It’s Not Our Founding Fathers’ Cath Lab

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 - Society for Cardiovascular Angiography and Intervention
Society for Cardiovascular Angiography and Interventions
Source: Society for Cardiovascular Angiography and Intervention

At the Society for Cardiovascular Angiography and Interventions’ (SCAI) Leadership Boot Camp, catheterization laboratory teams will learn skills they need to thrive while tackling high-pressure, high-stakes challenges.

A decade ago, cardiologists didn’t attend medical conferences to learn how to understand their cath lab’s budget. They didn’t fill session rooms to hear colleagues talk about conflict resolution or calculating the return on investment for new technology purchases. Typically, they also didn’t invite their nurse, technologist and administrator colleagues to attend scientific sessions with them.

Now interventional cardiologists are doing all of those things and more to improve the ability of their teams to navigate the complicated world of contemporary cath labs. The educational needs of cath lab personnel have diversified, as evidenced by standing-room-only attendance at Cath Lab Leadership Boot Camp, a program launched at the 2014 Scientific Sessions of SCAI. Based on attendance and feedback, the society is offering the program again, on May 8 at SCAI 2015 in San Diego. The core of the program and its goals—to support quality interventional cardiovascular care by enhancing the leadership skills of its practitioners—is much the same, but the program has evolved with some significant changes.

All together now

Last year’s boot camp was divided into two sessions, one primarily for cath lab nurse managers and the other for cath lab medical directors. Attendees later said the divide was unnecessary since working as heart teams has been embraced throughout the country. In 2015, the boot camp is a full-day session offered as a key component of the Quality Improvement Track of SCAI 2015. The program will run 10 a.m. through 5:30 p.m., with three topical segments relevant to all cath lab team members.

The sections are Leadership Issues and Challenges; Quality Initiatives; and The Cath Lab Service Line: Operations, Budgets, Logistics and Staffing. The mandate from the program’s steering committee to all of the faculty is to address the requirements ensuring high-quality appropriate care for patients while reducing cost and improving resource utilization. SCAI’s boot camp is intended to be intense, covering a lot of material while focusing on practical learning that attendees can take home. The sessions will be interactive; we want participants to share what has and hasn’t worked in their labs.

Tightrope walking & other skills

Just as today’s cath lab is worlds different from the labs of interventional cardiology’s founders, so too are many of the skills that support a successful cath lab. Several presentations at boot camp focus on striking a balance between leadership and teamwork, quality and cost, and medicine and economics.

As achieving balance can feel like walking a tightrope, the 2015 boot camp faculty will emphasize sharing tools. For example, a presentation on cath lab economics will address budgeting, finances and staffing. Clinicians will walk through a cath lab budget, looking not just at the lines that interest them as doctors or nurses but also the items that administrators worry over.

Looking at issues through the lenses of those in other roles is key to survival today, so boot camp will feature presentations on the roles and responsibilities of cath lab personnel, including where overlap is helpful and where it causes problems. When everyone knows what is and is not their job, the team functions more efficiently, avoiding duplicated efforts and communication breakdowns that can lead to tensions that could spill over to affect patients’ outcomes and satisfaction.

The cath lab’s metaphorical tightrope may be hardest to traverse with payments and high-cost technologies. Lisa Murphy, a co-author of this article, will outline how physicians and administrators can work together to solve an increasingly common dilemma: how to afford new, often expensive technology that isn’t tied directly to reimbursement. Where the physicians and administrators haven’t learned to work together, these scenarios can become adversarial. Boot camp faculty and attendees will discuss how the two sides can work together as partners, align goals and develop creative solutions.

Speaking the same language

This year SCAI changed its bylaws and established a new membership category that allows the society to welcome all cath lab personnel as members. Already we are seeing the transformative effect of collaboration across the organization but especially in our education and quality missions. One eye-opener was that many of us haven’t been speaking the same language despite our shared goal of delivering excellent outcomes for patients.

One goal of boot camp is to expand everyone’s lexicon so that clinical personnel are more comfortable with the vocabulary of hospital economics and administrators can decipher medical terminology. But the bigger objective is for members of the team to realize the pressures the others are under. Cath lab medical directors are responsible for all medical decisions and for being the patient’s advocate, while the administrator is responsible for the financial health of the service line.

Increasingly, they share responsibility for tracking and improving quality metrics that are being tied to public reporting and reimbursement. At boot camp, attendees will discuss how disconnects occur and how physicians and hospital managers can combine their strengths so the whole system works better. 

Partnering for patients

If the first interventionalists could see today’s cath labs, would they be amazed at how much we can do for our patients, or would they be shocked by how complicated our healthcare systems have become? We suspect they would be surprised that there’s a need for Cath Lab Leadership Boot Camp today but would agree that then, like now, the best way to survive—and the only way to thrive—is for teams to unite around shared, patient-centered goals and then to work together as partners to achieve them. 

To learn more about Cath Lab Leadership Boot Camp, go to

Dr.  Applegate is a professor of internal medicine-cardiology at Wake Forest Baptist Medical Center in Winston-Salem, N.C.  Dr. Mahmud is the chief of cardiovascular medicine, director of the Sulpizio Cardiovascular Center, director of interventional cardiology/cardiovascular cath labs and a professor of medicine at the University of California San Diego Health System. Ms. Murphy is the chief administrative officer of clinical programs at the University of California San Diego Health System, overseeing the cardiovascular, medicine and primary care clinical programs.