The Blood sciences laboratory at King's College Hospital NHS Foundation Trust was the first in the UK to pioneer full integration of the core pathology disciplines. It opened three years ago, in October 2006, and consolidated clinical chemistry, haematology, immunoassay, serology and microbiology testing on a single integrated automation solution, the ADVIA LabCell from Siemens Healthcare Diagnostics. It is now one of the largest integrated and automated facilities in Europe and offers a comprehensive service to King’s, other NHS trusts, primary care providers and the private sector in the south London area. Each year, it delivers nine million test results comprising 65% to the hospital environment, 30% to GP practices and the remainder to external users of the service.
Strategic decision-making has put King’s in pole position for a consultant-led blood sciences development pathway. However, beyond its redesign, facilitated by technology and Lean methodologies, has been the emergence of unexpected value advantages.
“Our motivation for change was based on a strategic look at where pathology was going in the future. With the input of Lord Carter we were aiming to be ahead of the game and we are,” says Dr Roopen Arya, clinical consultant in haematology.
Dr Caje Moniz, consultant chemical pathologist, supports this view, “When we started planning, the concept of a consultant-led, integrated blood sciences laboratory was innovative. People were not familiar with the idea and often confused it with co-location where everything is under one roof, not integrated and connected to work as one. I believe that this is due to a lack of understanding of the benefits of consolidation on a single platform and perhaps even possessiveness across the disciplines.
“However, the clinical knowledge base at King’s felt it was a good idea to go for a blood sciences strategy and to be operationally Lean. A second reason was that it was more efficient in terms of laboratory space than to have two separate departments. We therefore decided that if we could live with each other, we might as well thrive with each other.”
Full integration yields more benefits
King’s started its integration at the front end, in sample reception. Prior to the blood sciences redesign, the different disciplines had different sample reception areas which operated duplicate processes. Today, all samples – approximately 8500 per day – come into one central reception for sorting and allocation to the appropriate work stream. Unification has enabled a reduction in support staff numbers in pre-analytical areas and has facilitated the efficient utilisation of staff, particularly during periods of high workload.
“Integrating the disciplines on a single platform did take a leap of imagination as we’re such a large department and were used to functioning autonomously, but it worked really well. Right from the front end we work as a unified laboratory, and it’s only when we get the results that the clinical validation process is split up again,” states Dr Arya.
The single ADVIA LabCell analytical pathway on a 21.5 metre track also consolidated technical processes. With routine work automated and manual handling reduced, staff profiles have changed. Biomedical scientists now have more time to manage problematic samples, or to focus on service development opportunities.
Frank Oliyide, blood sciences laboratory manager states: “It used to be that 85% of samples were handled manually, now it’s only 15%. This has streamlined the way we manage peak workload and enabled us to redistribute our scientists towards added-value areas.”
Unexpected benefits
The integration of departmental functions has created a unified approach and the disappearance of a ‘them and us’ culture. Operational elements such as quality management and health and safety converge and show common ground that encourages joint working.
“Functioning as one team, we really have a great culture now and appreciate the overall purpose of a hospital laboratory. We used to have separate departmental meetings, planning and developing the same processes was replicated on different sites. Now we have focused and engaged discussions that share best practice and drive overall improvements,” states Dr Arya.
A series of corridor notice-boards outside the laboratory displays key performance Indicators for the entire pathology service. Information on analyser uptime rates and scorecards are posted in order to communicate laboratory and individual test performance to all staff members. Open communication in the shared areas helps foster inclusion and further drives process and performance improvements.
The enthusiasm and drive generated by teamwork is further explained as Dr Arya states, “When we restructured and integrated the disciplines into blood sciences, people took overall ownership of the goals and created a much more dynamic working environment than was apparent in our previous separate structures. We didn’t necessarily anticipate that.”
Discipline integration
Dr Moniz agrees, “Blood sciences is a better use of resource and allows cross-pollination of expertise, experience and solving operational challenges. I see other laboratories that have two or more tracks and I think that they have missed an opportunity to get it right by using technological advances more efficiently.”
He continues: “We planned what the laboratory should look like, reconfigured, but involved our people throughout the process so that there were no big surprises. We also empowered them to drive the changes needed and created a post for an overall operational manager. You might anticipate this to be a political problem as chemistry staff could put up barriers to a haematologist running the blood sciences laboratory, or vice versa. It doesn’t actually matter so long as the person understands the operational process and overall objectives, and, in practice, with judicious appointments and good candidates, we were not faced with this issue.”
David Budd, head of marketing at Siemens Healthcare Diagnostics, says: “There is always a fear when pathology disciplines amalgamate that identities will be lost and control loosened. This is part of managing the change and expectations within the laboratory at the planning stages. Possessiveness is a hurdle to overcome but it is important to stress that the technology pathway is designed around the sample type, not the department. The clinical interpretation and patient input always remains within the specialties and disciplines.”
As Dr Moniz confirms: “None of our identity has been lost. Our output has improved in terms of turnaround times and the quality of results has been kept high. Ultimately, no-one outside of the laboratory knows we’re integrated, they just see the output and think ‘great quality of service’.”
Dr Arya agrees: “You may not have sight of the specimen tube, but you always retain clinical control, irrespective of whether you are a haematologist or a virologist. Furthermore, IT has enabled remote access to assay performance, quality control procedures and results.”
Dedicated manager spearheads success
A key decision in driving the success of the redesign was the appointment of a dedicated blood sciences laboratory services manager to drive change from within. A single laboratory leader for a single team matched the aim of achieving a unified and dynamic approach.
The appointed manager, Frank Oliyide, is positive and progressive in his outlook. He states: “Taking the blood sciences route brought much more clarity to laboratory processes. It highlighted what was working and what needed changing. Embracing Lean methodologies and using technology to its full potential have enabled us to pioneer automation and change the way people work together inside the laboratory. Now we’re here we’re not standing still, we’re looking further ahead to achieve continual gains.”
The clinical leadership at King’s has been retained, keeping haematology and biochemistry services focused on the patient. With the bulk of routine work running smoothly, biomedical scientists now have the time to develop new tests and steer the services in new and competitive directions.
Fit for today, fit for the future
Forward-thinking and constant open communication between the pathology disciplines has enabled the King’s blood science laboratory team to achieve its clinical aims, operate smoothly and position itself for a competitive future. The consolidation of disciplines has been embraced positively by laboratory and clinical teams to deliver an improved service to users. Furthermore, an unexpected benefit is an enhanced culture propelled by staff enthusiasm. This has injected dynamism into meetings and encouraged cross-pollination of ideas to power ongoing improvements in the blood sciences service.