Everytime......

It’s funny when people know what you do how the conversation trends towards that topic. One of my dear friends mother has been in the hospital for over a month with kidney failure and infection. Tammy has been the epitome of advocacy. She called me one afternoon to share the trials she was going through.  Pouring her heart out to release the pain of watching her mother suffer.  Before she got off the phone she said “Make sure to tell your friend – the boss here – how great our experience has been – how great these nurses are in making sure we are taken care of every time we need something.” My friend, Damond Boatwright, the CEO of Lee’s Summit Medical Center has done a great job of cultivating a culture of caring staff.

I began to think about that statement “making sure we are taken care of every time we need something.” I know that hospital – I know the technology, the staff, the design, the process, and how they manage their care. Managing by metrics is only part of the equation – the other half is care.

I had a great post written for you all – about metrics and managing by numbers and pushing for results. It was insightful and interesting with recent data from a new hospital.  Exploring Dynamic vs Intuitive responses based on the “need type” and weighting averages. Numbers and the quantification of expectations – it was brilliant……..but listening to Tammy reminds me - it's only part of the solution....have you been reminded today?  If you haven't had a recent hospital encounter - technologist, you need one.  Don't let the math cloud the reality of what we all do.  Don't let the flashy exciting technology be the cetner of your universe.  Don't let competition between bitter rivals reduce the ability for the patient to have the win.  I want to win as bad as the next guy - but I don't want to win at the expense of the patient.

Maybe some of the best things I post have nothing to do with fancy math (or as Steve says "Algorithms")  but have everything to do with the human condition – the patient as a person – the clinician as a giver.

Who would think a geek could feel?

Press Release on APERUM

Kansas City, Missouri (April 18, 2011) -- Sphere3™ Releases Aperum™ targeting patient satisfaction Indicares™ within U.S. Hospitals. Sphere3™ is the first to reach the market in an emerging category of software targeting patient satisfaction and safety during a hospital stay. Since it’s inception in 2009, Sphere3™ has focused on nursing activities that indicate quality of care. Aperum™ uses data found within standard transactions of the hospital’s patient communication platform to provide performance and risk indications.




The Company’s proprietary algorithms dissect the data path and normalize basic elements for analysis related to patient requests and resulting caregiver responses. The resulting Indicares™ within Aperum™ reveal actual caregiver performance against hospital expectations for performance based on patient needs by category. Further analysis within Aperum™ reveals behavioral patterns for patients and peak times for certain patient needs, offering new insights in caregiving and staffing models.



“We are very excited about how Aperum™ can advance the suite of clinical management tools within the hospital,” says Kourtney Govro, Founder and CEO of Sphere3™. “Most CNOs and Directors of Nursing manage staffing and clinical care decisions based on subjective data. Few have access to the necessary technical expertise to evaluate the real and changing patterns of patient needs and caregiver response.”



Hospitals invest heavily in the nurse call systems and clinical alarms found in a patient’s room. These devices are the primary method in which patients can request assistance from hospital staff. In some cases, the systems have advanced to “sense” patient needs based on physiological movement or biometrics and automatically generate a request from the room. Although very technical and advanced in their design, the platform makers are more about devices and less about offering critical management information. Yet, the systems are rich in data and capable of revealing behavioral patterns in patient care.



Govro offers, “Our progress was initially challenged by the lack of understanding for the information available from resident systems. We are bridging the knowledge gap within the hospital by creating a common language for this data and the behavioral patterns revealed within it.”



Govro believes a number of drivers will aggressively move hospitals to using this new category of software. For example, Lean Principles for staffing target more flexible movement of staff as needed throughout the hospital without compromising the level and quality of care. Objective measures of patient needs, priority, wait times and associated risks should assist caregivers and managers in assigning the right staff at the right time to a floor.



“Patient safety is at the heart of this balance,” Govro says. “Patients are in the hospital because of acute needs. The simple act of getting out of a bed unsupervised creates the risk of a fall, which is a costly event for hospitals.”



Govro explains patient falls are closely measured by hospitals. Because the event is considered avoidable, Medicare and insurance companies deny the associated costs of care linked to the fall, including additional days of stay in the hospital. According to a study completed by the Washington University School of Medicine, St. Louis, MO with Barnes Jewish Hospital, St. Louis, MO in 2004, the typical patient fall occurred during activities unassisted by staff (79%) in the patient room (85%)1.



The makers of patient communication platforms place continue to investment heavily in more accurately categorizing and routing the patient needs to caregivers. Sphere3™ has filled the information void by developing the necessary enterprise level management software to manage the aggregate of needs with caregiver availability.



“Although Version 1.0 is a retrospective review of the data,” Govro says, “future versions will move data to real-time and allow for immediate care management decisions.”



1 Characteristics and Circumstances of Falls in a Hospital Setting: A Prospective Analysis. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492485/)

How to Define "Help"?

When you order BBQ in Kansas City – you don’t just order burnt ends – you can order chopped burnt end sandwiches which can be sauced or dry – you can order a platter which can be sauced or dry – you can order it as a combo. Then there are the side dish selections…cheesy corn, beans, slaw, pickles….

Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?”

The interesting thing about the next section of the question is its tie to “help”.   What defines help?  In most hospitals if you press the “call button” there is one “button” it’s big and it’s red. You can figure out it’s for “help” even when you are groggy or sick. The newest fad is to add more buttons – which is great for me would work. I am used to self selecting. I self-check at the airport, I order meals and movies on my Iphone, and think nothing of the lack of real “service” that is providing.

My mom (who is 62) would think the extra buttons were a novelty. She would laugh as she tried to find her glasses to read the small words on the extra buttons “water, pain, or toilet” then ask me if she pressed toilet does that mean she has to go or that she went. She would never press the pain button because she rarely admits when she is in pain.  She would always press the red button.  (Please no hate mail here, I am generalized a generation based on my experience with my parents)

My grandma would press no buttons….even with her glasses she probably couldn’t read those little words, and she would look at the crazy “paddle” and say why are there so many buttons. Then she would look at me and say “Bo, go get my nurse” I would either press her big red button or I would just walk out of the room to find the nurse.

The point is defining “help” is challenging in a healthcare environment especially in a patient self-directed self-selection process. Evaluating “help” is even more challenging. There are numerous options and building the paddle would be a challenge. Ironically, in an industry move to be more efficient and direct patients needs to a caregiver using a decentralized design method – we lost a great deal of the data modeling. There is no way to track the request specifics in an automated fashion in a decentralized design without additional manual steps (which frankly defeats the purpose). There is no way to get specifics but there are request patterns.

There are ways to collect this request data – get a good understanding – then design you call processes. Just to take it a step further – we can tell you how many of each type of request hit when, how many were answered in your desired time frame (or what your average time frame), and even how the caregiver interacted with the request. If there is a hospital interested in knowing how to create a real patient centric care model – call us – we are looking for partners in a study to make life better.

The current analysis structure (at least what we have found published) looks at qualitative information – how many focus groups does it take to get to water, pain, and toilet? What’s crazy is all the information you could want to design the paddle or better the process is locked inside the nurse call system….if the hospital has a reporting package because most nurse call systems are built like archaic life safety tools with proprietary databases.

What’s more – I am the patient – I want to know how quickly you responded to my need – I know the information is there and frankly I know how to get to it. Stop and think how valuable that could be though - if I am going to do a survey (qualitative) to evaluate my care would it be better if I knew on average you answered my call light within 30 seconds every time PRIOR to me filling out the survey. Sometimes it feels like longer – but when you KNOW what the time is aren’t you more patient….Do you think that would influence my decision on whether or not I had good care?

But what do I know…. I am just a mom who had a sick baby and instead of blasting a hospital for a bad experience – I dug down to figure out how to solve for a pain I felt during a hospital stay.  It really is that simple….by the way so is the data.