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Laboratory Strategic Planning Since 1981

 

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Hospital executives and laboratory directors rely on the American Hospital Association for valuable strategic information.  AHA published an important "Special Report" regarding future hospital laboratory services.  The following summarizes that report.

Hospital Technology Special Report

 

 

ABOUT THE AUTHOR

Barry Portugal is president of Health Care Development Services, Inc., a Northbrook, Illinois-based management consulting firm specializing in hospital laboratory strategic planning, organizational, and operational issues.  Health Care Development Services, Inc. represents more than 320 hospitals and integrated health care systems.  The firm also sponsors the LabTrendsSM Hospital Laboratory Comparison program with more than 320 hospital laboratories in its database.  Mr. Portugal is a frequent speaker on laboratory issues for the American Hospital Association, Clinical Laboratory Management Association, American College of Healthcare Executives, the American Pathology Foundation, and other health care organizations.

The following lists the table of contents and tables included in the Special Report.

CONTENTS
INTRODUCTION 1
Performance Indicators for Laboratory Services 1
Factors Influencing Utilization 2
Acuity, Length of Stay, and Laboratory Utilization 2
Outpatient and Outreach Services 4
FACTORS INFLUENCING TESTING COSTS 5
Employee Productivity 6
Turnaround Time 7
Supply Costs 8
Send-out Tests 9
STAFFING MIX VERSUS PRODUCTIVITY 10
HOSPITAL LABORATORY ORGANIZATIONAL SPAN OF CONTROL 11
SUMMARY: IMPACT OF BENCHMARKING ON STRATEGIC PLANNING 15
STRATEGIC ALTERNATIVES FOR LABORATORY SERVICES 16
OBJECTIVES DRIVE LABORATORY STRATEGIES 18
COST REDUCTION OPERATIONAL MODELS 19
ARRANGEMENTS WITH PATHOLOGISTS 20
NETWORKS MAY PROVIDE MARKETING EDGE 21
CONCLUSION 24

 

TABLES
Table 1. ON-SITE PERFORMED TEST VOLUME BY HOSPITAL BED SIZE 2
Table 2. AVERAGE LENGTH OF STAY VERSUS NUMBER OF INPATIENT TESTS PER DISCHARGE 3
Table 3. HOSPITAL TEACHING STATUS AND LABORATORY UTILIZATION   INPATIENT TESTS PER DISCHARGE 3
Table 4. HOSPITAL LABORATORY OUTPATIENT/OUTREACH TEST VOLUME AS PERCENTAGE OF TOTAL TESTING 4
Table 5. LABORATORY TEST VOLUME AND COSTS 5
Table 6. TESTING PERSONNEL PRODUCTIVITY AND COST PER TEST 6
Table 7. OVERALL LABORATORY PRODUCTIVITY AND COST PER TEST 6
Table 8. EMPLOYEE PRODUCTIVITY AND OUTPATIENT/OUTREACH TESTING 7
Table 9. TESTING PERSONNEL PRODUCTIVITY AND TURNAROUND TIME DEMANDS 8
Table 10. SUPPLY COSTS PER TEST 9
Table 11. COST PER REFERRED TEST 10
Table 12. STAFFING MIX AND PRODUCTIVITY LEVELS 10
Table 13. COMPENSATION PER PAID HOUR BASED ON STAFFING MIX 11
Table 14. PROPORTION OF STAFF BY JOB CLASSIFICATION 11
Table 15. ORGANIZATIONAL REPORTING RELATIONSHIPS 12

 

FIGURES
Figure 1. HISTORICAL HOSPITAL LABORATORY ORGANIZATIONAL CHART 13
Figure 2. FUTURE HOSPITAL LABORATORY ORGANIZATIONAL STRUCTURE 14
Figure 3. SUMMARY OF FACTORS INFLUENCING HOSPITAL LAB OPERATIONS 17
Figure 4. STRATEGIC CHOICES REFLECT MANAGEMENT OBJECTIVES 18
Figure 5. MUTUAL SHARING ARRANGEMENTS 19
Figure 6. CENTRAL LABORATORY MODEL 20
Figure 7. POTENTIAL HOSPITAL LABORATORY NETWORK BUSINESS RELATIONSHIPS 22
Figure 8. HOSPITAL LABORATORY NETWORK AS CENTRAL NEGOTIATING ORGANIZATION 22
Figure 9. HOSPITAL LABORATORY NETWORK INFORMATION SYSTEM 23
Figure 10. HOSPITAL LABORATORY NETWORK INFORMATION SYSTEM INTERFACES 23
Figure 11. HOSPITAL LABORATORY NETWORK BILLING SYSTEM 24

 

The following introduction summarizes key elements of the AHA Special Report.

INTRODUCTION

During the past several years, the scope of reengineering, reorganization, and consolidation in hospital laboratories has dramatically altered how laboratory services are delivered to inpatients, outpatients, and outreach clients. Significantly reduced numbers of inpatient days and lowered average length of stay have substantively impacted the number of inpatient laboratory tests performed, while outpatient/outreach testing has significantly increased. As health care system integration continues at its explosive pace, hospital executive management must consider which operational and organizational strategies are the most appropriate for individual hospitals, as well as integrated delivery systems.

This Special Report discusses relevant benchmarks intended to help hospital administrators and laboratory directors identify trends in hospital laboratory operational and financial performance so that comparisons of patterns of care and financial operations can be made. Benchmarking the relative financial and operational performance of hospital laboratories allows health care planners to design the most appropriate laboratory services delivery system for future hospital inpatient, outpatient, and outreach market demands.

Factors influencing financial and operational performance will be investigated, including utilization, testing costs, staffing mix, productivity, and organizational structure. This will be followed by a discussion on the future of laboratories and alternative strategies for hospitals and integrated health care delivery systems.

Performance Indicators for Laboratory Services

The financial and operational performance of hospital laboratories can be measured in many ways. One source for comparative management benchmarking information is the LabTrendsSM Hospital Laboratory Comparative Program. LabTrendsSM uses "performed tests" as the basis of most indicators. This method of counting test volume has been acknowledged by laboratory directors, hospital administrators, and chief financial officers as the basis of valid, legitimate comparisons to benchmark hospital laboratory operational and financial performance. More than 265 hospitals are currently in the LabTrendsSM database. LabTrendsSM data are used in this report to establish ranges of current performance in several key areas, including utilization, costs, staffing, productivity, and financial performance. To illustrate trends, the 1996 data included in this report are compared and contrasted with historical data from a previous AHA Special Report, Benchmarking Hospital Laboratory Financial and Operational Performance, published in December 1993.

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