I have a real problem with laboratories who use work load units to talk
about workload. They are an archaic way of looking at costs and were
developed in the 60's 70's as a way to compensate for laboratories who used
manual methods when being compared to automated laboratories. With the
advent of real automation much of the cost of work load units is in reagents
as opposed to actual staff. I have had a huge increase in workload units,
efficiency, and even staff intense activities such as phlebotomies (from
39,000 per year to 150,000 patients per year) with approximately a 25%
overall decrease in staff. Certain areas such as Micro have increased in
staff but every where else in our laboratory has decreased (Biochemistry 33%
decrease) I also work on the wards and I can tell you to wait for results on
patients while you do a stepwise analysis is really a gross waste of
hospital resources. Most patients who are in hospital nowadays are very ill.
Outpatient care is were most sick patients are. How many times should a
patient come back for a step by step investigation. Imagine what it costs a
patient in lost time to go to a Test Centre 5 times to get blood taken.
Imagine how many extra visits to GP's, specialist's etc to do every
investigation in a stepwise fashion. Yes logic needs to be used in ordering
tests but nowadays most possible diagnoses are looked for at first
investigation not one at a time. Yes there is a certain waste but show me
anything in this world that does not have waste. One of the main problems in
eliminating waste in Quebec is the issue of patient confidentiality. Doctors
have no right to see the analyses ordered by other physicians. In hospitals
it is easy to overcome as it works as a group practice but when one looks at
a patients practice of going to several hospitals and many specialists they
all end up reordering the same tests, including X-rays.
I also would like to make a plea of eliminating the use of the traditional
workload units for comparison of laboratories. In Quebec the Government
developed a workload unit which reflects productivity and allows pretty good
comparison of laboratories. Each test is given a unit which is related to
its cost. The cost was determined by going to 7 laboratories and asking them
how much it cost them for a sodium, TSH etc and the average was determined.
The cost includes labour, sick leave, reagents, service contracts etc. There
are a few problems with it such as it does not include cost of informatics
but it is a good estimate. Then all laboratories are compared using their
total budgets and the number and type of tests they produce ie how much they
spend to produce 1 unit. The spread of cost is from $0.55 to $1.26. We who
are cheap hope that one day the government will take the politics out of it
and only give $0.70 to hospitals for each unit. This way we can earn money
and be rewarded for our efficiency and those that are inefficient will have
to send their tests to us or improve their efficiency.
Elizabeth Mac Namara
-----Original Message-----
From: clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of Reynolds Tim (RJF)
Burtonh-tr
Sent: January 16, 2003 7:37 AM
To: [log in to unmask]
Subject: Re: Mass production of tests
Clinical budgeting is probably not the answer! Below are the workload stats
for Queens where all is done in house..
Achieved Output for each year
TOTAL Clin Chem Haem Micro
Histo Blood Bank
1995-1996 515256 258645 128974 75930 11008
18270
1996-1997 540164 282875 134703 75465 7646
17868
1997-1998 621734 316555 166617 87852 9815
19470
1998-1999 691541 349214 179333 96724 11098
31208
1999-2000 720112 372098 180839 96175 11945
33479
2000-2001 773343 414036 197937 96447 12206
32277
2001-2002 837092 474630 216245 101915 11723 32579
2002-3 892552 512367 226303 107974 12430 33478 (projected)
TOTAL Clin Chem Haem Micro
Histo Blood Bank
%age Incr 73.22% 98.10% 75.46% 42.20% 12.92% 83.24%
APR 8.17% 10.26% 8.36% 5.16%
1.75% 9.04%
Chemistry and haem workloads growing rapidly; micro growing at about 5% and
histo pretty much flat.
And which department has doubled its consultant numbers from 2 to 4 - yes no
prize for guessing - histopathology [despite the fact that for years they
have been the only department that could arrive late, depart early and get
lunch in the post-grad centre every day]
TIM
****************************************************************************
*********
Prof. Tim Reynolds,
Clinical Chemistry Department,
Queens Hospital,
Belvedere Rd.,
Burton-on-Trent,
STAFFORDSHIRE,
DE13 0RB,
UK.
tel: 01283 511511 ext. 4035
fax: 01283 593064
email: [log in to unmask]
alternative email for the all too frequent occasions when the NHS email
connection doesn't work:
[log in to unmask]
****************************************************************************
**********
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> -----Original Message-----
> From: Wayne Bradbury [mailto:[log in to unmask]]
> Sent: 15 January 2003 14:09
> To: [log in to unmask]
> Subject: Re: Mass production of tests
>
>
> I think the answer is Clinical Budgeting - or something like it.
>
> Microbiology services in Carlisle are provided by PHLS and the
> Acute Trust and Primary Care Trusts get what they pay for as
> agreed in contracts.
>
> In contrast Biochemistry and Haematology are provided in the usual
> open access way and we have no workload sensitive contacts.
>
> Guess which lab's test workload is growing at 14% per annum and
> whose is growing at 5% ?
>
> Wayne Bradbury
> Cumberland Infirmary
> CARLISLE
>
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------ACB discussion List Information--------
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community working in clinical biochemistry.
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via the internet. Views expressed are those of the individual and
they are responsible for all message content.
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