Threats Remain

In “Northwell Health Laboratories: The 10 Year Outcomes After Deciding to Keep the Lab,” in this issue of the Archives of Pathology & Laboratory Medicine,²  the authors share the inspiring story of the laboratory's decade-long journey as it advanced patient care and simultaneously improved fiscal efficiency, all to the betterment of its patients and its parent institution. The authors and their colleagues must be congratulated on an extremely successful decade-long trek toward advancing patient care and improving institutional economics. The authors' recitation of the changes they believe led to Northwell Health Laboratories experiencing such a successful decade is made more remarkable as one considers those changes occurred during increasingly difficult economic times for pathology departments and laboratories.

Their story of Northwell Health Laboratory's journey reinforces the value of some bedrock principles pathologists have long employed for maximizing patient care safety and quality while simultaneously increasing cost efficiencies. These principles remain instructive to anyone attempting to find a path for future success in laboratory medicine. The authors emphasize teamwork and dyad building, their team's active engagement with administration, and their refusal to passively accept potential outcomes put forward by others. They worked to find hidden potential value within the laboratory, with transparent, clear communication with their institutional leaders. Although cost is always the driving factor, it is encouraging to see that along with the cost savings and increased revenue, the authors recognized additional, less-obvious benefits, including reputational growth and increased regional value. These valuable reputational benefits are very real and are an intangible asset akin to corporate good will. Northwell Health Laboratories strove to serve its constituency and never lost focus of its mission of providing high-quality medical care. As the authors note, Northwell Health Laboratories is well positioned to succeed in today's turbulent, patient-centered, molecular-driven world of precision, personalized medicine that demands the maximization of financial efficiency and continuously improving patient quality while requiring careful navigation of increasingly numerous and burdensome legal, regulatory, administrative, and social demands and expectations.

However, despite their and their team's enormous success during the past decade, the authors wisely acknowledge, “… threats to Northwell Health Laboratories remain.”²  Among these threats, “Northwell's ultimate stakeholder, the consumers, may not recognize the value provided by the Northwell laboratories as opposed to other alternatives.”² 

Perhaps pathologists' greatest threat today is our inability to clearly explain the value equation³  to administrators, payors, legislators, and patients and their families. Because the laboratory remains to most people an unknown “black box,” it is difficult for them to clearly understand or appreciate the quality that pathologists and laboratories provide patients. In contrast, administrators, payers, and others can usually quickly and comfortably understand cost. As such, the “value” of pathologists and laboratories often is highly focused on cost, and so “increased value” is often synonymous with “lower cost.” Quality is too poorly understood and messy to address, so quality is too often merely discounted, assumed to be a constant across pathologists and laboratories. Moreover, decisions affecting pathologists and laboratories are more frequently coming from corporate offices, often far away from the laboratory, or even the hospital that the laboratory serves. Decisions then may occur that lower cost and may also lower value. Accreditation of a laboratory by the College of American Pathologists is a strong indicator of quality; however, the pathologists' role in educating administrators, payers, and others cannot be underemphasized. Pathologists must be ever vigilant in seeking out opportunities to improve communication with health care leaders, display the value we provide, and assertively invite ourselves to a seat at the table of health care policy development.

Read and celebrate with the authors their remarkable achievement but also consider how best to communicate the quality we bring to the patient care team. Pathologists recognize there are many difficult-to-quantify, hard-to-clearly-explain imponderables that pathologists, as leaders of College of American Pathologists–accredited laboratories, influence every day. Accurate and timely testing reduces patient length of stay, ensures timely use of appropriate medication, and reduces the risk of iatrogenic injury. All of these improve the patient experience, which is translated through an improving Press Ganey score—a score administrators certainly recognize and respect. Because the pathologist's and laboratory's influence in attaining improvements reflected in the Press Ganey score is typically far downstream from the ultimate improvement recognized, too often the pathologist's and laboratory's role in attaining those improvements reflected in the Press Ganey score goes unrecognized.

The pathologists' task is 2-fold: to improve patient care and institutional value by improving laboratory quality and cost savings, and to communicate effectively those quality improvements in a manner that clearly highlights the pathologists' and laboratories' role in improving patient care and institutional value. Only when both are successfully accomplished will threats to pathologists' and laboratories' successful provision of cost-effective, quality patient care abate.