In 1998, a tri-hospital committee, representing clinical, laboratory and administrative staff at three hospitals in Essex County, Ontario, developed a master plan for laboratory services reform. The "Mosaic Model" envisioned the laboratories of Leamington District Memorial Hospital, Hôtel-Dieu Grace Hospital and Windsor Regional Hospital working as one service in three locations. The Integrated Hospital Laboratories Service (IHLS) would provide clinicians and patients with more accurate and timely results in a cost-effective manner.

ONCE THE PLAN WAS APPROVED, THE HOSPITAL IMPLEMENTATION TEAM FACED SIGNIFICANT CHALLENGES:

  ACCESS TO LAB TEST RESULTS

Results were paper-based and not standardized across the hospital network. There was no laboratory information system in place to allow clinicians access to patient results at other hospital locations.

  CAPITAL INVESTMENT IN NEW TECHNOLOGY

The key to integration was a $1.5 million investment in a laboratory information system that would link testing results with the three different hospital information systems.

  EMPLOYEE RETRAINING AND RELOCATION

Employees' jobs would change. People with no computer savvy would need to become highly skilled information systems operators.

  MULTIPLE UNION CONTRACTS

Five bargaining units were asked to participate and agree on the fair and equitable treatment of skilled staff that would be transferred with their work from one hospital to another.

  AGREEMENTS ON COST SHARING

The hospitals had to change accounting practices to ensure consistency. Having confidence that each hospital is fairly charged for laboratory services, no matter where the tests are done, was key to developing trust in the new model.

"The lifeblood of medicine is information and the laboratory is a key component of that information," Ken Deane, President and CEO, Hôtel-Dieu Grace Hospital."

THE PARTNERS  Leamington District Memorial Hospital: an 80-bed hospital providing emergency care, general medicine and surgery, and obstetrics for a rural population.  Hôtel-Dieu Grace Hospital: 400-bed acute-care hospital with specialties in trauma, renal dialysis, neurosurgery, adult acute psychiatry and cardiovascular medicine.   Windsor Regional Hospital: 650-bed acute, ambulatory care and rehabilitation hospital with specialties in oncology, pediatrics and women's health.   MDS: a leading North American expert in transforming and managing diagnostic laboratory organizations to help them meet today's health care challenges.

PRIVATE SECTOR PARTNERSHIP WITH MDS
To help achieve these changes in a short period of time, the implementation team made a strategic decision to partner with MDS, a leading expert in the transformation and management of diagnostic laboratory services. "The hospitals had the vision to integrate, but MDS brought the leadership, expertise and corporate commitment to make it happen," says Ken Deane, President and CEO of Hôtel-Dieu Grace Hospital. "MDS was a logical partner. The company is in the business of running laboratories; MDS has the technology and intellectual capacity and, most importantly, a value set that is consistent with ours."

TEAM PUT IN PLACE
In 1999, MDS provided an implementation plan to guide the required platform changes. Ruth Jaeger, the contracted MDS General Manager, would lead the implementation and operational changes. Dr. Greg Flynn was brought on board as the Medical Director. Cross-sectional task groups were put in place. This, along with Greg's coaching management style and Ruth's strong leadership skills, facilitated decision-making and resulted in staff integration with minimal grievances.

"I believe we've created an environment in which staff at all levels--medical, laboratory and administration--can do their best work. With integration, the pathologists have opportunities to develop their specialties. They've become expert resources for the entire Essex County medical community." Dr. Greg Flynn, Medical Director, Integrated Hospital Laboratories Service, Windsor-Essex.

IMPROVED ACCESS TO PATIENT INFORMATION
Within 18 months, the labs went from paper-based reporting of test results to an integrated laboratory information system that allows clinicians to access patient data from computers at any of the three hospital sites.

The Windsor-Essex region has some unique health care challenges," says Cam Crawford, President of MDS Diagnostic Services. I really respect the fact that the three hospital CEOs took a leadership role in meeting those challenges. We know from our experience with other integrated health systems that, although hospital laboratory integration is rewarding, it is also complex. It is great to work with the Windsor-Essex hospitals. Their strong commitment smoothed the way to the development of a new, up-to-date and effective laboratory service for all the hospital patients."

While rapid-response laboratory tests for routine chemistry, hematology and transfusion medicine are offered at all three hospitals, the integration process eliminated the need for costly duplication of the more specialized services and equipment. Now microbiology, special chemistry, immunoassays and cytology are centralized at Hôtel-Dieu, while histology, special hematology and autopsy services are located at Windsor Regional.

Despite apprehension that the integration process and introduction of the lab information system might be very disruptive, the process proceeded extremely smoothly," says Dr. Martin Girash, President and CEO of Windsor Regional Hospital. Overall, it was a very positive experience, totally lacking in negative aspects." Girash continues, The integration process was very efficient and amazingly unobtrusive. I refer to it as 'ease of commerce'."

Leamington District Memorial Hospital now has access twenty-four hours a day, seven days a week, to laboratory testing as well as technical and clinical consultation on a real-time basis. Laboratory results from the Windsor-Essex hospitals are transmitted electronically directly to patient care units. Previously, access to clinical or technical consultation was limited, and the laboratory to which many tests were referred was closed on holidays and weekends.

Before integration, we were struggling to stay current. IHLS gives us sustenance to move on. Now we have ready access to knowledge expertise." Warren Chant, CEO of Leamington District Memorial Hospital.

UNIQUE HEALTH CARE CHALLENGES IMPACT LABS Although the three hospitals in the predominately rural Essex County serve catchment area of only 425,000 people, some unique health care challenges result in a disproportionate demand for hospital laboratory services:  Windsor is a mid-sized border city, just across the river from the large US metropolis of Detroit. A high volume of daily traffic brings an influx tourists and heavy trucks.  Hospital emergency departments are flooded with victims of trauma—traffic accidents, gunshot wounds, industrial and agricultural accidents.  As a result of poor air quality, Windsor-Essex has a very high incidence of respiratory illnesses.   Cancer rates are above normal, and the IHLS provides all testing for the Windsor Regional Cancer Centre.   Cardiac disease is 29% above the provincial average.  This community is the number-three destination for immigrants to Canada. They bring diseases from their native countries that are not commonly seen in Canada such as tuberculosis, malaria and other illnesses.  Last year, the new Integrated Hospital Laboratories Service for Windsor-Essex completed and reported the results on 1.96 million tests for emergency rooms, in-patient testing and many out-patient clinics.

The model for the Integrated Hospital Laboratory Service (IHLS) for Windsor-Essex has raised the bar for the delivery of hospital laboratory services with:

FASTER TURNAROUND
The direct and immediate electronic transmission of test results provides significantly improved response times for frequently ordered tests.

CONSISTENCY
All laboratories in the network now use standardized instruments, reagents and base-line reference ranges, supported by system-wide quality control practices.

ACCURACY
The laboratory information system (LIS) reduces the possibility of human error due to transcription errors.

REDUCED DUPLICATION
When a patient moves from one hospital to another, it is no longer necessary to repeat their tests. All patient test results are available through computers at any of the three hospitals.

INCREASED CAPACITY
Over the last few years, some test volumes have increased by as much as 35% without the need for more staff.

STATE-OF-THE-ART EQUIPMENT
Individually, none of the hospitals could have afforded to install an LIS or replace antiquated equipment. By sharing costs, the laboratories achieved dramatic modernization and saved an estimated $875,000 in capital costs on the LIS alone.

GREATER DEPTH IN CLINICAL AND TECHNICAL EXPERTISE
Laboratory, medical and technical staff developed special competencies and are now expert resources for clinicians throughout the entire community. Patients in the rural hospital have access to the same laboratory expertise as those in urban hospitals.

OPERATING ECONOMIES
MDS management and buying power reduces operating costs. Estimated savings in reagent and maintenance cost avoidance are $228,000 annually.

"Consolidation means we have been able to do more with less, concludes Deane, "We've achieved our goals for economy, efficiency, effectiveness and increased capacity. Now we are committed to continuing to look for further opportunities to improve. This process of consolidation and partnering with the private sector should be a model for other communities."

Mission of the Integrated Hospital Laboratories Service for Windsor-Essex
To provide state-of-the-art laboratory medicine as essential members of the health care team.

Leamington District Memorial Hospital
194 Talbot Street West,
Leamington, ON N8H 1N9
www.leamingtonhospital.com

Hôtel-Dieu Grace Hospital
1030 Ouellette Avenue,
Windsor, ON N9A 1E1
www.hdgh.org/

Windsor Regional Hospital
1995 Lens Avenue,
Windsor, ON N8W 1L9
www.wrh.on.ca

MDS Diagnostic Services
100 International Boulevard,
Toronto, ON M9W 6J6
www.MDSdx.com
© MDS Inc. August 2003.

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