Managers’ Issues in Medical Laboratory Services

Introduction

Healthcare is a major priority for individuals, governments, and non-governmental institutions. The productivity of a nation depends on the health of its citizens. Further, mortality rates are directly influenced by the level of health in society. As such, healthcare has been rapidly expanding to accommodate the growing health needs of society. Among the most important fields in health care is the medical laboratory. The medical laboratory field has been expanding in recent times, thanks to the improved technology in the area of medicine. Various issues, both positive and negative, have emerged in the medical laboratory’s leadership and management. This paper discusses the major issues and concerns, which leaders and managers in the medical laboratory must consider in their day-to-day managerial responsibilities.

The Need for Maintaining Quality at Affordable Costs

The primary concern of leaders and managers in the medical laboratory involves ensuring that quality is attained within reasonable costs. The healthcare of the United States has been gradually shifting from volume-based to becoming a value-based field. As a result, Agha [1] argues that the emphasis is being placed on the proper utilization of resources to ensure that maximum benefit is achieved at reasonable costs. Ordinarily, laboratory orders are made and procured improperly, thus resulting in exaggerated costs. Such high expenses waste resources that would have otherwise been directed to other areas of healthcare. In addition, over-procurement and the purchasing of undesired materials lead to high volumes of waste. Thakur and Ramesh [2] confirm that the disposal of healthcare waste is already a major concern for healthcare systems in both developed and developing countries. For these reasons, leaders and managers in the medical laboratory world concern themselves with developing test utilization plans that will not only minimize costs but also reduce waste.

Baird [3] defines test utilization as a strategy adopted to perform laboratory and pathology analyses in a manner that promotes quality and cost-effective healthcare. Laboratory managers are charged with the responsibility of ensuring that a utilization strategy makes both financial and medical sense. In other words, any test plan adopted must be reflective of cost-effectiveness, yet must also promote quality care. Patients today are more concerned with the quality of care they receive. As a result, laboratories have to strive to meet the demand for quality by their patients. The voice of patients has specifically been enforced by the Affordable Care Act. This Act provides for the pay-for-performance approach to care where patients compensate practitioners based on how they perceive the quality of healthcare received [3]. This approach places great pressure on the health care system to guarantee proper diagnosis and effective treatment of patients. Thus, leaders in the laboratory department must conform to this emerging issue of increased demand for quality.

The Need for Leaders and Managers to Minimize their Spending

Amid suggestions to cut the healthcare budget in the country, and efficient test utilization plan is more relevant today relative to the past. Recently, the US administration made a proposal aimed at trimming health spending in the country. If such a proposal becomes law, healthcare leaders and managers will need to devise ways to cut their spending to match the reduced federal funding. These proposals could be justified given the huge portion of the US budget directed to healthcare. According to Kaplan and Haas [4], about 18 percent of the US GDP goes to healthcare. Specifically, between $60 and $70 billion, which is spent in medical laboratory programs, continues to increase at an annual are of between about 25 percent [4]. There is the need to tame this high spending. Thus, the leader in the medical laboratory is contemplating ways of effecting such reductions without hurting the laboratory practice in general. Kaplan and Haas [4] warn that cutting healthcare costs can become counterproductive if not properly carried out. Already, the plan to reduce the costs is a major concern among managers who are worried that the move will compromise the quality of healthcare.

Some common mistakes that managers commit while attempting to reduce costs include retrenching laboratory staff, under-investing in certain laboratory equipment, and concentrating narrowly on procurement prices without considering how supplies are being consumed. Hence, managers may propose to increase patient throughput without considering how it will affect the quality of care disseminated. As Reichard and Wood [5] assert, physicians are more productive when they handle fewer patients. Thus, the dilemma between quality and costs is a major pressing issue in the present medical laboratory situation. Such practice calls for adherence to the philosophy of the correct check at the opportune time for the correct verdict [5]. As such, errors that can affect the quality and cost of healthcare are minimized.

Waste Management

Waste management is another common issue in a medical laboratory. Medical laboratories produce a huge amount of healthcare waste every day. Chartier [6] argues that effective disposal of this waste is a major concern for the management, given its potentially harmful nature. Different types of waste require unique ways of disposal, some of which are costly to implement. Specifically, biohazardous and radioactive wastes are difficult to dispose of. Proper disposal calls for cooperation among the laboratory, environmental protection agencies, and other relevant departments. The various waste streams have to be isolated and plan effected for efficient removal. Further, there is a need to ensure that waste management personnel are properly trained to facilitate effective disposals and the elimination of injuries [6]. The staff is always under the threat of coming to contact with contaminated materials such as sharp objects or radioactive items. Thus, it is upon the management to conduct proper training of the personnel to ensure that such instances do not occur.

Laboratories are always under pressure to conform to the federal, state, and local legislation concerning the disposal of waste. Failure to meet the various regulations put in place may attract hefty fines. Thus, it is incumbent on the management to educate the staff about the various laws and ordinances that concern laboratory operations. Additionally, any waste disposal method settled upon must be cost-effective. Further, it should be sustainable in the sense that its operation and maintenance must not pose a threat to the environment. For instance, Sharma et al. [7] reveal how modern incinerators are often designed to produce minimum emissions. As such, managers are concerned with replacing old waste disposal systems and replacing them with modern and more efficient ones.

The Need to be at Par with Technology

Another major concern for leaders and managers in the medical laboratory is technology. Mukherjee [8] opines that the success of medical research depends on the effective use of the various technologies to perform chemical, immunological, and hematological diagnostic analyses, among others. Sophisticated technologies require highly trained technicians to handle them, more so in a sensitive environment such as a medical laboratory. According to Helander [9], equipping staff with adequate computer skills not only ensures improved efficiency but also minimizes errors in procedures. Another element of technology in medical laboratory pertains to record keeping. Information systems are critical for the effective coordination of administrative tasks within the laboratories. Given this situation, managers are often concerned with the kind of technologies to adopt based on their ability to render technologically advanced solutions. As a result, the aspects of speedy delivery and accuracy have become central to any technology adopted in the medical laboratory. Paper documentation is also rapidly becoming phased out since healthcare systems endeavor to revolutionize their information systems. Karaca-Mandic, Town, and Wilcock [10] recommend that patient information and other statistical records must be kept properly in an easily retrievable manner. Further, such records must provide information that can be used to direct policy and decisions. For instance, it should be evident from the records whether a certain infection is increasing or decreasing in a given population. This way, stakeholders can initiate the appropriate response when the situation demands.

The Need to Ensure Efficient Record Sharing

Another concern relates to sharing laboratory information and records among stakeholders. In a healthcare system, all tests are performed in the medical laboratory and forwarded to the relevant department. A proper information system ensures rapid dispensation of these results to where they are needed. At the same time, laboratory managers should maintain constant communication with other departments in the healthcare system. This goal can only be achieved with the appropriate information system in place. Horvat et al. [11] recommend the use of software that ensures that the management of laboratory samples remains automated. Thus, any new findings or changes effected can be reflected across the entire healthcare system. An example of such software is the Laboratory Information System (LIMS). A medical laboratory configures its operations into the LIMS, which allows it to print barcodes for results obtained from laboratory analyses. Further, the system automatically validates results, which conform to various criteria.

The Need to Train Laboratory Technicians

With the improvement in technology comes the challenge of technical knowledge on the part of laboratory technicians. In 2011, a patient at MedStar Washington Hospital, Washington DC, died. Another low-blood sugar patient was mistakenly treated for insulin, forcing her into a diabetic coma. The mistake had occurred because the hospital staff had misread a pop-up box on the automated blood-sugar reader. This instance illustrates a common trend where patients receive the wrong diagnosis or treatment because laboratory staff fails to comprehend modern technology. Webster and Eren [12] argue that such cases occur where new technology is introduced without proper analysis of the staff’s ability to use it effectively. This challenge is not limited to technology. However, it occurs where new lab tools are involved. Thus, leaders and managers are involved with ensuring adequate training is extended to their staff before rolling out new technology or tools for use in the laboratory. Productivity calls for physicians to work fast. However, where new technologies or tools are involved, medical errors and injuries can easily occur.

Researchers have found that the rapid implementation of technology and digital health records is a major contributor to a medical injury. Patient-monitoring gadgets and surgical robots among other equipment must be integrated alongside appropriate training to users. A major mistake made by healthcare systems is to perform tests on this equipment and technologies in a controlled environment. According to Landman et al. [13], controlled environments omit the “human factor”, which is how people interact with such equipment and technology. Often medical operations are performed under high-pressure situations, something that controlled systems do not capture. Therefore, the human factor should be a major priority when implementing any technological change or introducing new equipment. Managers must emphasize the need to scrutinize new devices from the point of the users. This need may call for simulation scenarios that attempt to reflect reality as much as possible.

Conclusion

Productivity in healthcare requires the implementation of efficient systems, particularly in the laboratory department. Managers and leaders in this department often have to deal with various common and emerging issues that shape the nature of operations. Cost-effectiveness in the procurement of materials and service delivery is one of the primary concerns in a medical laboratory. Amid the concerns that the US is spending a huge portion of its budget on healthcare, pressure is mounting on laboratory managers to trim costs. Secondly, the issue of waste disposal has become more relevant, as the volume of healthcare waste continues to rise. Leaders are looking for efficient ways to minimize the waste produced in the laboratory. Besides, proper disposal mechanisms form an important aspect of waste management efforts. Finally, technology, being a central part of medical laboratory practice, remains an important concern for leaders and managers.

References

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