All laboratory directors are well aware of the integral nature of laboratory services to patient care, including the direct correlation of proper diagnosis to laboratory testing. However, despite this internal well-known fact, the crucial impact of laboratories is often overlooked by others viewing patient care from the outside.
The COVID-19 pandemic has placed an immediate and intense spotlight directly upon clinical disease testing like no other event in history. The COVID-19 crisis has levied a profound impact on all aspects of health care delivery and clinical laboratories have been especially hard hit in several areas—including inconsistent (to nonexistent) supply chains, a highly unstable landscape of laboratory-developed tests and FDA-approved test kits and systems, high and/or greatly varying test volumes, and the vast unpredictability of future testing needs. Beyond these challenges are the unknown repercussions of recovering from the pandemic and how that recovery will manifest for each individual organization.
The Paramount Need for Constancy
While substantially contributing to positive patient outcomes is every laboratory’s goal, maintaining the health and safety of laboratory staff is critical to achieving it. As accreditation constructs of The Joint Commission are intended to support good laboratory practice, clearly there are significant unknowns facing laboratories and health care organizations in general as we seek recovery from the pandemic’s numerous impacts. With both internal and exterior economic forces exerting tremendous pressure on health care systems and their practitioners, along with substantial emotional and physical pressure placed upon front-line clinicians and support staff, the road to recovery may seem fraught with peril. Further, efforts must be made to prevent, or at least mitigate, future disease outbreaks.
One of my colleagues, a Joint Commission laboratory surveyor, is also a pathologist working on the front lines of an organization that was recently designated as a COVID-19-only facility. As the laboratory director, he bears great responsibility for ensuring quality services during unprecedented times. He owns his laboratory’s ability to manage this new and unique workload to consistency in methods and a dedication to reproducible, high-quality operations. While his primary focus is conducting COVID-19 testing quickly and accurately, his and many other laboratories are additionally involved in drug studies and therapeutic initiatives that are designed to protect us from future outbreaks. Thus, clinical laboratory directors and managers face the difficult task of advancing the quality of services they provide while working in a wildly shifting and, at times, dangerous environment. Exposure risk remains top of mind for health care workers concerned about their own well-being and that of their families. And lest we forget the substantial challenges facing laboratories that predated the pandemic; namely, declining reimbursements, lack of skilled incoming staff, and incorporation of new regulations.
Look to Lab Data for Answers
There are no cure-alls for recovery and each laboratory’s new normal will be different. However, with common drive, laboratories can achieve new and existing goals and boost efficiencies, including reducing time-to-test with streamlined workflows and improving cycle times to stay ahead of demand. One method that can be customized for each laboratory and will improve outcomes is revamping the laboratory’s approach to data collection. Simply put, the amount of data the laboratory produces can be leveraged to help it shift to a value-based care model. With these key data sets at hand, health care organizations are better able to clearly view their patient populations and enable the transition to predictive medicine. A recent article by a group of well-known pathologists in Academic Pathology goes into great detail on what lab data to use and how best to leverage that information.1
Maintaining a continuous improvement mindset in laboratory management is key and unlocking the power of data can create numerous improvements. Laboratories must evolve beyond volume-based care and take advantage of the laboratory’s elevated role, which is clearly evidenced by the reliance of COVID-19 testing on lab resources. Reducing costs is always a pain point, but judiciously managing a laboratory budget may mean expecting more from its strategic relationships, including those with accreditation organizations. Leveraging accessible data can help administrators balance budgets without compromising quality.
The Joint Commission’s Role
The Joint Commission’s intended role in increasing laboratory quality is to help ensure consistency of process. Both accuracy and precision are necessary for sustained success in a laboratory. Achieving a high level of testing sophistication is both beneficial and admirable, as we have seen clearly demonstrated during the COVID-19 crisis, and the ability to maintain quality over time is perhaps the most important element to foster sustained positive patient outcomes.
Moving forward, The Joint Commission has sought to enhance our program to support accredited laboratories and will continue to provide education through collaboration via the accreditation process. Our teams will continue to share high-quality information and best practices, which are subject to change dynamically in the wake of COVID-19. It is important to The Joint Commission that our accredited laboratories collectively learn from what we all have experienced and subsequently, make heightened efforts to recover from the crisis stronger than before.
One example of the resources The Joint Commission offers its accredited labs is the Survey Analysis for Evaluating Risk (SAFER) tool, which helps laboratories recognize specific risks in certain areas by potential impact to the patient.2 The SAFER Matrix report provides the information laboratory managers need to prioritize resources and focus corrective action plans on areas most in need of compliance activities and interventions. This is a standard method of how The Joint Commission helps identify risk. For COVID-19-specific risks, laboratories will want to focus on how their organization specifically performs in areas of infection control and emergency management.
Another way for laboratories to solidify their value within the health care continuum is to proactively seek to improve processes that may take place outside of the laboratory (such as delivery of clear test results and interpretations to clinicians) yet significantly affect how the laboratory contributes. With intense public focus on hospital care, it is essential that hospital laboratory leadership communicates its critical needs and conveys that nonfulfillment of those needs could jeopardize continuous high-quality outcomes.
The willingness of medical laboratory professionals to excel during the global crisis has been nothing short of amazing, although not surprising. The Joint Commission has currently resumed its accreditation processes and remains sensitive to how accredited laboratories are recovering. There is no amount of gratitude that can accurately express how honored and thankful The Joint Commission is for the continued collaboration and support of our accredited health care organizations within the medical community, except to say: Thank you. We are behind you and we will continue to support your organizations any way we can.
Heather Hurley, BS, is executive director of Laboratory Accreditation and Health Systems Strategic Accounts at The Joint Commission. She is responsible for leading business strategies and activities, including the development and implementation of products and services for the Joint Commission’s Laboratory Accreditation Program, Patient Blood Management Certification, and Integrated Care Certification. Heather leads The Joint Commission’s Laboratory Professional Advisory Council and serves as liaison to other associations, collaborative partners, and accrediting and regulatory bodies in the laboratory field. Previously she was the director of sales for the Life Science Reagent Business Unit at Affymetrix, and prior to that, Heather worked as a research technologist in the department of molecular genetics at The Cleveland Clinic.
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