MHA 506: Health Care System Organization

Case Study 3: Hospital Laboratory

Dr. Ohlson

June 2013
Ancillary services refer to the health care services provided exclusive of room and board.

Supplies and laboratory tests provided under home care, audiology, durable medical equipment

(DME), ambulatory surgical centers (ASC), home infusion, hospice care, skilled nursing facility

(SNF), cardiac testing, mobile lithotripsy, fitness center, radiology, pulmonary testing, sleep

centers, and kidney dialysis are examples of ancillary services. Without ancillary services

doctors, dentists, and nurses will not be able to function effectively. (Gans, 2009)

Ancillary services can be classified into three categories such as diagnostic, therapeutic and

custodial. If a physician sends a patient for a blood test, then s/he is using a diagnostic ancillary

service. Service received from a physical therapist for proper exercise routines after repairing leg

bone is called therapeutic ancillary service. Service taken from nursing home is called custodial

care ancillary service. (Gans, 2009)

Doctors, dentists, and nurses are the primary healthcare providers that are ordinarily thought of

first when patients think of healthcare. However, ancillary services providers far outnumber the

primary care providers in healthcare. (Commerce Business Daily, 1999) Without ancillary

services doctors, dentists, and nurses would not be able to function effectively. Ancillary services

generally fall into three broad categories: diagnostic, therapeutic and custodial. The laboratory

services (Lab) which will be the subject of this case stud falls under the diagnostic side of

ancillary services category. (Commerce Business Daily, 2001)

Ancillary services such as laboratory can be located in a variety of medical treatment settings, in

both in and outpatient settings. For instance, in the hospital, laboratory services are used within

various departments throughout the treatment facility. The same services used in massive

treatment centers can also be located in a physician’s private practice, known as Physician Office

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Laboratory (POL) either as another office in the building or the physician can sometimes

perform their own ancillary services at their own private medical offices. This is commonly

found at Endocrinologists and Hematologist offices, where the physicians need the lab results as

soon as possible to establish diagnosis and start early treatment. Furthermore, it is more

convenience for the physicians who have lab equipment at their practices are able to perform lab

services right away after seeing the patients, rather than sending their patients to another facility

to have their laboratory services performed.

A clinical laboratory function as a facility designed for the biological, microbiological,

serological, chemical, immune-hematological, hematological, biophysical, cytological,

pathological, or other examination of materials derived from the human body for the purpose of

providing information for the diagnosis, prevention, or treatment of any disease or impairment

of, human beings.(Clinical laboratory services, 2013) These examinations also include

procedures to determine, measure, or otherwise describe the presence or absence of various

substances or organisms in the body. Facilities only collecting or preparing specimens (or both)

or only serving as a mailing service and not performing testing are not considered clinical

laboratories. (Clinical laboratory services, 2013)

Some of the key players in a medical lab include pathologist, clinical biochemist, pathologists’

assistants, biomedical scientist, medical laboratory technician, and phlebotomist. (Commerce

Business Daily 2001)

A pathologist is a physician who examines tissues, checks the accuracy of lab tests, and

interprets the results in order to facilitate the patient’s diagnosis and treatment in some cases.

They normally work closely with the patient other providers and is a vital member of the

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patient’s primary health care team. Pathologists work in many areas of the medical laboratory

and often serve as the Lab Director. (Commerce Business Daily 2001). They have significant

educational requirements that include: completing medical school, and then more training in

Pathology residency programs, and furthermore possibly fellowships (Commerce Business Daily

2001).

Clinical biochemists carry out complex analytical work much like those of the pathologist. They

analyze and interpret data relating to patients' samples to assist with the investigation, diagnosis

and treatment of diseases. Clinical biochemists work with other health professionals, such as

pathologist, to detect changes in the complex biochemistry of body fluids, for example, increases

in glucose levels in diabetes mellitus. They also develop and implement new techniques,

interpret results and liaise with and advise clinical staff. They are responsible for the evaluation

and quality assessment of diagnostic tests and play a role in developing and managing hospital

and community analytical services. Biochemists commonly work in research capacities that are

related to biological systems and organisms. (Commerce Business Daily 2001)

This can include the study of a wide variety of topics; include living tissue, molecules, and

genetic patterns. Typically, these professionals work in laboratories conducting experiments in

order to analyze the results. While some entry-level positions can be obtained with only a

bachelor's or master's degree, a Ph.D. is commonly required for research positions. (Commerce

Business Daily 2001)

A pathologists’ assistant is an intensively trained allied health professional who provides

anatomic pathology services under the direction and supervision of a pathologist.  A

pathologists’ assistant is qualified to do all the work leading up to (but not including) diagnosis -

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including tissue banking, gross examination of surgical pathology specimens, and complex

surgical resections and autopsies. (Commerce Business Daily 2001)

The laboratory director has the responsibility for the overall administration and operation of the

laboratory, including hiring personnel who are competent to perform laboratory testing and

record/report test results promptly, accurately, and proficiently. (“Physician office laboratory

(POL) director duties,” 2015). The director is also responsible for assuring compliance with the

regulations. The regulations related to the director are contained in Subpart M, along with those

for the technical consultant, clinical consultant, and testing personnel (“Physician office

laboratory (POL) director duties,” 2015). The laboratory director must be accessible to the

laboratory to provide on-site, telephone, or electronic consultation as needed.

A person may direct no more than five laboratories. If qualified, the laboratory director may

perform the duties of the technical consultant, clinical consultant, and testing personnel, or

delegate these responsibilities to personnel meeting the appropriate qualifications. If the

laboratory director reassigns performance of his/her responsibilities, he/she remains responsible

for ensuring all duties are properly performed. (“Physician office laboratory (POL) director

duties,” 2015).

Biomedical scientists work in healthcare and carry out a range of laboratory tests and techniques

on tissue samples and fluids to help clinicians diagnose diseases. They also evaluate the

effectiveness of treatments. Their work is extremely important for many hospital departments

and the functions they carry out are wide ranging. For example, they may work on medical

conditions, such as cancer, diabetes, AIDS, malaria, food poisoning, or anemia, or carry out tests

for emergency blood transfusions or to see if someone has had a heart attack. Biomedical

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scientists tend to specialize in one particular area. (Commerce Business Daily 2001) A

biomedical scientist needs to study in the field of biology and especially in the context of

medicine. The education provided should help the individual to gain knowledge on the vital

principles of how a human works and should also make them aware about treatments to cure

various diseases. A biomedical scientist needs to have a bachelor’s degree in the field of

medicine with knowledge in biomedical equipment and supplies. (Commerce Business Daily

2001)

Hospital lab technicians process tests on body fluid specimens such as urine, blood and stool

samples. These are often used to screen patients for disease or determine an appropriate course of

medical treatment for a specific illness. A postsecondary degree is almost always mandatory for

hospital lab technicians; many states and individual employers also require licensure and

certification, respectively (Commerce Business Daily 2001).

Phlebotomists are medical professionals who draw blood from patients for various lab tests and

procedures. Some nurses also commonly perform phlebotomy, and hospitals and medical offices

will often hire additional staffs that are trained in phlebotomy. A high school graduate or college

student could take a course at a local technical or vocational school and learn phlebotomy

(Commerce Business Daily 2001).

Ancillary healthcare services include a broad array of services that supplement or support the

care provided by hospitals and physicians, including laboratories, dialysis centers, free-standing

diagnostic, non-hospital surgery centers, as well as durable medical equipment such as orthotics

and prosthetics, and others. Almost all departments within a medical treatment facility will at

some point need ancillary services. Communication is one of the organizational functions that

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help a medical facility to stay efficient and productive and provide quality patient care. One of

the more important forms of organizational communication is inter-departmental

communication. The importance of communication between different departments in a hospital

becomes most evident when that communication breaks down. An example of this kind of

breakdown is when labs are not properly labeled before being taken to the Lab. Accurate and

efficient communication between departments like the Emergency Department (ED) builds trust

within the organization such as when a request for blood is asked and the correct blood type is

given. When departments trust each other to deliver accurate information, this eliminates the

extra fact-checking step that can slow down patient care. (Hospital laboratory integration

celebrated, 2012)

Automation is a trend that seems to be quickly spreading through the world of clinical labs. This

trend of routine clinical laboratory work that generally done at work stations and through

software to program instruments, already exists for basic hospital laboratory routines. Some

hospital laboratories have started using these automation tools and services of fully functional

robotic systems to replace jobs that were or are done by skilled employees that take them away

from other duties that they could be performing. Laboratory automation and the growing

(Zaninotto, Plebani, 2010) emergence of robotics have transformed the typical workday for many

individual lab employees. They can also accomplish the tasks with less hands-on intervention

than ever before. As a result, associate scientists and technicians who used to spend their days

performing tasks of tedious repetition now have the time work with patients and spend time on

task that require more of their attention. (Zaninotto, Plebani, 2010)

At the facility level, and particularly for hospitals involved in clinical diagnostics, automation

and robotics have significantly increased productivity and lowered costs. Form administrators

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point of view these hospitals, squeezing the maximum efficiency out of every department is a

constant issue.

Another trend that is found in the ancillary service of the laboratory is outsourcing. To face the

economic pressures arising from the current socio-economic conjuncture, hospital laboratories

are endangered by an increasing trend towards the outsourcing of clinical laboratory tests to

external laboratories. This should allow hospitals to meet their economic requirements, but with

an increased risk of loss of medical quality and, mid- to long-term, loss of cost effectiveness of

healthcare at the national level. To anticipate current developments economical and

technological that inevitably will affect the future of laboratory medicine, hospital laboratories

should be proactive and enhance efficiency, reduce costs by consolidation, integrate into regional

networks, and form alliances or partnerships. To create additional value, the core competency of

laboratory professionals must be refocused to provide medical knowledge services consultative

support to clinicians related to in vitro diagnostic testing. To integrate cost-efficiency with

medical quality, implementation of a matricidal organization - operational vs. biomedical level -

could be an interesting approach. This integrated structure should create total quality of

laboratory testing, managing the entire medical diagnostic cycle from the pre analytical to post

analytical phase (Pract. 2006).

Although many hospital now realize the power of automations, however from a healthcare

administrator prospective automation makes since because it allows technicians to do more and

not be forced stand and perform tedious task. Thus it make use of the human resources however,

some administrators may have a hard time discerning which automation system are effective and

which are not for their hospital or medical facility. In order to mitigate the negative impacts

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medical treatment facilities need to be more selective about what labs to order and how much

time it would take and how long it would take a tech away (Zaninotto, Plebani, 2010).

The steady increase in the use of outsourcing in healthcare centers has led hospital administrators

to ask and require that their providers and physicians be more reluctant about sending patient to

other facilities do to cost. In the last year alone, more hospitals have started using outside

laboratories to run special and sometimes routine. This trend can be capitalized upon by using

outside labs that will require automation. In order to avoid the negative side effects of

outsourcing, hospitals need to run their own labs when at all possible this helps save a lot of

money not spent on commuting, and paying for labs to be read and the results relayed back to the

attending physician (Pract. 2006).

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 Reference

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MGMA Connexion, 9(9), 23-5. Retrieved from:
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Hospital laboratory integration celebrated. (2012, Jul 12). Arnprior EMC. Retrieved from:
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Pros and Cons of Outsourcing Laboratory Services J Oncol Pract. 2006 July; 2(4): 162–163.
PMCID: PMC2793606
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Zaninotto, M., & Plebani, M. (2010) The “hospital central laboratory”: automation, integration
and clinical usefulness. Clinical Chemistry & Laboratory Medicine, 48(7), 911-917.

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