It's time for laboratorians to start thinking like entepreneurs

Featuring insights and innovations from:
Stan Schofield
Managing Principal, Compass Group
Former President, NorDx

Eric Carbonneau
COO, TriCore

OPINION | December 2023

Clinical labs are at a crossroads as hospitals face a historic financial crisis and labor shortage.1, 2 The pressure on health system leadership to cut costs has never been greater. And every laboratory that is defined as a cost center may be at risk of being outsourced.

Yet, opportunities abound to redefine diagnostic labs as revenue drivers. Finding and acting on those opportunities, however, requires a mind shift. A new way of thinking about what it means to be a lab leader can make all the difference. Here’s how.

Two trends are merging that are putting labs at risk—and also creating new pathways toward growth:

1. Healthcare systems are saddled with structural challenges that are pressuring all service lines to deliver greater profits. Yet labs play a critical role in helping clinicians diagnose and treat disease. This is a moment to shine a light on the value of the diagnostic lab.

2. New care delivery models, such as home-based and point-of-care testing, are emerging and risk disrupting the lab’s traditional role in patient care. Yet, those models are also an opportunity for labs to connect directly with consumers and their communities with new services.

To transform risk to opportunity, lab directors must adapt a for-profit rather than not-for-profit mindset. Laboratorians must learn to think as much like MBAs as MDs and PhDs.

Take TriCore, New Mexico’s leader in clinical laboratory services, an organization that has expanded its services in multiple innovative directions. “We’re nonprofit, but we’re not operating at a loss,” says COO Eric Carbonneau. “We’ve taken the approach that many businesses do, and we’ve diversified revenue sources. We’ve had to change, we had to bring that business acumen.”

Thinking like business leaders opened new directions for TriCore to better serve both communities and clinicians—and establish new revenue sources. But it wasn’t a simple pivot.


Lab folk, says Carbonneau and other leaders in the field, tend to be inwardly focused on protocols, test accuracy, staffing, and the demanding day-to-day tasks of laboratory diagnostics. Coming up from the ranks, from technologist to administrative or medical director, many laboratorians are skilled at clinical lab science, not in building and promoting a business.

Compounding the problem is that laboratorians may be less comfortable interacting outside the lab than inside, says Stan Schofield, managing principal at the Compass Group and former president of NorDx, a regional laboratory corporation in Maine. Pitching a new service line or business concept to the C-suite or out in their community is fairly uncommon. “If nobody hears from you and you’re not visible, then you’re a commodity,” says Schofield.

Indeed, at the peak of the pandemic when many hospital labs became a primary revenue source for their health systems, too few lab directors went to the C-suite to claim their just reward: a seat at the table. A prime opportunity to shine a light on the value of labs as revenue drivers was lost. “It’s not in the personality of lab scientists, and that’s absolutely the biggest handicap, which is most lab people are introverts,” says Schofield.


Today, with their very existence threatened in a storm of cost-cutting, labs must prove their value as revenue sources. And many are already doing so by diversifying services to better serve consumers, whether those consumers are patients or not. It’s a major shift in lab strategy and one that begins with a shift in thinking.

To do that means developing qualities that haven’t traditionally been in demand in the lab space: risk tolerance, adaptability, and innovation. It also requires willingness to create and pitch a business plan to leadership, to promote their lab’s successes, and to commit to growth for a sustainable future.

A dramatic shift in thinking in the lab can have a dramatic impact on the future of your lab. Carbonneau wanted his labs to serve their communities. In one initiative, TriCore partnered with civic leaders to create a data map of areas that were underserved for COVID testing, and then sent mobile vans out to provide it. In another, TriCore surveyed the spread of STIs in the community. “When we declare an outbreak of a drug resistant pathogen, we’re the first ones to see it.”

And, with data-driven visibility into the health of communities, TriCore can do more than surveillance: they can deepen their understanding of consumer needs. “How do we engage patients directly, saying ‘How can TriCore be your lab?’ Then, whenever a doctor says they need a lab, a patient could say, ‘Hey, it’s really easy for me to order it from TriCore.’ Or, ‘I’m really concerned about my cholesterol. I don’t have to have a doctor, I can order it from TriCore.’”

“Laboratorians should be part of the community. That’s the laboratory of the future,” says Carbonneau.


This type of innovation requires business and staffing model innovation. And it requires time, and with many labs chronically understaffed, the question gets asked, “who is going to do it?” Strategies like automation and consolidation are gaining ground in labs, helping to reduce the strain on their existing workers. And forward-thinking labs are tackling the labor shortage by rethinking the way they recruit, train, and retain staff, as well as how they allocate tasks to free up more senior level laboratorians for innovating.


Making the leap from inward-facing to outward-focused took a fundamental shift in thinking for Carbonneau. “I had to get my eyes out of the microscope and actually be a businessman,” he says, attributing much of his entrepreneurial perspective to excellent mentors, coupled with his innate desire to create the changes that would help his lab better serve all people. “You have to take this on. But how do you do that? We’re not taught that.”

Yet mentors are out there, ready to help. To find one in your organization, look for leaders invested in making your health system consumer-friendly, either through digital health tools or other forward-thinking innovations. They may be eager to extend their thinking into your space. Young laboratorians can find mentorships through AACC’s Society for Young Clinical Laboratorians (SYCL). The American Society for Clinical Laboratory and the American Society for Clinical Pathology both also offer mentorship programs.


While training programs in the business of lab leadership are rare, professional groups are beginning to fill in the gaps, with continuing education programs and mentorships programs, including:

  • AACC’s Society for Young Clinical Laboratorians to help young laboratorians develop management skills and find mentorships.
  • The American Society for Clinical Pathology’s series of online and live leadership courses.
  • The College of American Pathologists’ leadership training through its AP3 Laboratory Medical Direction (LMD) program.

Looking beyond the lab space, however, opens wider choices for learning to think like an entrepreneur. Harvard Business School Online offer certificates in Entrepreneurship Essentials, Disruptive Strategy, and Power and Influence for Positive Impact, all valuable topics for making the shift to a new way of thinking.

Yet, in the end, course work can only take you so far. Without adopting a mind shift that sets your sights beyond the walls of the lab, it will be challenging to persist and create a sustainable future.

Polishing communications skills and deepening your understanding of business plans and strategy may not be what attracted you to pathology, but these are the skills that will lead your lab toward sustainable growth as healthcare recovers and the industry reshapes itself.

1. The current state of hospital finances: Fall 2022 update: AHA. American Hospital Association. September 15, 2022 https://aha.org/guidesreports/2022-09-15-current-state-hospital-finances-fall-2022-update. Accessed July 27, 2023.
2. Market insights: Evolving care models: AHA. American Hospital Association https://aha.org/center/emerging-issues/market-insights/evolving-care-models. Accessed July 27, 2023.

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This material is intended for a U.S. audience only.

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