Monday, February 07, 2022

By Irwin Z. Rothenberg, MBA, MS, CLS(ASCP), Technical Writer /Quality Advisor, COLA Resources, Inc.

Introduction

The 21st century challenge is to redesign healthcare systems to be safe, efficient, effective, timely, equitable and patient-centered. Laboratory medicine is integral to many of these objectives, involving disease prevention, diagnosis, treatment, and management. 

As a result, the laboratory profession continues to undergo rapid change.  Not only is there an impact through advances in technology, with new tests and test methodologies, new modes of communication, and new capacities for storage, retrieval and analysis and dissemination of  data, but through emerging socio-political trends resulting in changes to the very structure of organized medicine, and how medical care is delivered. These include major legislation such as the Affordable Care Act which encourages shifts from private practice to integrated healthcare networks; and the development of new models of healthcare delivery such as Accountable Care Organizations, which mandate value-based compensation models.   These changes, whether on a macro institutional level, or micro departmental level, impact our laboratories.  Millions more insured will lead to significantly increased demand for laboratory services at the same time that baby boomer staff (who have been the backbone of laboratory staffing since the 1960’s) are retiring in large numbers, but with fewer schools training replacements.  Exacerbating this is the continuing growth of tests available (currently at least 3500 tests), new specialties, new global health issues (i.e. Opiod epidemic), accelerating the increase in workload.

Challenges and Changes Forecast for the Laboratory Profession

The two main forces directly affecting laboratory operations are rapid technological advances (e.g. total laboratory automation, molecular diagnostics techniques, digital technology; point-of-care and remote testing, etc.) and resultant  increased economic pressures, with the need to align to increasingly limited budgets[i]

One major outcome of the introduction and growth of digital technology, in particular,is the huge increase in the generation and utilization of data, both for immediate patient care needs as well as population health management and trend analysis. This has resulted in the laboratory becoming “information central” within the greater healthcare environment, touching almost every point of healthcare delivery.  Under these circumstances it is easy to recognize that laboratory medicine has a pivotal role, increasingly integral to many clinical decisions on disease prevention, diagnosis, treatment and management. The overall challenge for the laboratory profession is to adapt to these rapid changes, while maintaining quality service.

A summary of these challenges include[ii]:

• Increased scope of services offered, requiring changes in laboratory organization and communication, including workflow, scheduling, reporting policies, data transmission and storage; expanded relationships with other healthcare providers; integrated roles for information technologists; and increased direct interaction with the public.
• New roles and responsibilities of the laboratory due to changes in healthcare delivery through integrated network organizations —Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), integrating the laboratory as a part of team-based care
• The need for updating policies and procedures to reflect this new paradigm of increased scopes of practice and involvement
• New personnel requirements, recruitment and training to ensure a competent workforce to meet these challenges.
• Adjusting to the new age of patient empowerment: patient initiated testing; and test results reported and interpreted directly to patients.
• Keeping up with the changing political and regulatory climate
• Changing population demographics and the need for interventions for specific subsets of the population; use of big data influencing government resource allocation.

Dealing with all these changes can be stressful for laboratory professionals. The clinical laboratory industry is already embracing networking, consolidation, integration, outsourcing, and creating additional value by providing knowledge services related to in vitro diagnostics. Clinical laboratory services are also increasingly defined by their value provided for patient outcomes[iii].  Already, there is evidence that ongoing technological developments have considerably improved the productivity of clinical laboratories.

The next thirty years comprise a perfect storm scenario for laboratory medicine in terms of meeting professional staffing needs to meet these challenges[iv]:

• Millions more people will be insured and able to access the healthcare system far more comprehensively than ever before, including laboratory services
• Millions of baby boomers adding to the post-65 year old demographic, requiring more frequent and intensive healthcare, including laboratory services
• Significant numbers of boomer clinical laboratory professionals are part of this retirement tidal wave, contributing to the shortage of available staff
• The continued rapid development of advanced technology such as molecular genetics. requiring ever more sophisticated instruments and advanced training by staff
• Increased competition from other healthcare professions that are able to promise and deliver on better working conditions, higher compensation, and greater recognition.
• Lack of adequate funding for enough schools and graduation capacity to provide the needed numbers of laboratory professionals.

Resilient Leadership

As a result, these times call for leadership that is more adaptive and agile than ever before, i.e. resilient leadership. This is leadership that understands change, and can adapt through creating an organizational culture of resilience; going beyond continuous quality improvement to embrace change on an institutional as well as departmental level, enabling their laboratory operation to not only survive but prosper and grow.

Resilient Laboratories

These are laboratories that are able to respond effectively, and adapt to all kinds of changes in operation, internal and external demands, and expectations, through effective planning and resource allocation, thus allowing the continuation of normal services without compromising quality. Gaps in the continuity of healthcare threaten a patient’s well-being and introduce the potential for adverse events. Whether, or how, a system responds to fill such gaps in care continuity indicates its resilience[v]. Adaptations include new clinician initiatives, adaptive instrumentation, flexible staffing patterns, continuous quality improvement practices, and institutional networking leading to improvements in performance and service.  These approaches make up the resilience that is built into the system to help accommodate demands for care.  Resilience provides the means for organizations to target resource investments by integrating safety and productivity concerns. Quality work processes are not static properties of an organization, embracing resilience reflects a dynamic effort to maintain quality.

A culture of resilience[vi]

A culture of resilience recognizes the value of the laboratory staff, the stresses that they may be experiencing, the training that is needed, and the need to be supportive and understanding.  It goes beyond a culture of continuous quality improvement to include trust, teamwork, tolerance, and a global perspective that more  change is inevitable.  The properties necessary for resilient organizations include:

Top Management commitment: to recognize performance concerns and addresses them with continuous and extensive follow-through based on applying competency improvement processes utilizing coaching and management observation.

Key management strategies include: providing staff with key information about future plans for the development of the laboratory, and involving the staff when possible; and determining how to implement these changes through adjustments to job assignments; staffing levels; policies and procedures; management of timelines and budgets.

The characteristics of a resilient laboratory include support for:

An open and fair culture :  the reporting of issues, problems, events, and errors throughout the organization is supported and encouraged, but culpable behaviors are not tolerated.

A Learning culture: Wherein issues, problems, events, and errors are handled with an eye toward cofrrection, and solution, not denial;  but not a “blame game” attitude either

Realism: Management is aware of any potential for serious problems and events due to weaknesses inherent in their operation, and continuously monitor these.

Awareness: Management collects ongoing data to gather insight into quality of performance, problems, and the state of safety defenses.  Utilizes the staff for feedback and innovative ideas.

Flexibility: New or complex problems are handled in a way that maximizes the ability to solve the problem without disrupting overall work. 

Transparency: Management keeps staff informed of all happenings, both good and bad.  This can open up new avenues of discussion, problem-solving, and team-building.

Resilience relies on constant feedback from the staff regarding the effectiveness of the changes made by management.   Additional steps that enhance the ability of the laboratory to successfully adapt to these challenges include[vii]:

1. Encouraging two-way communication
2. Recognize and reward achievement.  
3. Help employees succeed. Provide employees with the resources and support to do their work, and as they show signs of readiness, be willing to entrust them with new tasks and greater responsibility.
4. Provide continuing education. This should include a formal orientation program, cross-functional training, maintenance of professional skills, coaching, career development, and personal development.

Out of this develops a resilient innovative workforce, one that is capable of adaptively learning to correct errors and to take advantage of new opportunities (e.g., digital technology; remote testing; ACOs), to improve quality of service.

The end result is the leveling of silos, enhancing communication, creating a workforce that is not hesitant to innovate and adapt to change; feels appreciated and experiences less stress when change is needed.

Irwin Z. Rothenberg is a Technical Writer/Quality Advisor for COLA’s Educational subsidiary, COLA Resources, Inc. (CRI), a leader in online continuing education for physicians, laboratory personnel, and allied health professionals.  CRI offers continuing education through online courses, informational products in both electronic and hard copy form, webinars on cutting-edge technology and regulatory issues, and CRI on-site Symposia for Clinical Laboratories, providing live educational sessions and interactive workshops with leading industry organizations. For more information, visit their website at www.criedu.org or call 1-800-981-9883.

[i] Laboratory Medicine in the New Healthcare Environment. Ferraro, S., Braga, F. and Panteghini, M. De Gruyter.

 Oct.14, 2015.   https://www.degruyter.com/view/j/cclm.2016.54.issue-4/cclm-2015-0803/cclm-2015-0803.xml

[ii] Ibid.

[iii] Laboratory Medicine: Challenges and Opportunities. Bossuyt, X., Verweire, K. and Blanckaert, N.  Clinical Chemistry.  Sept. 2007.  http://clinchem.aaccjnls.org/content/53/10/1730

[iv] Building a Laboratory Workforce to Meet the Future: ASCP Task Force on the Laboratory Professionals Workforce. Garcia, E., Schulze, M., Bailey, M., Doyle, K., Finn, W., Glenn, D. Holladay, E.B.,  Jacobs, J., Kroft, S., et.al. Jan.2014. https://academic.oup.com/ajcp/article/141/2/154/1760592

[v] Minding the Gaps: Creating Resilience in Healthcare. Nemeth, C., Wears, R., Woods, D., Hollnagel, E. and Cook, R.  Semantic Scholar.  2008. https://pdfs.semanticscholar.org/0e2a/37fbc0762f7b909277c18178902df603f010.pdf?_ga=2.100922756.48796617.1547406901-1451235872.1547406901

[vi] Elder N, McEwen T, Flach J, Gallimore J.  Creating Safety in the Testing Process in Primary Care Offices.   .

http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Elder_18.pdf

[vii] Shenkel, R, Gardner, C. Five Ways to Retain Good Staff.  Fam. Pract. Manag. 2004 Nov-Dec: 11(10) 57-62.