DATELINE: Calgary, Alberta, Canada—When it comes to regional consolidation of clinical laboratory and pathology organizations, this city at the foot of the Canadian Rockies can assert a credible claim to have achieved one of the most comprehensive consolidation comprised of hospital laboratories, academic center laboratories, and anatomic pathology laboratories seen anywhere in the world.
Officially, this unified multi-site medical laboratory organization is called Calgary Laboratory Services (CLS). Last week, your Dark Daily editor was invited to tour the main laboratory facility that CLS operates here in Calgary.
Calgary Laboratory Services (CLS) is a single, integrated clinical laboratory and anatomic pathology testing organization that is the product of at least three major laboratory consolidation initiatives since the mid-1990s. Each cycle of consolidation contributed to a more tightly-integrated network of laboratories and patient service centers that currently span the Calgary metropolitan area and a service region that reaches down to the Canada’s border with the United States.
Single Clinical Laboratory Organization for Calgary Metro
CLS’s flagship laboratory facility is called the Diagnostic and Scientific Centre. It is located in the University Research Park and the University of Calgary. Two major hospitals are nearby. One is 1,000-bed Foothills Medical Center and the other is 133-bed Alberta Children’s Hospital. Dark Daily’s site visit was an opportunity to see how bringing nearly all the clinical laboratory testing sites in a major metropolitan area into one operational company can deliver multiple benefits to the health system.
It helps to have some background on CLS. This unified regional laboratory organization:
- serves a population of over 1 million people in the Calgary metro, plus another 300,000 in surrounding rural areas.
- handles specimens from 8,000 patients each day.
- performs 21 million pathology and medical laboratory tests annually.
- employs 1, 950 full-time and part-time people.
- operates four rapid response centers in acute care hospitals and four testing labs in health centers.
- operates 18 patient service centers for community patients.
- provides laboratory testing to office-based physicians in its service region.
- maintains a centralized system for specimen transport.
- operates a single, region-wide laboratory information system (LIS).
- supports a comprehensive academic training program in pathology and laboratory medicine.
The history of healthcare in Alberta, and the birth of CLS, is equally interesting. Back in the mid-1990s, a newly-elected provincial government—facing significant budget shortfalls, undertook a major reorganization of the Province’s entire health system. Regional health authorities were restructured and both hospitals and physicians were asked to accept a 20% cut in health funding in a single year.
Tough Budget Cuts in Pathology and Clinical Lab Testing
For medical laboratories and anatomic pathology, the reduction in budget from one year to the next was targeted at 40%. To meet this requirement, all clinical laboratory organizations in Greater Calgary were brought together to work as part of a single regional organization. This included independent clinical laboratory companies, hospital laboratories, and the academic center laboratory. A similar laboratory consolidation effort took place in Edmonton, to the north of Calgary. (See Dark Daily, “In Alberta, Clinical Laboratories Adapt to One Integrated Province-Wide Health Services Administration Model”, July20, 2011.)
Much sacrifice and dedicated effort was required to consolidate all the activities associated with specimen collection, specimen transport, laboratory testing, and lab test reporting during this time. The goal was to eliminate expenses associated with redundant test services and excess capacity while streamlining operations and consolidating testing to achieve further economies of scale.
The effort to consolidate and further integrate clinical laboratory testing and anatomic pathology never ceased. Two more major consolidation initiatives took place in the years since the official formation of Calgary Laboratory Services in November 1996. Thus, CLS, as it operates currently, is the product of 15 years of focused effort to use a single, consolidated lab testing organization as a way to sustain a high quality of laboratory testing at a competitive cost.
In many developed nations across the globe today, government health systems are using regional consolidation of clinical laboratories as a way to squeeze out cost, reduce redundant services, and achieve economies of scale while maintaining the quality of clinical pathology testing services.
Calgary Lab Services Actively Implements Lean Improvement Projects
As currently configured, the CLS central laboratory is located on three floors of a modern office building near two hospitals and the University of Calgary. The layout and the workflow through the laboratory reflects the improvements made from a series of Lean and process improvement projects that were initiated several years ago and continue today.
This CLS laboratory provides primary testing for office-based physicians across greater Calgary. It also provides most reference and esoteric testing services to hospital laboratories and other medical facilities throughout the service region. For this reason, the laboratory test menu is extensive.
One noteworthy feature is a single laboratory information system (LIS). This LIS is used across all the laboratory facilities managed by Calgary Laboratory Services and is the Cerner Millennium LIS. Among other benefits, it means CLS is accumulating a sizeable data repository of laboratory test results for the population of Calgary and Southern Alberta.