The Hidden Engine of Value: Repositioning Laboratory Medicine as a Catalyst for High-Performance Organizations and Laboratories

Abstract Laboratory medicine has long been described as the “Cinderella” of healthcare systems: indispensable to diagnosis and care delivery, yet persistently undervalued in strategic, financial, and governance decisions. Despite informing most clinical decisions and underpinning care pathways, laboratories are still frequently treated as cost centers rather than drivers of system-wide value. This chapter brings together perspectives written by partners of the UNIVANTS of Healthcare Excellence program, offering a practice-informed reflection on how laboratory medicine can evolve from a hidden function into a catalyst for high-performing, value-based health systems. Drawing on health economics, patient-centered care, and real-world implementation experience, this chapter explores how laboratories generate value beyond the analytical phase of testing and drive organizational transformation. Established frameworks—such as value propositions, translational health economics, linked-evidence approaches, and patient-centered evaluation metrics—show how diagnostic services shape downstream clinical decisions, patient outcomes, and resource allocation across care pathways. These frameworks are interpreted through the lived experience of healthcare leaders and innovators engaged in system transformation. This chapter also reflects on lessons from the COVID-19 pandemic, which made laboratories visible as strategic assets capable of rapid scaling, innovation, and support to public and population health, while exposing structural weaknesses, including fragmented governance, siloed funding models, and underinvestment in digital infrastructure. Laboratories can enable multidisciplinary collaboration, pathway redesign, and data-driven decision-making, generating measurable improvements in outcomes, efficiency, and equity. Collectively, these perspectives reinforce a clear message: repositioning laboratory medicine at the center of health system strategy is essential to unlock sustainable, value-based transformation.