Lancet Laboratories is already one of the leading pathology services operating throughout Africa. Moving into Nigeria will be a step change for the 60-year old partnership.
Because they are a support activity, active behind the scenes of primary and secondary healthcare, diagnostics tend to go unnoticed. From the patient’s point of view, any medical procedure is seen in terms of the outcome and how smoothly it is reached. To get there, doctors need to orchestrate a whole range of specialist services and one of the most important of these, whether in an acute or chronic case, is pathology. From diagnosis, through treatment, to long term post-treatment monitoring, the laboratories that analyse the samples sent to them by physicians are the backbone of the system.
The patients have no contact with these labs and even the doctors rarely visit them, so it comes as a surprise to find the extent and depth of this activity. Lancet Laboratories is one of the largest providers of diagnostic services in South Africa after the National Health Laboratory Service (NHLS). Lancet is not in competition with NHLS though, as marketing director Peter de Wet explains. “We deal principally with private clients, though on occasion we do work for the NHLS when they have a backlog of cases or if a machine were to go down, for example.”
Lancet started as one of the first private pathology laboratories in South Africa almost 60 years ago in the heart of Johannesburg. In 1996 the main laboratory moved out of the central business district to Richmond, strategically placed to service the whole of the Gauteng region. Today it is the hub of Lancet’s 250-strong network of laboratories large and small: some standalone facilities, others located in hospitals. “The Richmond lab is a three storey buildingof 4,500 square metres, and to support a 24-hour service we have a total of 200 technologists working there,” says de Wet.
The partnership has grown continuously since it was founded. An early goal was to provide coverage throughout South Africa, and strategic acquisitions were made to achieve this. A merger with Pillay MacIntosh and Partners extended coverage to KwaZulu Natal in 2000 and subsequently Lancet merged with the Dyson and Niehaus laboratories in Pretoria and the Independent Pathology Services in Alberton, Johannesburg. Lancet now has an effective presence in five of South Africa’s nine provinces; however, organic growth has been just as important, and more recently the group has extended its operations into other African countries.
The group structure is the same as a legal partnership. Shares are held by 23 partners, the board of directors and the chairman. There is healthy competition from the two other significant players in South Africa as well as numerous local laboratories; the provider that can deliver the best service is the one the physicians will choose. “We focus on improving our efficiency and effectiveness and providing our doctors with a good turnaround time,” says de Wet. “They expect a good quality, accredited result as quickly as possible. We are constantly looking at how we can upgrade our processes internally.”
The business depends on the reliable collection of samples, transporting them to the laboratory and returning the printed report promptly, so Lancet’s 450 couriers are a key part of the operation, he continues. “In South Africa the courier handles two types of specimens: the routine work and the urgent.” The bulk of samples are taken by couriers on a regular ‘bus route’ that calls on the clinics at set times each day. In the cities this can be as often as four times a day.
In a crisis—say where a heart attack is suspected—the doctor may have sent the patient to the hospital but needs cardiac enzyme analyses performed as a matter of urgency. In such a case, a special courier would be dispatched. “We are in the process of setting up a call centre for urgent work that comes in from outside the hospital. When the doctor practice calls in, the operator liaises with Logistics and they dispatch a courier to collect the sample there and then, rather than waiting for the scheduled collection.”
The entire system is replicated in the other countries that Lancet operates in but with the benefit of local expertise. “When we go into another country we generally tend to look for a local partner with an established business who is looking for growth in their practice. We send them a team to establish the infrastructure in terms of IT, communications, and all the compliance checking that needs to be done and to up-skill the local staff. Eighty per cent of the tests ordered in Swaziland, Botswana, Zimbabwe, Zambia, Mozambique, Ghana, Uganda or Kenya are performed in the local laboratories. Some are already SANAS [the South African National Accreditation System] accredited to an international ISO standard so the result you get in Nairobi or Accra is going to be of similar quality to what you’d get out of Richmond in South Africa.”
Some highly specialised tests do have to be sent back to South Africa, and that too happens seamlessly, he says. “It is a fundamental part of our infrastructure to make sure we have a good IT feed into every country we work in. All the pathologists are linked electronically so if a doctor in Nigeria, Ghana or Uganda wants to consult with one of ours, that pathologist can view the results in-country, online, using our intranet.”
Every year a team of external auditors comes in and audits each lab, which is a rigorous process, says de Wet. “To audit a relatively small lab will take two or three auditors a whole day. When you audit our main Richmond laboratory they can send in up to 18 or 20 auditors, and they can be there for two days!”
Lancet is now in the process of setting up in Nigeria and aiming to go live with its service in early 2012. Just one more country, but a huge step, since Nigeria has three times the population of South Africa. This will certainly help achieve its modest goal of maintaining ten per cent annual growth over the coming years.
Another major contributor will be Lancet’s commitment to cutting-edge equipment. In March 2010, Lancet opened its P3 TB lab—a facility which de Wet says is a major technological achievement. “We are talking about a state-of-the-art TB diagnostics centre which not only enables us to diagnose TB within 24 hours as compared to the weeks it used to take but also gives our people a clean and sterile environment to work in,” he concludes.
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