10 years ago mom started calling me Job (the Biblical Character) not because I had monumentus faith, but because my personal life was a series of unfortunate events.…..it seemed for a period of time that if an unfortunate event could occur that I was magnetically attracted to it. I started waiting for the next bad thing to happen. Professionally, it was different...I was beyond good – driven, killer instinct, aggressive, admittedly immature but always driving forward. Then one day my professional life hit a road bump…..
We picked up a product that – on the surface was amazing – it zipped, it zinged, it could walk on water….I sold 4 enterprise level platforms with that promise…..then during the first install….it sank like the titanic without a life boat. I thought – WAIT a sec – my professional life is amazing…I am a 25 year old power house and this is not supposed to happen….but it did. I began to see my Job life seeping into my wonderful career.
I experienced true grace by a senior leadership team at that hospital. Even though we offered to replace the software with another for free – they determined it was best to identify how to make it work in an alternate workflow. (My first impromptu design job) That grace is a post for a different day about partnership with Vendors...
Following that experience, as a very humbled professional, I went to each of the remaining CIO’s to let them know what had happened, and that we no longer going to be working with the product. It was hard for a 25 year old to say good bye to over 50% of the years revenue based on a poor choice – it was harder to sit in front of those people who had put their trust in me and admit my failure. Each meeting went different – one was angry and gave me a solid chewing….like any professional I took it then went to my car and cried all the way home. The next told me he was disappointed in me but determined that the product was solid and wanted to proceed directly with the manufacture – he shook my hand, told me he appreciated my honesty, and said my Dad had done a good job raising me. (He had worked with my dad for years) That made me cry in his office.
The final CIO shocked me. As I sat in her office reviewing the challenges and reasoning for my need to step away from the recommended product – she stopped me and said “Kourtney, can you just tell us how this whole things should be set up and what to do in this alarm area?” I shrugged, started to lower my gaze to the floor and said “Well, I….” She interrupted sternly and said “I will pay you for your time.” What? She will pay me for my time, but I am the idiot who brought her a product that didn’t work. Confused I blurted out “You mean like workflow documentation?” “Yes, can you do that or not?” To which I responded “Absolutely” and my journey began.
One of my greatest professional failures became the launching point for one of my greatest successes – Sphere3 and a consulting career I loved - which eventually lead to Aperum.
That was my "Joseph Moment" - the moment I realized I was not destined for a disaster at every turn that lead to nothing. If you don’t know the story of Joseph (from the Old Testament), it’s worth the read. But here is the Cliff Notes – Joseph was going to be killed by his brothers but then they decided to sell him into slavery….he had a series of unfortunate events…and then another series of unfortunate events....that eventually lead him to a position of power that allowed him to save his family…..if he would not have been sold into slavery by his brothers then the entire family would have died.
Are you so busy waiting for your next failure or lamenting over your current disaster that you are missing the moment of your next great success? Do you see each “bad thing” that happens as pointless or is it possibly a progression to the Joseph moment you were meant to have.
Time to change your perspective - time to change your focus.
I stopped to visit a friend in the hospital and had a chance
to observe some clinical workflow in person.The Nurse walked in.She had a
large brick of a phone wrapped in a plastic case pulling the side of her scrubs
uncomfortably down.She began asking
questions as she prepared the medications. She reached into her pocket and pulled out an
Iphone……confusing…..then I realized it was her medication scanner.
As she was preparing to hand the medications to my friend
the brick rang…..loud….very loud…. She apologized as she reached down and
complained that the previous shift must have had the ringer turned up. (I was
there at 8am in the morning so evidently night shift likes to carry a mobile
alarm clock) She silenced it and went back to medication work. I asked “Do you like your phone” – she held up
her iphone and said “This isn’t used as a phone it’s just for meds and stuff.”
I laughed and smiled “No the brick wrapped in bubble wrap hooked to your
scrubs.”She laughed and said “No
Comment” as she finished putting the medication in the cup and talking to Holly
she looked at me and said “That thing interrupts me when I am trying to work
with a patient and it’s just rude to the patient. I don’t think it’s very
practical…..I like to be fully engaged when I am with a patient”
Ouch…every technologist who has designed a decentralized
workflow should wince when they hear that – this nurse is a young lady who grew
up with a cell phone in her hand wanted to be what? “fully engaged with her
patient”She wanted to walk into a
patient’s room and only think about what she needs to do in that moment.She wanted to focus on getting my friends
medications accurate, make sure she didn’t miss any aspect that could be a
warning sign…..crazy thing….she wanted to be a nurse.
As I worked on this post – I started writing about ideas for
fixing….pointing out that holding on to old technology only hurts your facility….listening
to nursing because they actually do the work….blah blah blah…..but then I
started think this isn’t just a hospital thing.
I was sitting in my family room – Noah (aka #4) on my lap
talking about his day and my phone rang…..in that moment I stopped engaging
with Noah and answered my phone…I tried to justify in my mind that I had tried
to get ahold of this person all day and needed the information….as I hung up
Noah said “Mom, can you just talk to me for a minute”….ouch…. As I began
writing this blog for “Linkedin Content” to promote my industry knowledge…..I
am pausing for a moment.
Our workflow design reflects our society design….the nurses
response is reflecting the shift in our society to tolerate interruptions. She recognizes that everyone would like a bit
of undivided attention, especially when they are in a new environment.She recognizes that the technology she had
been given was not serving her well and was making her less effective in her
job.She recognizes that – just like
Noah – her focus on my friend in that moment should be the most important part
of her day.
So this post should serve two purposes – rethink how you are
designing your clinical workflow and alarm design.Clinicians are fatigued because their
attention is constantly being split.Clinicians are fatigued because we, as technologist, aren’t doing our jobs.
The second purpose – does your personal life reflect an
interrupt driven society? When will that become not ok for you?
Last night…..I left my phablet in the kitchen….turned the
ringer off….and enjoyed my family and some friends.It was probably the best night I have had in
months…..today…..the ringer is still turned off.
I had to make a change….it was hard…my needs weren’t being
met…..after lots of consideration….I got a new phone. It all started when my husband made a change
I couldn’t believe… he bought a Samsung Galaxy (aka the phablet – phone/tablet).I teased him a lot…why would anyone want anything other than the iphone.
My love of these little Apple Devices started about 4 years
ago…..The first time I saw our software, Aperum, on an iPad I was hooked –
mobilizing our software allowed it to be utilized at the point of care.The ipad is so simple to use – it’s cute –
it’s trendy – dare I say sexy. In the past 4 years, I have purchased dozens of
“i” products. (Especially after I met
the REQUIRED otterbox – nothing breaks like an iphone.)As we have grown, we have made lots of trips
to the AT&T store to buy new iPads for our people.On one such trip, Kristal (our VP) and I were
waiting on the salesman to retrieve our next iPad when she asked about the
Samsung that David just purchased.I
teased – I joked – but by the time our sales guy got back with the tablet we
were logged into Aperum and playing with it on the Samsung.Then….it happened….he began to run us thru
features…I drooled…. These were things we only dreamed about on the Apple.
Here is what I love and why I eventually bought a Phablet….
1)The built in Stylus….I admit I thought this is
really useless and will never be used.I use it all the time – it automatically unlocks the device when removed
from its safe little corner home.It
makes selecting and typing a breeze.
2)Typing….using the slide function where instead
of typing you slide the stylus across a series of letters. Frankly, it looks like magic that it knows
what word to select. It’s super simple
3)Writing…there is a function on the tablet where
you can write with the stylus.I will
admit the first few times it wrote some words…. maybe it was just me getting
used to it but it seemed to learn my handwriting the more I used it.It became more accurate as time went on. Which
was good because I had a really embarrassing demo when it translated what I
wrote into a swear word…
4)Voice Recording…yes…it works…it’s cool. Again,
use it a few times before you demonstrate it….
Here is what I find troubling…..we talk to dozens of
hospitals a month and it is a rare event that the clinical staff is enabled
with a tablet or even a smart phone.I
am not even just talking about floor nurses – I am talking clinical
When we show our software and how easy it is to use at the
bedside… we have nurse managers asking their CNO if they can bring in their own
tablet to use.Why?It’s not only because they see the value of
automation in their leadership rounding process using Aperum.Frankly, they see the value of smart devices –
it is not uncommon for nurses carry their personal smart phones in the pockets
so they can use aps that help them do their jobs.
So, what is holding hospitals back? Budgets? Device
Selection? Device Management? “Ap” Selection / Deployment?
Here are some quicks Do’s and Don’ts:
·Don’t Buy a Tablet for one application. (unless
it’s ours.. J)The hospital should create a team to research
and understand the usability for different applications in their hospital. Different teams need different applications.These applications should show value in
safety and satisfaction.
·Do identify application that align with the
hospital’s care models and strategies to enable safer and more satisfying
·Do identify a mobile device management platform
that meets your needs.
·Do engage IT…. I know it sounds silly to say,
but there have been times when we come to hospitals and the IT department is
avoided by the clinical department (which is a blog all in itself)
·Do buy cases….a serious cases like Otter
Boxes.Make sure you engage your
infection control team to identify how these devices will be cleaned. We have tested all sorts of cases….ones with
built in keypads, zipper fronts, plush, and flashy – some of our hospitals
launch their tablets naked….let’s just say mistakes were made….
·Do understand that they are practically
disposable….did I say that outloud? Yes, just like your “purpose driven”
wireless phones that nurses carry.Either buy the replacement plans for them or have a budget allocated for
·Do buy a nice tablet….I have the war wounds on
this one…cheap tablets stink in a hospital setting.Spend the money get a name brand.
We are going to be testing Aperum in some live environments
with different tools in the coming weeks.We have hospitals looking at the Surface and others looking at the new
Spectralink Smart Phone – it’s fun to be vendor neutral and get to play with
all sorts of different toys…I mean tools. JI will update you all on what we identify as
positives and negatives.
Are you a Nurse or Nurse Leader? Want to win a FREE Samsung Galaxy Tablet?
1) Like our Facebook Page 2) Share the Update with this Blog Post 3) Post a comment below about how your hospital uses tablets or smart phones.
Usually when I arrive at a hospital
there is a scheduled meeting with a CNO or there is a team of us looking at
some cool new technology or fixing some alarm automation design problem.I can’t help but be enamored when I walk onto
the units and see nurses with wireless devices, call light systems in
action, or new EMR being implemented. I
have a slight attention issue – so the movement of people, flashing lights,
everything really kind of sends me into sensory overload….but I love it.
However, last week I didn’t visit a
hospital for work.I visited to sit with
a friend as her husband passed away.It’s amazing how still your mind can become
when you are looking into the eyes of someone you care about and know they are suffering.
stepped out of the hospital room for a moment and all I could think to say to
my friend was “Cancer Sucks.”
I hadn’t been exposed to a patient experience
in a while and this one really sucker punched me in the gut.
Yesterday, I saw that HISTALK did a great
interview with my dear friend Regina Holiday.Regina gave Sphere3 our patient voice. I am a proud member of the Walking
Gallery. She inspired me to openly talk
about the patient story that launched our company, and to never forget why we
started it in the first place.I must
tell you – running a startup is no cake walk – there have been many times that
I want to just close the door – but I look at the picture she painted me and am
reminded to fight another day.
This was an excerpt from the interview
and it is the epitome of why we need to keep listening to patients. What
would you say to healthcare software vendors? I
want you to think of your parent in that bed or your child or your wife or your
husband when you’re designing software. I want you to think of them. Because
every single thing you do should be to make sure they get the best possible
care. God, I hope you get to that point before it happens in your very own
life. If I can do anything or say anything to get you to emotionally that point
where you’re thinking about them while you’re designing, then I’ve done my job. (The entire interview is
I have learned from e-patients that if we
let the story – tear jerking emotional heart felt story – be a momentary event
and not impact our on-going development then the battle is lost. It has to be a part of your development conversations - part of your core values. Ours is easy: The patient is the purpose of the hospital.
If you are a big Health IT company and you
haven’t had Regina in to speak – call her, email her, find her on facebook,
send her a tweet…. You owe it to your team to meet her.
In closing…. The morning after he passed
away, while I was having my quiet time, I wrote this down.Eloquence has never been my strong point, but
I thought I would share it with you all anyway.
It does not care how old you are…. You
could be a middle aged mom with young kids or a Grandpa with lots of
grandkids.You could be 80 years old or
8 years old…. Your age means nothing.
It does not care how much you weigh, if
you are ugly, or beautiful in the sight of others…. Your looks mean nothing.
It does not care about the color of your
skin, your race, or how you chose to live.Those things means nothing. It
does not care if you have a billion dollars, million dollars, a thousand
dollars, a single dollar, or no dollars at all.Your wealth means nothing.
It does not care whether you are smart
or dumb whether you have a degree from the school or hard knocks or from
Harvard.Your education means nothing.
It does not discriminate…its open door
policy…. We don’t get to choose whether we walk
in the door….Cancer chooses for us.
Your schedule means nothing. Your loved
ones mean nothing. Your plans and dreams mean nothing. It hates…it destroys… Cancer just Sucks
So I say back to you Cancer…. The only
thing you can truly impact is time.The
only joy you steal is the joy we let you steal.You have no impact on faith because it is independent of circumstance.You have no power over love. You never really
When I was a kid, my Dad had a thing for Zig Ziglar.
We had videos, cassette tapes, scheduled listening times, and lots of
conversations. Dad would say “If you don’t know where you are going – you
won’t know when you get there.” Coming from a man who I saw as remarkably successful,
I was intent on learning his secret.
He wrote his goals down – he made them attainable,
measurable, and part of his overall strategy. I never had a problem writing
down my goals….I found a notebook a while back from 1993 (you can guess my age
later) and I had 10 goals written down, even a plan to obtain each of
them. The problem I have had since 1993, and even still today, is
measuring along the plan consistently. Generally, my measurements are
done on a schedule, but often take several hours to collect information or run
It’s interesting when you are running a growing organization
how measuring consistently sometimes escape us in the hustle of things – new
version releases, launches, growing customer lists, etc. It’s more fun to
think of new software features based on the latest customer feedback then to
focus on the “details”. As a small company – the devil is in the
details…..as we have gotten “bigger”….we have found the devil is still in those
Setting and managing goals is more than measuring the end
result, it’s about measuring along the process, measuring each individuals
contribution…….and doing it in an efficient way.
On February 11th, Sphere3 will be releasing
a new tool for our clients called myMetrics™
this tool measures individuals progress in specific categories using not only
patient feedback from our Leadership Rouding tool but real metrics of actives
from your call light system. It gives the caregiver an understanding of
how their efforts play into the whole strategy of improving HCAHPS.
·What is the individual’s ability to respond –
whether they are the first person to get the call or the third?
·What is the individuals visit rate – how often
does this individual go to the patient room whether beckoned or not?
·How does the patient perceive the care they are
HCAHPS is a balance between perception and actual execution
of task. Goals of perception mean nothing if you don’t have a
quantifiable balance point – a benchmark on the task associated with achieving
that goal. A quantifiable balance point means nothing unless it can truly
be applied to an individual’s performance.
Here are some thoughts as you enter the new year:
1)A paper or “report” based process to manage
these items won’t cut it – you will spend more on the resources to pull the
data then you would having a tool to do it for you “auto-magically”.
2)Caregivers (any employee) needs a concise view
of their contribution to the overall vision and strategy of the
3)Your job as a manager should be coaching them to
improvement not compiling data, and creating a report.
Devices have been created to notify a care team if the patient condition has slipped
outside of the desired parameters.The
alarms are essential to provide safe care for patients.The challenge is that when a device cries
wolf (even if it’s reacting the way it was designed to react) that the care
team begins to become fatigued….the more fatigued they are the higher the risk
been a number of solutions applied to the issue – everything from large
technology investments to seek a better balance of “right alarm, right person,
right time” to centralized alarm command centers to reduce the interruptions on
the floor to simply creating policies that enable consistency on how alarms are
to be treated and reacted too.
Commission is focusing on challenges to the care teams caused by ALARM FATIGUE.
I will be
hosting a panel discussion providing the HOSPITAL perspective…no vendors....at
the 5th Annual Medical Device Connectivity Conference
Jennifer Jackson, Director
of Clinical Engineering & Device Integration
Marni Chandler-Nicoli RN, MPH, Intensive
Medicine Clinical Program Manager
Here is a little throw back from one of our most popular posts! I know it can be searched but thought you all might enjoy seeing something from 2010....
Wednesday, September 15, 2010
I was cooking a BIG meal – one with several burners going, the oven on, and even the microwave. It was one of those “Martha Stewart has nothing on me moments.” (Ok, I was really more like a I'm a tall version of Rachel Ray) There were 4 boys running in and out asking questions and trying to “help” - other kitchen noises like the garbage disposal, can opener, food processor plus of course the TV was on in the other room. It was loud - like the Chiefs Stadium when we beat the Chargers on Monday night – LOUD! The point is I had a lot going on and neglected to set the egg timer for one of my pans and ignored the beeping on the oven……all of this to say we ended up eating at Culvers that night.
My kitchen scenario is much LESS intense than a nursing floor. No one was critically ill, there were no emotionally distraught family members, there was no Code Blue – it was a kitchen. (Well, the food was critically ill by the end of it – I digress) The point is think about your most intense - loud - busy moments and then think of how much more intense - loud - and busy the nurse is and you will begin to understand “Alarm Fatigue”.
On a floor with 30 patients with IV pumps, nurse call, telemetry, other physiological alarms, etc there is bound to be some noise. The current methodology of listening for an alarm can really hinder productivity – but leave productivity out of it – it is a major safety concern.
Let’s take an easy one - Do you know the most common way we document a response to an IV pump alarm? The patient has pressed their call button and the nurse is notified that the IV Pump was dinging in their room. Think about how scary that is for a patient and their family – who has no idea what the dining means. Do you know the most inexpensive way to fix that problem? Automate an IV pump alarm to the caregivers wireless and explain to the patient and their family what will happen if the alarm goes off. (BTW – repeat that information every time you enter the room for rounding.)
Here’s a freebie - Depending on your nurse call system there is generally a quarter inch jack that can take a contact closure alarm – old school – this is the way my Dad did it when he sold nurse call in the early 1980’s. Order the cord you can use it tomorrow in your hospital. IF you have a question (hospital) – call or email me I will walk you through it. There are much more expensive ways to automate these as well.
The challenge is at some point in alarm automation and “management” you simply begin to displace the problem. If a clinical alarm device is trigger happy then your wireless device will be as well. Too many alarms is still TOO MANY ALARMS – just because it’s quieter on the unit does not mean its better. At some point it’s time to really review the technology that is making the alarm happen, AND review the process of who is getting what alarm when and why. The event in Boston was not due to the alarm noise, really it wasn’t even due to accountability because no one “heard” the alarm. The Critical alarm was turned off and the Warning alarms were ignored. Some automation would’ve helped the issue but it may not have solved.