Clinical laboratories are an integral part of the overall care delivery system and 60% of medical decisions are based on results produced by clinical laboratories. A leaner and more efficient laboratory leaves room for growth by removing excess waste and improving processes related to specialized testing services. A high growth market, the government in Vietnam launched the 2020 vision to modernise health infrastructure in the country. However, Vietnamese laboratories face challenges in establishing laboratory practice and high-quality standards which means that the lab practices, quality standards and patient safety can be further improved to bring it at par with other countries in Asia Pacific. To enhance clinical laboratory practice in Vietnam, Roche Diagnostics together with leading industry associations, government-linked bodies developed an educational Lean Six Sigma program designed to improve and ensure laboratory quality standards through a lab quality improvement workshop to specifically address the needs and challenges of these labs in Vietnam. In an exclusive interview with BioSpectrum Asia Magazine, Ms Jozica Habijanic, Country Manager at Roche Diagnostics Philippines, talked about the impact of the program, trends in the medical diagnostics industry, and future plans of the company. Ms Jozica supported the LEAN Clinical Laboratory Practice Programme in Vietnam in her former role as Head of Strategic Development at Roche Diagnostics Asia Pacific.

Excerpts from the interview

Q. In the context of emerging markets in APAC, what are some of the opportunities and challenges that we see in clinical laboratories practices?

Ms Jozica: The rapidly evolving healthcare landscape calls into play new ways of working that can effectively address existing challenges: the rising burden of chronic diseases, fast-ageing populations and the growing burden on already struggling healthcare resources.

We know delayed diagnosis can result in higher upstream costs of treatment, poorer outcomes for patients, putting tremendous burden on healthcare systems. Yet, diagnostics remains greatly undervalued and under-utilized. It represents just 2% to 3% of all healthcare spending but influences 60% to 70% of medical decision making. 

So, there is a significant need to move healthcare from the volume-based care that we currently have, to care that is centered around the value it brings – to patients, doctors and healthcare systems. In this context, diagnostics has a critical role to play.

By giving diagnostics its rightful place across the entire healthcare continuum from screening, diagnosis, prognosis to patient stratification and treatment monitoring, we can help to improve clinical practice, enhance quality of care and ultimately patient outcomes. And, we are gradually seeing this happen. The in vitro diagnostics (IVD) market in Asia Pacific is expected to reach $19.64 billion in 2021 growing at a CAGR of 6.3%.

But it’s not to say there aren’t challenges. Doctors rely on diagnostic tests to make the right clinical decisions for their patients. Which is why improving quality standards of clinical laboratory practice is undeniably critical to clinical practice and patient treatment.

Furthermore, healthcare infrastructure is not homogenous across emerging markets in Asia Pacific. There are some areas, such as larger metros, which are relatively more advanced while the distant interiors or rural areas may not have the adequate capabilities. But we are starting to see this change, slowly and steadily. More governments in the region are working to enhance healthcare delivery.

For example, the Vietnamese government has developed a comprehensive roadmap to 2020, which aims to upgrade and modernise the healthcare system. As a result, laboratories will play an even more important role.

Q. Please elaborate on Roche Diagnostics’s LEAN programme in Vietnam, and its partnerships with business associations & government bodies there?

Ms Jozica: The LEAN Clinical Laboratory Practice Programme in Vietnam is a multi-stakeholder and multi-pronged approach that aims to raise lab quality standards and create lasting improvements by establishing good laboratory practices.

This is a first of its kind public-private partnership that brings together local and regional associations to spearhead laboratory excellence in Vietnam. Roche Diagnostics has partnered the Asian and Pacific Federation of Clinical Biochemistry (APFCB), the Vietnam Association of Chemical Biochemists (VACB), the University Medical Center (UMC), and the Hanoi Medical University (QCC) for this initiative.  

The LEAN Clinical Laboratory Practice Programme is split into two core areas, and is based on the participants’ skills sets and level of experience:

1. LEAN Facilitator Workshops – Created specifically for senior laboratory staff, the train-the-trainer workshop uses real-life scenarios to illustrate certain methodology and principles of LEAN thinking. This allows participants to better understand the concepts and they can apply it to their daily operational practice within the laboratory. The train-the-trainer model ensures the sustainability of the programme as it develops local talent and builds local capability. It helps participants build their skills as trainers and gives them the confidence to conduct a two-day LEAN workshop independently. Since the launch, 31 trainers from 13 institutions in Vietnam have completed the train-the-trainer workshop. 
2. Education and knowledge building workshops – Targeted at a wider range of participants, from laboratory managers, section heads to junior staff, participants are given practical cases and examples on the different sections within the laboratory. Participants are encouraged to review the different processes from start to end and identify possible solutions. Currently, 210 laboratory staffs have been trained under the programme.
3. Practical application of LEAN methodology and learnings: As phase two of this programme, we will work towards the implementation of LEAN methodology within selected labs. The aim is to apply LEAN in practice within the laboratory environment, improving workflow and processes with the aim to improve clinical laboratory practices by optimising turn-around time (TAT) and reducing the sample rejection rate.

Q. Are there plans for Roche to expand the LEAN programme to other markets? Why those markets specifically? 

Ms Jozica: At the moment, our focus is on continuing this programme in Vietnam, and there were several factors that led to the launch of this pilot programme in Vietnam. The strong in-country expertise, robust educational network and keen interest from local stakeholders were major factors. Our partners – the Vietnam Association of Chemical Biochemists (VACB), the University Medical Center (UMC) and the Hanoi Medical University (QCC) – supported this initiative tremendously, right from programme development to execution. 

Q. What role does Roche see for itself in working with government bodies and associations to shape good clinical laboratories practices? What does Roche aim to achieve?

Ms Jozica: We are committed to delivering innovative diagnostic solutions that can improve the lives of people. This includes supporting capacity and capability building efforts. One area that we identified within the context of Asia Pacific, was the need to enhance laboratory quality standards.

Together with like-minded partners, we have embarked on this mission of uplifting the overall quality of healthcare delivery.

Laboratories play a crucial role in this regard. Lab test results help physicians make decisions so good laboratory practices are essential to maintaining high quality standards within the healthcare system. The outcome is quick and accurate results that allow physicians to make decisions confidently so that patients can get the right treatment, faster.

Q. How can doctors, service providers, government bodies, industry associations or other interested stakeholders help to ensure better clinical laboratory practices and standards are implemented across APAC?

Ms Jozica: The responsibility to deliver quality care lies with all stakeholders within the healthcare system. The same holds true in the case of improving laboratory quality standards.

Public-private partnerships create an environment that encourages the sharing of knowledge and best practices, with everyone working towards a common goal. With the LEAN Clinical Laboratory Practice Programme, we are tapping the collective experience, expertise and network of a diverse group to improve operational efficiency, and ultimately, deliver good quality healthcare to patients in Vietnam.

Q. Is the medical diagnostics industry expected to evolve more through inorganic (partnerships, acquisitions or franchise based) or organic growth? What role does Roche see itself playing in that, in the short to medium term?

Ms Jozica: The laboratory environment is undergoing rapid transformation and we will see the industry continue to evolve, driven primarily by two factors: One, through the modernisation of laboratory infrastructure and upgrading of skills which is brought on by the advent and adoption of newer technologies as well as the growing shift towards data driven diagnostics. Digital diagnostics platforms that can support evidence-driven clinical decision making, will become increasingly important.  Two, growth led by the expansion and consolidation of lab chains will bring higher standards and practices, and introduce more modern technologies into the country.

Our focus at Roche Diagnostics has been to deliver diagnostic solutions that can improve medical decisions and support better patient outcomes. This includes bringing the latest innovative technologies to the market in the form of state-of-the-art analytical systems, pre/post-analytical automation and digital pathology. For instance, our NAVIFY Tumor Board solution is a new, cloud-based software solution that fundamentally changes the way oncology care teams prepare for, conduct and document clinical treatment decisions for cancer patients.

As countries continue enhancing their healthcare models, the role of laboratories will be central to the delivery of high quality healthcare. This is why, we also provide various consulting services that cater to the needs of the laboratories whether to increase efficiency, effectively utilise resources or to consolidate different clinical disciplines while at the same time ensuring proper integration between them.

And as with the LEAN initiative in Vietnam, we support efforts in collaboration with customers and industry associations that enhance existing healthcare capabilities or through education efforts that enable the sharing of knowledge and best practices.