Digital Pathology Implementation: Addressing Impact on Culture, Teamwork, and Communication

Background: Digital pathology is slowly being adopted in laboratories around the world, yet discussions of barriers to digital implementation in pathology tend to focus on hardware and software choices, technical interfaces and compatibility, data management, and the adoption of new AI based decision support tools. The cost and quality of the digital transformation are cited as recognized as the major barriers in wide adoption. Another challenge in successful digital pathology implementation is the impact on work culture, prioritizing digital workflows in a high paced environment, the alignment of pathologists and laboratory staff on digital image availability turnaround time, and the need to define the requirements and expectations around communication and performance. This adoption of disruptive technologies preceding transformation of processes and employee interactions is not unique to digital pathology, and can result in costly failures, lack of workflow change, and flawed organizational practices.Methods: An assessment and identification of workflows and teams affected by the introduction of digital workflow was conducted at Memorial Sloan Kettering's (MSK) Department of Pathology and Laboratory Medicine, an early adopter of digital pathology. The study aimed to define the training needs of the different teams and the change management activities required for the digital pathology transformation through workflow observations and interviews of team members.Results: The digital transformation at MSK started years before the clinical implementation of digital pathology in 2020, and it is still ongoing. These activities included team identification, new departmental workflows development, training materials and townhall meetings, as well as small group training, digital adoption surveys and leadership/champion identification and development in the different teams. The activities are continuing well past the introduction of the new digital workflows into the histology laboratories and are aimed to allow seamless migration from analog to digital workflows while maintaining quality operations metrics and all stakeholder approval.As the current laboratory technologists training program in the US does not include digital pathology workflows, most histotechnologists are not familiar with the Digital Pathology Certificate NSH/DPA. In addition, most laboratory staff is not involved in discussions of digital pathology workflow adoption and will only get trained on the technologies once they get brought into the laboratory. Pathologists were given training sessions in a group setting as well as access to training materials. There were departmental wide town hall meetings that discussed the change in the workflows and gave updates on the timelines and the teams involved.Conclusions: The practice of laboratory medicine and pathology requires multiple teams to be physically present in the workplace to conduct tests and provide coordinated care with clinical teams. Transformations occurring without attention to the changes' impact on worker experience, and how our clinical colleagues experience us, may affect teamwork and morale. To prevent transactional relationships from replacing deeper relationships, full engagement of the pathology and laboratory community in the coming sea change will be necessary. Technology adoption across pathology departments should include clear communications, all stakeholders' identification and involvement, clear goals and policies, review of all existing analog and future digital workflows, and the setting of new roles and responsibilities. Other change management activities include administration support and leadership guidance before, during and after the digital pathology workflows implementation.

Learning Objectives

1. Understand impact of digital pathology implementation on teamwork, culture, and communication.
2. Describe change management activities developed for digital pathology implementation in a clinical setting.            
3. Recommend steps for departmental wide adoption of digital pathology.