Interruptions.....

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.

Alarm Fatigue Revisited

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

Alarm Fatigue

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.

Patient safety officials across the country have said the heart patient’s death at Mass. General shines a spotlight on a national problem with heart sensors and other ubiquitous patient monitoring devices. Numerous deaths have been reported because of alarm fatigue, as beeps are ignored or go unheard, or because monitors are accidentally turned off or purposely disabled by staff who find the noise aggravating.  ()http://www.boston.com/news/local/massachusetts/articles/2010/04/03/alarm_fatigue_linked_to_heart_patients_death_at_mass_general/?page=1

It’s tragic that a death occurred due to an alarm issue, and no family should have to go through that.  That death should be a rally point for all of us in the device industry.  

Consumable

Many of you who have read my blog for a while would read that title and think – here she goes again talking about food…not this time.  This time I am talking about the consumable nature of mobile technology used in the healthcare environment.   This post will focus mainly on hand held devices – in alarm notification that’s code for wireless phones.   I have heard them called all sorts of creative things – “workflow enablement tools” “mobile caregiver communication platforms” – all of which boils down to…. a wireless phone.   

Don’t get me wrong I was selling these innovative pieces of technology…..before the birth of #2.  (who turns 9 this week) While I recognize that platforms have changed (WiFi etc) – has the end user functionality really improved?  When a color screen is an “improvement” worth changing out all the handsets it’s kind of a sad statement for these little plastic wonders.

 I have been working in the medical device alarm and alert area of Health IT for many years (you might think I started working in grade school based on the number). I have noticed, wireless phones are becoming disposables….like gloves or needles…. (the sales tactics are certainly with that mindset) One of my hospitals has been offered 3 upgrades to their handsets from their single vendor…..when that happened all of the handsets (phones) needed to be traded in.   I heard that some EMR companies are wrapping it into the sale of their product….which just makes me scratch my head….and frankly should make any investor scratch their head as well.  Is that revenue worth the effort (because it’s surely not the margins)…..is it just a move to be more sticky in the client…..is it worth it?

When my clients ask me about the workflow of these plastic wonders, I quote one of my favorite CMIO  “It’s like fine tuning a model T, my friend.”  Really it’s time for better evaluation of end points, and if your hospital is still buying, replacing or upgrading your wireless phones….it’s time to rethink your strategy, ask yourself: 

·         Why am I buying a device that is as disposable as gloves?

·         Do I supplement our current wireless phone with other devices such as Ipads, Itouch, or other tablets (for those of you who have been able to keep away from the I-monopoly…..) could I combine it for more impact?

·         In the ever shifting reimbursement world – is a little plastic phone worth our time?  What’s the value vs return – could I attain more value with a different strategy?

·         If I have a lot of these devices…ie I was ahead of the curve 9 years ago – how do I phase them out to new devices?

·         Should I be evaluating the BYOD strategy for my hospital?

The point here is – hospitals are tired of disposable expensive technology that gives them Model T level experience?  They need to identify vendors that have the same mindset – how do we move to a modern “workflow enablement tool”?

Ascom Wireless Acquires GE Nurse Call

You may have remembered back during HIMSS – I made some comments  on the blog about GE’s nurse call and may have even said something along the “lack of vision” lines.  (which my mother said was shockingly not nice of me to say)  GE did have a strong lack of vision surrounding its nurse call product…if you remember GE purchased EST who had purchased the once competitive Dukane line.  As they divested the “Security” division of their product lines (EST) due to the lack luster performance the nurse call line was shuffled around and never could get past their market status of third place.

So here is what really blows my mind - GE potentially they had the perfect scenario…..how cool would it be to walk in and offer everything soup to nuts to make your hospital run. (If you are a dreamer thinker – why wouldn’t GE just have a hospital…why not?)   Even if the hospital didn’t want everything – how amazing would it have been to have access to every piece of a hospital – think of the flexibility and potential for innovation.  The potential intellectual capital was just squandered – to me this was purely an execution faux-paux on the part of GE.  They had all the pieces – they just couldn’t get them to move together.

I find the acquisition to be really interesting play for Ascom Wireless as well – while they have had reportedly good success with their nurse call line Internationally – I do wonder if the same model will apply in the US.   The company line is that the nurse call and wireless phone system will be “kept separate” as to not upset too many apple carts (since Ascom distributes both through nurse call manufactures, and independent integrators).  It would be silly to keep that mindset for long.

Ascom offers a nice middleware product called Unite – same thought process of all middleware it interfaces to different alarm generating technologies such as nurse call and distributes the information the assigned caregiver.   The acquisition gives them more control on the development side of the product – creating better workflows but it limits their vendor agnostic approach to market.   It’s perplexing why that they would tether themselves to another “end point” device – like they have done with their handsets – Yes, I know that Unite integrates with several handset devices BUT if you know middleware you know they integrate best to their own handset.

Areas where disruption may occur in the space – Distribution (who is selling it, not who is shipping it), IP consolidation, and IP development……further market consolidation.

Nurse Call is a really interesting technology....not interesting in a creative way - interesting in a how are we going to mold this old school technology, that's required by code, into a new highly relevant technology.....as my new favorite CMIO would say - "Where is the Disruption?!"  It's hardware and software blended together and without one being high quality it will fail to meet the expectations of the hospital.   

My firm belief is that the hardware will continue to decrease in value and the software will continue to increase….but not just software the content of that software is the real value.     Watch the market - I think another Nurse Call company will make movement like this soon......

Intego Acquired by CAS

Recently, I had the chance to chat with Charles Bell, Founder of Intego Nurse Call.  I always enjoy meeting fellow entrepreneurs - for those of you who don't know entrepreneurship is an incurable disease as much as it is a passion.

Listening to Charles, I am reminded of the raw creativity and passion that drives innovation and ultimately new jobs into our struggling economy.  Charles started his company in the early 1980s but has been in the industry since the early 1970s.  He regaled me with stories of old Zettler systems that he was able to wire and do innovative things with, but finally settled on the fact that he needed to build something all his own that would challenge the status quo.

The Intego mindset is simplicity - how can we provide a system let the RNs be with patients more?  How can we leverage what has to be there in the wall In a communication model that compliments ease of use? 

Charles speaks highly of what he calls the ROC - this model takes all the patients calls from nurse call and routes them directly to the centralized operator core.  Thus, removing the direct interaction from the caregiver and allowing her to prioritize her response using her skill set as a nurse to determine who/ what needs attention first.   The strategy is to utilize a low cost device - such as a pager - that can compile the messages the caregiver receives.

This model is one that I have been promoting for a while as well.  The data models that I have run support the idea that providing greater context to the alarm and alert message can be extremely valuable to the caregiver.  The challenge is the design model - the clinical aspects of the design must be setup by a RN with a technology background.   Someone who understands the information being recievded in the command center and how it can be distributed in a meaningful way. 

The theory is this - patient presses the big red button on their pillow speaker (aka the "paddle") the call goes to a centralized point in the hospital, such as the operator area (where external calls are received) then the operator triages them back to the floor.  (Look back to the blog I did on Chris Heim from AmCom) 

Since you are using a lay person to triage - its important to design a really simple decision tree process.  (Similar thought if you have your IT Help Desk triaging Nurse Call issues)  

What I have found looking at this model is often laziness kills it's effectiveness.  The operators may not use the available messages and only distribute a blank - assigned message - ie "PCT Needed".  If the team answering the calls are not driven to follow the process it becomes garbage in garbage out.  It is critical to manage the data associated with their effectiveness and following the process. 

The other side of this data is to identify if the caregivers are using a task list approach or varying their response based on type of need - you cannot run the data model or report on this model any more effectively than decentralized to phones if you are not following the process correctly.   

I also HIGHLY recommend coupling this with strategic automatic distribution of specific Emergency level call types AND allowing the caregiver to call back into the patients room via a call back feature on their wireless phone (or smart phone if available).

This strategy is complimented by Intego recently being acquitred by Critical Alert Systems. CAS is a relative new comer to the industry, as its a purpose built organization to compile specific technologies to drive full throttle into the industry. Charles will remain with Intego focused on driving new business and strategic relationships. 

Great conversation - thanks to Charles for taking the time to chat with me.

If you have a health IT business in the medical device space and want to be featured in the blog email me - our next feature is with Strykers Rich Mayoras - talking about their new wireless bed.

A Coloring Page for Root Cause Analysis

The other day #2 boy brought home a coloring sheet from church.  I asked him to tell me about his picture.  He went into a wonderful description of the story of David and Goliath.   Goliath was colored blue similar to a giant smurf and David was wearing a green skirt.  He had added grass, bushes, and even some small animals.  His hands flew through the air describing his well colored picture and telling me in detail that Golliath blue from him blueberry pancakes and why David was “late to the party”.  As he talked, I began to focus in on the upper corner of his paper to the small gray airplane.  “What is that?” I asked.  Tucker’s eyes lit up and he replied “That’s the fighter pilot backing up David in case he missed.”

It's interesting when we begin see the outline of a picture and think we have the whole story.    

As I have been reviewing RCA’s from different hospitals and researching the rebuild of the incident – I find it interesting that many hospitals do not build the picture from data that is very representative of what is occurring in the room.   Many times this is simply that they do not know that the data is available or that they have systems in place that the data is locked inside and not accessible. 

I was working with a hospital on a fall analysis - extracting data to begin to layout the outline of a picture of what happened surrounding the patient fall.   The patient requests and responses are a lot like a blank coloring sheet.  The outline is your basic patient request data and based on the patterns it began to paint a picture.  The physiological alarm data, the medication data, and other bits and pieces began to color in the outlines to give a full view of what was occurring in that patient’s room.   Did the patient have a critical telemetry alarm?  Who received it? What were they doing?

Another interesting piece of the puzzle is communications between caregivers.  I was having a conversation with Voalte’s Trey Laudedale about the value of the Text Message.   As I was thinking about this blog it occurred to me – the text messages are the hand drawn fighter jet in the picture.  Sometimes the outlines and the information we are looking for does not create the whole picture. Sometimes the picture needs to have more data then what we would normally consider to complete it.  

So here is my tip for an RCA

·         Review the Patient Requests from the Nurse Call and Response of the Caregivers
·         Review the Physiological alarm data that was sent to the Caregivers
·         Review the text messages between clinicians

Remember data is always available if you are careful to set up your technology correctly.

An Industry in Flux

It strikes me that there are some fascinating industry changes occurring in the “middleware” space and more are on the horizon. Interestingly, its not aggressive competitive behavior - it’s shuffles, buyouts, ReOrgs, partnerships, major players leaving major organizations, and simply surprising business decisions.
Dramatic human capital changes as opposed to dramatic technology change.
But what does it all mean – is it that alarm notification tools are not doing the job they set out to do, is it that the alarm notification tools promised too much and delivered too little, or is it that creativity and design ability was not balanced with well researched deployment on the cause and effect of the disruptive technology.

My thought is well intentioned creative individuals saw an opportunity in the marketplace that allowed the perception of faster communications. (If you haven’t figured it out – I believe most people are well intentioned.) The crux is more than 10 years after Michael McNeals press to market with the game changing Emergin platform – the cluttered market space is starting to relax and mature into a “what’s next” mentality.

Major platform changes are needed to meet the demands of a healthcare ecosystem that has a broader expectation of what information needs to go to which person. The new mantra is not about “alarm notification” it is more about “information distribution” and “decision support”. “Notification” brings with it the thought of disruption while information distribution and decision support bring the picture of well balanced and focused approach to patient care.

The problem is alarm notification has not reached maturity before the next change. What I mean by that is we have started to move to a new thinking without truly looking at the data associated with the “old thinking”. We have no base line comparison to clearly identify how information distribution will affect the ability of the clinicians to serve better. The industry has no clear baseline of information to compare the emerging decision support capabilities of the patient communications platforms (aka Nurse Call) with the old way.

Technologists, ask yourself:

Are we making things more flashy, exciting, techy because we can or because it’s right?

I challenge Nurse Call providers – Middleware developers – and even you EMR players who get in the game to prove it.

Show us how a change to status quo solves….if it doesn’t make the patient’s and caregiver’s lives better in documentable, data backed ways – then don’t waste your development dollars.

My prediction – major change is coming – large players will be motivated to change their focus and new players will be motivated to create better platforms.

The Recipe Matters

I love a challenge, and recently I have taken to making cakes. I am not Duff or Carlos, but I am determined to conquer the cake. My weakness is I don’t like recipes – ok, so I don’t like being told what to do, and I feel a recipe is just Betty Crocker’s way of bossing me around. When cooking, her recipes are general suggestions, but unfortunately in baking, it’s an order.

The thing with a recipe in Betty’s book is someone experienced has documented it – it has been verified – and it has made it to the general public. A recipe is successful because the common language used in each step. We are taught in grade school the standard terms of measure – cup, teaspoon, tablespoon, etc. We are also taught time – minutes, seconds, or hours. We are taught by our moms how to “preheat”, and we are taught by the Food Network how to “fold” in an ingredient.

Documentation of anything requires standard terms and common language. In a recent revelation in speaking with others about my professional passion for clinical alarm data and the picture of patient needs hidden within it, I found that there is not a current standard terminology in the arena of clinical alarm design. Therefore, I am proposing one. Just to set the minds of my readers at ease – Patient Communications Platforms are in my blood. You could say my youth encoded a understanding of clinical alarms into my DNA. I went to my first “nurse call” training before I could drive a car, and had a doll house with RTLS. I am not a novice, however, I am not so proud to think that what I’m proposing can’t be improved upon. Actually, I’d be thrilled if this proposal sparked a debate. So,I challenge all of my readers (all 700 of you) to comment. Collaboration can only occur if we are not so prideful to think we are perfect – if we can agree that little companies have as good of ideas as big companies – if we can solidly stand by saying we must create things for the betterment of healthcare because it’s really about patients – not all about profits.

This is Sphere3’s proposal for common language for documentation of Clinical Alarms. Below is a cascade of action – reaction that can either be generated by a person or the configuration of the clinical alarm system.

Initiating Action:

This is the beginning of the call. It can be manual, such as a patient pressing a button or physiological, such as a telemetry alert. The initiating action can also be a system trigger such as an occlusion or a system creating an alert based on a malfunction or necessary service request. The easy way to remember an Initiating Action is “it’s gotta start somewhere”.

Example:

Patient Press a “Normal Call” button on their Nurse Call System

Patient’s heart beat indicates a “V-Tach”
Notification Action:

How do people know that a clinical alarm has occurred? A Notification Action is the ring, ding, buzz, text, etc. This is the way in which a caregiver knows that an initiating action has occurred – they way they know the patient is in need. There are generally multiple Notification Actions for every Initiating Action. Every Notification Action is an invitation for the Caregiver to interact with the patient or their device.
Example:

Initiating Action = Patient Presses the “Normal Call Button”

Notification Action 1 = The Dome Light is White

Notification Action 2 = The PCT’s Wireless Device buzzes

Notification Action 3 = The PCT receives a Text Message “Normal Call Room #” with the option to “dial back” to the patient room.

Acceptance OR Rejection Actions:
If the Notification Action is the caregivers invitation to interact with the patients need it forces an acceptance of that request or a rejection. Accepting the alert requires an interaction with the patient or their technology. A rejection is a “delay of response” while it could indicate that the call is being ignored, mostly it indicates that the capacity of the caregiver to interact with the workload is challenged.
Example:

Notification Action3: The PCT receives a Text Message “Normal Call Room #” with the option to “dial back” to the patient room.

Acceptance Action 1: The PCT presses “Accept” it “dials back” into the patient’s room, they communicate with the patient.

Rejection Action 1: The PCT is unable to answer the call due to being engaged with another patient.

Escalation Action:

A Patient Communication Platform (aka Nurse Call) has a feature called “always an answer” where it will bounce a call if it’s not handled within a set time frame. Anytime a call is rejected, it bounces either automatically based on timeframe or physically based on a button push. That being said anytime a call is “rejected” technology should be programmed to create an automatic escalation action. Similar to an Initiating Action the escalation action is the technologies methodology of moving the call to the next person or place in line.

Example:

Rejection Action 1: The PCT is unable to answer the call due to being engaged with another patient.

Escalation Action1: Since the call has been “ignored” the technologies internal timer has allowed for a wait time of 2 minutes after which the call is sent to the RN’s wireless device with a message “Normal Call Rm 320”.
Escalations drives additional Acceptance and Rejection Actions, based on time frame. Again, a Rejection Action will create an additional Escalation. The hospital has to decide when the patient request (physiological or physical) has gone on too long, and at what point a failure to respond will generate the final Mandatory Action.
Mandatory Action:

The hospital’s determination of the final phase of the escalation process is the mandatory action. This designation is generally linked to Overtime calls. When a mandatory action occurs, the technology should force a physical face-to-face interaction with the patient. Mandatory Action is a new Initiating Action with a required interaction from staff.

Example:
Normal Call has not been answered in 4 minutes.

Mandatory Action: Due to escalation past allotted time frame the technology changes the alert verbiage to “Overtime Room 320” and tones at the main console and duty stations in all caregiver work areas on the unit. Additionally, the PCT and RN’s wireless phone receives a text message “Overtime Room 320” with no capability to call into the patient’s room. The call can only be cancelled at the patient’s bedside.

Now, let’s get back to baking cakes. Here is what I’ve learned in my most recent experience. There is a certain amount of discipline that comes with baking. To try to get creative on the basics is the best way to really ruin a dessert. Getting the basics of a cake right makes for a great foundation. But, the real fun and creativity begins once you have solid knowledge of the basic fundamentals of a cake. You see, I’ve now learned how to take a basic recipe and make an exciting dessert for my family—its about the secret additives, the substitutes that have just a little more interest in flavor, the interesting style of presentation, and complimentary chemistries of toppings, sides and coffees.

Clinical Alarms is the same thing. You have to know the basics and assure the foundational strategies in clinical alarm design were applied. BUT, once that is accomplished, there is so much more that can be done to enrich the patient and caregiver experience with request and response.

The documentation above associated with each phase is laid out similar to a process chart used in lean, however Sphere3 has created a methodology that is easy to understand and see at a glance. I will create a blog series on each phase of the process if there is feedback on this, but if there is not then we will just leave it as one persons attempt to create some normalcy to the market.

Comment Back – Ask Question - Email me kgovro@sphere3consulting.com if you don't want to post a comment – join this conversation.

It’s not “IP” it’s about creating something we can all use. This shouldn’t be an uneven playing field - this is Sphere3 stepping up and saying it's about the patient - not about the technology.  If alerts are designed incorrectly in the extreme case someone could die – in the most likely case a patient is dissatisfied with their care.

Symphony of Information

Have you ever heard a 9th grade band on their first few days of rehearsal? I lived it – well a much heavier, awkward, glasses wearing, hair out of control, version of myself. The interesting thing about 9th grade band is everyone has had their instruments for a while so most can make a noise that resembles music, but “musicality” is really lacking. What they teach you in that critical year is how to be “Symphonic” which means taking something that is very complex and diverse and pull it together harmoniously. For a percussionist (like myself) that means - just because you can play the loudest doesn’t mean you should and that following the conductor is not an optional activity.

As I was reviewing data this week (reams and reams of data) I began to notice a series of new patterns. Patterns, within themselves, are fascinating but they get interesting when variations occur. So in musical terms if you have 4 measures of quarter notes and then a measure of 8th notes and then a measure of 16th notes the original pattern varied to a pattern that builds intensity. Intensity builds excitement and excitement builds to the climax of the song. As geeky as this may sound the workflow data we review is often like a musical score to me – sometimes just out of sync.

I don’t know about you but when my mind gets stuck on patterns I have a hard time breaking free. My solution has always been to get in my car and turn the radio up to blaring sound to let my mind focus on the patterns in the music. After a few minutes identifying them, and figuring out the layering it is easier to refocus on something new.  This week was especially overwhelming as we discovered patterns outside of alarms that affect our data points AND that the information is readily available.

That’s when it hit me – the problem with the patterns that I was seeing for this particular hospitals report were that they are simply out of sync with the other dimensions of the unit. (Clear as Mud?) Think of it like a musical score – if the woodwinds are playing 3 measures behind the brass who is playing two measures ahead of the percussion it sounds like noise. However, if the conductor is able to see how the patterns line up and is able to pull everyone into sync then it’s an amazing symphony.

Music at it's base is a complex math equation - music at it's core is art and soul.  The key to making beautiful music is to be able to define where the math ends and the soul begins.  The same is true in clinical workflow design the numbers may speak the "truth" but the answer may lie in the "soul" of the work.  That's what we do - we help the hospital define the math so that the clinicians can better create the soul.

I know this is two months in a row of shameless plugs but we are creating a new dashboard that is unlike anything in the market today.  We have welcomed several new team members in to help us mold the product into something that can quickly help a hospital reduce falls, increase patient satisfaction, and increase safety. 

Defining What "Matters"

Creating focus can be challenging. I am a firm believer in goals (lots of Zig Ziglar growing up) but sometimes defining those goals is just as hard as achieving them. We may create a visionary goal, but not understand the detail to make it achievable. Many times our inability to identify what “matters” leads to failure, and our lack of understanding of the information produced creates a foggy understanding of success. That’s why it’s critical to be able to break things down into digestible chunks so we can quantify the achievement (or failure) towards our goals.

My six-year old struggles with spelling – if you have read my blog long, you know it’s genetic. In September his third spelling test score was a D. As soon as I saw that paper, I emailed the teacher to request a conference. The teacher explained that they had 20 words and 10 phonics per week, and the importance of good penmanship. (All I heard was 20+10= 30 items per week to learn!)

That information in hand, I devised a plan of action for home study. The plan was simple break down the materials into daily digestible goals. The next week we hit the ground running. We practiced daily, and he got a D+. To me, this indicated failure of the plan, not the child. We reviewed the goals, made an adjustment to the plan, and the following week he got a C+ then a B. Last week, I am pleased to announce, he had his first A, missing only 1 word!

The reason I am reviewing 1st grade spelling tests is because had I waited for the grade card, my baby would have had a D or F on his grade card. (The C he got broke my heart.) Using indicators, in this case the spelling test, to shine light on a potential problem we were able to thwart a hard to recover disaster of a bad grade card.

Hospitals are faced with a number of challenges – one of which is alarm fatigue. Alarm fatigue is a multi-faceted problem that encompasses everything from noise, to acuity mix, staffing and so much more. If you try to tackle the problem by saying "REDUCE ALARM FATIGUE" that solution is foggy at best.  However, if you look at the issue pragmatically then you can identify the multiple layers each with a “spelling test" indicator. Just like the spelling test above the solution lies in breaking down the problem into digestible chunks and refining those goals based on the outcome of the result.

Shamelss Plug - Our Scorecard is a tool – something that can be used like a spelling test – that along with daily goals and observation could solve the problem. The quarterly trend is much like a grade card. If you wait for the grade card to correct course – then you may be too late.
My advice for today – look at everything as a solvable problem. When the problem is too big – break it down as many times as it takes to become understandable and digestible.

Product Life, Technology Life, Workflow Ability - Part 3

Technology Life Decisions are more readily linked to the exciting features that differentiate the products one from another. Some might call them frivolities, some might see them as necessities. Either way they are items that enhance the base goal of the product.

Technology Life Decisions are difficult to make due to the ever changing nature of technology. The “lifespan” for many technology decisions for medical devices is shortened to 5-6 years (sometimes more or less depending on the flexibility of the platform that is being purchased). Hospitals may delay purchase to wait for the next model to be released. Road Mapped items become decision points and actual realities become less critical. Not to say that a product, software, or service that has a vision for the future is unimportant but reality is more critical than vaporware.

Interestingly, the technology life decision points – things that a manufacture or developer creates to differentiate their product - often become base product decisions. Think of power windows. 20 or fewer years ago wasn’t it suitable to have a crank and before that wasn’t it a luxury to have a crank? Power Windows are an enhancement, but because of the end users interest they have become the standard. The point is often the technological enhancements won’t be enhancements for long .

Early Nurse Call Light Systems consisted of one light and one tone. Now we have systems that have unlimited light and sequence capability through LED and unlimited tones by allowing for wave files to be uploaded. Eventually, this will not be a technological enhancement – it too will become the standard.

So how do we bridge the gap between the technological enhancements of the new products and the apparent short comings of previous products. We believe the answer lies in Unifying Technologies coupled with proper workflow design.

For example, in a car, Micosoft SYNC integration allows the information from your mobile phone to download into the car and allows for voice command and hands-free calling through voice command. While all base capability of making a phone call while mobile is available using just your mobile phone, SYNC increases the value of the vehicle by enhancing your experience with the phone.

SYNC’s value is enhanced because of a unifying technology called BlueTooth.
Similarly, all nurse call systems can notify a caregiver of a patient’s need with a light and a tone. However, some can integrate to wireless phones allowing the caregiver to be mobile while speaking to the patient. There is intrinsic value to the time savings that a hospital will find by integrating their nurse call system to the nurses wireless phones. According to our research, over 30 minutes per day per RN or more depending on the style in which the integration is made. However, prior to today all of that is only possible with a unifying technology called Middleware. Interestingly, this "feature" and ability developed by a vendor outside of nurse call is becoming part of nurse call systems. Eliminating the need for a "unifying technology" all together.

Stay Tuned for
Workflow Ability and how you can transition from one platform to the next more easily and over a longer term investment.

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.