CEO SUMMARY: What an opportunity! On the same podium were the presidents of both the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Quality Forum (NQF), specifically to speak about laboratory medicine’s role in the evolution of the nation’s healthcare system. Their opinions and predictions provide useful clues to what lies ahead for all laboratories.
THERE ARE LOTS OF REASONS why healthcare leaders of national stature seldom deliver public speeches devoted to the subject of laboratory medicine and its role in the healthcare system.
Thus, when Kenneth W. Kizer, M.D. and Dennis O’Leary accepted an invitation by the Institute for Quality in Laboratory Medicine (IQLM) to speak on this subject, it was an important event. Kizer is President and CEO of the National Quality Forum (NQF) and O’Leary is President of the Joint Commission on Accreditation of Healthcare Organizations.
Thought Leaders’ Insights
I am writing this at the IQLM meeting. My objective in this intelligence briefing is to share with you key insights which emerged from presentations given by these two thought leaders in healthcare policy. Each presentation is an uncommon opportunity to hear how such policymakers view the role of laboratory medicine in healthcare. More significantly, these thought leaders commented specifically on what the laboratory profession should be doing to establish its value proposition in ongoing health policy discussions.
IQLM’s conference was kicked off by the keynote speech delivered by Dr. Kizer. His overview of increased healthcare cost and failure of the system to provide better quality care would be familiar to most healthcare professionals. That was the foundation for his observations and predictions about how various forces of change would reshape the American health- care system in coming years.
Kizer observed that 1998 was the “watershed year for explicit recognition of healthcare’s quality gap.” He referenced such publications as Quality First: Better Health Care for All Americans (President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry) and the Institute of Medicine’s (IOM) “The Urgent Need to Improve Health Care Quality” (JAMA 1998: 280: 1000-1005).
He next discussed employers and their response. “Certainly the double digit increases in the cost of health benefits to employers is widely-known,” stated Kizer. “This is motivating employers to take proactive steps to slow down the rate of such increases. Those initiatives can be seen in the support employers give to organizations like the Leapfrog Groupand the National Business Coalition on Health.
“Further, employers see the health of their workers declining, even as the cost of their health benefits is climbing,” noted Kizer. “This creates a powerful economic motive for employers to take proactive action to improve healthcare. Improvements in the overall health of their workforce reduces the cost of sick days and the lower productivity attributable to how the healthcare system fails to deliver the right quality of care.”
Kizer is making a significant point. He has identified an often-unrecognized, but powerful, economic force that motivates employers to confront health- care providers and demand improvement in the services they provide to patients. I view this as an opportunity for the laboratory profession. In coming years, we may find employers interested in working directly with laboratories to improve how clinicians use laboratory testing for early detection, diagnosis, prognosis, and patient monitoring.
Business Case For Quality
Kizer believes one way to improve existing deficiencies in the healthcare system is to use the vehicle of payment to change healthcare outcomes. “The problem with the business case for quality is that the existing payment system neither rewards nor incentivizes providers to improve current levels of clinical service,” he declared, adding that the number of pay-for-performance programs was growing rapidly, but design flaws in many of them were likely to retard their ability to produce better quality healthcare outcomes in the near term.
One point made by Kizer succinctly captures a change in consumer attitudes. “Patients are shifting from blind trust in their healthcare providers to wanting transparency and collaboration in their interaction with their healthcare providers,” he commented. “This is a paradigm shift which providers must recognize, or they will become irrelevant.”
Important Consumer Shift
Lab administrators and pathologists should not let that observation go unaddressed within their laboratory. Kizer is describing a fundamental shift in the consumer mass market. His use of terms like transparency and collaboration describe traits not intrinsic among many physicians and healthcare providers. Consumers want an active role in the decisions made about their care, but many providers are not prepared to interact in such a fashion.
As he finished his presentation, Kizer made a bold statement which plays right to the strength of all laboratories. “Healthcare is the most information-intense activity in human history. All healthcare is driven by information, so progress in healthcare informatics is critical. Healthcare needs a Manhattan Project [to solve its information technology roadblocks],” stated Kizer.
Since all clinical laboratories are essentially information factories, Kizer’s statement promises a key role for laboratory medicine in the future. However, Kizer qualified this point. “Laboratory medicine is not at the table today,” he said when discussing how decisions to reform and evolve the healthcare system are now being made. “Without a place at the table, it is unlikely that such reforms will take full advantage of how laboratory medicine can contribute to higher quality healthcare outcomes.”
Echoing this last opinion was another influential and respected healthcare leader. “Laboratories need to make their case with policy makers,” stated Dennis O’Leary, President of JCAHO during a panel discussion. “Laboratory medicine has great potential to contribute in improving quality and outcomes while managing the cost of care. But in discussions on how to reform and improve our system, laboratories must make their case.”
During his prepared remarks, O’Leary elaborated on this point. “Laboratories represent a link across many areas of healthcare,” he stated. “For that reason, it is imperative that labs develop a systems approach in how they interrelate with the healthcare system.
“Laboratory medicine is not a silo,” he continued. “People in labs need to reach out and engage these other areas of the healthcare system. Much of the future of laboratory services rests upon good leadership and initiative from within your profession.”
Labs Lose Accreditation
Having offered that advice, O’Leary next discussed a recent development. “During the past year, 12 to 14 hospital laboratories were found to have serious problems, to the point of withholding accreditation,” he noted. “We don’t yet fully understand why so many labs fell out of compliance. We need to go deeper. This may be an unusual ‘blip,’ or it may be an early sign that more laboratories are on ‘on the edge’.”
O’Leary then directly confronted the issue of the medical technologist (MT) shortage. “On the surface, I can see potential parallels to the nursing shortage. It may be that there are not enough trained technical staff to work in our laboratories,” he explained.
“At that same time, the complexity of laboratory testing is increasing, and that only makes the labor situation worse,” continued O’Leary. “This raises the stress levels in the working environment. Not only is there a lack of adequate med techs to perform the work, but the work itself is becoming more complex and detailed.
“At the same time, there is a trend where MTs with four years of training are supplemented with medical laboratory technicians (MLT), trained in a two-year program,” he commented. “This shift in the balance of skills, combined with working in situations that are increasingly complex, may be causing laboratory staff to leave the laboratory profession.”
Crisis In Lab Staff Shortage
O’Leary is making a significant point. It is a sign that, at the highest levels of JCAHO, there is recognition that the nation’s hospitals face a serious crisis if their laboratories lack an adequate and trained staff to do the lab testing necessary to support their patient populations.
Moving to another point, O’Leary gave a big thumbs up to the use of quality management methods in laboratories. “Lean and Six Sigma are effective tools to fix [work] processes,” he declared. “That favors patient safety and con- tributes to better healthcare outcomes.”
In his own way, O’Leary also validated the important role of information technology and its link to laboratories. “In striving to improve outcomes, we need to know, with confidence, that laboratory test results are electronically delivered to referring physicians,” he offered. “It is essential that accurate and timely information be in the hands of clinicians when they make the decisions which affect patient care.”
These comments by Kizer and O’Leary provide useful insights about their views on the ongoing evolution of the healthcare system. Laboratories can use these insights to better focus their strategic thinking.