Interviews

The recently-retired head of the Labs Are Vital™ initiative talks about developing, launching, and growing the popular laboratory community program.

Paul Epner talks about Labs Are Vital™

February 2009
Sten Westgard, MS

For more than 30 years, Paul L. Epner, B.S., M.Ed., M.B.A, worked for Abbott Laboratories, in areas including operations, strategic planning, marketing, R&D, and general management. His last project for Abbott was spearheading the extremely impressive Labs are Vital™ initiative. Having reached the pinnacle of success with Labs are Vital™, Paul has recently retired and is currently a strategic planning consultant in laboratory medicine.

We caught up with Paul in December 2008 and asked him to tell us, among other things, about the genesis of the Labs are Vital™ program.

[Following the interview, we include links and excerpts of his recent publications.]

Q: What was the idea behind Labs are Vital™? How did it get started?

Paul Epner: Abbott created the job eventually called Healthcare Improvement Initiatives in 2005. It’s purpose was to demonstrate Abbott’s long-term commitment to the laboratory profession at a time when some were still focused on short term issues that grew out of Abbott’s Consent Decree. We were one of the few vendors with a very deep investment in the profession and who saw that the health of our customers was a critical factor in our health as a business. I asked for the opportunity to fill this position and continue work that was already doing related to the profession - patient safety and other things. “Let me make this my full-time job. Let me focus on partnerships with the profession." They agreed and that was the first step.

In December 2005, I convened a meeting and invited people inside Abbott including legislative people from our Washington office and outside including representatives from an advertising firm and a PR firm. One of the ideas I presented was an initiative to help laboratories assert their role as a strategic asset instead of a cost center. I described morale in the laboratory as generally poor. I observed that the lab rarely had a “seat at the healthcare table.” People liked that idea. The advertising agency, Lehman Millet, was also working for a senior executive within Abbott Diagnostics, Don Patton. They did their own research and validated this idea. They then did all the creative things that became Labs are Vital, the concept, the colors, what it would be. They made a proposal to Don Patton and he supported it. I came back into active participation three to four months later, to provide strategic guidance, when Lehman Millet was ready to implement.

As we developed specific programs, like the Equipment Donation Program for med tech schools, I took ownership of some of those programs. Over the next six to eight months, leadership for many components of the Labs are Vital™ program implementation gradually shifted over to me. I started in 2006 and spent 2007 and 2008 as part of a team. Most of Labs are Vital™ initially was focused on the US and I drove that direction, but working with and dependent on other team members, not as a Lone Ranger.

Labs are Vital™ wasn’t one person. It wasn’t one creation. It was an iterative process. Lehman Millet had some great ideas but they became better after Abbott channeled information that captured the passion for the profession. Don Patton's support for the vision was critical. Mary Coduti, Fran Collopy, Denise Brunner, and many others were key members of the team - without them it never would have come to fruition. I'm happy to have been part of the team. We worked very well together to find the success equation that became Labs are Vital™.

Q: In retrospect, choosing to launch this program was obviously a great move for Abbott as well as the laboratory community. But at the launch and early months of Labs are Vital™, how confident were you of its success?

Epner: We launched at the July 2006 AACC/ASCLS meeting. There was a ton of work - 12 hour days, trying to get the bugs worked out of the Equipment Donation Program, trying to get the first video put together, trying to agree on the messages. It was a challenge. We thought this had some real legs, really had a chance to be something special, but we knew Abbott's role had to be tightly managed. This couldn't be about Abbott. It had to be about the profession.

There were no end of small battles over, "When can we use the word Abbott?", "What are we trying to accomplish?", "Are we going to spend money on something that goes nowhere but looks flashy?" It was important to do something that was meaningful and had real impact and brought Abbott benefits as a by-product of that - as opposed to making it a marketing effort. There was a constant debate over when Abbott got credit and when was it invisible.

Everyone at Abbott was excited at the 2006 AACC/ASCLS launch. People who didn't think it was going to be that big a deal were amazed at the response. Because we really did stay pure and we really did tap into this unmet need of laboratorians. That success was the best way to secure ongoing support.

That first year, we probably spent over $2.5 million dollars. Diagnostic companies do not spend those kind of marketing dollars in a single year on their best products and they certainly don’t spend this much on this kind of program. If there hadn't been Don Patton at an executive level who authorized the spending, it never would have happened.

Once it happened, once the response was seen, it became easier to keep the dollars going. Starting something always takes more energy than maintaining it. We knew we wouldn't keep spending $2.5 million dollars a year. But, even in the second year, we probably spent $2 million. Even in 2008, I suspect it will be over $1.5 million. That doesn't even include the people, just the direct expenses. A big part of the initial expense was creating the website, letting people know about it. Now we can maintain things at a lower cost without cutting back on the activity level of the program.

Q: Is there any part of the program that has been particularly successful?

Epner: Obviously, there are different audiences for different pieces of Labs are Vital™. But the thing that resonates with the laboratory community is the effort to elevate the profession. Getting a letter to the editor about the profession printed in USA Today meant something. Sending out letters about the profession every year to the membership of the American College of Healthcare Executives means something. Setting up the Facebook Initiative means something. The laboratory community sees those efforts as a valuable way to increase visibility and raise the laboratory profile.

Q: What's in the future for Labs of Vital™?

Epner: As a consultant, I will continue to work with Abbott to support Labs are Vital™ at a strategic level. Abbott is committed to sustaining and growing the program. We have identified one major new initiative for 2009 - and we are going to expand to a second initiative.

The first new initiative is Channel One. They beam a news show into high schools and junior highs throughout the country. The schools show their students a twelve-minute show every day, 10 minutes of real news, and about two minutes of quasi-advertising. They're hitting about 25% of the high school population in the country, which is pretty good penetration. We intend to create a contest as we did last year with the Facebook initiative. Channel One will also produce an editorial story on the laboratory profession. We will support it with ongoing educational activities: lesson plans, web support, like that. This is still unfolding, but it should be out during February. That'll be huge and it's as big as Abbott's investment in Facebook.

Q: Have you been able to gauge the impact of the Facebook initiative?

Epner: We weren't able to track the Facebook impact quantitatively. We have anecdotal evidence that people told us that they weren't aware of the profession and now that they were, they were interested in it. We know of at least one person who said they were enrolling in a med tech program who hadn't intended to originally. We do know that more than 30,000 unique visitors went to the Labs are Vital Facebook site. We feel good about that.

Q: It's hard to expect an immediate payoff on something like that.

Epner: Well, here's what we were responding to. I was running a recruitment workgroup for the Coordinating Council for the Clinical Lab Workforce. My workgroup created a survey. We got 4500 qualified responses. One of the questions we asked was, "When did you first learn about the laboratory profession?" 75% said they learned about the laboratory profession after leaving high school. The respondents were people who recently went into the laboratory profession or are still studying to go into the profession. Yet, they weren't even aware of it until after they left high school, which means it had no impact on their college selection. So where they went may not have had a Medical Technology program. From that survey, we know that we need to increase awareness at the high school and junior high level. Facebook was designed to do that. Channel One will hit 25% of the student body and , in part, address the need for increased awareness.

It's reasonable to say that if 75% of the current profession wasn't aware of it when they were in high school, probably better than 95% of the total student population leaving high school isn't aware of the laboratory professions. If we get our message in front of 25%, there's a probability that we will increase awareness and some of those newly-aware people will choose the profession. That's the payoff.

Q: How do you think the current economic conditions will impact the profession? Will hard times help people choose the profession?

Epner: I think hard times drive people to look for where there are openings, and there are vacancies in laboratory medicine. Nature abhors a vacuum. We both know you can get into laboratory medicine with as little as a high school degree if you're willing to be a phlebotomist or a lab assistant. You can also stay in school while doing part-time work. You can then get an associate's degree and move on to a baccalaureate over time. The nice thing about laboratory work is that there are jobs at each of those levels. So I think it fits hard times.

Q: What other things can people in the laboratory do to support Labs are Vital, or just support the same goals as the Labs are Vital™ program?

Epner: Labs are Vital™ has been focused (until now) on recruitment to Labs are Vital™. We haven't really given laboratorians a vehicle for more structured involvement, but Abbott wishes to change that.

To that end, they have created a speakers' bureau for Labs are Vital™. It's an online web-based training program with a varied message dependent on the audience that will hear the message. There’s one module available now targeted for civic and community audiences: church groups, rotary clubs, lions clubs, groups like that. People who want to become speakers will first take a web-based course called Speaking 101, then they will have to pass a multiple choice test. Then they will get some pre-reading, some information from Lab Tests Online and an article I wrote. They have to read the pre-reading and take a test on it. Finally, in the third step they actually watch a video of someone giving the presentation and then take the test on their understanding of the presentation. They will then get a copy of the presentation and be certified to give the presentation to civic audiences. They will log their participation at the Labs are Vital™ site. To maintain their certification, we ask them to do four presentations a year.

One of the things Abbott has asked me to do in my retirement is work on the second module, which will be intended for student audiences. We’re also trying to get continuing education units (CEU’s) for completing this work. Ultimately, there will also be a presentation for non-laboratory healthcare audiences. So we'll then have at least three tracks. This will give people a structured role, something they can do, visit a school, run an in-service. We also want to identify best practices in communication and recruitment and share that through Labs are Vital™.

Q: What kind of work are you doing now as a consultant for other organizations?

Epner: Even while I was working at Abbott, I was always an active member of various workgroups and committees. So in retirement, I am continuing that work. I am chairman of the Patient Safety committee for CLMA. I am on the Steering Committee of the Coordinating Council for the Clinical Lab Workforce. I am a member of the Levels of Practice Taskforce and chair one of the workgroups there.

I am motivated by two passions. One is increasing the utilization of the laboratory professional in order to improve clinical and economic outcomes for patients. The other passion is trying to mitigate the workforce shortage. At least some significant portion of my retirement will be devoted toward volunteer activities trying to further those objectives. When I have the opportunity to do work aligned with those passions, then I also look to do consulting. For instance, a professional association hired me to facilitate a two-day meeting to solve a strategic problem that was aligned with the direction the profession needs to go. That was a no-brainer.

I'm also looking to identify health systems that are interested in moving away from what I call the Factory Model of laboratory medicine into what I call the Department of Medicine Model of laboratory medicine, where you just don't turn out an accurate number on a test tube, but you turn out important clinical information about a patient and aid in the interpretation and utilization of that information.

I'm also on the Steering Committee of the CDC initiative, “Better Health Through Laboratory Medicine.” One of our workgroups is on how to better integrate laboratory medicine with primary care and clinical care. We have non-laboratory physicians and laboratorians meeting and working together on strategies to improve clinical and economic outcomes for patients by different and appropriate use of laboratory medicine. I’m hoping this effort will lead to improved utilization of laboratorians.

I think of all the ways that people have tried to cut costs in healthcare, attacking the laboratory budget is one of the poorest ways. They've misunderstood the role of the laboratory. One of the most expensive parts of healthcare is the circuitous diagnostic journey that so many patients endure - the trial and error approach to coming up with a diagnosis. The appropriate use of laboratory medicine can shorten hospital stays, reduce the need for people to return to the hospital, speed up the initiation of appropriate therapies. There are all kinds of payoffs when the laboratory is optimally used.

Q: Paul, you've identified this very optimistic future where healthcare is better optimized by improved utilization of laboratory professionals. What's stopping that from happening? Why hasn't it already happened if it's such a good idea?

Epner: We're a very fragmented, non-participatory profession. We lack a uniform vision as a profession. We're fragmented by all the associations and there's infighting between associations over different parts of healthcare policy. When you look at the Bureau of Labor Statistics data, you see there are more than 300,000 laboratory professionals just in the US. Now add up the number of all the people who are a member of a professional association, not counting the people who just maintain credentials with a certifying organization - I'm guessing it's no more than 30,000. That means that, at best, the active, involved members of professional associations represent less than 1% of the profession. The other 99% work, but aren't helping the profession in a coordinated fashion. It’s tough to drive change when so few are helping do so.

Our thanks to Paul Epner for granting this interview. Not only did he supply candid, interesting answers, he even offered some of the best questions, too.

Additional Information - Links and Articles by Paul Epner

Here is a set of excerpts and links from articles by Paul Epner, BS, MEd, MBA, where he discusses in greater detail many of the topics covered in the interview.

From "Owning the Total Testing Process", February 2008, Advance for Administrators of the Laboratory, Volume 17, Issue 2
http://laboratory-manager.advanceweb.com/Editorial/Content/Editorial.aspx?CC=1420

"At the recent G2 Lab Institute, keynote speaker David King, president and CEO of LabCorp, described laboratory services as a commodity. Webster's definition of commodity is 'a mass produced unspecialized product.' Clinical laboratory services are at risk of becoming an undifferentiated commodity and the clinical laboratory is increasingly taking on the characteristics of a factory evaluated for its ability to produce diagnostic results at the lowest possible cost (quality of results is assumed).

"Barring change, clinical and economic outcomes of healthcare consumers will worsen. But this future is not inevitable. To better serve patients and concurrently the profession, laboratory professionals must increase their participation on the patient care team and in patient care initiatives and shift their focus from the operational efficiency of the laboratory to that of healthcare efficiency and effectiveness. This will require laboratorians to collaborate actively with clinicians on the appropriate utilization of clinical diagnostics and the interpretation of the results; to mine clinical data to support improved evidence-based healthcare processes and reduced clinician practice variability; and to assert ownership for the 'total testing process (TTP).'"

From "Awareness: The 'A' Factor", Critical Values: News for the Entire Laboratory Team, ASCP, Volume 1, Issue 4, October 2008
http://www.ascp.org/pdf/CVShortage.aspx

"Awareness building is necessary but may not be sufficient. Moving students from awareness to a career decision cannot be taken for granted. To increase the commitment of aware students, it is important to nurture their interest in the laboratory profession. Targeting those efforts to all students would likely prove inefficient. When asked to recall their career interest when graduating from high school, respondents listed medical and nonmedical researcher most frequently (15.4%) of respondents), followed by doctor (15.2%), MLP (13.8%), nurse (6.6%), pharmacist (5.1%), and multiple other health professionals combined (13.7%). Focusing efforts on students with any of these career interests could be a significant first step in expanding the pool of students considering the profession."

From "The Future Laboratory Professional: Health Care's Secret Weapon", Critical Values: News for the Entire Laboratory Team, ASCP, Volume 1, Issue 4, October 2008
http://www.ascp.org/pdf/CVShortage.aspx

"Currently and increasingly, the clinical laboratory is viewed by major stakeholders—clinicians, hospital administrators, governments, private insurers—as a factory with inputs and outputs. Some laboratory colleagues refer to diagnostic testing as a commodity. In many hospitals the laboratory’s role is to simply turn out an accurate result at the lowest cost and, if requested, in the shortest possible time. With ever-rising health care costs and concurrent efforts to lower those costs, laboratory professionals confront ongoing demands to do more with less. There are unfortunately by-products of this model: unnecessary tests are requested; necessary tests fail to be requested; test results are misapplied; and processes break down. Each of these by-products can have adverse consequences for patients.

"The overlooked, underestimated laboratory professional may be one of the last major untapped resources in the battle to combat the health care system’s ills. First, laboratory professionals should assume ownership for the total testing process—from the time a clinician considers the diagnostic question until the results of laboratory testing are interpreted and applied. This does not mean tallying how many short-fills or missing sample labels have occurred. It means exerting the same level of ownership for pre- and post-analytical process breakdowns as for process problems within the walls of the laboratory...."