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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.

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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