Molecular testing can be stubbornly fragmented. Unfortunately, this means that molecular departments often struggle with budgetary constraints, or are unable to reap the efficiencies that could come by aligning their testing with other departments. As a result, lab leaders are often forced to rely on high-volume viral testing to support their bottom lines, while other time-intensive, but equally important testing may not get the attention it deserves.
Does it have to be this way? In this article, lab leaders discuss the possibility for de- siloing the lab—looking at proven steps to both incentivize change within the lab and to secure the attention and backing of key leadership. While siloing has long been the M.O for lab structure, it may be time for lab leaders and administrators to embrace change.
Which approach is right for your organization? Here's a look at the pros and cons of each according to two experienced and respected laboratory leaders.
For administrators to sign off on changes to lab structure, there needs to be a clear understanding, at the lab level, of what that change will look like. "I don't think a culture of change is now something that we can just suddenly just flip a switch on. Change in laboratory management and de-siloing the lab is something that's going to be driven from the bench up," says Dr. John Longshore, director of molecular pathology at Carolinas Pathology Group, Atrium Health.
The key to change management, he says, is to involve lab stakeholders at every level— especially those on the lab floor—to craft a detailed vision of what de-siloing the lab should look like. This helps lab leaders to answer the "why" question of de-siloing—the improvements they stand to gain—while earning broad ground-level support. In particular, Dr. Longshore recommends partnering with lab technologists—those who perform the day-to-day testing—who often have insight into productive change: improvements to lab layout, lab design, test processes, where testing needs to be performed, or how tests can be combined with other departments.
With this in mind, Dr. Longshore recommends that lab leaders collaborate to address four critical areas: needed space, equipment, and personnel, and strategies to gain administrative support.
Without the support and input of lab-level stakeholders, lab leaders risk faltering in their efforts. With this support, however, lab leaders can present a unified and detailed de- siloing plan to administrators.
Of course, this latter piece—administrative support—is critical . "Even though the noise comes from the bottom up, the support has to come from the top down," says Dr. Pamela Ward, associate professor of clinical pathology and scientific director of molecular pathology at the Keck School of Medicine of USC. Without the backing and enthusiasm of key administrators, efforts to de-silo will have trouble getting off the ground.
And what is the number one factor in securing their support? "It's the dollar amount," Dr. Ward says. "If you can show that dollar amount has significantly changed, that's going to make [administrators] more conducive to opening their ideas to a paradigm shift, more than any other single thing." In other words, lab leaders need to clearly demonstrate not only the procedural benefits of de-siloing, but the improvement to the bottom line.
There are a number of ways that lab leaders can slice this question, quantitatively. For instance, they could answer any of the following questions, if possible, with, "Yes, by X amount": Will de-siloing help drive economies of scale and labor (reduced costs and labor hours per test)? Will it save money by consolidating testing on automated platforms, or by making molecular processes more efficient by handing off time- consuming testing to other departments? In other words, will de-siloing save the hospital, at large, money? Yes, by X amount.
Paired with this, Dr. Longshore recommends that labs emphasize their full value to health systems—not just those reflected in siloed financial figures. He points, for example, to the instance of healthcare-acquired infections (HAIs). While testing for HAIs is invaluable to the health system, labs aren't reimbursed for it, so it doesn't show up on their bottom lines. Labs may want to make an effort to quantify this kind of value, especially if isn't currently captured: "We need better models for helping to evaluate the contribution of laboratory services, beyond simply looking at numbers on a spreadsheet," he says. These kinds of efforts are essential for demonstrating to administrators the full value picture of de-siloing.
Indeed, the move to de-silo, in general, is one of value for molecular lab leaders: to do more with less for the benefit of the health system. As lab leaders approach de-siloing and change management, they need to carefully evaluate where this value may come from and how to articulate it to stakeholders. Oftentimes, the best ideas for this kind of change may come from the ground up.
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