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Lab Leads with Team-Based Vision

 |  By Philip Betbeze  
   March 16, 2012

Recently I've talked to a lot of senior healthcare executives about healthcare reform. It's a broad topic, but it seems reform is all we talk about.

One of the most pervasive themes in our conversations is the concept of teamwork in the struggle to transform the healthcare system into one that manages the health of the patient rather than one that treats problems on an ad hoc basis, often long after patients have gotten worse due to delays or gaps in care.

The concept of teamwork in what has been a pay-per-encounter business is, admittedly, a warm-and-fuzzy notion. It evokes a generally accepted ideal in healthcare: Preventive and connected care is better care.

But senior executives are sometimes not as tuned in as we'd like to think they are about the actual progress that's being made in their organizations toward that goal of team-based care. Sometimes they don't realize they have valuable team assets in unexpected places. 

Carol Quinter is not one of the most senior leaders in her healthcare system, yet she has a critical role as the senior leader of the lab at Kettering Medical Center, the flagship hospital of Kettering Health Network in Dayton, OH. And from what I learned through talking with her, the teamwork message is getting through, at least at Kettering.

The lab as catalyst for efficiency
The example we talked about was the dramatic downstream effect that efficient lab work can bring to the difficult-to-solve equation of providing the right care and the right time, with as little waste as possible.

Late in 2010, Quinter, Kettering Medical Center's director of laboratory clinical services, evaluated a new testing system that could diagnose infectious diseases faster and more accurately than traditional testing. In fact, in most cases, it provides results in six hours instead of the traditional 48. As might be expected, the acceleration has a tremendous effect on patient care, quality, and length-of-stay.

"If we know what they have with a high degree of reliability, that is 98% or better, and a clinically relevant turnaround time, that helps us decide whether patients can be managed in an outpatient setting or in the hospital," she explains. "Patient populations aren't defined. The only way to define is to do a test. But we need those results in a timely fashion in order to do what we want to do interventionally." 

Quinter and I talked about the many scientific evaluations that she and her team had to make in deciding whether to introduce the new technology, and I have to admit I got lost a few times. But the essence of her decision was based on accuracy, (the Diatherix-based testing program now used is as high as or higher than culture tests) and, at least as importantly, treatment time.

"If we have a critically ill infected patient, their organism won't grow [in a culture] for 2-3 days, but this test is accurate within hours," she says. "That allows us to shift the balance toward recovery. Knowing the organism that's causing the problem dramatically shifts that balance."

Fast, accurate decisions lead to better outcomes
Critical to Quinter's decision-making was the big picture: getting patients treated appropriately, and quickly, so their stay is shorter, less expensive, and less traumatic.

Speaking of expenses, ROI for the testing system in the first year of use, 2011, yielded $3.7 million in terms of hospital savings directly tied to reducing patient infection rates, decreasing the days patients need to be kept in isolation, and prescribing fewer antibiotics.

Kettering's financial expectations for the new testing regime had been low—about $225,000 the first year. In addition to the financial piece, Kettering saved about 2,000 isolation days and prescribed fewer—and Quinter would say more accurately targeted—antibiotics.

Critically, the decision to use the new test was left largely to Quinter, a 30-year veteran of the lab, and to a broad patient care team. Quinter says the effect on patient care was dramatic, which is what ultimately sold them on the testing procedure.

However, financial success of the technology was also important, says Quinter.

"We all have the responsibility to drive financial integrity in our organization," she says. "We can't look outside the lab and say that's someone else's problem because we all have to understand that we need to deliver care in a fiscally responsible way."

But she's even more proud of the results because it took teamwork from across the service lines of the organization to make it successful, as well as empowerment from the highest levels of the organization.

"In that environment, people come together focused on the same results," she says. "I often get the question ‘how do you get your docs to do this or how do you get nurses to do that?' I can't help them, because when we approach any patient care models driven by technology, we're a team." 

While decisions on such specialized scientific and technological changes can't be driven from the top levels of the organization, says Quinter, culture is and should be.  

"Because we embrace innovation, our administration places trust in us, but we have to prove it at the same time," she says. "Fundamentally, the most important thing is that the administration has trust in people they've selected to drive patient care models."

The impact of such a small change in process likely goes far beyond the tangible. And while this particular change in testing protocols has had a dramatic effect, it was enabled by Kettering's focus on process improvement generally.

"We map the course the patient should take without waste," says Quinter, "Every time the diagnostic doesn't meet our needs, we send the patients off that direct path. If you have a conventional lab test that takes too long and isn't sensitive and specific, that creates waste and costs dollars."

Quinter often speaks at professional conferences about her experience in cutting waste and improving accuracy in the lab, and she's often asked where to start.

"The bottom line for that is you have to define and understand your current process. That's where organizations fall short," she says. "You have to understand your current process in order to improve it."

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Philip Betbeze is the senior leadership editor at HealthLeaders.

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