Standardisation of laboratory systems and the benefits for stakeholders

• Laboratory testing capabilities play an important role in any healthcare system.
• Standardisation of testing across laboratory sites, each with its own requirements, can be a huge undertaking.
• M Health Fairview recently standardised its system and has seen multiple benefits including testing efficiencies, enhanced knowledge sharing, and more certainty in its supply chain.

With its large network of hospitals and clinics, laboratory testing capabilities are a key part of M Health Fairview’s healthcare offering. Following acquisitions of other health groups, they were operating different chemistry systems across the organisation, each with their own vendor. 

This created a complicated situation that they wanted to change. They wanted to create an easier, simpler healthcare experience. Their organisational focus was on reducing care variation, reducing unwarranted resource use, and reducing cost per case. 

The team decided that this required a substantial change. They looked into the standardisation of their laboratory system in order for all tests to be conducted using the same parameters, and results reported in a way that are easily interpreted by all providers across their network. 

Jina Forys, Director of Acute Laboratory at M Health, Graham Gregorich, Site Leader and Lab Supervisor at M Health CSC, and Dr. Anthony Killeen, Director of Clinical Laboratories, explain what they hoped to achieve by standardising their network and the benefits they have seen.

Q: You recently standardised your laboratory system. What brought about this change? 

Jina Forys: Before we undertook this project we had acquired two different health groups so we ended up with three unique chemistry analysers and three different vendors in our system. Across 13 different sites, we did not have standardised chemistry, and that caused a lot of problems. If you were a clinic patient and you went to one clinic for bloods one day and another a different day, the test might go to different labs with different reference ranges and different critical values. The providers were very confused as they had to try to interpret sets of results reported using different parameters. We had known cases where results were misinterpreted and patient care was impacted. 

We knew we had to optimise chemistry as quickly as possible to remove this confusion and ensure our providers were able to optimise patient care. We also knew that standardisation to a single vendor and creating one central core laboratory would support our organisational goal to reduce the total cost of care. 

Graham Gregorich: Our acquisitions resulted in a non-standard environment for the  M Health laboratories and we recognised there was a need to rectify this. With our legacy vendor contracts coming to an end, it seemed like the right time to standardise across all of our sites.

Q: What did you hope to achieve through the standardisation of your laboratory system? 

Jina Forys: Labs typically want to standardise to a single platform. The benefits of that are having the same reagents, the same reference range, and the same critical values for all tests. This means results are reported in the same way across the board. This is the most important reason to have a standardised platform across an organisation, so that any provider across your system will be able to interpret results the same for every patient.

For us, it was also about having a centralised laboratory model. We really wanted to create a hub and spoke network across our labs where the hub would act as a central connection point for the spoke sites. Before this, we had four different sites operating as “hubs”: two within the clinics and two within our existing hospital laboratories. There was not any single laboratory that could operate as a single hub because of the equipment that they had on-site. A bigger and larger capacity hub meant we could consolidate non-acute tests there and simplify testing menus at spoke sites.

Anthony Killeen: There is a big impetus today in clinical medicine to reduce costs and the belief generally is that there is a lot of overuse of clinical lab tests, maybe by as much as 20%.1 There’s also underuse of other tests that might help a speedier diagnosis or better define a treatment course. When it comes to lab test ordering practices, there has been a recent focus on how we, the lab, can help providers order the right test at the right time in the right scenario. This helps to reduce the total cost of care (in the case of overused tests) or improve diagnosis and treatment (for underused tests). I think standardisation of laboratory tests can help us to provide these resources to providers more easily rather than having multiple of the same but slightly different tests.

Standardisation is not just about tying together results, there is also a potential financial windfall in terms of use. If you have higher volumes, you may be able to reduce the cost per test by consolidating all your testing into a single platform and vendor.

Q: The standardisation of a laboratory system is a huge undertaking. What were the key considerations when making the change?
 

Graham Gregorich: Before making any change you need to understand what your requirements are. Above all, what do you need from this new system? For example, if you are looking to standardise to one platform do you understand what the non-negotiable aspects of your testing needs are. 

Anthony Killeen: There are a lot of considerations on a technical level about individual assay measurement ranges, and reference intervals that we might expect to see. What sort of test results are you going to be generating without having to do, for example, dilutions? What are the analytical measurement ranges of the assays, and what are the pediatric sampling and volume requirements? It is not just about integrating lab tests, it is about deciding which tests are needed and which tests are not.

Q: What feedback did you get from stakeholders? 
 

Jina Forys: Asking for feedback was a critical step in the process and it was important to include all of our key stakeholders. We communicated about why we were creating a new model for testing and said, ‘these are the things that we think are important, but what things do you have to add?’ From that, we got things that we hadn’t even thought about from experts at our children's hospital or considerations from smaller sites or larger sites that each have different needs. 

Graham Gregorich: It’s so important to speak with all your stakeholders to get their input. What do they like about the current state? What do they not like about the current state? That can help drive certain decisions. For example, when we spoke to our providers we did not know that things like a two-hour turnaround time for cholesterol testing would impact their practice, but evidently, it did to the point where that testing had to remain on-site instead of being sent to the core lab.

Jina Forys: Also getting agreement on the definition of standardisation is really important in a project like this. A lot of people, when they think of standardisation, think of it being that the outcome for everybody will look exactly the same. My definition of standardisation is that we have standard logic for making decisions, which may result in what looks like a different outcome.

An example in this project would be choosing the equipment models that we have at each site. Different hospitals have different needs, and we would choose the model based on the need of the site rather than have every lab have the exact same equipment.

Q: What main benefits have you seen since standardising the system and creating a hub and spoke model? 

Testing efficiency

Jina Forys: Creating a single core lab in our system allowed us to consolidate non-acute testing in a single location. It streamlined and simplified the test menus at the other sites so that they can focus on the acute tests that are most important to their population. 

Graham Gregorich: By condensing some of the lesser volume testing to the hub site, the spoke sites also realise cost savings. By not performing some tests you can eliminate some QC products, calibrators, and proficiency testing requirements. The cost savings in that can be significant. Having a single vendor for the whole system also created value by reducing our cost per test.

Knowledge sharing

Graham Gregorich: The greatest benefit as I see it is that you have 11 laboratories now that are all developing knowledge independently, but then it can be brought together so we can share information. There is regular communication between sites if any issues arise and we can troubleshoot problems together. Being able to share problems that we encounter with the hub and other spoke sites can prevent them from getting too far down that same problem road.

Supply chain certainty

Graham Gregorich: You also get supply-based benefits of standardisation. The supply chain has been experiencing various disruptions since the pandemic. With everyone using the same products it means we are able to borrow things on short notice from other labs in our network to get us through, which has enabled more consistency and continuity in operations in general. If somebody is having problems with a certain reagent or whatever it might be, we have resources available in the system where we can quickly acquire additional products. 

QC checking

Graham Gregorich: We can also compare our performance to other labs to check if we are seeing QC shifts. We have essentially created in our system a network of peers. That is an additional benefit beyond what you would have if you were not standard.

Team alignment

Jina Forys: Not only did we have our expected outcome of a standardised solution across our system for standardised results to our patients, but it aligned us as a team and as a group. We worked together across all of our sites to create standardised procedures and training checklists and it brought us together to make us more efficient. 

It was a big project but it was also something that, with each site go live, we all cheered for each other, and we celebrated each other. We worked together toward that common goal.