Point of care adoption and maturity: Why so many organizations are playing catch up
Point of care adoption and maturity: Why so many organizations are playing catch up4 January 2023 | 9min
The maturity of point of care adoption differs greatly across healthcare systems
Workforce and resourcing plans are required in order to support the effective use of POCT innovations
Success is reliant on effective leaders and advocates
Point of care adoption and maturity within clinical services must surely be an expectation across the healthcare landscape following a torrid few years. Why are so many organizations still not investing their efforts and resources in developing their point of care services?
There may be many factors at play. Is there evidence to suggest point of care and rapid diagnostics should not be adopted or is the opposite opinion the correct one? This article explores all angles and opinions, offering context as to why some organizations remain behind the curve with adopting new technologies and service development.
Where to start?
It is natural to have variation in the provision of healthcare, even within the same territory. In England this is sometimes referred to as the postcode lottery, often referring to the availability of certain drugs and medicines in one region and not in others.
A common question asked is ‘Where to start?’ If an organization or individuals have the aspiration to build a service, acquire resources and funding, and successfully impact the delivery of healthcare, where would they start?
Fear of the obstacles ahead and the barriers which might be encountered could seem insurmountable. The essential act is to take the first step, devise a service development plan, and engage with stakeholders and decision-makers at the earliest opportunity.” Tony Cambridge
Historical attitudes toward point of care testing may hinder its adoption
Point of care testing (POCT), or near-patient testing, has not always enjoyed the best reputation. This specialty of healthcare has seen rapid growth since the 1990s, driven by developments in manufacturing techniques, miniaturization, and the use of new materials to drive technological advancements. The accuracy and imprecision point of care test results have improved to near laboratory quality, and in some cases, the results generated are claimed to be comparable to that of laboratory analyzers.1
Clinicians and technologists who might previously have had less than favorable experiences may now be in positions of influence where point of care might be adopted. They may not be open to revisiting the use of tests deployed in non-laboratory settings, regardless of evidence of improved performance and utility.
Another attitude that could still be playing a part is the medical laboratory versus point of care debate. Many believed point of care testing would have a negative impact on laboratories, with the loss of work to frontline testing. This simply isn’t the case, easily evidenced by the year-on-year increase in testing performed in pathology laboratories. Alongside this, there has been a similar increase in the use of rapid diagnostics to speed up clinical decisions in patient cases where rapid intervention is required.
Technological advancement will continue to drive point of care adoption and maturity
In recent years there has been an explosion of new technology, accompanied by the ascendance of existing methodologies. The lateral flow test is seeing a lot of investment in new applications and a wider test repertoire. It has been used to great effect in frontline services during the pandemic and may contribute to the future adoption and maturation of point of care diagnostics.
Other developments in sensor technology, dry chemistry, cartridge and test cards, coupled with artificial intelligence (AI) and algorithms, have improved the quality of results as well as accessibility and ease of use. Attitudes towards adoption may change if awareness of available solutions increases, but who is going to champion them?
Factors needed for successful point of care adoption and maturity in your organization
Effective leaders and advocates
The success of any service will be linked to the effectiveness of leaders and identifying advocates for POCT. Advocates will ideally be from different specialties of healthcare in acute and community settings. This will ensure wide rollout and engagement with stakeholders which is a recipe for success and longevity.
Leaders need to be able to articulate the vision and devise a plan to scope, select and implement solutions based on how those solutions can address the clinical challenge. The pitch should be aimed at the decision-makers and influencers with persistence, patience, and persuasiveness.” Tony Cambridge
The advocates need to be active in promoting the need for point of care, along with positive reinforcement of the benefits of point of care adoption.
All organizations will expect a large amount of evidence to support expansion and investment in point of care teams. It is key to use benchmarking and service analysis to support improvements in the staffing structure. Process mapping of existing services and projection of future services can be extremely compelling when drawing up a workforce plan.
Service leads should quantify the time taken to deliver individual service elements, and at which pay range, to work out the cost to the organization. Where shortcuts are having to be made, impacting quality or safety, this must be identified and accounted for in the proposal.
It is essential to state the aims and objectives of the service. This will add focus to the argument and allow for a roadmap on delivery to be developed.
Investment and funding
Many key individuals continue to be confused by funding streams and who to approach for capital and revenue investment. The popular opinion is to think there is no funding available which could be far from the true position.
The ability to be agile in bidding for funds is also a must so business plans and workforce plans should be ready as funding can become available at short notice. Successful bids come from leaders who have already mapped their requirements.
Developing relationships with procurement and finance, along with network leads, can help identify pots of money that would otherwise be inaccessible.” Tony Cambridge
Engagement with laboratory senior management is also key to success. Funding streams can be communicated to these individuals, and if they are unaware of POCT service needs, they may not know to pass on the opportunity. Keeping the awareness high can result in success and POCT leads need to be persistent in raising concerns regarding service delivery. It is often these individuals who table the bids, so having them fully appraised of the requirements and benefits is a must.
Cost-benefit evidence and the silo effect
One element of business case writing that continues to confound is understanding the downstream benefits of introducing service improvements. Introducing a project rarely has no impact on other specialist areas of care delivery. Applying the cost to any positive impact on patient flow remains a difficult task but the organization’s performance team should be able to indicate the cost of care to an individual patient case based on the specialty.
This will also be true for presentations in emergency departments and admissions. Length of stay can also be quantified in terms of cost to the organization but also to the long-term outcomes for patients. Those patients who remain longer in the hospital setting can often have protracted recovery periods so discharging patients to home or to ongoing care is key for improved outcomes and patient experience.” Tony Cambridge
If we continue to think about localized cost improvements whilst ignoring service-wide cost benefits, there is unlikely to be support for service improvement projects on a large scale. Moving away from the silo mentality, promoting shared successes, and working collaboratively to quantify benefits is a requirement for any successful case.
Services can often be disjointed and isolated from one another even when there may be interdependencies. Sitting all stakeholders around a table is the best way to engage with those impacted by change, addressing any concerns raised.
There will often be a standard template that the organization uses to standardize the information being presented. They are not always fit for purpose depending on the case being made but bidders should be prepared to manipulate the content to drive home the message and present the key benefits.
Requesting examples of successful business cases from procurement is always a good idea to inform the content of any new bid. Authors should make the content relatable to those assessing the case, using non-scientific phraseology, and making the benefits clear.” Tony Cambridge
If a clinical pathway is impacted then include statements from the clinical leads in these areas, which adds significant weight to a bid. Having a clinical champion on board is as valuable as having executive buy-in. There are still cases where POCT is delivered by one person or very small teams with little room for growth, and issues around resilience.
What actions can executives do to support POCT adoption and prosperity
Overcoming the barriers to adoption
Point of care adoption of new technologies can hinge on attitudes toward clinical risk, faith in the methodology, and appropriate use of tests within a well-governed structure. The executive team will be well placed to understand the opportunities and benefits of introducing point of care testing and should consider the following actions:
- Address any clinical concerns and opinions around deploying point of care diagnostics
- Assess the clinical risk of both introducing and not introducing point of care solutions
- Request and support business cases for the development and expansion of POCT
- Introduce initiatives to promote point of care testing as a discipline of pathology and biomedical science
- Review success stories of where point of care diagnostics has contributed to improved patient care, hospital flow, and medical outcomes
In achieving the above, the result is likely to be improved interest in point of care activities which will improve the understanding of the impact on healthcare delivery.
Achieving point of care maturity
Once POCT has been adopted into an organization, most aspire to improve their POCT provision or have been instructed by networks to standardize their service with other organizations in their region, or even nationally. Naturally, some organizations will be more mature than others.
As part of those aspirations, the following actions should be considered and effectively lead to the delivery of your set objectives:
- Produce a 3 to 5-year plan illustrating the strategy for implementing POCT
- Engage with stakeholders at the earliest opportunity so their needs are met
- Source evidence of best practice and benchmarking data to inform your plan
- Prioritize point of care adoption based on clinical risk, improvements in patient care, and organizational objectives
- Develop the service leads of the future who will champion point of care and deliver change with enthusiasm
- Encourage your point of care service leads to create a name and image for themselves and share successes to help build their identity and reputation
- Identify funding streams and have business cases ready to move quickly
One approach to consider is giving a regular update to the executive team on how current projects are progressing, requesting input or assistance from key individuals. In turn, they will become invested in the delivery of the project objectives and will more likely approve future projects when successes can be demonstrated.
The future of standardized POCT
Hospitals and networks need to standardize testing capabilities so that patients receive the same care wherever they need it. The role of networks in driving standardization is beginning to bear fruit although maturity is difficult to measure at this point in time.
Those organizations playing catch up within a network will be required to make significant gains in a short space of time. POCT specialists who’ve craved support may now receive it with interest.
Want to hear about point of care testing, then check out our previous article with Tony Cambridge to find out how point of care testing can aid sustainable healthcare.
Tony Cambridge, Lead Biomedical Scientist is the Managing Director of Thornhill Healthcare Events and Consultancy, and Lead Biomedical Scientist in the Pathology Management team of a busy acute care hospital in England. He frequently speaks at national and international healthcare events and is a key opinion leader for point of care testing. He recently cowrote the British Society of Haematology’s point of care testing guideline for general hematology and remains active across healthcare platforms offering advice and guidance. He is also a member of a global diagnostics company’s scientific advisory committee.
- F. Hoffmann-La Roche Ltd. (2022). cobas pulse system web page available from https://diagnostics.roche.com/global/en/products/instruments/cobas-pulse-system.html#advancedsafety [Accessed December 2022]