What does the future hold?

Pathology laboratory managers have come together to find out how commercial change will impact the field

More than 250 laboratory managers descended on London in May to take part in Siemens Healthcare Diagnostics’ inaugural Academy meeting, developed to provide an educational agenda on the macro-environmental issues facing pathology today.  Moving beyond the daily conversations pathology has with diagnostic suppliers, it set a lively and informative pace over three days to cover management, quality, budgeting, resource planning and strategy.

There is now no escaping the trend to commercialisation of pathology as set out by the Carter reports and the move to decentralised, closer to the patient care as outlined in the Darzi report.  Laboratories are now focussing on improving the business elements of management and finding more effective ways of working via networks, to assist in positioning in this new environment and to develop new ways to service primary care, secondary care and private industry.

The tone of the meeting provided a forum to learn commercial skills, understand the need for long-term planning, embrace business planning tools and absorb best practice from peers spearheading change. “Equipped with management and wider commercial knowledge, laboratories will be well prepared to develop a vision and strategy from inside, rather than have change forced upon them,” states Luis de Luzuriaga, managing director of Siemens Healthcare Diagnostics.  “The Siemens Academy was developed to help prepare the pathology landscape for consolidation or competition by providing a wide range of speakers, open debate and learning sessions on key topics facing us all today.”

Dr. Ian Fry, director of Partnership Pathology Services in Surrey, presented on the next steps in commercialisation stating: “Change is now unavoidable. To survive and thrive it is time for pathology to look outside the walls of the laboratory. There is a need for pathology to have a commissioner led focus with appropriate regulatory control and transactional processes. The service should be planned, commissioned and delivered as part of an integrated healthcare system.”

Colin Carr, associate director of operations, Investigative Sciences at Cambridge University Hospitals NHS Foundation Trust agreed and called for NHS pathology to accept that change is coming and to get ready for it. “Our experience of bringing in specific business skills to our new cytology service has reduced average local turnaround times from 14 weeks to one week over the last five years - this gives us a clear market leading position to differentiate our services.”

“The focus for Foundation Trusts is to increase efficiency, increase revenue, improve quality, improve patient safety, innovate and invest for quality and excellence.  This will avoid the all too familiar NHS cost cutting spiral where budget problems lead to cost cutting reactions that harm service delivery thus affecting patient confidence.  With patient choice now at the heart of the modern NHS, we have to take a consumer, commercially orientated approach,” Carr stated.

NHS Pathology Plus, a partnership programme that helps leading NHS services to better respond to the evolving commercial marketplace was also launched to delegates.  NHS Pathology Plus defines superior service delivery and long term care management programmes that deliver an enhanced patient experience.  Partnerships are now contracted with Addenbrooke’s in Cambridge and Partnership Pathology Services in Surrey.

David Budd, Head of the NHS Pathology Plus programme, clearly states that this partnership programme is different from what others in the UK environment are doing.  “Our approach is about partnership and leveraging the clinical excellence of NHS Trusts with the commercial expertise of Siemens.  We elevate and enhance NHS service provision, but we leave the Pathology department we work with structurally intact. The staff stay with the NHS, giving the Trust the ability to control their future and strategy. Once you outsource your staff to the private sector, the process of unwinding it in the future is very difficult, if not impossible.”

The ageing pathology workforce has been one catalyst in the adoption of automated analysers, tracking systems and the use of Lean and Six Sigma to refine processes for ultimate efficiency.  Paul Drew, laboratory manager at Aberdeen Royal Infirmary shared his automation experiences with peers during the first day.

Computer assisted microscopy, the automation and digitisation of the microscope, is also emerging as a new imperative in the process of automation and was discussed at length during the haematology managers stream. This technology speeds up the time to final blood film report and addresses quality issues by providing an electronic and auditable trail into LIS. 

End-to-end haematology is a concept that integrates numerical data, graphical information from the analyser and digital images from microscopy.  By doing this it provides a more complete understanding of the patient’s disease state.  It also speeds up the validation process for results and as digital images can be associated with the patient results, a more integrated approach for clinicians is provided to assist the assessment of the patient.

When integrated with IT networks it also enables the results to be viewed far beyond a single institution, offering a solution to resource shortages.  Where skills shortages are acute, the ability to review patient results across sites or even regions, will greatly assist in the speed of diagnosis and ultimately patient care.  A consultant based at one hospital will not need to physically travel to another site to pick up the case and review results.  With IT connectivity to haematology information, the review can happen more quickly resulting in the swift development of treatment plans.

During the management sessions, guest speaker Jan Teahon, head of Pathology Operations and Strategy at King’s College Hospital NHS Foundation Trust presented her experiences of staff utilisation in the Blood Science Laboratory environment. She illustrated how efficiency is gained by looking at the overall process, from phlebotomy to clinical validation of results. The Blood Sciences Laboratory configuration at King’s allows for the recruitment and training of multi disciplinary staff, and an approach that is financially efficient and addresses issues around the recruitment of the traditional workforce. Dr mike bosomworth, consultant clinical biochemist and head of blood sciences at Leeds Teaching Hospitals NHS Trust also shared his views on modernisation of scientific careers in the current climate stating, “The constantly changing environment is an opportunity. If we don’t grasp it, we’ll be kicked back into the evolutionary swamp.”

With the responsibility of Point of Care (POC) often lying firmly at the door of pathology, it means that the end-to-end quality and safety of the entire process needs to be carefully supported.  The topic of connectivity throughout the hospital environment was therefore the focus for the POC managers sessions.

Connectivity of POC instruments enables monitoring of remote devices so that details such as reagent inventory or calibration can be viewed by the POC co-ordinator to remotely trigger any remedial action required. This is faster than waiting for end user reports. Details such as quality assurance and quality control results can also be safely stored and audited for future laboratory inspections.

David Harrison, point of care testing manager, blood sciences at The Royal Liverpool and Broadgreen University Hospitals NHS Trust presented his experiences of using Siemens RAPIDComm to monitor remote analysers from connected workstations, speeding up the response to performance issues and connection to all instruments through a single interface to the laboratory information system. He stated, “Connectivity enhances what you have from an instrument perspective to gain wider efficiencies. The integration of Blood Gas instruments into our data record systems means that patients can be tracked, recording results is much simpler and some common errors can be avoided. It also offers a more versatile delivery of information back at the ward, even at the patient bedside for a higher standard of care.”

Siemens presented solutions for the integration of devices from multiple manufacturers, allowing for the deployment of a comprehensive point of care IT strategy. Ken McCartney from Siemens commented, “Typically instrument manufacturers have IT solutions only for their own products.  From a Trust perspective, no manufacturer has the range of instrument solutions needed for a modern and compliant POC strategy. POCcelerator is a multi-vendor open software platform for information and system management for point of care testing and telemedicine. It allows for the connectivity of over 100 devices from over 20 instrument suppliers, including Siemens, Roche, Abbott, Sysmex, IL, Menarini, and Nova Biomedical.

Other Academy speakers from University Hospitals Bristol NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust and Norfolk and Norwich University NHS Trust also presented best practice examples of how laboratory technology has brought about positive change.

For effective business management and in preparation for future tariff structures, understanding costs is key.  This will drive commercial transparency and provide data to assist with decision making.  By fully understanding current costs and also modelling ‘what if’ scenarios, pathology services can identify the attractiveness of commercial opportunities, where efficiency savings can be gained and avoided, or alter areas where tasks don’t meet efficiency aims.

Activity Based Costing (ABC) tools help define specific test costs by incorporating analytical equipment, staff and overheads. Simply, it quantifies an activity in terms of time, the appropriate utilisation of staff and all associated costs.

Lee Coppin, healthcare solutions manager at Siemens showcased the ABC solution to delegates and highlighted that, “ABC helps customers gain an overview of the business and identify key areas for making cost efficiency changes. It provides lab managers with the information needed to make rapid management decisions and develop new service offerings.”

Beyond technology, IT integration and Lean philosophies, the development of management and leadership skills inside the laboratory is called for to lead pathology into positive change. Key to defining success or failure in the commercial world, but often lacking in the traditional laboratory setting, the importance of ‘the leader’ was cited as a means to set proactive examples and empower the workforce. The resounding message for managers at the Academy was to identify those capable of leadership in the laboratory and give them the support and means to spearhead change. External speaker Larry Siedlick from Sunrise Medical Laboratories in the USA looked at the distinct role of the leader in comparison to a laboratory manager. 

He summarised his motivational speaking session stating: “How many people in the world have a job that supports the healthcare of millions of people every year, literally on a case-by-case, day-to-day basis?  In that context, those of us that work in the labs have the best job in the world.  How can that not inspire us to achieve and lead every day? Leaders exist throughout your organisation, not just at the top. One of your jobs as top managers is to identify your leaders and give them the tools to innovate.”

With its combination of specialist lectures, real laboratory case studies and open debate sessions, the Siemens Academy drew together all the key topics facing the modern pathology environment. Guest speakers, Siemens representatives and the hundreds of delegates were able to discuss openly the current challenges and solutions.

Overall there was recognition that change is here. If powered from within the pathology environment the outcomes can be effectively managed to best suit the profession. Without a forward looking mindset in pathology, change will be forced from the outside.