resources.
Managing a laboratory has become extremely complex. Sophisticated information systems are now needed to support the logistics, measurement and planning involved to avoid overburdening staff with manual processes.
Lab consolidation is not the only way to cut costs
Healthcare systems across the world are pursuing consolidation strategies to improve efficiency. In the UK, the February 2016 Carter Report confirmed that consolidated pathology services first recommended in a 2008 review, were now the most efficient pathology organisations anywhere in the English National Health Service. New technologies and larger scale operations have resulted in a significant cost reduction.
Beyond consolidation, even greater efficiency gains are possible with an ongoing improvement program. Transforming laboratories into an agile and responsive pathology service capable of continuous improvement, however, requires new generation software that captures and delivers real-time information in a manner that supports evidence-based decision making.
Healthcare has generally been slow to adopt the techniques that improve quality and safety in other industries. Many claim that medicine is too different and too complicated - that advances in other industries are not applicable to the care of patients. Others argue that the prevalence of medical errors and a lack of processes - often only exposed by litigation - mandate that changes be made.
Lean principles can revitalise lab services
Recently, there has been a surge in the number of healthcare initiatives utilising lean principles which centre on continuous improvement and respect for people. These aim to address service and quality issues while containing healthcare costs that have been spiralling upwards at levels above inflation in almost every country.
Some laboratories have adopted lean principles in response to increased demand. Lean, originally developed in car manufacturing, is a systematic approach to process improvement. It focuses on reduction of variations and elimination of waste, aiming to balance the process or workflow. In the laboratory, focusing on lean principles create an opportunity to revitalize process, sharpen workflows and improve service delivery.
Lean adoption brings its own challenges. Significant change faces inevitable resistance, as people fear losing their jobs or not coping with new requirements, and can be difficult to manage. Challenging preconceived and embedded beliefs about lab work requires uncomfortable critical thinking about the actual value to the customer of many routine or historically accepted tasks.
Determining the real value of each action allows you to develop the most suitable protocols to achieve the desired outcomes. You can design a process from end to end to optimise each step, taking advantage of automated platforms and parallel tracks to enable sorting and workload allocation. Standardising processes reduces variation in outcomes and allows comparison and benchmarking across sites to continually improve efficiency.
Overcoming resistance with evidence
Lean initiatives can only overcome resistance to change and go on to deliver continuous improvement, however, with evidence that they work. This is now practical with modern information systems. Laboratories can monitor compliance with procedure and process, and capture and analyse data to produce useful information and provide the knowledge required to make better decisions.
When improvements in turnaround times, costs and the quality of test results are all captured, then enhanced operational performance can actually be proven. Better quality of results also improves safety for patients and employees. The reduction of errors and faulty results leads to less re-testing, reduced costs and lower wastage of reagents and manpower.
Quantifying waste reduction associated with lean processes and gauging the impact, however, requires measurement of individual performance indicators and cost drivers. All of this is necessary to prove to management and funders that the laboratory is more efficient and effective.
Management dashboards that monitor real-time data relevant to the laboratory's function and performance, and which are flexible enough to enable better planning, also support more agile responses to changing circumstances.
Quantifying the actual cost, both fixed and variable, to perform tests enables better utilisation of resources and available budget. Managing stock for just in time ordering and reducing reagent costs contribute to lower overheads. Software that captures and reveals each cost supports day-to-day management of processes and facilitates planning and budgeting. Understanding the volume of tests and expected demand allows logistic planning and staff management.
Moving beyond LIMS
Most laboratory information management systems (LIMS) today do not have these capabilities. Demands to measure and understand performance are necessitating a new breed of system, which has been labelled a laboratory business management system (LBMS).
Following standardisation of existing processes laboratories can reduce development times for new tests and streamline their implementation process. The laboratory can quickly increase its repertoire of tests to remain competitive with the least disruption to the existing service. An LBMS that provides full traceability and audit capabilities is now increasingly needed to enable compliance with onerous accreditation processes that may otherwise require days of preparation and assessment.
Ultimately, pathology is often seen as a driver of medical cost that in many parts of the world continues to receive a shrinking slice of healthcare budgets. There is an understandable fear that new technologies and tests - including personal genetic testing, other molecular testing and an expanding repertoire of diagnostic molecules - could escalate costs.
Any service improvement must consequently be evaluated against a clinical outcome that is measureable and quantifiable for the patient. This requires easy integration of laboratory results with the electronic patient record to support clinical decision making and minimize over ordering of tests.
In this environment, driving continuous improvement is a prerequisite for laboratory survival, as is the need for underpinning information analysis that supports the management of the laboratory and empowers staff to contribute to sustainable service provision.
About the author
Dr Gene Elliott MBChB, FC Path (micro), M Med (micro), MBA, is a Johannesburg-based Physician Executive for InterSystems.
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