Elsevier

Clinica Chimica Acta

Volume 427, 1 January 2014, Pages 118-122
Clinica Chimica Acta

Management structure: Establishing a laboratory utilization program and tools for utilization management

https://doi.org/10.1016/j.cca.2013.09.026Get rights and content

Highlights

  • •

    Describes key attributes for successful leadership of test utilization efforts

  • •

    Outlines steps for establishing a utilization management program

  • •

    Discusses the medical director's role as liaison to the clinical practice and administration

  • •

    Reviews leadership and management tools for utilization programs

Abstract

As laboratories are challenged to do more with fewer resources, the pathologist and laboratory director will play a greater role in improving the effectiveness of the laboratory, as well as addressing the overuse, misuse and underuse of laboratory testing. We describe the necessary characteristics for pathologists and laboratory directors to successfully lead utilization efforts, as well as key leadership tools and essential steps in creating a utilization management program. When we established a laboratory test utilization program de novo, it became clear how important the laboratory director was in guiding those initiatives by working with stakeholders outside of the laboratory, particularly clinicians, nurses and administrators.

Section snippets

Rationale for establishing a utilization management program

In the past laboratories were rewarded for performing more tests and charging for higher test volumes that resulted in greater revenue. This is typically called practicing to volume. Given recent economic concerns and debate over healthcare spending, laboratories are increasingly tasked with providing more services with the same or less revenue. This shift in focus from performing many tests to performing only the necessary tests has been termed practicing to value. Utilization programs are a

Characteristics of the pathologist or lab director responsible for test utilization

Laboratory testing UM is still in its infancy in the United States. However, there are some common elements in the utilization programs that have shown success. One of those elements is full engagement by a knowledgeable laboratory medical director [4]. Successfully steering a test utilization program requires a pathologist or lab director to demonstrate strong scientific, communication, and leadership skills. The individual should have sufficient knowledge of the specific areas included in the

Recognize the need

Moving from the subjective desire to establish a utilization program to an objective reality requires data. The data acquired to support the need for UM will likely steer the format and targets of the program, and can often be used to gain clinical and administrative acceptance, as well as justify funding and resources. A laboratory can compare its institution's ordering patterns against other medical centers, through literature review, personal communication with colleagues, or benchmarking

Tools for test utilization programs

Key to the success of any laboratory utilization program is lab test formularies, test algorithms, and the use of reliable data generated from the local informatics of the system. Detailed discussion of the power of informatics in improving test utilization is provided later in this special edition, as are focused articles on lab test formularies, test algorithms, and other specific tools for utilization programs. Although the pathologist should provide medical and scientific oversight of these

Role of the pathologist or lab director in the test utilization program

The lab director should be intimately involved in all aspects of establishing and maintaining a utilization program. In addition to providing scientific guidance for the steps outlined above, the lab director, whether a pathologist or a laboratory scientist, has several other leadership roles. He or she is responsible for establishing deadlines to eliminate tests that have strong published evidence against their use. The director should support projects in all areas to optimize the process of

An example of a laboratory UM program

Concern regarding the perceived over-utilization of some tests and an audit of our testing patterns resulted in a project in 2011 to optimize ordering habits to minimize unnecessary repeat laboratory tests. Our test utilization program was established with a focus on decreasing the number of high volume, high cost tests while maintaining appropriate patient care. There was a deliberate attempt to employ evidence-based medicine to move from practicing to volume to practicing to value.

Test

Conclusion

Simply put, UM efforts cannot succeed without a knowledgeable and engaged pathologist or laboratory scientist director with strong leadership and communication skills, as well as the ability to manage change and provide motivation to a large collaborative team across the medical practice. Beyond simply imparting medical and scientific expertise, the director must serve as an effective liaison to providers and administration, to steer the cultural shift toward including utilization

References (15)

There are more references available in the full text version of this article.

Cited by (10)

View all citing articles on Scopus
View full text
Copyright © 2013 Elsevier B.V. All rights reserved.