Lab leaders on growth, labor, and cybersecurity

The third is that there aren’t people out there. The pipeline in New York is not sufficient. This is not about histotechnologist and medical technologist schools. This is about lateral recruitment. It’s about recruitment from out of state, and the state of New York has high walls since it does not recognize coursework or certification from out of state. So right now is the advocacy effort to have the state tear down the walls. This is definitely one of those, “Don’t let a good crisis go to waste.” It’s precisely COVID that has given us access to the state Assembly and the state Senate to have a new law written and, we hope, passed to create a much more lateral openness so that we’re not relying on an inadequate pipeline.

But in the end, it’s lack of people, which means strategy number four is you must retain your people, which means doing everything you can as a leader to advocate for a good workplace. Round. Talk with people. Small victories count a lot. Even retaining one employee who has light feet and might go somewhere else is a boost for the people who remain and are saying, “Oh my God, we’re going to lose another staff member.” That means you and your senior lab colleagues have to be willing to go to bat with any HR unit that’s nonresponsive and non-agile, because the fourth strategy is you have to do everything you can as a leader to retain your people. You hopefully do so in a fair fashion so it’s not just Whac-A-Mole, and the people who look for jobs elsewhere are the ones who get the pay raises. You have to advocate for the whole workforce.

Stan Schofield, what kind of regulatory relief might there be, not only in a state like New York but nationally through changes in CLIA or CMS regulation? Could this be a bit of a breathing space as you deal with the labor shortage, or not?
Stan Schofield (MaineHealth): I don’t think the regulatory or legislative process is going to take into account the impact of COVID and the shortages. I don’t think anybody is going to water down CLIA. State licensure is hard to change or move very much. Labs are going to have to adapt and adjust. Instead of having a four-year MT(ASCP) kind of staff, we will have to move more to not just MLT-level staff but people with a bachelor’s degree to be a machine operator. And I’m not being cruel or facetious—a button-pusher with basic training with the automation but not making clinical decisions. The few medical technologists we have are going to have to be expanded into the quality control and safety component more than we’ve done thus far.

In the past, there was talk about only having the right people doing the right work and making the right decisions, but it’s been slow to be changed and almost impossible to completely go down to a stripped-down model because you lose so much intellectual capital in doing so. I heard someone say recently if a person with 20 years of experience leaves, you can’t replace them with one or two new graduates, if you can even find a graduate. Labs are going to have to supplement their workforce by being creative and growing a few of their own at less advanced technical understanding and scientific awareness and using lower-skilled people to run the automated equipment.

So you are talking about real changes in how the laboratory looks at its own workforce.
Stan Schofield (MaineHealth): Absolutely. We’ve all been talking about it for 10 or 15 years. A lot of us have done a lot of the pieces. Now it’s hitting the wall; you have no choice.

Darlene Cloutier, would you like to comment on this labor issue?
Darlene Cloutier, MSM, MT(ASCP), HP, director of laboratory operations, Baystate Health, Springfield, Mass.: At Baystate, we’re feeling the same pain. We performed a market adjustment with our team a couple of years ago for the med techs, MLTs, histotechs, and other technical staff, and recently we revised scales for the supervisor, manager, and quality positions on the team—because there was inequity and because we’re challenged not only at the technical level but also at the leadership level. We are starting to look at international recruitment of ASCP-certified individuals. We’re trying to get creative.

By and large, the laboratory’s relationship with the system executives improved dramatically during the COVID crisis. For the first time, many of you felt understood and appreciated in ways you had never felt before. As we look at the declines in COVID revenue and at the demands on labor, and at the reimbursement difficulties because PAMA is sure to return in some guise, do you feel that the new rapport you have with system executives is going to stand you in good stead for these challenges? Or do you think this progress will disappear as the emergency of COVID disappears? Darlene, what are your thoughts on that?
Darlene Cloutier (Baystate): You need a crystal ball for sure, but I do feel like we have a place at the table in a different way than we ever did before. My senior leadership were with me step by step through the COVID crisis and now have gained a much greater understanding of what it takes to mount a response like we did in COVID. So I am hopeful that moving forward, because we have this greater understanding and appreciation of the work that’s done in a laboratory, we will gain support.

I’ll give you an example. The other day I brought to my senior leader’s attention the impact we’re seeing on our workforce at a state level of the expansion of the Paid Family and Medical Leave Act, an impact we’re feeling in certain teams even more so than in others. I identified that when we develop our budgets, we may have to add FTEs because we’re feeling the impact of so many people out of work. The organization is listening and understanding these challenges.

Mike Quigley, please share your thoughts on the labor issues.
Mike Quigley, MD, PhD, vice president, diagnostic services, and medical director, Scripps Health core laboratory, San Diego: We have a lot of biotech in our area so we’re in competition with them, but sometimes we get well-trained people who leave biotech. So that can go two ways. We also set up a CLS training program and have been successful in recruiting graduates. That has been a powerful tool. So overall we are treading water with the CLS hires right now: doing okay, not going under.

Ian McHardy, do you have anything to add?
Ian McHardy, PhD, D(ABMM), director, microbiology, molecular, and immunology laboratory, Scripps Health, San Diego: We responded to COVID surprisingly well. We probably are a bit insulated compared with much of the rest of the country in that we can recruit people from places with worse weather. Ultimately we end up making life harder for all of you, unfortunately. We were able to recruit people relatively quickly when we needed it the most, and so far we’ve maintained our staffing. As far as the long-term strategy goes, it’s our CLS training program.

What are your thoughts on the improvement in relationships with hospital and system executives and whether it is going to be a new resource you can count on as you try to solve problems in the laboratory?
Dr. McHardy (Scripps): We have shown the value of the laboratory in the response to COVID and during the recent cyber incident that affected our system. We’ve developed strong relationships over the last year and a half that I think will continue into the future.

Stan, do you think this rapport with system executives is going to benefit everyone who’s facing the typical kind of threat from a Labcorp or Quest, or do you think it’s still going to be out there?
Stan Schofield (MaineHealth): The threat will always be out there because Quest and Labcorp are not going away and they’re only going to grow by acquisition. The value of the lab has never been greater if you are a lab that delivered during COVID. You had to do the testing. You had to make a difference in what was going on in your system. Those people will have the halo effect for the next year or two. But there’s a lot of external financial pressure for everybody, and no matter how good or how successful you are, hospitals are bricks and mortar, and they may have to monetize an asset to keep their bricks and mortar going. An example: We’ve had a tremendous success story here. We’ve made a lot of money for the system under COVID, but at the end of the day they’re a system and they’re hospitals and you’re just a laboratory. As long as you’re producing and doing the quality and giving the service, you’re going to be fine. You fall short, you will be up on the block.

Joe Baker, what is your view on this, and how does a labor shortage play into it, because the lab could be the best lab operation in the country and yet if it doesn’t have enough high-quality lab people working there, it can be difficult to defend an independent position?
Joseph Baker (Baylor): We definitely have a lot more visibility with our senior administration team because of COVID. I would agree with others that we have a seat at the table. I see it as my function, as Dr. Dysert’s, and that of our other laboratory leaders within our system to maintain that going forward so we don’t lose what we’ve gained. We’re looking at strategic ways we can bring additional value to the system so we’re not looked at as a commodity.

With regard to labor, we have more than 100 positions open within our system. About 60 percent of those are in the med tech, MLT, histotech arena. We’re struggling to find people to come in, not so much in our metroplex area but definitely in our more rural hospital locations. We struggle significantly in the esoteric laboratories—HLA, molecular—they’re a real challenge. We’re offering higher sign-on bonuses than we have previously done, but it’s just to compete with what our competitors are offering.

We published a couple of articles on cybersecurity recently. Hospitals have had significant outages, and we know health care could be the most vulnerable major industry to cybersecurity threats. And laboratories are front and center as suppliers of critical data. Terry Dolan, what are your thoughts about cybersecurity in the current environment?
Dr. Dolan (Regional Medical): We can’t get enough of it because we are a target like any other vulnerable target, and I tell our IT staff that I want the very best available anywhere. Unfortunately, there are a lot of smart people out there who are criminals doing their best to undermine us, and the question is: Who will win in the end? I have no idea. We have fortunately been able to avoid it, but that may not be the case tomorrow. And IT specialists are hard to come by. It’s going to be hard for us to keep coming up with honest people who are smart enough to keep ahead of the criminals. It’ll be a continuous challenge.

Peter Dysert, you know a lot about the IT side of laboratories and pathology. If you think you have a problem with med tech labor, imagine the kind of problem you have with the highest degree of IT expertise to combat cyberattacks. How are the discussions at Baylor going on this?
Dr. Dysert (Baylor): I don’t know that we are any different than anyone else, but at an industry level, it’s a topic that’s going to drive a new conversation for some organizations, and that is to outsource through the large consolidated technical initiatives so that the organizations have the talent and infrastructure to help them deal with the threat. The idea that an organization can take this on on its own without getting outside help is naïve, and the players in that space will get bigger and probably more sophisticated in terms of those who can protect us. It is going to mean a whole new conversation for your IT staff to look to those types of partnerships that they may not have had in the past.

How will your vendors in the laboratory play into that? Will they participate in a larger-scale enterprise on just the cybersecurity issue?
Dr. Dysert (Baylor): That question goes to Epic, since we’re probably headed in that direction, and Epic as an EMR provider. The question will be asked: If you’re an Epic systemwide install, what is the answer for these kinds of problems? What type of technical infrastructure, from a security and cybersecurity perspective, does a partner bring to the table that Epic cannot represent, because usually these things get in the door not through Epic per se but through email apps and other things. So you’re going to need an enterprise-level consulting group that can help you figure out what type of risk you have and then manage it for you.

Wally Henricks, you have a lot of IT expertise. What are your thoughts about cybersecurity at the Cleveland Clinic and for others?
Dr. Henricks (Cleveland Clinic): We’ve been aggressively planning for this, and it’s at the institution level on down. Every department is tasked with business continuity planning for a ransomware attack, all the way down to complete loss of network. Everybody has downtime plans, but this is a different kind of downtime. What business processes can stay, short term and longer term? How do we best coordinate support of the clinical services? Trying to function at anywhere near full scale in a complete ransomware situation is hopeless, but you have to keep people alive. How do you best do that? How do you convert to manual processes when necessary? There’s a body of work being done for that, and it’s been ongoing.

On the technical side, there’s a different skill set—the IT people that labs often think of are those who support the LIS. They know the lab operations that the IT supports. Often med techs or others have gotten LIS training and maybe more technical training, but here we are talking about IT security specialists who know how to keep networks safe, how to manage devices, how to distribute patches and changes, and how to keep up on all of the breaking developments. It speaks to the need for what Pete Dysert said—it’s an enterprise-level commitment, one that can be made at the largest stratum of the organization. It’s not really an EHR vendor-specific issue. These attacks get in through insidious emails and websites. Our group has been aggressive about clamping down on where we can get to on the Internet, and I’m sure all of you have some variation on this.

What are the odds that the Cleveland Clinic will suffer a major cybersecurity breach in the next three years?
Dr. Henricks (Cleveland Clinic): I can’t quote a probability. Hopefully the odds are being reduced every day, but I can tell you that we are under constant attack.

John Waugh, do you feel besieged and under attack on a regular basis at Henry Ford?
John Waugh (Henry Ford): It’s on my anxiety list all the time and very high up there. The article in the April issue of CAP TODAY [“Weeks of lab turmoil follow cyberattack”] was absolutely chilling.