Reaching across disciplines and harnessing the power of laboratory data for healthcare transformation
Asour world progresses through an unprecedented pandemic, the benefits of laboratory medicine have never been more clear. Many healthcare leaders, however, have been championing healthcare transformation and quality improvement efforts through clinical laboratories for over a decade. Abbott has partnered with top healthcare organizations to present the UNIVANTS of Healthcare Excellence Awards, a prestigious program that recognizes integrated clinical care teams who collaborate across disciplines and transform healthcare delivery, improving patient lives.
Fawn Lopez, publisher of Modern Healthcare, sat down with members from the top three winning teams from 2020 to explore their best practices in healthcare transformation for improved efficiency of care, streamlined patient experiences and measurably better outcomes.
For more information about the projects discussed in this roundtable, visit www.UnivantsHCE.com or ModernHealthcare.com/ UNIVANTS2020
FAWN LOPEZ: Many UNIVANTS winners have devised innovations that expedite diagnosis, uncovering potential illness early in its progression in hopes of avoiding adverse outcomes and enabling a better patient experience. How have you seen the importance of preventative medicine change at your institutions and in the healthcare industry at large?
PAUL KOMENDA: In our specific project, the prevention targets are very clear. We want to prevent the morbidity, mortality and healthcare system costs associated with kidney failure or dialysis. We’re doing this through early detection and a targeted screening approach with a vulnerable, high-risk population: indigenous First Nations patients. This population is CHRIS at a disadvantage FLORKOWSKI in terms of opportunistic screening, by virtue of geography and systemic Chemical racism. We’re trying to facilitate care by bringing innovative Pathologist but well-validated operating procedures associated Canterbury with point-of-care District testing to these populations. Health Board
ABDULRAZAQ SOKORO: Early diagnosis is incumbent, but also informs resource stewardship in medicine as a whole. Allowing for a timely, targeted diagnosis prevents the misuse of other resources that could not necessarily be needed, while also allowing for an extended intervention that would improve the outcome of the patient in terms of quality of life.
FRANCISCO J. POMARES-GÓMEZ: Preventative medicine and early diagnosis are especially important for people in the prediabetes stage. Our project seeks to diagnose early, and we use preventative measures to fight the overweight, sedentary lifestyle that can cause diabetes. In our area, diabetes is a condition that affects about 14 percent of patients, but only eight percent of them know they have this condition, so it’s underdiagnosed. When we make a diagnosis of diabetes, we can encourage not only preventive measures for people at the pre-diabetic stage, but also relevant treatment in order to avoid complications.
FL: How are your care projects addressing social determinants of health?
MARTIN THAN: Our project developed a new pathway that more quickly, efficiently and safely identifies those patients at a lower risk for major adverse cardiac events, freeing up hospital and ED space for critical patients, including those with COVID-19. Like other teams here, we have health disparities among our indigenous populations. Our indigenous Māori patients have significantly worse health outcomes than other members of the population and have suffered many decades of prejudice. With regard to our own project, what I’d say is that we have found that Māori and Pacific Islanders don’t like coming to the hospital and they definitely don’t like spending an extended period of time here—they want to get back to their family as soon as possible. So, being able to tell them they don’t have to spend time in the hospital overnight or spend a lengthy period of time in the emergency department encourages them to participate willingly in the care pathway we’ve prescribed for them.
CHRIS FLORKOWSKI: In New Zealand’s publicly funded health system, although there is equity of access in principle, the fees to access primary care are prohibitive to some—especially post-COVID. This has a trickle-down effect in the ED, where patients presenting in crisis are never turned away. This can result in overcrowding, and therefore is relevant to our work designed to minimize unnecessary time spent there. Another area where we’ve addressed social determinants is in improving rural healthcare access. Some of our team’s other projects have focused on this area to develop rural chest pain pathways supported with point-of-care troponin testing.
“Build relationships with your colleagues, build collaborations, and above all, communicate—these success factors apply equally across all disciplines.” CHRIS FLORKOWSKI
“It’s so important to have a partner that has a similar thought process, but also similar goals for the patient and better healthcare. The communities and the individuals that you serve as patients should be at the table as well. If they are not there, then you have missed half of the equation, no matter how many caregivers are aligned with your mission.” ABDULRAZAQ SOKORO
PK: We do what we can, within our sphere of control, and we advocate where we don’t have sphere of control. We have a sphere of control over conditions like chronic kidney disease; finding it early, trying to connect people with early interventions and providing education on healthy choices. But my sphere of control as a nephrologist and that of the biochemists we work with is limited in terms of how we can affect social determinants. Alone, I can’t fix housing. I can’t fix high food prices or access to fresh food in the remote, rural, icy tundra of Northern Canada. I can advocate, but I can’t address directly. What we’ve tried to do is lessen the barrier to accessing early, appropriate and accurate diagnostic testing, and provide people with education using a non-deficit approach. Involvement of patients—indigenous people in our case—has been very important in framing our messaging. I think there’s been multiple facets to this being successful, and number one is working with indigenous clinicians and scholars in this area. Those team members who build patient trust are as important as the clinical biochemists or information technology specialists. There is a lot of detailed training and a lot of humility we’ve got to have to execute these programs successfully. That really lends to the sustainability and the success down the road that we’ve seen.
FP: We have a challenge with diabetes, mainly with the young people with type 1 diabetes, who need an education intervention. The treatment for diabetes is not just drugs, it’s mainly education. The pandemic has accelerated the use of digital technologies to educate patients, and we have created some material to share virtually as more and more people are connected with us. I think this shift to virtual care has been great, because patients are very grateful that we’re able to provide them with a structured educational program about diabetes online.
FL: What best practices can you share for the successful integration of technology into care projects? What role does IT have in future applications of your work?
MARÍA SALINAS: My honest opinion is that in the 21st century, having at our disposal so many sophisticated IT tools, it’s our duty through our work, to design and implement technology-enabled interventions to improve the patient outcome. The interventions we have presented in our care project make use of sophisticated algorithms to automate laboratory testing to improve and expedite diagnosis of diabetes. Working like that in the long term, we will change the vision of preventative medicine in our institutions and also in the global healthcare industry.
AS: It is central to anything that we drive in medicine nowadays, especially when we’re empowering the patient themselves, to be part of that care decision-making. I think having the IT specialists as part of the team is quite important and integral to the system. IT specialists are significantly important to our Kidney Check program—without their input, we would not be able to do what we are doing right now, because the amount of paperwork that would otherwise be needed to accomplish this in silos is significant.
FL: We’ve talked with many of you about how your care projects represent a shift for laboratory medicine from a passive role on the care team to a more active role in making clinical decisions and enabling outcomes. How have you enabled this within your care projects, and how are you expanding the role of laboratory medicine in other elements of your work?
MS: I think there are three laboratory models, the traditional laboratory that has a passive role, that just corroborates or discards the clinicians’ hypotheses. Then there’s the slightly more active technological laboratory. This model only intervenes in the clinical decision—it is focused on the laboratory’s focus on technology, in being able to measure the enormous amount of tests that we have to measure, and measures success through those intermediate
“Build the relationships before you have to solve problems. My advice for clinicians is that ‘knowledge translation has no hierarchy.’” MARTIN THAN
“Leadership involves setting a vision and trying to execute on that vision, but it comes with a great deal of humility and respect for your colleagues. There are really no shortcuts to building those relationships and understanding each other, but you also must pick collaborators and other team members that share that as well.” PAUL KOMENDA
KPIs. Third and finally, there is the “leader laboratory,” that not just intervenes in clinical decisions by discarding or corroborating physicians’ hypothesis, but also has the ability to make the clinical decision. A leader laboratory is a true active laboratory. A leader laboratory’s success is measured through final KPIs, through outcomes and patient KPIs, to know the improvement in the patient. I think we all need to go to this laboratory model.
AS: Everyone knows that there are certain specialties in medicine that are wholly dependent on laboratory medicine. Nephrology is one of them. Endocrinology is another one. And basically, laboratory medicine provides the window and is key for the diagnosis as well as the monitoring of patients. That being said, medicine has advanced so rapidly over the last 50 years that it is highly specialized and inevitably people have tended to be able to kind of burrow in their own silos of specialties, not realizing that there are significant interdependencies that are important, and those interdependencies have to be considered, whether it’s in clinical medicine between several subspecialties or whether it is across the spectrum with laboratory medicine and pathology as a whole. It’s difficult to come across any area of medicine that is not intersecting with laboratory medicine in any one form or another. In fact, many decisions are made based on the findings of laboratory medicine. So, it is incumbent for laboratory medicine, with its wealth and understanding of how diagnostic tools work, to be considered an active member of the team that cares for the patients as a whole.
CF: I like to think the team at our laboratory has never been passive—that we’ve always had an active role, and always had close dialogue with colleagues and referrers. And, of course, it’s been greatly facilitated by having proactive and engaging colleagues. Within the laboratory, we uniquely understand the properties of tests and have a great contribution to make, including expanding it to other areas locally, nationally and internationally through initiatives like treatment pathways.
MT: The ED is in touch with a lot of stakeholders—for example, the blood transfusion service, the laboratory and community GPs. We can bolster collaboration in these relationships through something as simple as assigning a primary or secondary liaison person within each service, who we are responsible for meeting with on a regular basis. That way, we strive to actually understand each other. Health systems are almost naturally siloed, and it can be very easy to speak a different ‘language’ from your counterparts if you don’t have a good relationship.
During one of the most challenging times for healthcare
in modern world history, the UNIVANTS winners featured in this discussion demonstrated collaboration and innovative thinking. Their achievements reinforce how teamwork, technology and interdisciplinary action can enable measurably better healthcare outcomes. With special thanks to Abbott, IFCC, AACC, EHMA, Modern Healthcare, HIMSS, NAHQ and IHE, the UNIVANTS of Healthcare Excellence Award offers an exciting platform for spotlighting measurable healthcare excellence across the globe, and ideally, inspiring new teams to achieve similar success. If you and your teams want to learn more about the award or apply for 2022 recognition, visit www.UnivantsHCE.com for more details.
“We all need to be focused on the patient, through agreement, collaboration and teamwork, to design and implement interventions for their benefit. One way to do that is by sharing knowledge between disciplines.”
MARÍA SALINAS
“It is very important to engage all stakeholders as well as teammates, and make them feel a part of your results and success. It’s also very important for everyone to widely communicate outcomes. Everyone is a part of the team, whether it be primary care centers, laboratory, pharmacy or social workers, and everyone should share the results.”
FRANCISCO J. POMARES-GÓMEZ