The Dark Report's Robert Michel extrapolates industry trends.

When Robert Michel is not working his way around an industry trade show, he is likely on the road with his wife, Debbie, working his way around the globe. Why? Because Michel actively provides strategic advice to several laboratories and companies that are developing diagnostic technology. Because he hosts or collaborates on several interesting global gatherings of industry leaders. Because his Dark Report must bring his readers intelligence about the increasingly global marketplace and the players involved. His varied career includes management, banking, marketing, and sales, with stops along the way at Procter & Gamble, Financial Corporation of America, and Centex Corp.

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When he and his wife are not attending conferences, meetings, trade shows, and globe trotting, they spend most of their time at home on Lake Travis in Austin, TX. Michel is a "retired" rugby player who attends rugby matches when the opportunity presents, and sometimes brushes off what he calls his "modest" fiddle skills and puts those to use at bluegrass and swing music jams.

Unique "fish;" big lab-industry "pond"

Armed with a BA in economics from the University of California-Los Angeles, Michel was hired in 1991 by the Nichols Institute business unit to help with its strategic marketing; he worked there for four years. His background was not health science, but he observed that pathologists, PhDs, and MTs were first-rate with lab science but not equally sophisticated about how to operate their fairly complex lab organizations at the time of the managed-care revolution. It seemed to Michel they had relatively little training in strategic management and, at most, a spotty understanding of the market evolution.

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When Nichols Institute was acquired by MetPath (now Quest Diagnostics), Michel was inspired with a concept: "There might be an opportunity to help pathologists and other lab leaders in lab management gain more sophisticated knowledge to help them run their labs more efficiently and understand the marketplace in such a way that it would allow them to guide their labs to financial stability." That essential vision created The Dark Report (TDR) in the fall of 1995 and the first Executive War College (EWC) in Pittsburgh in May 1996. In the last 13 years, Michel has come a long way in formulating this and other venues where industry networking and learning are premier.

Growth of global conferences

Michel expanded his scope in February 2003 with the first "Frontiers in Laboratory Medicine" held at the Royal College of Physicians in London, England. An EWC 2002 guest speaker from the United Kingdom was impressed enough with the range of lab-management knowledge and information offered that he approached the U.K.'s Association of Clinical Biochemists to collaborate with Michel for a meeting designed around lab-management issues. Now, an annual event, "Frontiers" continues to grow in attendance and participation.

The U.K. meeting and the War College inspired a few individuals in Canada to launch a similar lab-management conference in 2005: the Executive Edge. And this year, for the first time, in conjunction with the Australasian Association of Clinical Biochemists, Michel holds his first Asian Pacific Rim conference this month in Sydney, Australia. Michel quips: "Now, one could say, the sun never sets on lab-management meetings."

These meetings have sprouted up in other countries, according to Michel, because management issues in labs are common, including declining reimbursement or funding, a technical labor force that is inadequate to perform all the work, and an ever-expanding menu of new tests and increased utilization. "Around the globe in developed countries exist common problems with universal solutions," he says. "Labs do not want to reinvent the wheel if answers to their problems have been resolved somewhere else."

New Lab Quality Confab

Another of Michel's brainchildren is the new Lab Quality Confab, just held in Atlanta in September. "Over the past 12 to 15 years, I have supported and encouraged clinical labs and pathology groups to understand and incorporate quality-management methods like Lean, Six Sigma, and similar approaches into their organizations," explains Michel. With the progress that a number of pioneering hospitals, labs, and pathology groups have made over the last five years in introducing these concepts, the timing was right, he claims, to convene the Lab Quality Confab, bringing first-mover and early-adopter labs together to share their experience. Seven countries--among them, Australia, Argentina, Brazil, Canada, the United Kingdom, and Sweden--were represented at this year's Confab. Almost 280 participants traveled from around the world to hear 50 presentations. "Their enthusiasm is spectacular." Michel says. "All people who are using these quality-management methods to improve their work environments find it energizing to hear about best practices and successes that labs and pathology groups are having."

At EWC, the Lab Quality Confab, and the other conferences, presenters are lab professionals who have used these principles and almost uniformly have found some level of success, if not impressive success, says Michel. "There is a lesson in the collective wisdom of 50 presentations when an improvement project is implemented and informed by these methods and techniques. The consistency of the outcomes will be almost universally positive, from a modest to a spectacular improvement. These techniques work very effectively in any lab of any size."

Advancing lab globalization

When the word "globalization" comes up, Michel has definite beliefs. "I have visited labs in many different countries around the globe and have witnessed the emergence of a network of lab-management meetings that collaborate with The Dark Group in Europe, North America, and, now, Australia. This has given me the rare opportunity to note the differences and similarities in how labs organize different information systems and types of tests they provide to their referring clinicians. It is easy to see a convergence of lab operations in developing countries."

One powerful force for this convergence is that labs are buying basically the same analyzers, instrument systems, and assays from the first-line in vitro diagnostic (IVD) manufacturers: they are using common product and technology platforms. "My belief," states Michel, "is that lab operations will encourage adoption of universal best practices to maximize quality of service, accuracy of test results generated, and changes in testing services offered."

From Michel's perspective of how labs are organized and how they operate from day to day, the "next big thing." in his opinion, is clearly the widespread acceptance and use of quality-management methods: Lean, Six Sigma, ISO 15189, and so forth. His prediction is that this acceptance and adoption will continue to broaden over the next five years and can be expected every hospital, health system, lab, and pathology practice will find itself using these methods in order to consistently deliver a higher quality of service and improve clinical outcomes while reducing or eliminating errors that affect patients.

As to acquisitions and consolidations, outside the United States there are only a handful of global lab corporations: one of those is Sonic Healthcare Ltd. of Australia, which now owns and operates labs in Australia, Europe, and the United States. There is some lab-consolidation activity in Europe, says Michel, but it is yet uncertain as to whether global lab companies will join forces in the same way global IVD companies are combining.

Predicting trends

One function of The Dark Report and the EWC, says Michel, has been to make informed predictions about how different aspects of the lab marketplace will unfold: "We are proud of our published track record of accurate predictions since 1995.

"In business," Michel muses, "each of us has a particular skill. I have always had a knack for analysis and for dissecting events to understand their cause and development. I get a general, accurate picture of how a trend may unfold, as a consequence." He acquires information by visiting labs and perhaps lab-industry vendors in as many different cities and environments as possible. Another source of information he uses is the EWC and similar gatherings to access many lab leaders in one location and hear them discuss the issues, concerns, and successes that they have had.

"Have I ever been wrong? One cannot make predictions without the future making one look foolish," he says. In December 1998, TDR predicted that within 24 months most physician offices would be using Web-browser-based test ordering and reporting. "That actually took five to six years to occur--three times longer than what I predicted," he confesses.

The holistic proposition

Michel has a genuine curiosity as to how different laboratories have come up with ideas and solutions that, in one dimension, solve problems and, in another, actually make the lab more valuable to the clinicians and healthcare community it serves. "I track down folks I am interested in speaking to," he says, "in order to understand why the successes discussed in the lab profession have happened within different innovative labs and pathology groups." In assembling his various meetings, there is a deliberate process to provide a range of topics and speakers who meet the needs of the various audiences. "This combination," he explains, "gives ideas, evidence, and pure experience to listeners who then go back with confidence that they can achieve similar success."