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By Prof Dr med Kai Gutensohn, LADR GmbH, Geesthacht, and INSTAND e.V., Düsseldorf, Germany
In industrial nations expenditures in healthcare systems are continuously rising. Due to technical and medical improvements, a growing awareness of claims of patients and most of all, as the obvious result of a disproportionally ageing population, costs are increasing. On the other hand, financial resources are decreasing due to declining public and private revenues.
In general, determinants of health and illness, which can be classified into individual, medical, demographic, socioeconomic, cultural and structural factors, are stressing the fine-tuned balance of this system. As a consequence, a progressively accretive budget disparity develops. Solutions are needed to face current and future challenges.
Medical laboratories provide services as a secondary level support. While in the first level direct interaction with patients occurs, analytical activity takes place in the background. As a most prominent supplement, however, laboratory activity renders significant support for medical decision making and treatment. Therefore, the solid functionality of such analytical units is not only relevant for medical results but also critical for revenues of medical institutions.
To circumvent the drift between gains and expenses, modern laboratory units require a rising demand for management. In a functional manner, organisation, task management, shaping of processes, planning of technical and human resources, as well as leadership, represent relevant cross-sectional topics. Here, in order to understand the scope of these challenges three major characteristics are crystallised as key competences. To these count a modest degree of technical capability to transfer knowledge, technique and methodology to a given context. Second, social competence is essential which particularly comprises intersectoral comprehension, intelligent skills of communication, and readiness for cooperation. The third main skill is the conceptual expertise by which complex issues are simplified, structured and transformed into precise instructions.
Diagnostics is the link for a sustainable healthcare system, providing immediate opportunities to reduce costs, bringing value to the decision making process, to result in high quality of care. Focusing in more detail, several modules can be identified to achieve a pronounced leverage. First, identification of in-house costs must be analysed. Expenditure on materials and staff per analyte and benchmarking with comparable institutions show possible savings. Second, the outsourced analytical portfolio has to be screened. Current pricing agreements and services and the comparison with market conditions have to be analysed including aspects of additional services and quality. Subsequently, an alignment of internal and external content and performance must follow the initial efforts. The final step within this rightsourcing process is the interdisciplinary exchange to control and adapt the volume, content and behaviour of laboratory requests.
The equivalent consideration of management function with the focus on planning, organisation and control on the one hand, and functional matters with purchase, production and sales on the other hand, create the solid fundament and solution for the economic “yin and yang” in clinical hospital landscape. Its professional integration within the hospital laboratory network structure results in high productivity, a gain of efficacy and efficiency. Such gains have to be carefully balanced with quality aspects to maintain a value-based healthcare delivery. In this context, internal quality control, external proficiency testing, a well-established quality management system, and a profound supervision are mandatory. As a consequence, laboratory providers that are adaptive and nimble in the operational and economic considerations mentioned will pull ahead.
The world of healthcare delivery is changing rapidly. Organisations, hospitals and hospital laboratories need to permanently transform their business strategies to keep up with a metaphoric environment. Though, it is the patient’s outcome that matters the most and will continue to be the centre point and sum of all activities within the complex treatment process chain. Today, the mostly fragmented systems usually incentivise the delivered services of laboratories and dictate the payment for healthcare support. However, it is the patient-centred outcome system that must represent the overall strategy when looking at economic optimisation. This perception must never be disregarded as value-based care is the common goal and the integral approach for the solution based on patient needs. As an overall strategy must consider the overall performance, one may summarise this reflection with an analogy to current politics by saying “patient first”.