I was struck by the following quotation when I encountered it and decided to use it to launch a discussion about the interactions between lab professionals and hospital C-level executives. My goal here is to respond to the chronic complaint of lab personnel that they can't communicate with hospital executives. They are right, they can't, and there are very good reasons for it.
It is difficult to get a man to understand something when his job depends on not understanding it. - Upton Sinclair
I believe that the jobs of hospital executives depend, in part, on not understanding the needs of the labs despite one's best efforts to articulate them. In order explain this phenomenon, I first want to list what I believe are the three major goals for most hospitals executives: (1) increase revenue through increased clinical activity; (2) expand the healthcare system (e.g., purchase other hospital systems, construct new buildings) in order to increase revenue; and (3) satisfy those clinicians who generate revenue. Note the absence of "enhance the quality of care" from this list. In my opinion, C-level executives will talk about quality but they will rarely fund it directly -- they assume that quality is a byproduct of good personnel and good facilities.
Hospital executives view clinical lab operations largely as a fungible utility like heat and electricity. They don't worry about how the electricity gets to the wall outlet -- they only worry about what it costs and what steps to take when the lights in the hospital go out. They will provide capital and operational funds to the labs only to achieve a level of performance that satisfies those clinicians who generate revenue for the system. They certainly do not want the labs hunkering down in valuable hospital real estate that can be repurposed to clinical revenue-generating activities.
So let's assume that, as a pathologist or lab professional, one is dissatisfied with the above scenario. What course of action should you pursue? The future of healthcare will be a focus on the diagnosis and treatment of disease using sophisticated and highly customized drugs. This is sometimes referred to as personalized medicine or the ability to offer the appropriate treatment to the right person, only when needed.
Pathologists and lab professionals, in order to have "adult conversations" with hospital executives, need to become an integral and indispensable part of the cohort of hospital professionals who diagnose disease and manage the appropriate therapy for the diagnosed conditions. In so doing, they become part of the clinical cohort that generates revenue for the hospital executives. The fusion of diagnosis with drug therapy has been called theranostics. It is insufficient to merely diagnose disease because, in so doing, one provides only "ancillary' services to those who actually treat the diseases.