Leading....

I really enjoy watching soccer – though I am a relative newbie to the sport, over the past year I have learned a lot about the rules and strategy from my boys.  One of my favorite things to watch is when the players are driving the ball down the field towards the goal.  It’s amazing how they kick it to a seemingly empty space and out of nowhere one of their teammates will appear.  My oldest tells me this is called “leading”.   He explained “If you kick the ball directly to your teammate – where they are – then you will never make it where you want to go.”  What a powerful statement for everything we are doing…..

As I watched the MLS cup last night, and read through some information on a few middleware companies – I wondered – who is “leading” hospitals and who is merely kicking the ball directly to them. 

I will submit that if I am truly honest with you all – I think most are trying to figure out where to kick the ball.  Many of them know there is more that can be done than what they are doing currently, but can’t really seem to identify the open space so that their teammate can kick the ball into the goal. 

There are two things in that statement if you are paying attention.  The first is identifying the open space – the second is so their teammate can make the goal.   

They cannot identify the open space because they are too busy worrying if they have a “trail” someone trying to come up and steal the ball from behind them.  (If they are playing Chance Meyers – they should worry)   This watch your back mentality has stifled their ability to take a really good concept – middleware – and leverage it into a really powerful platform.   Old data models and proprietary mindsets are crippling that industry. 

The open space is not in your hardware or even some of your proprietary software….it’s the data, and your ability to understand it and to model it is at the root of the future. 

The second part of that statement is “so their teammate can make the goal”.  Have you noticed how few real teammates there are in health IT?  I think it would be interesting if Middleware could accept their role on the field.  They are the midfielder – the person enabling the end point device to make the goal.  The midfielder is an interesting position – probably the most interesting position on the team because they play both offense and defense.  They run more than anyone else and frankly their ability can decide the game.  The midfielder positions the ball – leads – to the open space so the forward can send it in.  The forward may get the glory of the goal – just like the end point device that the clinician’s use or patients touch is visible.  The midfielder enabled that goal.

Just some food for thought on a Monday morning -  compliments to the LA Galaxy on the win - thank you for beating the Dynamo.  

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.

Changing Lanes

I was driving to work yesterday in the Tahoe (aka Mommy Mobile) since my car (aka Princess) has a flat. As I sped down the road with Cruise Control set – I couldn’t figure out why the Tahoe wasn’t slowing down as I approached a much slower moving vehicle. All of the sudden, I remembered that the Tahoe does not have the cruise control distance feature that Princess has built in to ebb and flow with traffic.  I slammed on the break as to not hit the vehicle in front of me. You see, the Princess car can practically drive itself. You set cruise control and it slows down as it approaches a vehicle and once that vehicle moves out of your lane it resumes its constant speed.

This change in vehicles has caused a number of issues for me this week. I have no hands free calling if I push a button on my steering wheel and say “Call Dad on Cell” it only changes the radio. When I go to change lanes there is no light telling me there is someone in my blind spot. When I go to back up, I actually have to look over my shoulder because the radio does not change into a back up camera picture. All fun and joking aside - This experience really relates to what we are seeing with devices and workflow design in healthcare. (Bet you didn’t see that coming.)

There are really two paradigm shifts. First, there is an expectation that a technology will provide more and require us to “do” less. This does not discount the fact that we still need human interaction. Princess really can’t drive herself, but Ford has developed ways to reduce the amount of action I need to take while driving. They looked at the driving requirements and removed steps out of the process that could be replaced with technology. They also provided technology that could enhance the driver’s ability to make decision. Isn’t that what all technology is supposed to do?

There is a warning that should be going off in your head at this point.  All of this high tech stuff is great but what do you do if the technology is different from unit to unit? What if Med-Surge is driving a Tahoe and Med-Oncology is driving a Princess? Caregivers float between units. They are asked to shift from one process to another without missing a beat. This is the second paradigm shift, technology must be flexible but the flexibility must be tempered by continuity. We ask a caregiver to go from driving a full featured princess car to driving a low featured school bus then we wonder why there are mistakes.

Workflow design should be based in finding commonalities and working to drive similarities between the units. Every car is different but every car has a turn signal, break lights, head lights, and there are requirements to use them within the standard confines of the law. Then that has to be monitored to drive the similarities to be consistencies.

Please heed my warning to all of you in Kansas City – especially those at Cerner because I pass your facility daily - If you are driving home and see a large Tahoe barreling up behind you – I recommend you just change lanes. I am not an aggressive driver but sometimes I forget what technology I have (or don’t have) at my finger tips.

Top 5 for Nurse Call: 1) Can it do the workflow we have designed for our hospital?

Pre-Determining how the system will function is the only way you can determine which system will fully meet your needs. This can be done internally but utilizing a 3rd part workflow designer. If you are a do it yourself kind of place figure out what you are doing currently and how it would need to change to be better. One of the biggest mistakes made is allowing an equipment vendor to design the vision for a patient call system. Yes, they have experience but they are also partial to the system they are providing.

To put it in perspective, one of the largest personal purchase decisions you will make is buying a house. When evaluating houses inevitably you will begin to picture yourself in that house – what you will be doing? If you visit the house and the listing agent (seller's rep) is there – they are going to direct your eye to all of the “great” features and downplay any of the features their house is lacking. For example, if the house is a split entry the selling agent is not going to point out to you that you will be climbing stairs every week with multiple trips to carry in groceries. They will be directing your attention to beautiful view of the Cul-De-Sac and how your kids will love playing there.

The same is true for Nurse Call (stay with me techy geeks) If you have all of the Nurse Call Vendors present and you do not know what is important to you – then they will tell you what is important to you based on their systems capabilities. This is called features based selling. It’s not wrong or deceptive. It’s them presenting their product in the best way possible. It’s only deceptive if you ask them if their system can do something and they tell you it can when it can’t. Or they sell you a “road-mapped” item as current.

Entering the house with your top 10 criteria is the best way to approach purchasing houses. Understanding why you are purchasing is crucial. Has your family expanded, therefore you need more room? Are you getting older (or plan to grow old in the house) and need fewer steps?  Carry this thought process into purchasing a nurse call system.

The best tactic for reviewing vendors is to provide them with pre-determined workflow prior to their presentation then let them explain how they would provide you with that workflow.  Verify they can meet the expectation.   At that point they can show you additional items you may find of interest based on their products specific capabilities. This IS valuable information because your core need is being met. Their additional “features” then become the icing on the cake.

Stay Tuned for #2 Evaluating equipment warranty and lowest cost of ownership?

Patient Communication & Technology Part One

People ask me all the time why Sphere3 addresses Nurse Call first when we look at Alarm Automation. Quite Simply - it is the hub of all patient interaction at a hospital. If you want to see immediate change then address the way caregivers are interacting with patients. Nurse Call is the only Patient controlled device in the room that is related to their care. (Yes, interactive TV people may disagree) It is a life line for patients to interact with people who know how to help no matter what the request.

This is a medical device that is required to be in every hospital for notification of patient need. However, if you are just using it for that type of interaction then you are not fully leveraging the investment. For example, if you can purchase a button that can be used for bed management as opposed to a bed management system then isn’t it leveraging that base platform more efficiently? The key word above is “required” but the key idea is how do you leverage a required piece of equipment for innovative workflow processes that are outside the basic scope. Nurse Call purist will disagree with this point by saying that adding extra workflow processes decreases safety. By not using the system for its intended use you actually increase risk that a peripheral function would disrupt a critical one. However, most platforms are designed so that you can’t disrupt a critical process unless it’s not implemented correctly.

Further, when evaluating the system it’s important to define how it will be used. I have found that a majority of the time the system is being evaluated on a few key features – not necessarily on how the system will be used. Don’t follow the Shiny Ball folks!

To put it in other words – a hospital knows they need a nurse call system for communication but rarely has its uses or additional workflows been pre-defined. Many rely on vendors to provide outlines and designs on how the system set up, but that’s how it is looked at as “system setup” not workflow. There may be some base anecdotal type information about wanting to “send it to a phone” but not a true plan.   Having a plan of how each aspect of the nurse call is to be used prior to making a purchase decision is crucial.

Important: System design is how the components and cabling are put into the hospital. Workflow design is how the caregivers use the system. Workflow design overlaps system design because there are specific component needs that enable the workflow.

Stay Tuned for the next post: Top 5 things a hospital should look at when evaluating a Nurse Call System

Disruption is NOT Always in the Initial Splash

Disruptive Technology – at first glance it almost sounds negative. Disruption as a term means to throw into confusion or disorder. Disruptive Technology is disruptive to a process, disruptive to an industry, but most importantly disruptive to a mindset.

I sat in two conferences. One a group of well intentioned manufactures wanting to disrupt the space surrounding falls in hospitals and the other with a group who wants to disrupt current processes in healthcare by reducing workloads. Phrases like “Change is inevitable” and “If we don’t change then we will be left behind” resonated with me as I tried to collect my thoughts over the weekend. How does this add value to the hospital? How does a hospital make sure it’s not just one more PO on a piece of technology that could end up never being used because of its inability to fit into the life of the caregiver?

As we drove back to the office, my Analyst had a stroke of genius (which happens often) she said “You know that vital device we saw – that could save at least 30 minutes.” To which I replied “30 minutes a day doesn’t change much.” “Not a day! Every time they do that! Kourtney, that would allow us to decentralize at .…..” as she rattled on through several scenarios. (As a former caregiver, she is always excited to find ways to save time.) Then it really hit me – The disruption does not always lie in the immediate process sometimes it’s in the ripple effect.

Have you ever watched a pebble thrown in a pond or puddle? The initial splash is sometimes impressive but what’s truly impressive is to watch the rings as they multiply and span out over the water. Think through the ripples – there is an assumption that the time being gained is used for productive activities and that the productive activities free up another area.

As the ripple gets larger there are more related items that could fill that 30 minutes of time saved, and possibly more time can be gained in other areas. The direct connection back to “that” 30-minutes becomes looser as you move farther from the initial “splash”. In theory and on paper assumptions become strong cases to justify the actions/purchases of administration. I think we will see a lot of that in the coming year, and while skeptics might balk at simple associations – without the creativity of process design – no one would’ve found “that” 30 minutes and we would still be wasting it today.

Have you ever thought about that – let your mind wander through all of the things that one item changes? You have heard of 6 degrees of Kevin Bacon – what’s the 6 degrees of one innovation? How many rings does it make? That’s the true value.

My instruction “Blow it Up”! We work in an industry that is so ripe for innovation. There is a new era of change – not just change for the sake of change. We are not talking about technology that ends up in a recycle bin because its value was linked to “fancy” and not linked to improving the day of the caregiver. We are in an era where healthcare providers are demanding follow through on a promise and PROOF in the pudding.

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.