Pathologist Utilizes Systems-Based Steps to Improve Hospital Operations

Pathologists play a critical role in improving patient outcomes and reining in escalating health care costs

Health care executives and hospital leadership hold the responsibility of mitigating costs while simultaneously ensuring the quality of care for patients. However, they are not alone in this difficult task. As demonstrated in previous discussions like the H&HN Executive Dialogue “The Role of the Pathologist in Diagnosis, Quality, and Patient Safety,” pathology and its practitioners are in a unique position to positively affect health systems.

Delivering an accurate diagnosis may be one of the more obvious responsibilities of the laboratory, but Jennifer Hunt, M.D., chair of the pathology department at the University of Arkansas for Medical Sciences, Little Rock, shows how to engineer a systems-based solution that not only improves the outcome for the patient community, but for the hospital’s bottom line as well. Hunt isolates three processes to place pathologist leaders in a significant role for coordinated care: 1) small steps to marginal gains, 2) engineering-driven change, and 3) systems-based thinking. “The system has to be optimized to get to the best quality, to make the right thing to do the only way to do it,” Hunt says. “That’s where the best results come from in process improvement.”

While pathologists and their partner clinicians strive for perfection, health care leaders must take advantage of discrepancies large and small for teachable moments and to identify areas in need of improvement, according to Hunt. “I think you have the best opportunity to remind people when something goes wrong,” she says. “A problem is an opportunity to remind everyone that there is a patient on the other side. A careful step-by-step root cause analysis will give us answers to system-based problems, but it will also impact people and will affect their thinking beyond just one area. A formal root cause analysis can bring patient safety to life.”

Hunt recalls a recent experience when the clinical department at University of Arkansas for Medical Sciences faced pressure for statistics showing longer discharge times for patients. Initially, late laboratory results were blamed for the patient turnaround times; but after a deeper analysis by Hunt and her team, they discovered an easily remedied process flaw. Negative culture results were being batched instead of reported as they were ready. “A relatively simple system change resulted in real change for the clinicians who were waiting on those results to send patients home,” Hunt says.

The new rolling system allows physicians to discharge patients as soon as their results are available, cutting unnecessary costs while bettering the patient experience. “This is just one example where the administrative and investigative approach of a pathologist can improve overall care,” says Hunt. “Hospital executives should know they have some of their best allies in the laboratory when it comes to process and systems improvement.”