Sunday, January 31, 2010

Technology Life, Economic Life, and Workflow Life

“What color do you want?” This is the first question I am asked when I go car shopping. (Yes, it does irritate me.) While I see that is an important decision for most people, do people really buy a car for it’s color?

Wouldn’t it be more effective to ask – “Why are you shopping for a car?” This should be the question of every vendor pushing a medical device to a hospital. "Why are you purchasing this product? Why now? What initatives are you trying to solve with this purchase?"

If you look at purchase decisions. Most will fall into one of two timelines or life-spans: Product Life and Technology Life. Product Life is the underlying practical reason for the purchase, and Technology life is the technological enhancements we "can't live without". We believe there is a third area for medical devices that can leverage existing platforms, blend their usage with new product platforms making transitions easier – we call it Workflow Ability.

Technology Life = 5-6 years vs Product Life = 10-12 years

Workflow Ability can extend the Technology Life 3-5 years balancing out the difference between Technology and Product Life. It allows for proper transition between platforms.

So how do we bridge the gap between the technological enhancements of new products and the apparent short comings of a previous investment?
Many hospitals will simply make a Capital Investment and change to the new platform, but is that really necessary? In these economic times is that really a practical decision?
We believe that the first two decision points (product and technology), while important in making a transitional question are lacking in their ability to allow the hospital to make a long-term transitional change. We believe that Workflow coupled with unifying technology can really increase the lifespan of existing platforms thus leverage the hospitals original investment.
This is a LONG post so I am breaking it up into sections.
Stay tuned for more on:
Product Life
Technology Life
Workflow Ability with Unifying Technology

Saturday, January 9, 2010

Patient Satisfaction and Value

Patient Safety initiatives can readily be linked directly to value for the hospital. If a hospital reduces one fall there are savings of litigation, and non-reimbursable care. Patient Satisfaction can be a little more abstract when measuring results – not that you can’t get a score very readily from a Press Ganey Survey. What does that mean for dollars? How can we measure our effectiveness in these initiative? Adding new dimension to this is the HCAPS Surveys and how they will affect reimbursement for care.

Every business uses some sort of performance metrics. Often quantity of incoming requests (similar to incoming patients) and quantity of “credits” given for mistaken work (similar to non-reimbursable care) – not that these are exactly the same in all instances but they are similar and make the point that tracking specific information can be helpful when improving business practices.

Sphere3 believes that a stand-alone metric, while valuable information, is less effective as one that is cross-referenced with another. For example, if a hospital were to look at average response time balanced with the staff to patient ratio and correlated with total average call volume – you could use the information together and create a multi-faceted metric. Then take that metric and see if there is safety improvement and if there is also an improvement in patient satisfaction score.

Most importantly, what is the link it to dollars? Will the hospitals elective surgeries increase? Will the hospital have a consistently higher census? I understand there are some large assumptions when loosely linking these two data points but the point is if you had the power to easily look at information such as (1) your response times, (2) quantity of direct interactions with patients, (3) average wait time before exit, and (4) total call volume, would you be able to make specific linkages to improvement in patient satisfaction? Would you be able to take that information and link it to increase in electives and increase in revenues based on increase of paying heads in beds?

Our new Sphere3 Scorecard™ will make it easier for hospitals to get specific information on clinician response and interaction which can be compared to patient satisfaction.

Call us for a full presentation.

Sunday, January 3, 2010

Location, Utilization, and Movement

I had an interesting call with Will Lukens, Vice President of CENTRAK, a Real Time Locating System (RTLS) company. There are a number of debates swirling around RTLS such as what’s the best technology to use? (Wi-Fi, RF, Hybrid - Check out JHIM from Fall 2008 for further reading on the technology.) No matter what technology you use in the background, RTLS is a great mechanism to track the effectiveness of workflow for staff and “stuff”.

Step One is always to decide “what” you want to accomplish prior to deciding “how” or with which technology you want to use. The "what" or goal froma workflow perspective can be evaluated in three areas Location, Utilization, and Movement. Using these areas you can evaluate numerous abilities to track implemented technologies and initiatives.

LOCATION: It’s been reported that caregivers currently spend less than 30% of their time at the patient bedside, but that’s an average which is not applicable for every facility. Using RTLS a hospital could track the actual time frames that a caregiver spends with a patient and set a baseline for their specific facility.

Location is the portion of the puzzle that has the most value and the most apprehension. The ability to track caregiver’s locations with detailed reports of who, when is sometimes labeled “Big Brother” and “Micro-Management” and honestly, would you be pleased to wear a tag that tracked your movement the entire time you are at the office? “Bob, you spent way too much time at the coffee pot.” Using this as a coporate means of improvement as opposed to individual tool for punishment is really key.

UTILIZATION: “Work Around Artists” is a term that Karen Cox, Executive Vice President of Children’s Mercy Hospital in Kansas City coined in the last issue of Ingrams. That name captures the innovative spirit of the caregiver. They are the modern day MacGyvers using available resources to find more efficient paths.

Often hospitals will implement initiatives, or provide technologies with the desire to see an improvement in something that is lacking. For example, if there are high infection rates they may implement a hand washing initiative and provide a new sink in every patient room. What if the utilization of the sink could be documented automatically – even more so what if that information could be correlated back to the reduction of infection rate.

MOVEMENT: Frank Lloyd Wright would watch people’s movement habit’s to design walk ways. Once he didn’t put in a single side walk at a University until after the students had worn paths to show where he should be putting those walk-ways. RTLS is the modern day observation and automated documentation of movement habits. A caregiver walks 1 to 4 miles per day (depending on size of facility and quantity of patients) often a technology is provided to reduce that foot traffic. Hospitals can have humans track the movement with clipboards and pens or pedometers, but if they have an RTLS system that information is being collected.

Before you begin your journey - A great resource when planning RTLS purchase and implementation Robert Konishi’s RFID-RTLS Strategy and Planning Guide. Robert is the former CTO of UCLA Medical Center, and Current CEO of T2 Technology Group. According Konishi, there are four main areas that can be assessed to link to value when evaluating the RTLS system for equipment tracking:

• Cost savings associated with rental or duplicate purchases
• Lost Revenue and Opportunity Cost due to utilization
• Lost Time for Staff
• Quality of Patient Care, Throughput, and Regulatory

Konishi provides very helpful insights in the article from RFID News ( and a subsequent RFID-RTLS Strategy and Planning Guide.

The power of RTLS is the ability to track specific information. That information can become a metric which can be used to help the hospital better assess their workflow choices. A metric on it’s own is important – every business needs to track it’s ability to improve – however correlating those metrics with other data is the most powerful way to look at the data. That's why Sphere3 has developed our automated web based Sphere3 Scorecard™.

We look forward to sharing it with you.