The clinical laboratory is an environment that can feel isolated from patient care, even while delivering critically important information. Test results and interpretive findings are relied upon every minute of every day for care management and treatment decisions. The impact value of laboratory medicine is undeniable yet poorly demonstrated in an overall lack of outcome studies. Yet, physicians continue to acknowledge the indispensable value of the laboratory as recorded in a recent survey. This survey further found that interdepartmental collaboration between providers and the lab is foundational to guiding clinical decisions, improving patient outcomes, and avoiding unnecessary patient interventions and costly procedures.
Bridging the collaboration chasm between the laboratory and the provider requires a multi-pronged approach to establish communication channels that foster teamwork. Succeeding in this endeavor is no small challenge, but when viewed through the lens of improved workflows, disease management, and ultimately patient outcomes, this is a hill worth climbing. Here are some steps to consider when striving for improved collaboration.
Resources needed and modes of communication
Communication between the lab and providers is essential and requires the use of multiple channels. Most of the tools and personnel needed are already present in the healthcare system. The current state of technology supports a mostly digital platform for communicating with providers. Enterprise platforms that support direct messaging, chat, channels, or email are great ways to reach out initially and work well for short dialogue clarifications.
When larger objectives are being sought, such as input on changing test methodologies, ordering profiles, or workflow protocols, something more akin to in-person communication is preferred. The power of persuasion has been shown to be most effective when face-to-face contact is made compared to email or text. Video calls and in-person meetings establish the human element that we are all wired to appreciate at a biological level. It also allows for casual conversation and bonding over common ground, reading body language feedback, and building sincerity and credibility.
Have a telephone, don’t be afraid to use it! While this might feel antiquated, it can still be an effective means of building initial rapport.
In some instances, a leadership resource may be needed to generate the lab-provider collaboration envisioned. This liaison may be an administrative leader, like a manager, director, or vice president, or it may be a clinical leader, such as an MD, PhD, or even DCLS.
Identifying an opportunity
Find alignment with the care team and provider on a goal that spans departments. Often, this means looking at the larger system strategies and finding opportunities to work together. Improving population and community health is a common strategy in pursuit by many health systems.
Another opportunity exists in meeting goals tied to safety, quality, and outcomes. Accountable care, by CMS definition, is when a healthcare organization works to give patients high-quality, coordinated service and care that improves health outcomes while managing costs. In an ACO, high-performance scores entitle the organization to a portion of shared savings from the insurer. Conversely, fragmented care that results in increased insurance costs can also incur a financial penalty for the healthcare system.
Employee retention is another strategy that is often overlooked as a cross-departmental opportunity. Tension between departments and a lack of communication can lead staff to look for new opportunities in other healthcare systems.
Track collaboration
Labs need to establish an accountability reporting structure to ensure objectives are consistently advancing. Consider using a standing cross-departmental meeting, such as a quality reporting committee or utilization stewardship team. Continued tracking in meeting minutes establishes accountability principles and monitors success. It also creates an environment for celebrating joint achievements to boost morale while reinforcing the value of collaborative efforts.
Establishing an ad-hoc working group or task force can similarly be used. This may be preferred to pull in additional resources outside the normal operational departments (IT/IS, revenue cycle, quality, etc.).
Tools and tactics for collaboration
Messaging Systems
Messaging applications like Microsoft Teams are great for directly messaging a provider for clarity on test orders and other preferences. We often find success with this mode of communication after having already established some rapport with the provider. The EMR may also allow for securely chatting with a provider, enhancing provider efficiency as all pertinent patient information is housed in the same system. In our healthcare system, we’ve created a channel for both microbiology and endocrinology as laboratory-specific questions arise frequently with those provider groups. Several benefits exist with an integrated EMR and messaging channel:
- Laboratory experts reach out directly with questions about a specific patient’s test orders or pending results.
- Specialty providers can message our team directly when seeking clarity on reflex testing and result interpretation.
- Providers can message to ask about appropriate sample type or collection method.
- Providers can provide insight when cases are suspect for disease like coccidiomycosis and blastomycosis in the microbiology channel.
- Providers can suggest enhancement ideas for select tests, order sets, or algorithms.
Education and newsletters
Education and communication via newsletter, memo, or shared presentation is another effective collaboration tool. For newsletters and memos, leverage the physician chair of a particular specialty to gain more authority. As new tests are launched, the laboratory and a provider need to align and educate care teams on appropriate testing practices. Having the backing of a physician chair gives more credence to the content of the communication.
Stewardship committees
Labs are discovering that diagnostic stewardship has a significant role in advancing coordinated and high-quality care while containing unnecessary healthcare spending. Practicing diagnostic stewardship comes in many forms, with toolkits and frameworks readily available for use. Importantly, diagnostic stewardship needs to be clinician-led, laboratory-supported, and consider decision support tools and behaviors to drive effective change. Additionally, committees of this type give structure to data-driven feedback and guide future goals.
What are the benefits?
Lab + provider collaboration successes are multifold but rely largely on the goals being targeted. Often, these goals align with larger system strategies like improving population and community health or improving employee retention.
Employee retention
Building a collaborative environment is certain to shore up communication miscues between the provider and care team that can otherwise result in frustration and animosity. Clear and enhanced communication leads to healthier interdepartmental rapport and a more enjoyable work environment. Further, it drives up employee engagement, which pays out dividends in the form of increased productivity, employee loyalty, innovations, and patient satisfaction.
Population health
Reducing mistakes translates to fewer errors during the total testing process and ensures actionable results are used to improve outcomes. A great opportunity exists with a response to the national syphilis resurgence. Syphilis is a growing community health concern and there exists two CDC test algorithms and numerous testing options. Incorrect ordering or test interpretation can occur if the provider and laboratory aren’t aligned on test expectations. With the resurgence, more burden is on primary care today than in the historical past. Providers are having to re-learn which syphilis tests and algorithms are correct to use in each patient situation. Inappropriate testing leads to missed diagnosis, missed treatment monitoring, lack of appropriate follow-up, missed prevention, or false positive findings. Ensuring orders and test accuracy through collaborative tactics described above can help stifle this growing epidemic while directly contributing to the improved health of the population.
Many opportunities to collaborate on improving population health exist in laboratory medicine. Other areas where collaborative efforts can improve complex testing include Lyme disease, cardiovascular risk assessment, kidney disease, and various autoimmune diseases.
Workflow optimization
Reduced testing redundancy through improving laboratory utilization is another collaboration benefit. For inpatients, consider the frequency of complete blood counts and metabolic panels, and question the value of long-duration send-out tests that won’t result until after patient discharge. Inpatient order sets and standing orders may be set to occur in perpetuity without appropriate review occurring at a later date. Some routine order sets may contain extraneous and laborious orders not needed on a routine basis. Finding and correcting these defaults reduces busy work that isn’t providing actionable value.
A lasting impact
Successful collaboration starts with identifying goals that are relevant and impactful to the patient, the provider, and the laboratory. There are numerous opportunities with many tactical approaches available. Ultimately, goals that are aligned across departments are more likely to gain provider support and identifying that physician champion will drive long term benefits to all.