While most laboratory consolidation projects are eventually successful, many face unexpected hurdles along the way and a few wind up failing altogether. The specific reasons consolidation initiatives run into setbacks are varied, but may include anything from poor planning to inadequate funding. What almost every such failure has in common, however, is a lack of strong leadership from the very top of the health system. If you want your consolidation to proceed without a hitch, you must have buy-in from executives in the C-suite—and you'll need their leadership at every step in the process.
Here's a look at why that's the case and some advice from a few experts around ways that lab leaders might drive top-down alignment within their own organizations.
Some of those preparing for laboratory consolidation may wonder why it's important to have C-suite support. The answer, says Myra Wilkerson, MD, FCAP, chair of the Division of Laboratory Medicine with the Geisinger Health System, has everything to do with the need for strategic planning. “When you inherit all these different hospital laboratories and independent community laboratories, how do you bring them together? How do you combine purchasing power? How do you standardize your instruments? How do you do policies and procedures? How do you share staff, maybe for better efficiencies? How do you decide what's needed locally versus centrally?" There may be regulatory considerations to keep in mind as well, Wilkerson notes, and if you don't understand them and their potential impact on your operation, “your lab can be in real trouble."
Barbara Goldsmith, PhD, FACB, chair of Medical Laboratory Sciences and Biotechnology at Thomas Jefferson University Hospital, agrees. She's worked with four health systems that have embarked on laboratory consolidation initiatives, and while two of those organizations completed their projects successfully, and another just started and is heading in the right direction, the fourth system struggled and ultimately failed. “The theme that I've seen is that it works if there is a very clear directive from the top," Goldsmith says. "And it cannot be, 'Go make it work—we won't give you resources.'" The C-suite, Goldsmith notes, must give the laboratory what it needs to succeed. And it should establish a time line, with realistic goals, for everyone to follow through the project's completion.
At one of the health systems where Goldsmith worked, they created a “technical specialists group" to help smooth out the standardization process. “Every discipline— hematology, blood bank, clinical chemistry, micro—there were representatives from each hospital." Those reps met once a month, she explains, and together they'd share data and agree on procedures. “That way we had buy-in across the board." The laboratory leadership also worked with outside consultants throughout the consolidation process, Goldsmith says. They'd take their suggestions and recommendations and present them to the system's leaders. In the situation where the consolidation model didn't work, the decisions were made by the medical director of the lab. Where it did work, on the other hand, decisions were made at “the very top of the alliance."
Turning to the top is a good idea, agrees Michelle Barthel, MT(ASCP) MHA, System Director of Laboratory Services at Regional Health in Rapid City, SD. But be sure that leaders understand how consolidation will help the organization and that they know what you'll need to get the job done. “What are the impacts on patient outcomes? In addition to efficiencies that are gained, [standardization] improves quality. If you have standardized equipment and reference ranges, it's a lot easier and more efficient to have that patient transferred throughout your system if testing doesn't need to be repeated. It's really important for the C-suite to see those pieces," Barthel says.
When leadership knows what's at stake, they'll step in to drive the consolidation process, Barthel adds. And when that happens, you'll not only have their buy-in, “you'll also have their support."
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