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HCG’s hospital lab: A good example of an outsourced model

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HCG’s partnership with Strand Life Sciences has allowed the hospital to look meticulously at building efficient processes for operations and maintain highest quality standards
Raelene Kambli

Outsourcing of laboratory services within hospitals is a growing trend. This facilitates hospitals to save operating and labour costs and bring in more efficiencies to operations. However, the drawback of this model is that hospitals lose control on certain functions within the lab which can be critical and may spend more time in internal evaluations. Having said that, the trend has still accelerated in recent times, thanks to the aggressive moves taken by major lab companies seeking hospital customers looking to outsource lab services. One such hospital which has opted for outsourcing their lab services is HCG Oncology Speciality Hospital, Bangalore. The hospital informs that this model has been a win-win situation for them as well as their partner. Express Healthcare spoke to Dr BS Ajaikumar, Chairman and CEO, HealthCare Global Enterprise, to find out how this strategic move benefits his business.

The collaboration and service offering

As per Dr Ajaikumar, the agreement between HCG and Strand Life Sciences is on revenue sharing basis. Strand Life Sciences provides laboratory services to hospital including phlebotomy for outpatients. As a part of MoU, HCG management provides/shares services including facility management (including biomedical waste), registration and billing, customer care including customer feedback. The laboratory provides, OPD phlebotomy services, clinical biochemistry, clinical pathology, haematology / flow cytometry, microbiology and serology, anatomic pathology and cytopathology, molecular pathology, cytogenetics and phlebotomy.

Apart from laboratory services, the lab team contributes to the hospital functioning by being a part of various committees including infection control and ethics. Laboratory doctors participate actively in weekly tumour board meetings, cyber knife OPD meetings, MDT and other clinical meetings. The laboratory actively supports HCG Academics programme in conducting DNB course in oncopathology, resident course in oncopathology and B. Sc in Medical Laboratory Technology. The laboratory also supports quality activities in the hospital including NABH accreditation and related programmes.

When asked on how does outsourcing work for HCG, especially because the lab offers a large menu of oncology-related tests including tests like BCR ABL (Quant), IRMA, ALK Mutation, Minimal Residual Disease (MRD), EGFR Mutation etc., Dr Ajaikumar replied, “Strand Life Sciences is equipped in handling oncology- related services in respective departments unlike other labs. The laboratory provides wide range of testing from routine to next generation sequence testing as one-stop shop solution.”
He further mentions the varied services offered by the lab:

a) Immunohistochemistry: The laboratory offers a very comprehensive range and disease-specific IHC markers. 118 markers are available on completely automated platform within premises.
b) Expertise: Pathologists and other consultants in laboratory are specialised in oncopathology.
c) Molecular pathology: Offers all the molecular markers like BCR ABL, PML Ra Ra and MGMT methylation studies within the premises.
d) Cytogenetics: Karyotyping and FISH techniques for ALK, ROS-1, BCR-ABL are standardised and are available.
e) Tumour markers: Range of tumour markers including CA 125, CA 19.9, CA 15.3, PSA, AFP, Beta hCG, Free PSA are available as in-house tests
f)Bio repository services: Strand Life Sciences has established a division of Bio repository in the premises which acts as a huge database for oncology cases for prospective
studies
g) Clinical research: Strand Life Sciences has a division for clinical research as well which collaborates with HCG clinicians to conduct research activities for advanced cancer diagnostics.

The daily activity using automation and digital technologies

As told by Dr Ajaikumar, on a daily basis, the lab receives around 500 samples. He informs that the lab handles over 100 histopathology samples and immunohistochemistry markers each day. This is best supported by the technical staff and the equipment that the lab has. Moreover, the lab has two state-of-the-art automated tissue processors from Leica – ASP 6275 and rotary microtome that are capable of handling about 700 tissue cassettes a day. The grossing room is equipped with a cryostat from Leica, that is placed in a separate enclosed area to avoid aerosol exposure during frozen section diagnosis. The lab is also equipped with an embedding station from Leica — it is provided with a hot plate and cold plate. The laboratory has three rotary microtomes from Leica and Thermo scientific to handle the sample load. The lab is provided with an automated stainer from Leica for automated staining of H&E stain, papanicolaou stain and other special stains. This instrument can process about 100 slides in one go. This ensure accuracy, quality norms and decreases any human error.

Further, the lab is provided with a cytospin machine from Thermofischer for handling CSF and urine samples. The lab is also provided with an LBC machine – Eziprep for liquid based cytology. Apart form this, HCG’s lab has an immunohistochemistry laboratory with two automated IHC machines — VENTANA from ROCHE and Intellipath from BIOCARE. These systems are in place for effective antigen retrieval techniques. The laboratory also has a camera attached to the consultant’s microscope so that microscopic images are captured and incorporated in the reports. All these daily activities are conducted with the highest level of efficiency and Dr Ajaikumar attributes this success to his extremely competent staff. “The main strength of the department lies in the highly competent pathology staff that has a team of skilled technical staff and expert pathologists who strive hard to uphold the vision of HCG Hospitals. The pathologists are experts in the field, well trained to provide accurate and timely report even on scanty tissue samples. They are highly competent not only in handling oncology cases, but even non-oncologic cases including brain biopsies and lymphomas. The pathologists are competent in handling guided FNACs / biopsies. The pathologists are approachable for case discussion which makes us unique among other diagnostic centres. The reports at Strand Life Sciences are based on AJCC / CAP guidelines so that all relevant information for patient management are effectively communicated to the clinicians.”

The overall performance analysis

HCG invests around Rs 3 crore in their regular maintenance of this lab. When asked about its true success measure Dr Ajaikumar with a lot of conviction replied that successful patient outcomes is the true measure of success and for that reason they have system in place that on a regular basis measures this success.

They conduct the following process for the same:

  • Conduct internal audits and periodic intervals to assess the compliance of systems to QMS;
  • Collect feedback from patients and clinicians on lab operations;
  • Implement and monitor quality indicators including reports turnaround times, rate of rejections, sample labelling accuracy, reporting errors and communication of critical values;
  • Observations from external assessments from CAP and NABL.

At this point of time, the partnership with Strand Life Sciences has allowed HCG to look meticulously at building efficient processes for operations and maintain highest quality standards. But, with outsourcing there are some challenges associated with coordination and integration of organisational culture. As per HCG, outsourcing of their lab services has been beneficial to the organisation and they believe that in future too this will be a sustainable model to provide highest quality cancer diagnostic services in India.

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