You could be forgiven for thinking that bigger is always better when it comes to clinical laboratories. “Economies of scale,” “total lab automation,” and “centralized core laboratory” are all common phrases heard in the industry, and they imply that the main way to gain efficiency is through size.
The reality is that smaller laboratories play an essential role in the delivery of patient care by offering laboratory services close to the patient, whether that is by providing rapid results for inpatients or outreach services to geographically isolated communities. It is also true that smaller laboratories often have less support compared to large facilities, making it difficult to utilize staff and instruments efficiently.
The good news is that, whether you are a team member, manager, or medical director in a smaller laboratory, you can take to overcome these challenges.
Leverage System Resources
Many small hospitals are part of larger health systems, but the level of system integration laboratories have with each other varies widely. Evaluating the system resources at your disposal is a logical place to start when considering how to improve operations at a smaller laboratory. The resources available will differ depending on the system, but key resources could include:
• Shared purchasing agreements for instruments and reagents,
• Software solutions—most obviously laboratory information systems and electronic medical records, but also programs such as customer relationship management solutions, document management systems, or learning management systems that may be in use elsewhere in the health system,
• Policies and procedures, and
• Guidance from specialists and experts at other locations.
There may be alternative forms of support available to labs that are part of an independent hospital. Many independent hospitals choose to enter partnerships or affiliations with related hospitals. These may be either peer institutions or larger health systems that provide certain services to the smaller hospital. It may be possible to access some of the resources listed above through these types of arrangements.
As a laboratory consultant, I sometimes encounter the stereotype that small laboratories are inherently disorganized or out-of-date compared with larger facilities. Having visited many laboratories in my work, I can confidently state that lab quality is independent of size.
I have seen large laboratories that were cluttered and chaotic, with the main means of communication consisting of Post-it notes. I have also seen small laboratories that were extremely well organized and efficient, even though they were not considered to “centers of excellence” or flagship labs for the health system.
Laboratory managers can make progress in organizing laboratory space and streamlining processes. Managers can implement these initiatives without outside resources or institutional support, making them particularly relevant for small laboratories.
A simple but important place to start is with a “5S” initiative, which stands for “sort, set in order, shine, standardize, and sustain.” There are various online resources available that detail how to approach this project and engage your laboratory staff. The goal of a 5S initiative is twofold: First, to make it easier to navigate the lab, locate necessary items, and perform work with minimal distractions. The second goal, which is just as important, is improving staff morale, encouraging helpful recommendations, and increasing pride in the workplace.
Focusing on inventory management is another organizational initiative that provides benefits. Establishing formal order points for each supply item as well as tracking current lots and expiration dates in a uniform manner goes a long way to improve efficiency. It also can decrease costs and increase productivity by ensuring supplies remain in stock and are not wasted due to expirations.
Use Medical Laboratory Scientists Appropriately
Staff shortages are affecting many labs. While it is difficult to find qualified staff at all levels, the dearth of medical laboratory scientists (MLS) is the most acute. With staff shortages, laboratory staff have had to perform tasks outside of their everyday responsibilities. In addition to performing highly complex testing and verifying results, MLS staff were taking on tasks such as drawing blood and processing patient specimens.
This challenge offers an area of improvement for smaller laboratories that once found it simple to hire MLS team members who could “do everything.” Defining the various roles in the lab can mitigate the MLS shortage and decrease labor expenses, improving efficiency.
Grow Lab Expertise Internally
Training staff and retraining personnel are important for any laboratory but especially for smaller laboratories that might have access to a limited applicant pool compared with larger institutions. Even smaller laboratories can benefit from creating career ladder job titles and specialty roles. Developing a clear pathway for advancement is a great way to increase retention and encourage experienced staff to take on more responsibilities.
Additionally, developing a relationship with local colleges pays dividends in many ways. If there is a laboratory program in the area, hosting students for clinical rotations provides a pipeline of these scarce candidates and is worth the effort. Furthermore, graduates with associate degrees in the sciences can be eligible to sit for the Medical Laboratory Technicians exam after 6 months of training, making relationships with these institutions beneficial.
David Shiembob, MBA, C(ASCP), is manager of healthcare advisory services at ARUP Laboratories in Salt Lake City. +Email: [email protected]