Another call for a comprehensive transformation of #Pathology and #Laboratorymedicine came last week from Scotland. Bill Bartlett and colleagues from the Scottish National Laboratory Programme (NLP) argued in the Bulletin of the Royal College of Pathologists for a whole system approach to #pathology and #laboratorymedicine. It is another plea to break away from penny-wise, pound-foolish, 5% out of 5%, inward-looking cost-improvement ‘samsara’, which can only propagate depletion of capacity, capabilities, and attractiveness, and shift the paradigm by delivering a new, system-wide value proposition. In conjunction with the seismic effects of #COVID19 #pandemic on the industry, healthcare, and whole economy, this wake-up call needs due consideration. I’ve had a privilege to meet the colleagues from NLP at the meeting in Glasgow last year, and learn about their challenges, not the least providing modern and equitable service for the 30% of the population spread across vast geography outside the Scottland’s Central Belt. They endorsed a Distributed Service Model (DSM) based on the Whole System Value Paradigm (WSVP). The WSVP is deeply rooted in W. Edwards Deming’s system theory of profound knowledge. Deming himself advocated the necessity of sound theoretical foundations for change, something that is often discounted by the contemporary Deming-quoting service-improvement brigades. The authors of the paper deeply understand the problem and are striving to develop a theoretical framework to address core problems such as optimal use, quality, choice, responsiveness, equitability, and costs in such a way that it drives clinical and financial value for the whole system they serve. The Intelligent Liver Function Test (iLFT) initiative, prototyped by NLP team from Tayside is an excellent example of the approach. Typical for any crisis is that it provides us with a ‘magic mirror’ that exposes the weakness of our ecosystem. The reactive nature of our current transactional pathology models, which I previously labeled as Pathology 1.0 and Pathology 2.0, have reached the limits of their adaptive potential. At the moment, it is challenging to see effective strategic steer coming top-down; as implied by the article at NHS Providers site so far, the approach seems to be all tactics, but not much strategy. At one level, it creates a strategic opportunity for progressive laboratory services to set on the journey and provide local leadership for the integration of health and care. Some examples of innovative solutions are coming out from the foothills of the pandemic; drive through blood testing may be one of the pieces in a jigsaw puzzle that will transform the way how laboratory services can add value to the transformation of the primary care or outpatient pathways. The bottom line is, as Khosrow Shotorbani from the USA-based Clinical Lab 2.0 movement, colleagues from NLP and I have been pointing out, pathology and laboratory medicine are at the strategic inflection point, with, essentially, a binary choice. The sobering forecast of the looming liquidy crisis of the clinical laboratory services on the other side of the Atlantic will have its parallels everywhere. Strategically-savvy and successful pathology service will be those with the courage and skills to master the art of the strategic pivot. They will leverage their differentiating competencies towards becoming a system-wide provider of solutions that can meet the needs and add value to their users, rather than deceiving themselves that their historical core competencies or position at the marked, possibly propped up by system subsidies will suffice. A strategic pivot is all about turning toward the opportunities that the service can be uniquely positioned to address. Although this approach is ‘bread and butter’ for startups and agile, small-size enterprises, there are many examples where it worked for large corporations; it is the matter of the mindset, not the size.