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PathCare

Leading innovation in pathology services

Written by Ellie Duncan & Produced by Francesca Birkenhead

The story behind the growth and development of South Africa’s public and private pathology market is an interesting one. Not only does it give an insight into the history of the industry, but it also reveals the significance of PathCare within the pathology sector. It all began back in 1922 with Dr. Patrick Mulligan who formed the first private pathology practice in Cape Town.
Leading innovation in pathology services
The story behind the growth and development of South Africa’s public and private pathology market is an interesting one. Not only does it give an insight into the history of the industry, but it also reveals the significance of PathCare within the pathology sector. It all began back in 1922 with Dr. Patrick Mulligan who formed the first private pathology practice in Cape Town. Following in his father’s footsteps, Dr. Terence Mulligan joined not long after the Second World War.

Mulligan and Partners, as it was known, became well-established in the South African medical sector. Dr. John Douglass, CEO of PathCare, takes up the story. “The major growth and development came when Bruce Dietrich was CEO. He joined in 1973. When he joined the practice, it was about the fifth largest laboratory just in Cape Town” he explains.

EMERGENCE OF PATHCARE
Dr. Dietrich was a recent pathology graduate from the University of Cape Town medical school when he began working for Dr. Mulligan’s practice.

His presence turned out to be a formative period for the pathology business. He was the brains behind some of the practice’s most significant operational innovations over several years, all of which contributed to the company’s growth in the Western Cape from the mid-70s onwards. He also prompted the one major development that was to transform the pathology market into what it is today - he took the initiative to amalgamate Mulligan and Partners with the other successful private pathology practices across the Western, Northern and Eastern Capes, the Free State, the North West Province, as well as areas of Gauteng and Namibia. Those separate businesses eventually came to operate under the PathCare banner.

“In the 80s, what he saw was that one needed to consolidate the laboratories, so he led the move to the amalgamation of the laboratories and that brought in the many laboratories in South Africa. I think he achieved almost all of that by 1995,” says Dr. Douglass.

It’s no exaggeration to say that this was a crucial time for the private and public pathology sector in the country. Dr. Dietrich also recognised the need to standardise the way in which those practices were operating so that they came together, functioning as a single entity.

Following the incorporation of the laboratories and the subsequent creation of PathCare, Dr. Dietrich took the opportunity to put the laboratories onto a “single IT backbone”, as Dr. Douglass refers to it, called Meditech. Leading the way in healthcare information system software solutions, Meditech was implemented to ensure operational management at all levels of the organisation – but more on its significance and ensuing development later.

FORMING PARTNERSHIPS
The formation of PathCare saw the business demonstrate a growing interest in establishing partnerships with other African countries. It was yet another move that was to prove vital to the country’s healthcare standards and PathCare’s own reputation.

“What we were doing before that was receiving samples that were referred from countries in Africa, including Malawi, Rwanda, etc,” Dr. Douglass says. “But then we took the stance of looking for partners in African countries.

“He also then brought on Namibia; brought the private practices in Namibia onto the same system and into the partnership. After that, we looked for growth in Africa and elsewhere.

“We started Pathcare Kenya over seven years ago now and that was by finding a partner; somebody that also thought in the same way we did, had the same idea of ensuring the highest quality that we could,” he adds. “We actually took a minor share; we wanted it to be a Kenyan laboratory.”

The idea behind these partnerships, yet again, is to put medical care first in those countries. With the partnership in Kenya showing strong signs of growth, PathCare has used the same model in Nigeria, which has seen even better results. In fact, Nigeria is growing much faster and has become an unstoppable force.

“Nigeria’s growing incredibly quickly. We are launching new laboratories and new sites to be able to provide a venesection service regularly,” he reveals. “We now have three labs and multiple venesection sites but we are looking towards getting 20 sites up and running in the next year or two.”

And the partnership scheme is unlikely to stop at African countries, according to Dr. Douglass. Although he is reluctant to divulge too much about potential partnership opportunities, he did explain that PathCare has made some interesting progress in this area. “We actually have been in negotiations with a number of other laboratories in other countries and we have two confidentiality agreements currently signed that we’re negotiating as well,” he says.

A slightly more unusual partnership was also formed with a laboratory in Ghana, called Medlab Ghana. PathCare has no shareholding in this laboratory but Dr. Douglass still deems the project successful and has worked very closely with the laboratory.

PathCare also had five year contracts at Independent Sector Treatment Centres (ISTC) in Plymouth and Barlborough, where it provided the laboratory services.

Dr. Douglass admits that PathCare was unaware of how difficult it would be to grow the services in the UK but it seems to be a lesson learned and one that the company will move on from once these contracts come to an end shortly.

Finally, PathCare has a presence in Dubai. “We’ve had a site for a long while where we work with the Emirates Airlines Clinic to do their overflow work or referral work for them,” he explains.

PATHOLOGY SERVICES
Having discovered the thinking behind PathCare, and looked at its relentless growth, perhaps the most important part of it all is the actual services the company provides. Human pathology testing forms the core of the business, Dr. Douglass states. The four main areas are chemical pathology, medical microbiology, anatomical pathology and haematology. “Human laboratory testing towards diagnostics is the main part of the business,” he maintains, although he also acknowledges the range of other services that PathCare can provide to individuals. “The technical analysis is just one part of it.”

Indeed, the company also specialises in veterinary work, clinical trials and occupational health testing. “What we try to do is give the patients and the doctors a service as convenient as possible,” explains Dr. Douglass. In fact, there is an emphasis on efficiency and convenience, which is why many of its laboratories, if not actually on hospital sites, are close by. “We collect blood specimens from the doctors’ rooms multiple times of day, or any time during the day or night, with an extensive network of drivers, couriers, and nurses that are available.

“Particularly in the hospitals, we have nurses who will do the venesection immediately when requested to and get those samples through to our laboratories and then the results back as fast as possible.”

A venesection is the drawing of blood from a vein; a simple procedure but one that has the potential to diagnose many ailments and diseases. Therefore, the test results are often required urgently in order to respond with treatment or further tests.

URGENT RESPONSE
“In hospitals with emergency units, we aim at less than one hour turnaround time. Its consultation service of over 60 pathologists is a vital part of the process too. “We will call with unusual, abnormal or seriously problematic results, or we will call if we can help with advice on the most appropriate medical management. We get called for advice on antibiotic usage, infection control, or the best diagnostic indicator, depending on results,” he says.

“We have 101 patient contact points in South Africa and Namibia; these are venesection sites (what we call a depot), plus laboratories,” he explains. “Of those 101, 63 are laboratories, which are situated either as close to, or in a hospital, or regionally. We have one central laboratory in Cape Town.”

There are also provisions for when results are required after hours; in which case, the nurse or phlebotomist would collect the patient specimen (e.g. blood), take it to the closest laboratory for analysis immediately. “We have 24 hour couriers who are trained to receive blood samples or medical samples, and then transport them to the closest lab,” says Dr. Douglass, explaining the back-up plan that is in place for every eventuality.

The supply of reliable equipment that meets PathCare’s medical standards is part of its commitment to quality assurance. It relies on procuring equipment from some of the world’s biggest names in medical supplies, including Beckman-Coulter, Roche, Abbott and Siemens. “The medical equipment is all international instrumentation, available through mostly multinationals, or otherwise through agents in South Africa who are selling instruments from multinationals,” explains Dr. Douglass. “Our major technical suppliers are Beckman Coulter. We try to standardise as far as possible so that the results are going to be as close to each other wherever you are in the country, or at any Pathcare laboratory.”

GUARANTEEING QUALITY
Of course, quality assurance and standardisation goes without saying in the medical industry, despite the fact that it hasn’t always been prevalent in South Africa. However, PathCare broke new ground back in 1999 when it started guaranteeing quality assurance based on an international standard by introducing the ISO accreditation. “The ISO accreditation is a laboratory specific accreditation, which is now becoming quite popular.” Having been implemented throughout PathCare’s laboratories, it now forms the basis of the business’ quality assurance and was a first for laboratories in East Africa and West Africa.

“There is a strong professional body of people who are also part of ensuring quality as well,” says Dr. Douglass of the trained pathologists, technologists, technicians and nurses who form the core of PathCare’s service provision.

In terms of firsts, the company has paved the way when it comes to training staff. It began offering a phlebotomy and venesection course which had not previously existed in South Africa.

“The head of the Academy, Mr Eric Spencer, was instrumental in getting the phlebotomy course recognised and registered with the health professions council and then introducing it through the academy for people we recruited.”

The academy facility is also utilised to train technicians through a two year course. For Dr. Douglass, it’s all about providing opportunities that were not always available in South Africa. His pride is obvious: “We certainly find it incredibly useful. We are able to meet employment equity targets for training of over 85 percent in South Africa. We were able to recruit people from previously disadvantaged backgrounds and we’ve taken them through this training and they are now achieving the best results in the country, consistently, year after year.”

At any one time, there are about 250 students being trained under the auspices of the academy, Dr. Douglass estimates. Those are generally phlebotomists, technicians and medical technology interns. Certainly, the academy and all its achievements have had nothing but a positive impact on both its students and PathCare itself. Dr. Douglass deems it an undoubted success.

MEDITECH AND PATHPROVIDER
Dr. Douglass has spoken about how vital the standardisation of PathCare’s processes is but key to the success of this has been Meditech. It really is the company’s “backbone”. Meditech is a U.S. proprietary-based laboratory interface system. However, being PathCare, it has taken this system and produced its own add-ons. PathProvider is the company’s own innovation that has been designed to serve its unique industry in South Africa. Dr. Douglass explains the significance of the development: “We wanted to be able to provide doctors with an electronic means of receiving the reports as quickly as possible and the way we did this was to create a program called PathProvider.”

With the system loaded onto their PCs, doctors can access and receive results much faster from PathCare via the network. All information is encrypted to ensure security, of course.

It is a system that can also organise patients by date, name and requisition number. Results get updated almost immediately after the tests have been conducted. In other words, it’s a system that has become invaluable to PathCare.

“Particularly useful for doctors who are in outlying areas because they will see a patient, we’ll collect the blood, we’ll do the testing and instead of waiting for paper copy to come back the next day, they will get that result that afternoon and can act by managing the patient much quicker,” adds Dr. Douglass.

So successful has PathProvider been that the system is now in use in hospitals. Again, security is of the utmost importance.

“We control the access through personal identification numbers, so we have passwords and security codes for each doctor and nurse who needs to use it. It is a quicker way of getting results back should someone want to get results immediately.”

Importantly, PathCare still provides a paper copy of the results for the patient’s folder. While the system has worked for the back end, PathCare is finding that PathRequester is having similarly effective results at the front end as part of its strategy to make the process as painless for the patients as possible.

“We want to make sure that the patients’ experience when they come to any of our depots is as positive as possible because we know that having blood taken and needles are a fear for everybody,” admits Dr. Douglass. “We don’t want to add to that experience by making it a long, unpleasant event. So we aim to try and make the experience for the patient as simple and efficient as possible.”

The system itself is easy to use and accessible for both patient and doctor. Dr. Douglass talks us through the process: “All we really need for a patient who’s been to us before is their identification number; if that person has been to us before, the previous data is in our system, it populates the data required immediately. We are able to use it and capture all the data perfectly accurately, as well as having the blood drawn, all within about five minutes without it being a rush.”

Those are big claims but the truth is, PathRequester has had a serious impact by reducing patient waiting times and increasing data accuracy, both of which have been cause for concern for PathCare in the past. “In South Africa, for private patients, the funding is through a medical insurance system, and when a patient arrives to have blood drawn or testing done, we have to submit the invoice to the medical scheme,” he adds. “If you don’t have the data exactly correct, the account won’t get paid, which causes frustration for the patient and is a cashflow issue from our point of view.”

Missing information and incorrect details can delay results and are major areas for concern in laboratories around the world. The difference is PathCare is doing something about it.

The company is currently rolling out the system to its depots and laboratories in the hope that this will improve the patient experience everywhere.

MEDICAL INNOVATION
Having already established that PathCare is at the forefront of medical innovation, it is unsurprising to learn that Dr. Douglass is keen to continue to pursue that strategy. “The private pathology market (and the public pathology market) in South Africa watch each other closely. There is a lot of competition and any time one group comes up with something innovative, the others are very quickly there as well,” he maintains.

The company looks to differentiate itself from the competition in its service offering and relationship with medical professionals. “We are maintaining a world class standard. In addition to providing excellent service at an excellent rate that can compare to anywhere in the world,” Dr. Douglass says. “We are continually available and looking for partners in Africa.”

He also reveals that while only at an “embryonic” stage, there have been talks within the company regarding the possibility of other markets. “Whether we’re going to look further afield or not is a point of discussion in the immediate future for our strategic intent,” Dr. Douglass admits. “But yes, we have considered looking at either partnering or entering the market in Europe or other parts of the world.”

Closing the interview, Dr. Douglass is keen to outline the ethos that has got PathCare this far. “We recognise ourselves as a medical practice and we recognise that we are first a medical practice to provide a medical service, and only second are we a private practice that has to make a profit,” he explains. “So our main drive is not to make a profit through medicine but primarily to provide the best laboratory service we can and to make a profit.”

Talking to Dr. Douglass provides a real insight into PathCare and the groundbreaking steps it has made in a bid to better the medical care that South Africans and Africans receive. With Dr. Douglass at the helm, it seems likely that this level of innovation, along with a commitment to quality assurance across PathCare, will continue.
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