The Lab’s Role in Patient-centered Care

I became interested in the “catch phrase of the day”-patient-centered care-as my responsibilities as a point-of-care coordinator evolved beyond my original perception of the role. I was to provide regulatory guidance, technical expertise and ensure that the many departments within my organization that required reliable, timely, and quality testing by non-laboratory personnel was provided in an efficient, economical and satisfying means to our patients.or at least that’s what I thought it was.

A New Light
It’s time for the laboratorian to “get out of the basement” and become an integral part of the healthcare team and patient-centered care. I work for Kaiser Permanente, Colorado Region, and we advocate the total health of our members and communities. At Kaiser Permanente, we see ourselves as a health advocacy organization. We are here to help the patient get the most out of his/her journey toward total health-a journey that is different for every single person we encounter.

When we talk about total health, we’re talking about quitting smoking, eating healthier, and exercising more. But it’s more than that. Total health isn’t just about action; it’s about understanding the physical, mental, environmental, and intangible reasons that motivate the decisions underlying a patient’s actions, and supporting the person in making positive choices.

Patient-centered care is comprehensively defined as a new model of care aimed at strengthening the healthcare system by recognizing the total care of the patient in an integrated manner. This model of care is based heavily on the advent of health information technology and payment reform, with five key principles:

1. A patient-centered orientation

2. A comprehensive team-based care that is coordinated

3. Superb access to care

4. System-based approach to quality

5. System-based approach to service

The Lab’s Role
As with any model the three main requirements to success are communication, partnership, and health promotion. This is where the laboratory professional comes in. We need to learn to communicate clearly and form a partnership with other healthcare providers. We will be required to explore the needs of the patient not only from a laboratory point of view, but a comprehensive care view. We need to know what the patient wants or the reason for the visit (concerns need for information), and utilize an integrated approach that considers the whole world of the patient-emotional, socioeconomical and life issues on a common ground on what problem is and how to manage it. The goal will be not just treating or managing the patient, but enhance prevention by a continuing relationship with their healthcare team.

The benefits for the lab are:

– improved health status of the patient,

– increased efficiency by reduction of tests and referrals,

– improved meaningful communication to reduce uncertainty between lab and other healthcare providers, to ensure the best outcome for the patient.

With the evolution of diagnostic services, we (the laboratory) have made obtaining a result more complex – productivity and technology grew, more tests became available, and there was an increase need for the healthcare provider to understand, interpret and utilize the results.

3 Focuses
With this need for improvement the focus will be in three areas:

1. Structure
2. Process
3. Outcomes

Structure relates to how the healthcare system is organized; process relates to how services are delivered; and outcomes are the impact on patient health status. How services are delivered is where the laboratory professionals come in; we must become an integral and recognizable part of the healthcare team by supporting and communicating our expertise at the bedside, not from the basement. The use point-of-care testing (POCT) is becoming mainstream and will continue to grow. We must embrace our role now as part of patient-centered care.

We all know more steps can relate to more delay and greater chance for error so it makes sense to decrease the steps utilizing a patient-centered approach. We can accept the immediacy of a situation and minimize delay by reducing the time between steps, thus reducing length of stay, number of visits and ultimately the cost associated with care and increase the patient’s satisfaction with their care.

New Definitions
As a member of the healthcare team, I like to define patient-centered care as a process where the patient is the focus of all we do; they are our first and foremost customer, and my primary job is to make sure that the patient receives safe, accurate quality care (results) each and every time. POCT has several definitions based on geographical, functional, technological, or operational context. For example, geographical context is where the test is conducted (outside of the main or core laboratory). Functional context is the rapid turnaround of test results that are readily accessible for patient care. Technologic context is when testing is usually, but not always, conducted with small, portable devices or manual kits.

It is our fundamental role as laboratory profession is to assure that the practice of point of care involves an organizational culture of patient-centered care and is characterized not by discrete programs, but by the core values and attitudes behind the implementation of such a program. Patient-centered care is about engaging the hearts and minds of those you work with and those you care for. It is about reconnecting staff with their passion for serving others. It is about examining all aspects of the patient experience and considering them from the perspective of patients versus the convenience of providers or the laboratory. Ultimately, it is about a collective commitment to a set of beliefs about the way patients will be cared for, how family will be treated, how leadership will support staff, and how staff will nurture each other and themselves.

Stephanie Mihane is point-of-care coordinator, Kaiser Permanente – Colorado Region.

Suggested Readings and Resources:

Price C, St. John A. Point of Care Testing: Making Innovation Work for Patient Centered Care, AACC Press, 2012.

Kaiser Permanente, http://share.kaiserpermanente.org/category/about community-benefit/#sthash,rY9to6p1.dpuf. (Accessed November 15, 2014)

Patient Centered Care Improvement Guide, patient-centeredcare.org/inside/abouttheguide.htmlm, (Accessed November 15, 2014)

Research and Quality
www.ahrq.gov

American Hospital Association
www.aha.org

The Commonwealth Fund
www.commonwealthfund.org

Institute for Family Centered Care
www.familycenteredcare.org

Institute for Healthcare Improvement
www.ihi.org

National Quality Forum
www.qualityforum.org

Robert Wood Johnson Foundation
www.rwjf.org

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