A Focus on Culture Creates a Team Strong Enough to Face COVID-19

Autumn Farmer is Bon Secours Mercy Health’s chief laboratory officer. Healthcare Performance Insider caught up with her to ask how her organization – the fifth largest Catholic healthcare system in the country – has responded to COVID-19, and what she sees on the horizon for hospital labs.

Autumn calls her career in healthcare a “happy accident.” After starting college as a theater major, she took a business course – where she learned the meaning behind the phrase, “starving actor.” She switched gears, and while earning her undergraduate degree in business, she searched for a job. A family friend who worked in one of the Mercy labs told me that they were hiring. So, that was really how I started. I started at the entry-level position of phlebotomist and quickly learned to really love lab.

In order to move up the ladder, Autumn wanted to learn more about other parts of the hospital. She worked in the hospital’s finance department, working extensively with the pharmacy, for three years. I always knew I wanted to be on the business side. Her experience with lab, finance and pharmacy led her to supply chain. Supply chain at the corporate office was looking for someone with a lab pharmacy background and those people are few and far between, so I was uniquely qualified. I always knew I wanted to get back to labs. When the opportunity presented itself to move into a leadership position, I was very happy to move into that role.

Merger lessons learned

As the chief lab officer at legacy Mercy Health, Autumn was part of the merger process in 2018 between Mercy and Bon Secours Health. When we came together to merge, we knew there was a lot of opportunity in lab to move into more consolidation, and more of a structure that operates as one lab throughout our ministry. One of the things we proposed was an alignment of a reporting structure change from the hospitals to the home office, up through my position.

Among the merger’s top challenges, Autumn said, was getting buy-in from the sites on the new structure. As I’m sure you can imagine, there are many back-office functions that are rolled up at the system level for a large system like Bon Secours Mercy Health. But lab being a clinical department it was a much harder sell, I think, for hospital executives. So that was one of the biggest challenges we faced. Another challenge I had was really understanding the dynamics of each site that I wasn’t familiar with, sites that I hadn’t worked with in the past.

Becoming one team

Aligning labs’ cultures in the wake of a merger starts with leadership and aligning to a unified vision for the lab. One of the first things that I did was I met with each of the laboratory directors and shared that my view is that pound for pound, the lab is the most valuable department in the hospital. That’s really a mindset change for many leaders in lab. They’re used to being a support department, and I wanted to empower my team to have a seat at the hospital leadership table.

The next step was to engage and empower frontline staff. One of the things we’ve been working on there is developing standardized job descriptions. We started with 118 job descriptions, and we’ve gotten down to 45. Autumn’s team is also developing clear career ladders, so that employees understand the growth potential their position has and how their work contributes to the hospital’s success.

COVID-19: both sprint and marathon

When the pandemic hit, Autumn’s team put the pedal to the metal. We definitely started out at a sprint pace for the first several months, leading to burnout. We’re starting to pace ourselves more now.

Positive consequences of the pandemic include stronger and more frequent communication, including daily COVID-related communication with hospital leadership. I have more interaction with all of our managers at each of the sites than I’ve ever had before.

Another positive practice was the creation of some redundancy in leadership. One of the first things the team put in place was a series of contingency plans to cover what would happen if lab leaders got sick. Today, we have two leaders who can step in and do what I’m doing if I’m if I’m taken out of commission. We did that with each of our levels of leadership across all the laboratories.

A third positive change, Autumn said, is that the lab is much more visible within hospital leadership. We have a seat at the table and are invited to a lot more meetings. We are valued, and there’s a lot more recognition for what goes on in the lab.

Staying nimble to adapt to change

We’ve had to think outside the box to solve problems in a way that I don’t think we ever did before. This includes creating supplies, such as sterile swabs for swabbing for COVID-19. Autumn and her team bought non-sterile swabs and we worked with the system’s sterile processing department to sterilize them. The system has also created its own saline transport medium in response to reduced supply.

Lab staff has stepped up in many ways to meet needs created by the pandemic. We’ve staffed flu clinics, run flu clinics, things we didn’t think we would do, I think at the beginning of the pandemic. Now, we’ve had to expand into new roles and move people around as necessary to get work done.

Looking into the future of lab

The future of lab is really moving out of the basement, becoming that integral part of the care team. We want to focus on how we can provide information for clinical decision-making, versus just results. Artificial intelligence has a big role to play in making that shift over the next five years, Autumn said, both in terms of using lab data and in deploying digital pathology solutions as well.

The pandemic has changed that future landscape in a few ways, she noted. I think the focus on infectious disease molecular testing will increase. We were already moving in that direction anyway. I think we’ll move in that direction even more, and we’ll want to see more of that performed in our hospital laboratories rather than it being testing that goes out to reference labs.

She hopes the future will also bring an increased prioritization of hospital labs. I was very surprised to find that I didn’t hit anybody’s allocation lists for COVID-19 supplies. Because they see our hospitals, and a large health system like Bon Secours Mercy Health, as individual hospital labs. They don’t see us as one big lab doing the 20 million tests per year.

If, she noted, more of the COVID-19 tests had been allocated to the hospital labs rather than to the large reference labs, the country would not have faced problems with extended turnaround times for results. We wouldn’t have seen the problem we saw this year with seven-day turnarounds, 12-day turnaround times, because the testing would have been much closer to the patient. We had the staff to perform the testing, but all of that allocation went only to these large labs, which were then quickly overwhelmed. I’m hoping that’s something that can change so that if another pandemic happens, we’re better prepared as a country to address it.

In the end, Autumn said, her work to elevate the importance of hospital labs is good for healthcare, and ultimately good for patients. If we can profoundly change the way hospital labs are seen over the next five to 10 years, I’ll be happy with what I did in my career.

Autumn Farmer

Autumn Farmer

Chief Laboratory Officer, Bon Secours Mercy Health

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