Five ways you can synergize with surgery to redefine care

Five ways you can synergize with surgery to redefine care

Pathologists play a crucial role in medicine, but too often remain insulated in a laboratory setting. As a result, they miss many vital opportunities to contribute to the larger continuum of care.

One of the most important connections pathologists can make is with surgeons. When the hands-on skill of surgery is reinforced with the data insights and resources of pathology, a powerful partnership results. The trick—as with many other aspects of lab leadership—is to rethink the value you can bring and then act on it.

The following presents some tips that can put pathology on the path to playing a larger role in successful outcomes.

Contributing Lab Leaders

Article highlights:

  • Pathology can enhance its contributions to care by building close relationships with surgery and the larger care team
  • Synergy with surgery rests on simple principles—but it all begins with a change of mindset
  • This not only helps surgeons, but can directly influence quality, safety, and efficiency of your pathology practice
Jeff Myers, M.D., Ph.D.

Jeff Myers, M.D., Ph.D.

Director of Anatomic Pathology and MLab

University of Michigan

Julia Dahl, M.D.

Julia Dahl, M.D.

CEO and Medical Director

Mosaic Prime, LLC

Click through to discover the following tips that can put pathology on the path to playing a larger role in successful outcomes.
1. Anticipate the surgeon

Yes, your surgeons want test results. But they also appreciate solutions. When your interaction with surgery begins with a test order, make sure that you understand the patient’s condition, the goal of the test, and the ultimate goal of the treatment. This will allow you to better anticipate what the surgeon needs to know. Not just a result, but information clearly couched in terms of that particular episode of care. Your being able to place a result in this sort of customized context helps surgeons do their jobs better, while making you even more indispensable to treatment.

1. Anticipate the surgeon

On anticipating needs

"You have to have the skills and the tools that allow you to understand the wants, needs and desires of those you serve, even if they can't tell you. And I think that's something, as a discipline, we can do better."

– Jeff Myers, M.D., Ph.D., Director of Anatomic Pathology and MLabs; Vice Chair, Clinical Affairs and Quality, University of Michigan; President, ASCP

2. Be the stream

Boosting the value of pathology rests on rethinking the “value stream.” Remember that you are not excluded from pre- or post-analytical phases of care. You embody the whole analytical process and must play an active role in every phase.

Make sure the analytical data you provide rests on solid pre-work. And, once you’ve supplied that data to the care team, assist with its meaningful interpretation and follow-through. If you help shepherd the process, you ensure quality control for the surgeon while expanding your role in care.

2. Be the stream

On rethinking the stream

"In any other business, you would not be content to live with the defects handed down to you by your suppliers or to blame your customers for what they experience at the backend. Pathology needs to understand that we can influence the whole value stream, not just what happens within our laboratory. That means getting out of the laboratory and understanding value as defined not by us, but those we serve."

– Jeff Myers, M.D., Ph.D., Director of Anatomic Pathology and MLabs; Vice Chair, Clinical Affairs and Quality, University of Michigan; President, ASCP

3. Own the patient from the get-go

Part of widening pathology's scope of involvement centers on the concept of ownership. Julia Dahl states it in very human terms. "A clinical laboratory test begins at the moment a physician thinks about submitting the order," she says. "How I've practiced for the last 17 years is that the moment a patient is scheduled for a biopsy, that patient becomes my patient."

How does this help surgeons specifically? Dahl observes that early ownership gives pathologists the valuable lead-time they need to perform meaningful quality assurance. For a GI biopsy, for example, a little advanced planning with the gastroenterologist could pay big dividends. Just knowing when samples would be extracted and delivered to the lab helped her team know the moment something wasn't right. In fact, these extra quality assurances created a "red flag" that helped the lab locate three misplaced specimens in the course of five years.

3. Own the patient from the get-go

On planning in advance

"We looked at our surgery schedules for weeks in advance and would review them very methodically. If there was an instance where we could make a meaningful difference before the patient's procedure, we did that."

– Julia Dahl, M.D., CEO and Medical Director, Mosaic Prime, LLC

4. Be present

As Jeff Myers observes, "the primary way to build relationships is simply to show up." Your simple physical presence in the care continuum encourages recognition not just of you but your value as well. "Shortly after I arrived at Michigan," Jeff remembers, "I suggested that the pathologist who's performing intraoperative consultations provide that information in the OR, rather than over an intercom."

Jeff also boosted his pre- and post-procedural presence by making sure his pathologists changed in the same locker rooms as the surgeons. While it may have been more convenient for a pathologist to change into scrubs in his or her office, the contacts they made helped them learn surgeons' names, form relationships, and ultimately work better together.

4. Be present

On showing up

"Pathologists are very hesitant to think just being present has value. But simply letting surgeons see you, especially late at night because they needed you to be there, can have real value."

– Jeff Myers, M.D., Ph.D., Director of Anatomic Pathology and MLabs; Vice Chair, Clinical Affairs and Quality, University of Michigan; President, ASCP

5. Be consultative

Strength rests in numbers, and another angle to "being present" revolves around becoming a patient-facing member of the care team. For the patient especially, attaching a face and name to every discipline involved can be very comforting. For surgeons, it can be a concrete reminder that pathology is composed of living, breathing people who "have their backs."

Don't wait for specimens to enter your lab. Once a patient pops up on a surgery schedule, attend the preoperative evaluation with the surgeon to meet the patient to explain your role. And during intraoperative consultations, be there to lend your expertise in real time. This provides value to both the surgeon and the patient.

5. Be consultative

On expectations

"Pathologists shouldn’t have to be ‘translated’ through other members of the care team. Number one, it doesn’t take advantage of the opportunity to develop relationships. And number two, it doesn’t help folks understand expectations, which is often the root of many problems."

– Jeff Myers, M.D., Ph.D., Director of Anatomic Pathology and MLabs; Vice Chair, Clinical Affairs and Quality, University of Michigan; President, ASCP


Looking forward

Jeff Myers believes that pathology stands on the threshold of a new world. "As fee-for-service fades in the rearview mirror," he says, "we've been liberated to imagine value in ways never before possible."

Jeff Myers, M.D., Ph.D.
Director of Anatomic Pathology and MLabs; Vice Chair, Clinical Affairs and Quality, University of Michigan; President, ADASP

One of those ways rests on forging synergy not only with surgeons, but also with everyone involved in care. Widening the scope of involvement, providing in-person expertise, and simply getting to know colleagues and patients better will help pathology play an even more vital role in providing value and ensuring successful outcomes.

The best days of pathology lie ahead.

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