Within the Henry Ford Health System in Detroit, the Department of Pathology and Laboratory Medicine (PALM) provides diagnostic services to more than 2,000 employed and private-practice clinicians. In such a setting, collaborating with clinicians on new tests and adjudicating requests for send-out testing can be a governance and logistical challenge.
Clarifying why collaboration matters
If done well, collaboration removes process waste, improves patient outcomes, and delivers process efficiencies. If not done well, it causes intersite variation, variable patient experience, and stresses the professional relationships between laboratory medical directors and clinicians. Working within this framework, Gaurav Sharma, MD, FCAP, medical director of PALM Regional Laboratories, was asked to improve relationships with clinicians and provide them with a consistent user experience through a well-thought-out governance and communication framework.
“While the clinical laboratory plays an important role in the day-to-day life of each of our clinicians, it often lacks a structured way of capturing their needs and feedback. We wanted to do better by our clinicians—and we have done so using structured process improvements. We had no rule book to follow and no precedent to guide us, yet this blank slate was also an opportunity,” said Dr. Sharma. “We’ve created a formal infrastructure for connecting clinicians and laboratory professionals from the ground up—we’ve moved beyond the usual one-on-one conversations and relationships all pathologists and clinicians have.”
Working together to deliver value at Henry Ford
As Dr. Sharma explains, Henry Ford’s formal infrastructure for promoting collaboration between clinicians and laboratories has delivered value in four key ways:
- Better governance: “Our chair, Dr. Richard Zarbo, worked with hospital leaders to create a formal platform where any clinician can bring in any request or question about diagnostic testing, and that request is routed to the appropriate laboratory expert,” said Dr. Sharma. “Once the request has been studied, it undergoes a formal two-level review,” which ensures clinicians receive an objective and timely assessment of their requests. “Our approach also works because we have the consent of the governed—our clinicians and laboratorians have consented to being part of this framework.” The process is fair and transparent to clinicians and includes a built-in appeal process—so if a clinician disagrees with the answer to a request, another panel of clinicians evaluates the request.
- Consistency through structure: No matter the source, every request and everyone is treated the same, whether the request comes from the chief of a department or a resident. This approach gives all stakeholders a sense of fair play and allows PALM to document all pending and past requests—and these documented records are available to all. “We base our responses on what we’ve documented in our reviews, so our documentation is objective and consistent, and eliminates mixed messages” noted Dr. Sharma, “and when clinicians can count on consistent information, we eliminate uncertainty and inspire confidence in the process.”
- More accurate outcome measurement: “Given the formal structure in place,” Dr. Sharma reported, “we can formalize a clinical practice, which makes consistent measurement possible. It is impossible to measure non-uniform processes.” Once the clinicians agree to use laboratory services in a certain way, the laboratories then follow consistent service protocols—and as a result: “We know if clinicians aren’t getting better outcomes—and if they’re not, we use the preliminary data to go back to the drawing board,” said Dr. Sharma. “For example, if a group of specialists has agreed to use a specific expensive send-out test in a certain way and yet one of them fails to follow the agreement, our analytics tools pick this as an outlier.” Another key benefit Dr. Sharma noted, “We can focus our energy and time to understand the unique needs of that individual, rather than the entire group.”
- Know thy clinicians: Making meaningful process improvements requires understanding the daily needs of frontline clinicians—and Henry Ford has pursued this understanding using support from Clinical Lab 2.0, a group of forward-looking laboratories. “One of the best things from our 2.0 experience was learning about Value Proposition Canvas [VPC], a very powerful business tool that helps any organization capture the daily tasks, unmet needs, and potential opportunities in a systematic way.” With VPC, Dr. Sharma and his colleagues were able to bring together a group of laboratory leaders and clinicians and systematically assess clinicians' daily laboratory needs. “It was an eye-opening moment for many of our frontline leaders,” noted Dr. Sharma.
Steering clear of common missteps
Dr. Sharma identified four missteps that can impede progress when the goal is delivering increased value through greater collaboration between clinicians and laboratory professionals.
First, many organizations fail to invest time and energy in securing buy-in from clinicians and the health system leadership. This buy-in is a prerequisite to good governance, information consistency, and accurate outcomes measurement. At Henry Ford, PALM leadership worked with the C-suite leaders from all of the Henry Ford hospitals. “We were fortunate to have Dr. Zarbo lobby on behalf of the first systemwide program that explained the ‘why’ of the collaboration, above and beyond the ‘how’ and ‘what’,” said Dr. Sharma.
Second, Dr. Sharma warned against bringing in expensive analytics tools before defining the problem. According to him, “In analytics, activity is not same as productivity—more time needs to be spent in understanding the problem rather than in finding external tools that can fix it.”
Third, imposing educational programs without first understanding the clinician’s needs is often counter-productive. As Dr. Sharma explained, “I might have an opinion about what tests an ER clinician might need—but that’s just my opinion. The first thing I need to do is ask ER doctors, ‘Help me understand what you need,’ so I can craft educational programs and measure the downstream value of this test.”
Fourth, while collaborations hinge on celebrating successes, it is more important to learn from failures. “No matter where you are, any collaboration to improve the status-quo requires a lot of trial and error,” he noted. “Everyone needs to accept there will be bumps in the road along the way.” Stakeholders also need to accept that every department in the system will be unique in its own way.
Catching the next wave of better patient outcomes and increased efficiencies
Once strong clinician and laboratory professional relationships are established, “we can expect the next wave of improvements to come from industry analytics,” said Dr. Sharma. The precise form of these upcoming analytics innovations remains to be seen, but Dr. Sharma is confident their impact within hospitals systems will be transformative. “Who could have imagined how the advent of Uber would upend the transportation industry?” he asked, “We’re certain to see a similar impact in the EMR—because that’s where new real-time decision support tools will come.” In other words, real value—both for patient care and system efficiencies—will come from solutions that make decision support tools convenient for clinicians. “All of us in health care want to do the right thing, but good intentions are insufficient,” said Dr. Sharma, “because good intentions don’t deliver the outcomes our clinicians need. Clinicians need immediate solutions in the EMR. That’s where it counts.”
What is equally clear is that doing nothing isn’t acceptable. “We can’t be satisfied with living in an inefficient system that makes our day-to-day work dependent upon workarounds,” said Dr. Sharma. He concluded, “I think of this challenge metaphorically: we don’t want to be like ships stuck in the harbor, waiting for perfect weather to set sail—there is no such thing as ‘perfect’ weather or eternally calm seas. We need to set sail now, informed by the right intentions. While our progress may be slow, by working together, we are certain to achieve better patient outcomes, improved efficiencies, and greater value.”