Bridging the chasm between the C-suite and the lab

Driving health system innovation is a goal many share. Yet health system leaders often encounter a chasm between their upper-floor vision and core lab operations when it comes to execution.

Imagine a C-suite leader in a health system that is developing a plan to advance value-based care for its employees. They communicate a strategy to their direct reports–often at the VP and Director level–whose role is to make the strategy operational.

Yet even if that team has that strategy in hand and has thought through execution, the executive may not like what they hear when they sit down in a meeting with departmental leadership several months later. In a meeting with lab directors, for example, they may ask:

• “What are you doing these days that’s aligned to value-based care contracts?”
•  “How are you making sure you’re doing the right screening tests for our patients with diabetes?”
• “Do you have a pretty good overview of how the lab is paid and how that ties to our health savings objectives?”

The lab director may respond that they are not privy to this type of information. Worse, they may say, “Nobody’s told us about any of this.”

It’s time to bridge the chasm. 

It’s safe to say that most people in a lab management and operations have the best of intentions. What’s often missing is communication, partnership, and translation of value-based concepts or goals down through every layer of management to them.

Without question, there are technical challenges in moving towards value-based care in the lab. People see the value in driving down total cost of care over fee-for-service, but not everyone knows how to do it at a population level. Even when you do pull lab and screening data out of an EMR, for example, there’s a lot of effort involved in validating it, keeping it current, and conducting analytics on it.

In my experience, creating a shared framework for collaboration with your lab department is just as important as mastering the technical challenges. People talk about change management. I prefer to say that you can change machines but you have to inspire people to change themselves. How do you get there? Here are a few practices I have seen working in creating a collaboration-based framework at the laboratory level.

1. You’ve got to genuinely care. This sounds obvious, but if you actually care about the people you're working with and get to know them as a leader, everything else becomes easier. If you take the time to show you care, whether it’s to lab management or frontline phlebotomists, they will give you an audience. Lean practice would call this leadership observation with employees and work process, a Gemba walk. If employees know that you truly care about them, their personal growth, and what you’re trying to do, they are much more likely to come along on the journey.
2. Communicate transparently. Transparency means you’re not sugarcoating while building a shared vision. You can tell them this initiative will require their investment to get up and going, that there will be extra hours in the lab as well as some disruptions. But here’s why this initiative is so important for you, for the team, for the laboratory department, and for the health system. People who know you care about them will respect this level of honesty and look forward to shared progress after the investment.
3. Focus on data, not debates. Although changing the way people think is critical to get a change effort going, data is where you should focus. This is where people will be held accountable. In the lab, focus on where your volumes are, what your turnaround times are, and where quality can be improved. If you’re not measuring these criteria, start now. This provides a foundation to build from, then allows you to see where things may be going a bit awry.

If you show you care, communicate transparently and take a data-focused approach, laboratory professionals will start to lean in and say, “Wow, I had no idea it was taking that long to turn around a test” or “We’re doing unnecessary blood draws, we’re creating unneeded costs, and this work isn’t really standard of care anymore. We’ve got to change that. And I know we can even if we don’t know how just yet.”

Delivering value-based care is a lot of work. Systems need to be set up. Internal investment will be hard-won. But I encourage you to think of the upside. When you create the conditions for innovation in the laboratory department and start attracting more of these colleagues to get there with you, you’re on your way to becoming an employer that retains staff longer–and how invaluable is that today?

Laboratory staff who feel they know you personally will respect what you set out as priorities and respect the way you communicate. They will feel empowered to bring ideas to the table because they know the managers above them will bring them to you. People will start to focus on possibilities rather than barriers. And in the lab, at least, you’re on the way to becoming what a health system is meant to be: a force for positive change and better outcomes.