Service line strategy
Emily E. Volk, MD
April 2023—Here is a scenario for you: Your hospital administration team identifies a strategic need and establishes a new service line, perhaps in cardiology or women’s health. They speak with the relevant surgeons and specialists, gathering expert perspectives about this new service line. But only after everything else has been put in place does anyone consider how laboratory medicine will play a role. Sound familiar?
This has been a frustration that I, as a member of hospital leadership and as a practicing anatomic and clinical pathologist, have felt over the years. Laboratory medicine is too often overlooked in the development of new service lines. As pathologists, we are typically consulted only after the fact, if at all.
But pathologists could, and should, be strategic partners in service line development. We have tremendous expertise to offer in diagnostic tests, resources, and personnel that should be put in place to make a new venture successful for our hospital system and for our patients. We should be viewed not as ancillary but as central to the development of important, revenue-building, patient engagement initiatives.
And what if health care system administrators viewed the laboratory itself as a service line? Diagnostic results inform procedures and other treatments. We offer enormous value to our institutions, our clinical colleagues, and our patients. For so many reasons, pathologists can serve as strategic partners to hospital or health care system leadership.
Part of the problem here is that when we do our job well, it is easy for other health care professionals to forget about us. We fall into their blind spot. The laboratory is like your home internet service: You notice it only when it is not working properly.
So what can we do to get more involved in the planning of new service lines? I see great opportunities for pathologists to look at the suite of testing geared toward wellness of various populations and consider how it might inform the development of new service lines or improved utilization of existing facilities and services. For example, we can look at ordering patterns and electronic medical record data to see where and how tests are being ordered, whether they are being ordered and used correctly, and how all of that can be improved. We can also make recommendations based on our own population data about how to better reach communities in need of certain tests.
A lot of this information would be relevant to a laboratory utilization committee. These are typically seen as dull, but a well-functioning committee can offer highly strategic advice and critical information to the leaders of a variety of service lines. If you have an opportunity to get involved in your laboratory utilization committee, I recommend trying it. It could be a great step toward having a more strategic role at your institution. A pathologist’s perspective can help ensure that women’s health or cardiology or any other service line is offering the most appropriate test panels for their patient populations.
Unfortunately, it is incumbent upon pathologists to make everyone else aware that we are a foundational part of any care team and that we should be included in strategy as well. There are areas where our value is obvious to the entire clinical team—the oncology service line is a fitting example of that. Treatment for cancer patients cannot start until we have done our jobs and presented a clear diagnosis. Our work is regularly included in tumor board discussions, where pathologists’ perspectives are intrinsic to robust discussions.
That model should be extended to other areas, but it will be up to us to raise our hands and help make it happen. In my experience, pathologists tend to be included early in the development of new service lines only by happenstance—a pathologist hears about plans to grow a service line while chatting with a colleague in a lounge, for instance, and offers to get involved. Or a pathologist finds out that the human resources team is recruiting neurosurgeons and knows that it will be important to add neuropathologist expertise to the pathology department to support those efforts. Wherever possible, we should try to find ways to be more purposeful about our inclusion, expanding what has worked so well in oncology to other areas and to hospital administration in general.
On a personal note, I’d like to share some happy career news. I’ve moved to a new position as vice president for system laboratories and pathology at UofL Health in Louisville, Ky. I’m excited about continuing in a leadership role while getting to work more closely with other pathologists and laboratorians every day.
Dr. Volk welcomes communication from CAP members. Write to her at president@cap.org.