To increase revenue potential, efficiencies must be taken beyond the lab and into other departments
In the age of healthcare integration, IT implementation and the changing reimbursement landscape, laboratory workflow improvements should not be limited to the success of the laboratory alone and must extend to other departments to leverage the opportunity for improvements in the entire hospital organization. Improvements cannot be fully fruitful without the inclusion of IT systems to drive efficiency in decision making and information management to the next level. Quality and efficiency metrics, more than ever before, are critical to managing clinical practice, patient outcomes and maximizing reimbursement realization.
At Family Practice Center in Middleberg, Pennsylvania – an all-purpose laboratory serving 27 physician sites across central Pennsylvania – we approached an increase in lab volume with an open perspective and as an opportunity to establish workflow improvements using these five steps.
1Break Down Siloes: A shortsighted perspective of laboratory workflow — unfortunately held by many laboratories — is limited to what happens from the time samples are received in the laboratory to when the results are released to the physician. In reality, the clock starts ticking the moment the physician informs the patient that certain tests are needed. The expectation for results, then, is initiated at that physician-patient conversation.
Quite often though, the laboratory does not see the samples until 30, 60 or even 90 minutes after this initial order takes place. Improving laboratory workflow really begins then with patient care coordination between the prescribing physician, floor nursing, phlebotomy teams and the laboratory staff. Removing barriers between hospital departments and the laboratory breaks down the siloes that prevent continuous flow of work and delivery of quality, timely, clinically relevant information.
Establishing proper communication channels and alignment across departments and the laboratory is critical to achieving the level of patient care coordination that current competitive and reimbursement guidelines demand. Breaking down siloes between clinical departments and the laboratory is only the first step toward making workflow improvements and reaping benefits such as cost-containment, revenue generation and increases in the institution’s capacity to treat patients.
2Standardizing Practices: Standardizing laboratory practices in parallel with the practices of the rest of the hospital can reduce errors as well as the time and cost associated with managing variability.
We used Family Practice Center lab’s volume increase as an opportunity to employ standardized practices with outside departments when managing specimen deliveries. We joined forces with our outpatient clinics, which now have the ability to utilize unique barcode labels that are recognized by all of our laboratory analyzers. The specimens are analyzer-ready the moment they reach the laboratory. Standardizing work promotes easier and faster training; reductions in injuries and strain; the ability to sustain previously established process improvement; and provides a baseline for additional improvement activities.
Due to our ability to accession specimens into the lab so quickly, we can now stagger our courier drop-offs, as a large percent of our work comes from outside. Aiding the workflow process in the lab, we have instituted front-end automation which has further improved the process. Now, we upload all patient orders from the offices’ EMR directly into the LIS with just a few keystrokes. And by implementing autovalidation, lab techs can focus on the samples that need special attention, as opposed to every sample requiring them to release the result.
3Standardizing and Automating Complex Decision Making: By automating and standardizing the decision-making process through implementation of clinical laboratory information systems, the lab can decrease the margin of human error and increase the quality of results. New clinical information systems and state-of-the-art technology have allowed constant monitoring of analyzer functions by alerting the tech the second any aspect of testing could be compromised, simplifying complex decision making to streamline laboratory workflow and the results management process. Data management systems help determine the cost of errors caused by inefficient work practices and aim to minimize opportunities for loss of reimbursement. By tracking both the work and the outcomes, the lab can begin to see a decrease in work duplication, erroneous clinical decisions and inefficient use of resources.
At Family Practice Center, being interfaced with our out-patient clinics has increased visibility and room for improvement, easily allowing for comments and instructions to come directly into our LIS so that in a perfect world they are never missed. These open IT offerings integrate laboratories across the organization through interoperability and third party connectivity.
Seamless integration and flexibility of modern IT solutions can help drive future demands and growth opportunities. By standardizing decision rules across the organization, the entire institution gains peace of mind in results reporting and can benefit from advances in the technology -ultimately driving improvements to productivity and quality.
4Automating Processes to Increase Human Capital Utilization: Economic challenges and staff shortages in the laboratory industry leave little room for underutilization of talented staff. By implementing automated instrumentation and information systems that can take over ordering, accessioning and other pre- and post-analytical testing tasks and data entry, laboratory personnel are freed to direct their focus on higher value tasks — enabling the lab to do more with the resources they have.
The lab at Family Practice Center lab has been very successful in utilizing non-technical staff to manage most of the pre- and post-analytical aspects of the laboratory, which allows our technical staff to remain focused on the analytical part for which they are trained and educated. Automation has also improved workflow standardization, providing a consistent volume of work to each bench. Our lab techs are now able to clearly see when the best time is to perform maintenance procedures and the extras — such as linearity studies and other quality assurance studies — based on the volume of specimens that are currently on their pending lists and the future specimens that have orders in the system.
5Understanding the Value of Dashboarding: Dr. H. James Harrison, a pioneer in Lean ideologies is often quoted, “If you can’t measure it, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.” This is especially true in the complex world of the clinical laboratory where hundreds of different tests arrive from different locations every day. Unfortunately, performance metrics in the laboratory, beyond turnaround times, are uncommon primarily because data is difficult to gather. Investing in software solutions that provide easy access to this critical performance data and an intuitive reporting format is the first step in understanding and improving processes. Implementing a dashboarding system to track performance on a regular basis can prove to be critical in identifying opportunities for process improvement that result in cost containment.
While there are many ways to improve workflow in the clinical laboratory, through these five steps transforming the lab from a cost center to a revenue center is possible and not limited to the lab alone. To increase the lab’s revenue potential, efficiencies must be taken beyond the lab and into other departments to ultimately reduce costs, enable revenue generation and provide a competitive advantage.