Organization of laboratory analytics into centers – meaningful or not? 1

Abstract

Abstract Specialists working in the field of in-vitro diagnostics increasingly make use of similar methods. This applies to laboratory medicine, microbiology and virology, pathology, hygiene, environmental medicine, and, in part, transfusion medicine and human genetics. Although the diagnostic issues and/or the specimens differ in most cases, the molecular, cellular, immunologic, mass-spectrometric and other separation and detection procedures are based on identical principles and technologies. With some of these procedures costly multiple investments are unavoidable, since several specialties make use of them. Furthermore, an increasing degree of mechanization and the need for modern IT-based process controls in all specialty fields tie up additional resources. On the other hand, it is exactly these specialty fields in German hospitals that find themselves under considerable cost pressure, intensified by the competition with private large-scale laboratories and laboratory chains. Hospitals that still run their own laboratories and institutes in these specialties are considering either partnerships with such laboratories or outsourcing. Such changes, however, go hand in hand with the curtailment of each hospital's decision and development autonomy. For this reason many hospitals are seeking autonomous solutions. As yet no university medical center in Germany has decided on permanent outsourcing. To increase their economic efficiency on their own, hospitals have attempted to develop rationalization programs and to achieve qualitative added value by establishing laboratory centers. Large municipal hospitals had earlier already pursued this approach, some university clinics adopted it some years ago. They created competence and organizational centers like “diagnostic centers”, “centers for clinical pathology”, etc. with the objective of utilizing the technical and organizational synergies of the specialty fields mentioned above. In particular, the focus here is on joint methodological competencies, identical or similar instrumentation, similar requirements for IT-based process controls as well as overlapping qualifications of medical and technical personnel. These primarily specialized aspects unfold their potential for cost savings only when they are organized appropriately. Hence the key to success for the creation of a center is to change a specialty-centered organization into an organization that spans multiple specialties and is aligned along synergies. In view of the importance of technical decisions this challenge can be met only with expert leadership. Therefore successful concepts always envision such centers to be under the direction of a physician, regardless of their varying designs. In competition with large-scale laboratories and laboratory chains, large centers at this time can still frequently capitalize on their technical breadth as a unique selling proposition in their respective areas. So far private large-scale laboratories are active primarily in the areas of laboratory medicine, microbiology and virology and less frequently also in the area of human genetics, but only rarely in the areas of transfusion medicine and pathology. In comparison, the centers of large hospitals with greater technical breadth cannot only make even wider use of synergies, but can also bring to bear their comprehensive technical competence. Hence, the formation of centers can be a path to economic efficiency and to a strengthening of the competitive position above all for large hospitals.