HUSLAB is part of the Helsinki University Hospital network and the complex, multi-site organization provides diagnostic services across the Uusimaa, Kymenlaakso, and South Karelia regions. Managing diagnostic services across hospitals, laboratories, point-of-care settings, and outpatient clinics, requires 24 hour service and intensive logistics operations to meet the needs of such a vast area.
“All hospitals where we have laboratories are ’on call’ hospitals, so there is an emergency ward which works 24/7. Then of course, we have many specialized clinics,” said Tiina Mäki, Director of Clinical Chemistry in the HUSLAB core laboratory in Meilahti, located just north of downtown Helsinki. “In our core lab alone, samples come in three times a day from about 100 primary healthcare laboratories in Uusimaa as well as other areas in Finland.”
But what makes HUSLAB special is not necessarily the scale of the operation, but its attention to detail. HUSLAB prides itself on the level of service provided to physicians, the happiness of their staff, and a personal commitment to patients.
For example, HUSLAB is uniquely connected to patients in a way that many laboratories are not – their staff perform the majority of sample draws on the patients across the region.
While using laboratory staff for phlebotomy is rare in other countries, it is an important component of the quality control and lean methods employed at HUSLAB. This approach ensures that there are minimal tube-type errors or relabeling, and the lab has tighter control over the pre-analytical process, which can reduce sample draw issues such as hemolysis.
Keeping the schedule keeps things positive
The project started off on an aggressive schedule but keeping that schedule has been key to maintaining staff and management satisfaction. This required intensive planning from the outset to first transition satellite labs and then build temporary workflows for samples while there were changes in the core laboratory with automation and the main chemistry and immunochemistry analyzers.
Simulating the workflow of such a large volume of samples is critical to ensure that a laboratory, like HUSLAB, meets their key performance metrics, like turnaround time, even during transition phases.
Siemens Healthineers carefully analyzed data supplied by HUSLAB and determined optimized testing distributions based on the number of samples and the repertoire of tests available.
“We process tens of thousands of samples a day,” said Joutsi-Korhonen. “I think Siemens has done a good job on this. In addition, Siemens has also analyzed the workflows and determined what they will be when we switch back into routine operation.”
Perhaps the people who feel the change the most are the staff in the laboratory. That’s why one of the metrics most closely followed by the lab is employee satisfaction.
“Of course this type of change can be quite challenging,” said Mäki. “We looked at last years’ personnel barometric meter results and of course the impact of the increased workload was evident because of the change. But on the other hand, we felt that it is a good sign that the markers for motivation and the feeling of ‘being an expert‘, were really high and were higher than the previous year.”
Staff change management was a large component of the project, not only with intensive training by the Siemens Healthineers, but also with training and support from within HUSLAB. A group of dedicated laboratory technicians and a couple of chemists have been instrumental in providing comprehensive training across the network. The result is that HUSLAB staff have learned new skills and technologies while embracing change in the laboratory.
”The successful implementation of such a large project requires experience and planning.”
Keeping clinicians satisfied
All the laboratories in the HUSLAB network operate for twenty-four hours, seven days a week. Training staff that cover the night shift can also be problematic. It required cooperation from all of HUSLAB’s laboratory managers and the head technicians who plan the shifts.
“We trained the night shift during the day,” Mäki said. “To make training more efficient, pre-training material was provided for everyone to read before they went to the training.”
Siemens Healthineers also allocated trainers to each laboratory and every lab knew who their contact person was.
“But where Siemens have been good, and they have been hands on, is more with the setting up of the tests - helping to calibrate and run the tests that we were struggling with first, problem solving and running the new track. It has been quite impressive that Siemens has been so involved,” said Mäki.
Another aspect of the new system that HUSLAB identified as a potential issue is how the change would impact clinicians.
When switching between analytical instruments, it is typical that test results on one system can be different from the results of a similar test run on another manufacturer’s system. This is due to a multitude of factors, perhaps different pieces of an analyte are being detected, or there is a different analytical technology in use. So the result, while accurate, could be a problem for doctors who are not familiar with new reference ranges and what a specific result says about a patient’s condition.
“Some of the tests are really working perfectly well and correlate with previous systems,” said Joutsi-Korhonen. “Others are analytically correct, but the results differ from those of our previous supplier. So, the clinicians must change their mindset and integrate them differently.”
Managing the shift in results on a clinical level required a close collaboration between the laboratory and clinicians. It’s a change management component that is ongoing, but critical to patient care.
“For example, tumor markers are results that clinicians closely follow,” said Joutsi-Korhonen. “It is very important for the patients as well to see if the level is going up or down, or how stable it is. If we switch to different technologies overnight, there can be a very dramatic change in the results. So, we had long discussions with the clinicians on how to manage results and how to talk to patients about these changes.”
“Siemens have been good with helping to calibrate and run the tests that we were struggling with, problem solving and running the new track. It has been quite impressive that Siemens has been so involved”