The clinical laboratory, along with the bulk of the health care industry, has spent the greater part of a year responding directly to a global pandemic. Our laboratories have worked tirelessly to meet the needs of our organizations, our providers, our communities, and our patients. Some of our work has been standard and routine; however, the outsized demands of the pandemic have brought substantial disruption to what we considered normal operations. In response, we have implemented next-level technologies, expanded patient service locations and processes, and deployed substantial resources to address patient and community health care needs.

A Multifaceted Pressure on the Laboratory

In reviewing what we have seen so far of this tumultuous time, we know that the medical laboratory industry has been forever changed by the SARS-CoV-2 pandemic. But we will use this difficult experience to learn, grow, and be better prepared moving forward. Laboratories across the country have responded in various ways to several dynamic forces, particularly organizational, provider based, community based, patient based, and perhaps most important, personal forces. The duration and unpredictable nature of this pandemic has tested and exacerbated all of these forces, but we can leverage our responses to create a superior platform for the future.

Organizational Forces

The pandemic response required rapid action by laboratories to support care initiatives across their organizations. From establishing and managing complex specimen collections to performing new diagnostic tests and reporting data to various regulatory agencies, every laboratory faced new challenges, as well as opportunities.

Historically, hospital-based laboratory operations have rarely seen the spotlight from hospital leadership, yet in rapid order, the laboratory became the only department capable of providing the expertise and services required to triage and diagnose patients with COVID-19. Laboratory leaders became essential contributors to hospital executive leadership meetings, to provide updates and request needed resources. In many cases, previous financial restrictions were eased or lifted, allowing laboratories to purchase new and necessary equipment and supplies. Given the breadth of the pandemic impact, cross-functional work units were created comprising representatives from nursing, supply chain, phlebotomy, information technology, and facility logistics and support staff, all working together to create patient-friendly, drive-through specimen collection centers.

Technologically, many laboratories were able to secure new equipment, perhaps venturing into molecular testing for the first time. For some, this required reorganizing staff from various departments to perform the new tests. Furthermore, some laboratories increased their reference laboratory utilization, as internal resources were redeployed to support other testing needs or instrument capacity was absorbed by COVID-19 testing. This is not to mention staffing absences caused by positive or suspected COVID-19 cases within the laboratory.

Information management support is typically in high demand across every health care organization and many laboratories have had to compete for limited resources. In order comply with mandatory and time-sensitive COVID-19 result reporting regulations, many laboratories needed to create external interfaces, rapidly. As regulations changed, so did the data requirements, requiring a flexible and timely response from information management teams. These operational forces continue to fluctuate as the pandemic evolves, but interdepartmental collaboration remains essential.

Provider Forces

The pandemic response brought new challenges to traditional provider-patient interactions. Many patients have been unable or unwilling to visit provider offices, regardless of symptoms or circumstances. Accordingly, telemedicine practices have been leaned on heavily for providing virtual office visit options, but for many diagnoses, laboratory testing remains necessary. Upon resuming routine appointments (in-person or virtually), providers tend to order more tests for their patients in order to “catch up” on missed care or increased acuity of illness. Laboratories with non-hospital-based phlebotomy locations and home-draw services saw an increase in demand and these operations had to be performed safely for both patient and phlebotomist.

Community Forces

The pandemic response forced clinical laboratories directly into the community spotlight. As the term “testing center” grew commonplace and people with symptoms became aware of the importance of getting a laboratory test, so too grew the need for fully supported specimen collection processes in non-traditional areas throughout communities, with publicly supported promotion of locations and hours.

Non-traditional locations, such as vacant retail buildings, parking lots, and even county fairgrounds, served as valuable patient collection centers, providing access to laboratory testing on a scale never seen before. Likewise, non-traditional customers were reaching out to laboratories for testing support, including business and industry, colleges and universities, and athletic programs and sports teams. Academic medical centers came to serve as reference laboratories for many other hospitals across the states. This community dependence was largely buoyed by teamwork and collegiality among laboratory practitioners.

Furthermore, a special focus was placed on elder care, as staff and residents of skilled nursing, long-term care, and assisted living facilities engaged in extensive COVID-19 testing protocols. As communal interest in the provision of health care in general, and detailed laboratory practices, specifically, was already on the rise pre-pandemic, we now face communities with some knowledge, and even more interest in laboratory minutiae, such as antigen and molecular testing, and antibody response.

Patient Forces

The pandemic response required laboratories to further expand the patient-centric experience with as much virtual support as possible. Traditional, extensive patient registration processes with vast amounts of paperwork were no longer acceptable. At many locations, patient access and information management departments worked together to create streamlined pre-registration processes in order to support online service scheduling and payment. The expansion of specimen collection locations and addition of flexible hours have increased patient access and satisfaction with perennially necessary tasks, such as phlebotomy, for which pre-scheduling has enabled adequate cleaning between patients and reduced waiting times.

The pandemic has dramatically increased an already burgeoning interest in and awareness of laboratory practices and the broad value of diagnostic testing. This awareness is not expected to diminish any time soon, as many patients who postponed routine care during the pandemic are now returning to their primary care providers. With heightened patient engagement, providers can seize this opportunity to order laboratory testing that supports wellness and identifies individuals that may be at risk for chronic illness.

Personal Forces

Closest to home, the pandemic response required super-human efforts from every professional in the laboratory industry. We have worked long, exhausting, and stressful hours for the better part of a year now. And in that time, we have exhibited leadership skills in communication, creativity, flexibility, perseverance, stamina, and resilience. Negotiation and change management skills are honed and used daily with quick decision making and quick action the norm. We have built emergency management teams within and beyond the laboratory and we have learned to respond instead of react. Despite all we have seen and been through, we have kept the patient at the center of our attention. Our leadership skills have been tested and refined, and as professionals, we have risen to meet the needs of the pandemic and have proved vital to the health care of our nation.

Looking Ahead

In reviewing what may have been on a laboratory director’s wish list prior to the pandemic and comparing it to what we have learned in the last year, there are several important factors to consider that will shape our industry in the months and years to come.

• Technologic expansion: With increased technical capabilities, we are able to expand the laboratory test menu, allowing for a reduction in send-out tests, lower reference laboratory costs, and increased versatility and revenue creation through expanded in-house testing.
• Information management: With newly established interfacing capabilities and experience in rapid instrument and IT deployments, we can ensure that the information systems department is able to support additional interfaces with other laboratory customers, such as physician offices and skilled nursing facilities.
• Provider relationships: Providers will continue to value a relationship with the laboratory that can provide broad flexibility and clear information both for themselves and their patients.
• Patient experience and engagement: Online pre-registration and scheduling, expanded locations, and flexible hours have increased patient satisfaction and are now considered routine. Remote phlebotomy will continue to increase in demand and laboratories will need to expand on-site as well as house-call phlebotomy capabilities in the near term.

Along with increased patient interaction with the laboratory comes the opportunity to nurture that engagement. Take advantage of growing patient interest in laboratory operations through education on common laboratory tests that can predict chronic diseases (eg, blood lipids for cardiovascular disease, hemoglobin A1c or glucose for diabetes). The laboratory’s contribution to prevention and wellness strategies can be maximized here.

• Community awareness: The sharpened focus on the impact of laboratory testing has raised the visibility and importance of the laboratory in the general community. As we continue to face staffing shortages, we must capitalize on that demonstrated impact and increased exposure to aid in the recruitment of future laboratory scientists.
• Collegial relationships across the health system: Teamwork across departments has been critical to the creation of a comprehensive and effective support system in the fight against COVID-19. Leveraging these new or improved relationships to the benefit of other practice areas will allow the laboratory to help directly improve patient care processes quickly and effectively.
• Executive recognition and support: The recognition and appreciation the laboratory is receiving now has been hard fought and is well deserved. Now that the laboratory has a recognizable seat and voice at the executive table, it is up to us to continue to demonstrate our value and contribute to our health care system’s key initiatives.

Both the onset of the pandemic and the laboratory’s vital response has provided the opportunity to build a platform for the future. Instead of waiting for the next crisis to hit, we owe it to ourselves to be proactive, leading with our success and newly gained experience. We must continue to serve our organizations, providers, and patients with preventative care, leveraging laboratory services across the community to support population heath initiatives. We can nurture newly formed relationships with laboratory customers by continuing to expand our outreach programs and increase diagnostic versatility and revenues.

Conclusion

Heroes do wear lab coats; as an industry we have known this for a long time. Due in large part to the COVID-19 pandemic, our organizations, providers, patients, and communities know it too. But now is not the time to rest on our laurels. Rather, we must continue to serve our patients and providers, add value to our organizations, and promote the value of our profession across the broader community. More than any other time in our industry, this is the moment to celebrate and promote our profession as the difference makers we are.

Jane M. Hermansen, MBA, MT(ASCP), is Manager of Outreach and Network Development at Mayo Clinic Laboratories in Rochester, Minnesota. She received a BA in medical technology from Concordia College in Moorhead, Minnesota, and an MBA from the New York Institute of Technology. Jane’s 25+ years of clinical laboratory experience spans clinical research; process engineering; project management; and laboratory outreach consulting, training, and facilitation.