One size doesn’t fit all

Mike Clayton considers how the current systems and processes in the clinical laboratory aren’t necessarily up to the task of helping to meet demands and explores ways of working to create a successful pathology service

Pathology services in the UK perform an essential role within the ever-changing NHS and demands on the service are increasing, with higher workloads, more rapid turnaround of results needed and limited or reduced budgets. This is a classic example of a need to do more with less. With an ageing population, levels of chronic disease rising, and ever-increasing patient expectations, there will be no respite in this strain on laboratories and hospitals.Between 60-70% of all critical clinical decisions are influenced by diagnostic tests,¹ with today’s laboratories performing over 900 million tests each year in the UK alone². Laboratory services within the UK feel this burden. Increasing workloads, and the need for rapid turnaround of test results, are well documented. With this in mind, Lord Carter, chairman of the review panel examining the future of NHS pathology, advised in his 2016 report that more could be done to improve quality and efficiency in the NHS, including laboratory services³. Targets were imposed on Trusts to ensure a consistent approach to the quality and cost of diagnostic services across the NHS by April 2017³.

Lord Carter noted that unwarranted variations exist in diagnostics within the NHS, and laboratory services need to be able to measure and document their current operating activity in order to assess factors such as resourcing, staffing and relevant costs. To be considered cost effective, the cost of pathology to a trust should be less than 1.6% of the total operating expenditure, but, at the time, data gathered suggested that there was a two-fold variation in this cost – from 1.1% to 2.4%³.

Accurate benchmarking of laboratory services will inform key decisions that will shape and reform them, improve efficiency and advance patient care

This has instilled a sense of urgency across all Trusts, and pressure exists to assess current laboratory services in order to drive future efficiencies and ensure clinical needs are met within available budgets. Accurate benchmarking of laboratory services will inform key decisions that will shape and reform them, improve efficiency and advance patient care. In order to do this, there is a growing need for laboratories to use measurement to assess their operational productivity, and therefore to ensure the future of the pathology service. Strategies to do this can vary from inventory control, minimising instrument downtime, and developing a service that identifies patterns of requesting and optimising throughput, all in order to ensure there are no periods in the day when rapid and comprehensive laboratory services are unavailable.

[caption id="attachment_61156" align="alignnone" width="620"] More than 900 million diagnostic tests are carried out annually in the UK.[/caption]

 

Increasing pressures, limited resources

While there is a need to measure and benchmark services, laboratories are facing additional challenges that both hinder and delay the process for increased efficiency. One such issue is space. Laboratory professionals are operating in smaller spaces, and despite the increased demand, the provision of space allotted to laboratories is not increasing. Pathology services continue to run an increased number of tests in a reduced area, using equipment that was not designed for such volumes. This alone creates issues associated with inefficient automation, increased burden on staff, and as a result, many laboratories face problems with operational capacity.

Pathology departments will often layer on more technical levels of automation to cope with increased pressures, which introduces a greater degree of complexity. This results in inefficiencies in operational productivity and ultimately means that the service is not being enhanced in the way it should.

With restricted budgets, laboratories are experiencing a shortage of skilled labour, and so the problem becomes exacerbated, unless all grades of staff are able to operate the automation

In order to solve issues related to automation, laboratories need staff who are trained and able to operate all of the laboratory equipment, which subsequently must be simple to use. With restricted budgets, laboratories are experiencing a shortage of skilled labour, and so the problem becomes exacerbated, unless all grades of staff are able to operate the automation. The staff is a vital, precious resource in the laboratory and there is a need to optimise their effectiveness and reduce the burden experienced to help them cope with the increasing workload, complexity of tests and the need to rapidly provide test results. However, in recent years, there has been a shift from a perception of the pathology service as a supporting service, just providing results, to an increased understanding of the impact that the service can have on clinical decisions. The question is how can you build and shape a flexible solution using the right people at the right time? How do you do more with less and adapt within an evolving healthcare system?

Shaping the future

Lord Carter’s report explored consolidation and the different ways of responding to these issues, with a stronger and more attuned focus on cost effectiveness and the rationalisation of pathology services. These services are acutely aware of the established goals and are striving to meet them. Those that have been able to reshape their service and meet these objectives have thought strategically and broadly across the entire patient care pathway: from first visit, to diagnosis, to subsequent treatment and follow-up.

Pathology services that are actively considering the bigger picture, and mapping out the end to end process will have no doubt re-shaped their entire service

Laboratories that are open-minded to strategic change and comfortable with driving it are the ones that will respond well to the challenges faced. They will be better equipped to ensure pathology is more relevant, with the patient care pathway positioned at the centre. Pathology services that are actively considering the bigger picture, and mapping out the end to end process will have no doubt re-shaped their entire service. In doing so, they can potentially deliver value and realise improved patient outcomes, which is the ultimate goal. Measurement and automation can in many ways help pathology services address modern pressures, but how does this work in practice? From measuring inventory, to avoiding instrument downtime, to optimising throughput in order to standardise clinical care, it depends on the needs of the individual laboratory and the level at which a service is working. A total solution, both automated and simplified, should address the constraints healthcare providers face such as higher testing volumes, lack of staffing and space, and complex, time intensive processes.

It should support the end to end patient care pathway and enable the laboratory to deliver high value, while ultimately influencing healthcare performance explains Dr Catherine Bailey, FRCPath, Consultant Clinical Biochemist, Head of Blood Sciences Department, Aneurin Bevan Health Board. “It’s more about understanding the specific challenges facing the pathology service within a hospital institution or area, and building an appropriate solution that contains the right level of automation, and the right amount of staff shaping and professional services to be able to best influence the patient outcome within that environment,” she says.

More with less

The laboratory should consider innovative ways to work together with clinicians and hospital managers. Another trend we are witnessing is laboratories working together more than ever before. There are many different aspects of implementing new technology, but success ultimately comes from understanding how you can apply the right solution to the challenge that is faced by your hospital, primary care network and clinicians. The pathology services leader is very much seen as a crucial linchpin within the hospital environment – their role has evolved and the new NHS is driving that.

Looking solely at a technological solution is not the answer, as this won’t necessarily revolutionise the end to end process and positively impact the patient outcome. However, if streamlined, easier to learn technology is utilised that is more intuitive for staff across disciplines, it will allow efficiencies and all grades of staff to be able to contribute to success. For example, the same team might be able to work a chemistry system, immunology system and also operate a haematology service. New technologies can certainly help achieve a level of efficiency, which then improves the overall operational productivity and assists with staffing challenges that are ever present.

Dr Bailey again: “We need to recognise that we are living in a cost-constrained world and take into consideration the current climate. Laboratories are looking to do more with less whilst maximising productivity and flexibility.” Laboratories work better when there are simple to use, effective and efficient solutions designed to meet the needs of the laboratory rather than just “more” technology and more equipment. The whole approach should be assessed, from how staff are aligned, to how the entire process is measured and how it is streamlined from start to finish. Efficiency is maximised by introducing solutions that have a smaller footprint, which can be managed from an analyser perspective across the whole process by as many grades of staff as possible. Flexible solutions are necessary in order to provide a responsive and efficient service.

Pathology services essentially need to maximise the productivity of their workforce, and they need intelligent systems that really shape how they operate in a more effective and productive way. Most importantly, if information from the various elements of analysis can be turned into true insights that can strengthen the role of the pathology service it will undoubtedly lead to greater operational productivity.

Ensuring that effective patient results are delivered in a timely manner will enable the clinician to make the right decision, and this will inevitably result in positive outcomes for patients.

Author: Mike Clayton is Managing Director for Abbott Diagnostics Northern Europe

References: 1. Forsman, RW. Why is the laboratory an afterthought for managed care organizations? Clinical Chemistry. 1996; 45(5): 813-16. 2. Pathology Facts and Figures. The Royal College of Pathology Facts and Figures. https://www.rcpath.org/discover-pathology/news/fact-sheets/pathology-facts-and-figures-.html. Accessed April 25, 2017. 3. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. An independent report for the Department of Health by Lord Carter of Coles. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf Accessed April 25, 2017.