BC’s Agency for Pathology and Laboratory Medicine

Cheryl McCullough, John Garratt, Brenda Heartwell, Jim Cupples, Blake Gilks, Wendy Johnson, Michael LeBoldus
VP Medical for BC’s Agency for Pathology and Laboratory Medicine
“As is your pathology, so is your medicine”. This is as true today as when penned by Sir William Osler, more than a century ago. Patients and clinicians in BC depend on the high quality laboratory service that has been developed and advanced over many decades by laboratory professionals.

On October 1st of 2015, the provincial government enacted Bill 7, the Laboratory Services Act (LSA). This is a very significant shift in the control of publicly funded laboratory services. The LSA replaces the Medicare Protection Act and the Hospital Insurance act as the authority for insuring laboratory services and consolidates the responsibilities for the governance, funding and service delivery oversight of all publicly funded laboratory services in BC. Through the LSA, the Minister of Health or his/her designate approves all labs and the professions who can order testing. He/she has the power to enter or exit agreements for lab testing. This includes the responsibility to develop testing guidelines with audit and sanction provisions.

BC’s Agency for Pathology and Laboratory Medicine (BCAPLM or Lab Agency) was formed, initially under the control of PHSA but then transferred to the new independent, BC Clinical Support Services Society (BCCSS) as of April 2016.

To accomplish these obligations, BC’s Agency for Pathology and Laboratory Medicine (BCAPLM or Lab Agency) was formed, initially under the control of PHSA but then transferred to the new independent, BC Clinical Support Services Society (BCCSS) as of April 2016. The BCAPLM is the first member of the clinical division of the BCCSS and reports through the BCCSS Board to the Ministry of Health. The Provincial Blood Coordinating Office (PBCO), a very successful, long standing organization is also part of the Lab Agency. The Lab Agency has been mandated by the Minister of Health to undertake and complete by November 2017, a strategic service delivery plan for lab services, including both inpatient and outpatient, throughout BC. This will address a quality framework, human resource planning, development of funding models and delineation of the informatics requirements. The Lab Agency is to set up the functional infrastructure to ensure that lab services are available and meet both the needs of individual patients and the BC population while at the same time providing best value. Best value must consider the requirement for innovation, academic needs, the development of intellectual infrastructure and human capital. A recent update to the mandate requires that the Lab Agency implement a governance and decision making structure to ensure genomic services are available, and meet the expectations of the people of BC, i.e. safe, affordable, equitable, accessible and effective.

A question that is commonly asked is how this is different than previous initiatives. Since 1980 there have been at least 18 government commissioned, consultant reports on laboratory services. A common theme was to achieve a savings target possibly at the expense of the overall functioning of the laboratory system and with only minimal physician influence. The 2012, Laboratory Reform Committee, a joint Ministry of Health and Doctors of BC committee did have a savings target but there was significant pathologist input and was one of the first that had a provincial scope. A number of the recommendations have been implemented including of note, the establishment of a provincial lab agency or are actively being explored.

Under the guidance of John Andruschak, the Executive Lead for the Lab Agency, there has been considerable progress from October 2015. Originally a respiratory therapist, John has a wealth of experience in laboratory operations, having been the Executive Director for Lower Mainland Labs. John, a gregarious soul has assembled an experienced team with great ideas including Gail Crawford, Mick Maguire and number of very well qualified and motivated staff located in the Agency offices at Broadway and Burrard. As a general pathologist, practicing for more than 26 years in Fraser Health, I became the VP Medical for the Lab agency in September 2016. Dr. Debbie Griswold is the Medical Lead for Quality and Dr. Ken Tan is the Medical lead for Analytics. Medical discipline committees have been formed to provide guidance in the strategic service delivery plan development and assistance to the Test Review and Utilization Management Committees.

As a physician I am excited to be involved in the evolution of the laboratory system and believe that it is a unique opportunity. My guiding philosophy is to try to do the best for patients and the system in a considered manner, acknowledging that we all have personal perspectives but this should not prevent us from doing what is best.