Conversations with Partners: There’s a lot we don’t know about lab medicine
Craig Ivany was working in health administration when a mentor directed his attention to lab medicine. He was soon working for the Canadian Red Cross where he leaned into lab services. Several jobs later, he’s now Chief Provincial Diagnostics Officer, Provincial Health Services Authority, British Columbia.
One of Craig’s personal missions is bringing awareness to the necessity of lab as an investment in the future of health service delivery. Whether it’s diagnosing cancer, screening for HPV, and everything in between – lab medicine tells us about an individual’s health status and creates the care pathways that have a strong influence on patient outcomes.
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I understand you’re working on your Ph.D. What a great idea and noble pursuit! Why now?
I’ve been thinking about for a while. I’ve been a part of the UBC Faculty in the Department of Pathology and Lab Medicine as an adjunct professor since 2020. Part of it is the fact that there is a lot of work going on in provincial lab medicine services that needs to be harvested and understood. I’d like to be involved in compiling that knowledge for the benefit of future lab leaders.
Another reason is the opportunity to set an example – there are some really dynamic younger individuals who I would like to see invest time in their academic side. And who knows, when I retire I might want to teach some classes.
You’ve built your career in many Canadian cities. How has that experience affected your understanding of lab medicine?
While there is a notion of what we call the Canadian healthcare system, how lab medicine is positioned and the policies around it make it very different jurisdiction by jurisdiction. When I think about working in lab medicine, understanding those local structures gives you the insight into how and what you’re able to accomplish.
I remember a sage old guy who ran a successful joint venture in lab medicine in Arizona once said to me, Craig, when you’ve seen one lab system, you’ve seen one lab system. That’s the truth of it.
So lab medicine is different everywhere you go?
The machines inside the lab may look the same, but lab operations are their own enterprise inside a health system. They have a different set of contextual issues and elements that are pretty much sight unseen by the rest of the health system. That makes it challenging for anyone outside of lab – policymakers and senior administrators – to appreciate the fullness and the impact of lab medicine.
The value of lab medicine was front and centre during COVID, but a lot of people still view it as a transactional enterprise, test by test by test. That’s driven a perception of lab being a commodity, like wheat or oil, and not understanding that underlying lab service delivery are seven or eight different lab value chains, all of which are complex and operate differently from one another. In reality, lab medicine touches most of the systems that influence health and healthcare.
How did you get into lab medicine? What was it that put you there?
I started my healthcare career 38 years ago, working in health services in a secondary acute care hospital in rural Newfoundland. Even though I was overseeing non-clinical services, one of my mentors was a pathologist. Dr. George Horner grounded me in the value of lab medicine, always reminding me where lab fit into what we’re doing.
Then a series of career moves took me progressively closer to lab medicine, starting with a role in the Canadian Red Cross, running blood services for Newfoundland and from there to a leadership role in operations with Canadian Blood Services. Core to the business is lab testing and I was exposed to a lot of emerging technologies to evaluate the quality of blood testing, looking for markers, etc. After a few years at Gamma Dynacare – now Dynacare Canada – I was recruited to be the CEO of Eastern Ontario Regional Labs. That changed my whole career trajectory.
Since then, I’ve stayed solidly in the world of lab medicine – in Alberta as the inaugural CEO for Alberta Public Labs, and now in BC for five years as Chief Provincial Diagnostics Officer.
You’ve talked about the impact of technology and automation in lab medicine. There are many positive elements to that. Are there risks as well?
Lab has a more rapid turnover of technology than perhaps any other sector of the health system. These advancements – the power of information systems and increased digital capacities – are now critical to the operation of lab. But the dynamic of change creates tremendous risk issues for patient safety and the need to understand the impact of preventable harm.
Healthcare Excellence Canada has identified delayed, missing or incorrect diagnosis as a category of safety incidents. Another area is incidents arising from transitions of care. We move specimens from secondary care labs to tertiary labs in order to provide a diagnosis – the movement of specimens can cause patient harm.
You have to wrap all of this high change, high-risk environment against a backdrop of trying to pursue patient safety and quality. That’s an area where lab could do more.
You came into PLMS at a pretty chaotic time – 2020 – and much has happened since then. Can you talk about things you’re proud of, developments that came to fruition maybe because of COVID.
Because of our experience through COVID, there’s a new appreciation for lab services in the province. We’re invited more readily to conversations.
One example of that – in January 2024, BC introduced self-collect HPV testing for cervical cancer screening. We shifted from the traditional PAP technology to something called an HPV test, which is a high-volume, high throughput testing engine. Lab played a key role enabling the transition from traditional methods where we no longer had staff to keep up with the volumes. They were seeing 60-65% eligible population participating; they wanted to push it to 85-90%.
The HPV and self-collect methodology created an environment where people can go through the process in the privacy of their own home if that’s how they wish to do it. It also addresses cultural issues and psychological harm that many Indigenous communities feel about the health system. It opened up whole new avenues to get people involved, including those who don’t have a family physician.
This push towards HPV primary and the self-collect model was done in partnership with the BC Cancer screening program – and that confidence in lab probably came out of our time with COVID.
That’s a great example of managing through BC’s health human resource challenges. Are there other ways you’re doing that?
One hundred per cent of cancer cases require a pathologist report and that space is challenged with human resource pressures. We’re already seeing that the growth in demand is going to outstrip the supply of pathologists.
Over the last couple of years, we’ve been working in partnership with all the labs in the province, engaging with the Ministry of Health executive leadership to build a business case for a province-wide digital pathology strategy. It would allow local pathology practices to do what they do but connect them on a provincial scale so that there is equity of access to sub-specialty work.
Technology will play a role and we’ll also infuse artificial intelligence to help with decision-making support and enable our pathologists to be as effective as possible. The strategy addresses the human resources challenge and gives Northern British Columbia access and equity of care in terms of diagnosing cancer.
Another part of your life is being part of the CMEPP board. What attracted you to working with CMEPP?
I had the good fortune of completing my ICD (Institute of Corporate Directors) designation as CEO of Eastern Ontario Regional Labs, and that investment helped my development when I sat on boards there and in Alberta. I had my first experience with CMEPP when I was with EORLA and was happy to step in when the opportunity arose to sit on the board.
CMEPP had traditionally flown under the radar but provides great value in these times of change and health human resource shortages. It was an opportunity to expand my experience as a board director, but also in an area where I felt I had something to contribute.
What have been your impressions as CMEPP has changed and grown?
First, I would say it’s the desire by the board in the years I’ve been involved to pursue best board practice. There’s been good discipline around putting effective board governance in place that is thoughtful and mindful. We’ve transitioned from a management board to a board of governance, plus the evolution and the investment in a great leadership team at CMEPP.
The organization has positioned itself well with new strategic directions that will build on its capabilities in a way that is invaluable to its Participants across Canada.
Craig, you’ve held leadership positions in so many places and different kinds of organizations. I just wonder what kind of advice you give to colleagues and anyone you mentor based on your extensive experience?
Healthcare is an industry that is designed and intended to help people. So, I think you lead with the notion that you’re here in service of patient care first and from that basis, bring your own expertise to the table.
Understand that you’re part of a broad and complex system that needs good people who want to make a difference in terms of patient care, whether they’re engineers or accountants or hematopathologists or lab technologists or nurses. You have to be open to as many different voices as possible in decision-making because there is no one path.
I urge people to get involved in health system leadership and see it through the lens of being a partner. Someone once said, just lead with a listening ear and I certainly agree with that! It can be a very rewarding career.
