The laboratory's challenges are seldom presented individually. For example, a diagnostic center that added a second location, a home-collection service, and a company-sponsored employee health screening program all within the same year now has more samples to process, more employees to manage, and more areas for potential errors to occur during the entire process of sample collection through reporting. While the testing procedures themselves may be functioning correctly, the laboratory continues to face difficulties in providing timely reports, maintaining sufficient inventory levels, accounting for unaccounted revenues, and managing overworked employees.
This guide will address ten frequent laboratory issues seen in Indian diagnostic laboratories, distinguish the underlying cause of an issue from the visible symptom, and provide practical solutions that may be implemented immediately (with or without the use of new software). Additionally, each problem area will include a list of key performance indicators (KPIs) to allow you to measure progress.
What Is Laboratory Management?
Laboratory management involves managing people, samples, equipment, reagents, records and money in order for a laboratory to produce timely, accurate results while remaining financially viable. This includes the entire process of performing a test - registering the patient, collecting the specimen, analyzing the specimen, verifying the result, reporting the result, and billing for the test, as well as the quality control systems supporting each step.
It differs from a LIS or LIMS. A laboratory information system (LIS), on the other hand, is a type of software used to manage patient-centered work processes (i.e., ordering, reporting, resulting). In contrast, a laboratory information management system (LIMS) is typically focused on managing samples and/or processes. Management is the process/discipline, software is simply one way to help facilitate that process/discipline. Most current platforms integrate both types of systems.
10 Common Laboratory Management Challenges and Their Solutions
1.Disconnected Workflows and Operational Bottlenecks
Many laboratories have an obvious problem when you visit them at 11 a.m., but the cause of this issue is typically not the laboratory personnel. Samples wait in line at a single workbench, while another remains empty, and no one knows where any specific sample tube is located. The source of this problem lies in the fact that each of the four stages (registration, sample collection, sample processing, and reporting) are documented using a separate system, thus requiring the documentation to be either reentered into the computer system manually or communicated verbally between personnel.
What it costs: a small amount of reported information being lost each day, employee productivity reduced due to the pursuit of missing data, and patient phone calls to the front desk.
No software is needed to start. Time a sample from when it is received until a final report is issued, record each wait and handoff, then, address the longest wait period. Instead of using verbal handovers, use a written dispatch list. This guide to managing daily operations in a diagnostic laboratory describes the daily cycle.
The technology assists by having one patient-and-sample record with barcode scans throughout each step of the process which provides visibility of the current status to all individuals involved.
The KPI's: Time to collect a sample and receive results (Collection to Report), Number of samples that have exceeded the expected date for receiving results, and Number of times each sample has been transferred to another location or person.
2.Rising Test Volumes and Capacity Planning
Volume grows faster than benches, analyzer and staff. The main reason for this is that capacity is judged on how things "feel" (i.e., peaks such as morning hours and health camp days are averaged out). The lab does not realize it has hit its limit until reports begin to slip. This results in overtime, hurried validation of results, and increased repeat testing.
Start with no software: Create a chart of the hourly arrival of samples over the course of one month. Set up fasting-testing slots on different schedules than other types of testing (staggering), create batches of routine tests, and determine prior to an analyzer being down what testing will be done by a partner laboratory.
In addition to helping with scheduling appointments, cutting out manual entries through analyzer interfacing, and showing a peak in volume prior to becoming harmful, technology can help. To learn more about how LIMS and analyzers are connected, see our article on LIMS and analyzer integration.
KPI's: Samples processed per hour during peak periods, Analyzer utilization, Turnaround times for processing samples during both peak and non-peak periods, Number of tests contracted out.
3.Inconsistent SOPs and Shift Handover Problems
A night technician recalibrates a laboratory instrument, yet the morning staff remains unaware. For one hour after calibration, results appear unusual, and each individual recalls the incident differently. This represents a "handover" issue, and typically at its root is a "procedure" issue: procedures are excessively long, contained within folders that are rarely accessed, or vary across branch locations.
Fix: maintain SOPs as concise, up-to-date and located on-site. Have a single-page handover form with all uncompleted samples, QC status, equipment problems and unresolved complaints, signed by each shift. Do a 5 minute huddle and assign ownership of each SOP to an individual.
The use of technology has helped us to create version controlled Standard Operating Procedures (SOPs), assign tasks to individuals, and maintain an audit trail that indicates who performed a specific action and at what time.
KPIs: SOPs reviewed per schedule, completion of hand over sheet(s), number of repeated issues/errors made per shift.
4.Result Verification and Critical Result Escalation
A critical result is so much different than what was expected that the treating physician will need to hear about it immediately. If there are delays in communicating these types of results to the treating physician, there could be clinical consequences. The most common reason for this lack of clarity regarding responsibility is that no one knows who verifies, who calls, and where the call is documented.
Fix: Develop a written critical value list for each of your test menus by working with both your pathologist and quality lead. Assign an escalation person to each of your shifts. Document every single call made to notify someone of a critical value (time, receiver, and read-back). The process of verifying results and approving reports must remain in the hands of qualified professionals. Software simply assists the professional.
Where technology supports: Delta check and flag processes bring exceptions to people, while digital approval (digital sign-off) and audit trails document who authorized which decisions.
KPIs: length of time from critical test results until formal notification of those results, number of corrected reports per 1000 tests, turnaround time for verifying tests.
5.QC Records, Non-Conformities and Documentation Gaps
The quality control (QC) record missing is a symptom. The cause is usually because records are completed at some point after they should be completed, by someone who can recall when the work was done, and there is no daily review. Each of the following need to be owned: Internal Quality Control (IQC), External Quality Assessment (EQA), Calibration, Corrective Action.
Fix: take records at the time the work is being done, get the daily supervisor's signature to verify the quality control (QC) was done, keep a corrective action log with a person responsible for the corrective action and when it needs to be completed by, and perform a small internal audit each month, rather than doing one large internal audit just prior to an assessment. The World Health Organization Laboratory Quality Management System (WHO LQMS) handbook is a practical resource that can be used for reference purposes, and is based upon the ISO 15189 standard. It should also be noted that NABL accreditation is given to a laboratory, not a software product.
Where technology assists: Evaluation of quality control (QC) rules, scheduling of calibrations, tracking of corrective actions and creation of audit trails.
The metrics used to measure quality management are as follows: reviewing Quality Control (QC) runs on the same day they occur, tracking corrective actions that have exceeded their due date, monitoring External Quality Assurance (EQA) performance, and identifying repetitive findings from internal audits.
6.Reagent Inventory, Stock Availability and Expiry
Nothing will slow down a day as quickly as waking up to find you have used up all of your supplies during the night, or that expensive inventory has expired on the store shelf. Both are caused when people make their purchase orders based on their memories rather than on how much product they are consuming and what the lead-time for delivery is.
Set minimum stock levels based upon each product's average daily usage rate times the number of days it takes to receive an order from your vendor, plus some safety margin (buffer). Use first in first out, check product expiration dates on a weekly basis, and record lot numbers so that if there is a quality control issue during a specific shift, you can identify which new lot was used during that shift.
Where technology can assist is: tracking of batches and expiration dates, notifications when stock levels are low, and linking of product usage to testing performed.
KPI's: Number of times you are out of stock of an item each month, Cost of expired stock, Length of time you can use existing stock before needing to order more, Cost of reagents used to generate a reportable test result.
7.Billing Leakage, Costs and Revenue Visibility
Revenue generated through a service that is not billed, discounts given without authorization, partial payments which are not followed-up on, and/or billing for an outsourced service at the incorrect price are examples of typical forms of revenue loss due to billing leakage. Since billing is separate from reporting, no comparison between the two takes place.
Fix: Verify that all billed tests are verified with the tests reported on a daily basis, establish discount approval limits, document referral and panel rate structures, and conduct weekly reviews of outstanding balances according to their age. For further insight into our diagnostic laboratory billing software guide, click here.
Technology is beneficial because when you use it for your bills, test results, and payment information, you have only one file. Therefore, if there are any errors or discrepancies, they will be shown as "exceptions" rather than "surprises."
KPIs: discrepancies between reported costs and billed costs, discount rate, aging receivables, cost per reportable test.
8.Staff Workload, Training and Competency
Workload issues are evident when there are many errors, high turnover rates (i.e. employees quitting), and staff members who are exhausted at the end of their workday. The primary reason for this is typically because new hires are expected to learn from what they see on the job, and it is assumed that they possess the skills required to perform their duties successfully, rather than being tested for them.
Fix: Create a Training Matrix with a list of all tasks and the employees who have been approved to complete them. Evaluate employee's abilities when they join the company and on a regular basis thereafter. Cross train employees so that if an employee is absent, the workstation will continue to operate. Evaluate errors by analyzing processes instead of evaluating individual employees.
Technology assists in several ways: by limiting access to those who are authorized to verify/release results based on their job functions, and by showing when an individual has excessive work.
Competency Assessment Status, Training Completion, Overtime Hours, Staff Turnover, Error Rate per Process.
9.Patient Communication, Complaints and Service Experience
Patients evaluate a laboratory based on their perception of it – i.e., the amount of time they have to wait, how polite staff members are, and if the report is delivered in a timely manner. A large number of patient complaints result from unfulfilled expectations. This is due to the fact that no one informed the patient of when to anticipate receiving their report, and therefore, complaints are addressed through conversation and then disregarded.
State when you expect to receive reports when people register. Message them in advance if you think a report will be late. Keep a complaint register that includes the complaint category, the person responsible for resolving the complaint, and when the complaint was resolved. Check this register each month to look for trends.
Where Technology Helps: Technology helps to reduce the number of phone calls that are received from patients that cannot understand a grid of numbers. Technology is used to deliver messages via WhatsApp, SMS, and email, create patient portals, and provide patients with reports that can be easily understood in plain language (for example, the AI Smart Report approach).
Complaints/1000 Patients, Category, Closure Time, On-Time Report Delivery, Repeat Visit Rate
10.No Real-Time Operational Insight
Business owners often find out about issues with their business at the end of each month (e.g. drop in revenue, increase in rejections, etc.) when the numbers are put together manually, which means the data comes in after the damage has already occurred.
Fix: Pick 6-8 numbers that you will review for 10 minutes each day: Samples Received, Pending Reports, Turnaround Time, Rejection Rate, Stock Alerts, Collections, & Complaints. Our guide to reducing sample rejection rates demonstrates how to determine one of those numbers. Review the results from each branch individually, as the average can mask the branch with issues.
Technology assists: dashboards that reflect progress as it occurs and are organized according to branch, test, and date.
KPIs: the numbers listed previously, as well as the amount of time it took to designate someone responsible for addressing a value outside of range.
How Technology Can Improve Diagnostic Laboratory Management
Software cannot improve upon a process that is poorly defined, however, software can enhance a well-defined process and help identify areas of improvement for a poorly defined process. Laboratory software, which is integrated into the laboratory's daily operations, can assist laboratories in four ways: maintaining centralized records (the patient's sample and report histories), automating workflows (labeling, routing, notification and rule-based flagging), connecting with analyzer devices and messaging systems, and providing visibility into the laboratory's operations via dashboard.
Before you purchase an analyzer, make sure that it will work with your model, interface, and vendor. You may also want to consider using cloud deployment as a way to allow for remote access to your systems and better control over multiple locations. For more information regarding the pros and cons of using cloud-based pathology software see our guide on cloud-based pathology software.
How to Choose the Right Laboratory Management Software
- Test out the workflow by asking for a live demonstration of your workflow, which includes both a rejected sample and an updated report.
- Analyzers: obtain a written list of the models you have and if each model has a one-way or two-way connection.
- Quality support: audit trail QC records and role base access control. Please find out what the software has to offer not if it meets NABL requirements.
- Invoice/Billing & Stock Management: GST billing, Panel/Referral Rate, Batch/Expiry Tracking.
- Multi-branch control: centrally controlled testing masters branch specific permissions and reporting.
- Backups: Encryption and Exporting your Data.
- Pricing and support: You will receive a written quote that details your costs for setting up the service interfacing with your systems any applicable messaging charges and the number of support hours you are entitled to.
The first rule of thumb is that if a feature can't be seen in a demonstration it isn't available to you in your lab yet.
How MargLabz Helps Laboratories Manage Operations Smarter
A lab os that is integrated will help address the issues listed above in a single package. MargLabz claims to be an ai-powered lab os for diagnosis labs, and has stated on their site they offer 40+ modules across 6 areas. Of those modules the ones that are most applicable to this topic include:
- One process from registering to reporting, tracking with barcodes and collecting samples at home.
- Automation: two-way analyzer interfacing (HL7/ASTM), automated validation and delta checking to send exceptions to an individual for review and digital signature.
- Quality: IQC (Internal Quality Control) EQAS (External Quality Assessment Schemes) & Westgard Rules Evaluation Standard Operating Procedures (SOPs) Corrective Action Preventive Action (CAPA), Calibration Records and Audit Trail for NABL Documentation.
- Business: GST Billing, TPA (Third Party Administrator) Corporate and Franchise Pricing, Outstanding-Dues Ageing, and Cost-Per-Reportable Test View.
- Inventory: reagent batch and expiry tracking, and cold-chain monitoring.
- Patients & Growth: Smart Reports in plain English, ABDM/ABHA compatibility and with the higher level subscription packages a CRM and a Pharmacy Lead Engine which routes patient leads from local pharmacies.
- Multi-branch: centralised test masters and rate lists on its Enterprise plan.
The features described here are meant to enhance the work of your staff as well as the functionality of your quality system. However these features are not intended to substitute for the knowledge and skills of trained professionals nor will they provide you with a guarantee of accreditation. To determine if these features would be useful in your laboratory, please schedule a free demo.
Conclusion
Most problems in lab management fall into three categories a problem with a visible sign, a process problem that is hidden and a number that is being ignored. First measure how long it takes for a single sample to complete its journey. Then create a single page handoff document and pick six key performance indicators (KPIs) to track each day. These tasks do not require buying new software. When you understand your processes well enough to make them consistent across shifts and sites, you will be able to use a unified platform to maintain that consistency. To evaluate the effectiveness of an AI-powered Lab OS using your own real-world examples, schedule a complimentary demo of MargLabz.