Reclaiming the clinical conversation: A challenge for the laboratory

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Let’s start with some questions from the famous marketer Seth Godin: What would happen to your customers and to your prospects if you stopped doing your work? If you stopped showing up, if you stopped selling them something, would they miss you if you were gone?” (See “Seth’s Blog,” http://sethgodin.typepad.com/seths_blog/2015/04/what-if-you-stopped.html).

Would your clients miss you if you were gone? Is the quality and type of work you are doing so irreplaceable that if you disappeared tomorrow, they would feel the loss? If your answer is “yes,” stop reading this and go back to what you were doing. You are safe for now. As long as nothing changes, the work will arrive for you to do each day. (The key phrase there is “as long as nothing changes.”) But if your answer is “no” or “not sure,” please keep reading.

The old laboratory business model was as follows: if you did better work faster than the competition, you would thrive as a laboratory. As long as you had sound business practice and a patient population with excellent payor reimbursement, the laboratory business was straightforward. The work appeared throughout the day, because your lab was the best option for customers. Sure, there was some large, scary reference lab some place far away that could arrive under the cover of night to take away your work, but that thought was more of a nagging fear than a legitimate threat. All you had to do was show up, do the work, and all was well. The reimbursements smoothly flowed, and as long as your results were accurate and landed in a chart somewhere, things went well. The replacement cycles for instruments were manageable and predictable, and your staff efficiently managed the rate of test growth. And, there was no issue of staff shortages or a graying workforce in the laboratory. As long as you worked hard, you felt secure in the health of your lab business.

One way to think of a lab business—or any business—is that it is like an animal in the wild. Compare the animal’s anatomy to an organization chart. Both have a preferred diet, a preferred territory, and a handful of environmental threats. Your laboratory business may look like a contented animal that is surrounded by available food, without a predator to threaten it. But in fact there is always danger on the horizon. The traits of vanishing species include restriction to a particular habitat, a very specialized diet, a long lifespan with slow reproduction rates, and an inability to escape or evade predators. Translated into business terms, a vanishing business is one that is restricted to a small segment of the market (like a limited laboratory test menu), has a very small market share (it only services one hospital), is staffed with long-tenured folks who are slow to innovate (it can barely keep current with market needs), and is slow to respond to change (it lacks drive and the courage to change). If this sounds like your laboratory, you may need to make some changes or face eventual extinction.

So where to start? Let’s look at the most valuable things that you have—your knowledge and expertise. Remember what your customers, your clients, your patients seek from you: the knowledge and skills of diagnosis. Your ability to discern the pathological truth in a patient’s condition cannot be replicated anywhere else in the spectrum of healthcare. Over the years, as the world of healthcare has grown, the mode of delivery of your work has changed, however—from a mixture of verbal and written communication to a set of numbers or words with an occasional picture that lands in the chart. While that change was necessary to keep up with the increased volume the clinical side was presenting to the laboratory, along the way some labs lost a meaningful presence in the care team. They sacrificed their connectedness with the clinical world in order to scale to meet the demand. As a result, the laboratory became marginalized, transformed into a little black box that produces orders for results in a very predictable, reproducible manner. To a degree, the lab was scaled down into a commodity.

But close your eyes, and project yourself back to where you used to be, shoulder to shoulder with the clinicians taking care of the patients and engaged in the clinical dialogue. Go back to a time where the laboratory was more than just a sophisticated machine accepting questions and returning answers.

How do we get back the value we lost? There is a clear way to start: become engaged again with the care team and project your knowledge past the conventional confines of the lab report. That report can be seen as just the conversation starter, not the final product of your work. After all, gone are the days when clinicians can effectively consume and utilize a laboratory test menu, both on the ordering and the resulting side. They are having enough trouble just keeping their heads above water with the rapidly changing medical knowledge in their fields and the added pressure and noise of the modern practice of medicine. They want to talk with you!

To get engaged requires both a desire and a path. The latter is already here with the advent of new standards-based technology platforms that are on the market, as well as the push to population health. Everywhere you look, there are ways for the laboratory to become a proactive member of the care team. But while technology can help you get engaged with the care team, the other important ingredient is your mindset. You have to want to be involved. You have to want to step out of your comfort zone and be noticed. You have to be proactive, stand up, and project your voice for this to work. Simply being good and showing up to do the work is not enough. It is less about what the data is (we know and expect it to be correct and timely), and it is more about what we do with that data. Your customers (clinicians) need the laboratory’s help more than ever with complex data and results. It is time for the laboratory to stand up and speak.

Reclaiming the clinical conversation: A challenge for the laboratory
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John David Larkin Nolen
MD, PhD, MSPH, is Managing Director, Laboratory Business Unit, for Cerner Corporatiom.

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