It's a Tool not a Toy

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 and quick.

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 leadership. 

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 patient care.

·         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 replacements.

·         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. J  I will update you all on what we identify as positives and negatives.

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Zig would be Proud

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 a report.

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 details. 

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 11^th,  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 receiving?

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 organization. 

3)      Your job as a manager should be coaching them to improvement not compiling data, and creating a report.

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.  

AONE 2013 Patient Need Based Acuity

My husband ran a distribution center  for 13 years.  When we met had around 150+ employees and through automation, software, and workflow modification was able to reduce the employee count to less than 10% of that number.  His guiding principal was to break tasks down and manage the individuals according to the time it took an average person to accomplish the task.   He and his team could watch a process and identify skills sets and aptitudes that allowed them to manage the team to accomplish the goal in a timely way with a low error rate.

As I have researched acuity it seems to be a similar structure.  The DRG defines a grouping of tasks and the tasks have an associated average time of completion (geeks call this a weight) and the assignment is made based on how many “tasks” can be completed within a shift.  Then the patients are assigned to the caregivers based on the workload associated.  That’s when I started to ask questions….are we treating nurses like assembly line workers?   How does this affect how we assign them to a patient – does our technology really support the mindset?

I have watched this process at a number of hospitals, interviewed a number of managers and I do believe that it’s much more of an art than a science.    In the last few years I have also observed several production facilities - from a Milk Farm to a Coffee Roasterie to Electronics manufacture.  The thing that jumped out at me……the product or coffee bean or electronic doesn’t drive any additional demand or strain on an assembly workers day.  There are outliers where a piece of material is bad but for the most part it’s pick up the widget, put it in a box, etc.   The point is – the widget doesn’t ask for ice chips when you are trying to complete other assigned tasks....the widget dosen't code.   

I get it – there has to be a way to balance the workload of the caregiver and acuity (aka task management) seems to be the best method.  I am not trying to disregard the years of research and work done in creating the tasks associated with diagnosis, etc  but there is more here than just a task list.  We at Sphere3 believe there is a way to capture additional information to make assignment of patients easier and managing the workload more effective.  Stop by and check it out.

I am eager to see at AONE this week how many vendors try to tout their technology as a way to reduce staff….be careful with those statements…..technology should be an enabling tool the data should give the ability to manage the workload more effectively.  Patients aren't Widgets – Caregivers aren’t assembly line workers.   

If you would like to see how Aperum® can help your facility better manage workload of your caregivers stop by BOOTH 727 this week at AONE.

TMI....

When you were in high school did you ever use the letters “TMI”?  (Back in the days before texting we just said acronyms)  Usually it was used after hearing way “too much information” about someone or something.   Lately, I have been saying TMI a lot - not about inappropriate or gross info but about information in general.  We are generating too much information about ourselves and why? To “better” communicate? It’s actually less about communication and more about documentation.    I watched a show on sharks this weekend – the scientist were implanting devices into sharks to track their movements in the ocean to try to identify where they had their babies so that they could protect the species.   We don’t even need an implanted device we just freely put it out there.  

Think about it……I will use myself as an example.

In the past week….I went past intersection cameras that records driving patterns.  I used Facebook so that everyone could know my “status” and I could see theirs.  I visited with my son’s doctor and updated his medical record because they hadn’t entered all his shots.  (*Wished I could’ve just done that myself – click and drag or something)   I hopped on Twitter while I watched the Sporting KC game because I like to see what the community of fans is saying about the plays, it helps me learn the game.  I hopped on twitter again to see what articles the people I follow suggest.   I used my Chopper Shopper Cards (grocery loyalty cards) mostly to get a discount but full well knowing that they are recording every purchase I make to better market to me. (I actually get irritated when a retailer markets products I would never need to me – I think you know what I buy at least market something generally related)  I hopped onto Linkedin.  I checked the calorie content with an ap on my phone and recorded my Pilate's exercise in another.  I checked out Pintrest to see if there was a recipe for oatmeal pancakes – realized it’s really not a search engine but a big magazine which is strangely addictive.  I booked two flights using my frequent flier number.  I used the “genius” built in my iTunes account to see if there was some new flavor of music that would “suit” me.  Turned on Pandora for my kids. Amazon sent me an email of some books that they thought would entice me to buy.  This morning I used my access control card to get into my building.

As different as these items are - they all create the same thing – data.  Data that paints a picture of who I am, what I do, when I do it, and what I am interested in.    Do you ever look at your digital footprint and think TMI – wow that’s just too much!  Or do you look at it and think – wow that is such a missed opportunity.   We have developed a culture that likes to document ourselves - which really makes me strangely confused as to why there is so much resistance to EMR - but maybe if it were more like facebook nurses and docs would like it more.    

Here is my point – if you think about all of the things I listed above – all of the ways we document ourselves or allow ourselves to be documented – the model of business has rapidly and radically changed and will continue to do so.    How are you equipping your company to accept my information?  Is your EMR really ready all of this – is it really future ready?    How are you enabling me – the buyer – the patient – to provide you with valuable data about location, interaction, activities, diet, and more.   Are you building a tool for the future or are you hoping you can adjust your current technology consume the masses of information coming?

Let's just say mistakes were made......

It was a great Christmas holiday with my family this year.  There in front of me were all of the things I love – my kids, my husband, my parents, and mom’s famous hand decorated sugar cookies…..to say I “indulged” may be a bit of an understatement.    Sugar cookies are like a gateway drug.  They lead to fudge which leads to chocolate chip pecan pie and so on until I am like a desperate junkie looking for an IV drip of sugar.   So, when I hoped on the scale (for the first time in 2 weeks) I realized the inevitable……Let’s just say mistakes were made this holiday season.   

No worries, I know what it takes to lose – I have gone through the process before.  It’s simple  and only sort of about the ”what and how” – it’s mostly about the focus.  Paying attention and being aware of what goes in my mouth then monitoring with a scale. 

Isn’t that the truth with all improvement projects.  Haven’t most hospitals been through a number of processes improvements that have gotten them back on the straight and narrow.  Which makes me always wonder – do they really need a consultants?  I was recently in a hospital that had a “No Pass Zone” which simply means if the call light above the door is on – go in.    I have seen others like “KISS” and “Hello My name is “ the list could go on.  These aren’t bad things – it’s always good to look at things differently.   And don’t get me wrong consultants often know a very niche technology or methodology or have walked through programs so many times that their value is they are a lot like weight watchers – tell you what you already know but encouraging you to implement and holding you accountable for the implementation. 

I know this is funny coming from a consultant, but I am a business owner who is always evaluating what is needed in the market.    What the market has told me – don’t tell me what to do – give me the tools so I can do what I already know how to do.  So, in 2012 our goal is to remove the complexity of the “niche” for the hospital and put the tool in their hand that allows them to stay accountable (or to get back on the wagon).   

Our latest addition which releases in January is On-Call Fall™ a new module for Aperum™.  We are automating something that was once our service.   On-Call Fall™ was born out of a manual process we would do for a hospital to clearly document the Root Cause Analysis for each incident at the hospital.  It immediately draws a very clear picture of the activity on the unit, patient room, and caregivers assigned patients.  In an easy to use and understand way.  Our initial feedback from a Quality Director “This used to take me days and now can be done in minutes”     

All of this to say – there are sugar cookies on everyone’s path.  Most of the time we know how to fix it but it takes time and energy.  If the scale is not readily available the morning after the holiday season then how will we know we have fallen off the wagon.  

As for me and my 5 extra pounds – it’s time to get focused so I can be down to my end of KC Slimdown weight by HIMSS. 

Reflections of a Former Fat Girl

A wise CEO I know said that “Trended Change is the only Change of Value.”  In terms that most of us can relate to – if you lose 10lbs and can’t keep it off then you have failed.  I have been on as many diets as Oprah Winfrey and failed as many times.  At my largest I was well over 215lbs, my smallest around 140lbs.  Now, I am somewhere in between.    Whether it was a pill or a plan I would move blindly towards the current fad diet searching for my magic bullet.   I call it experiential learning, after years of failure I have figured out that the magic bullet does not exist.  

The only way to succeed in consistent long term weight loss and management is by lifestyle change.   Which is a lot different than saying “I am going on another diet” A diet may provide a specific goal but it also implies a designated time frame, at some point we reach the goal.  How many of us look forward to reaching the goal so the diet is over and we can go back to “normal”?

A lifestyle change means that you not only have identified the functional causes, but you have established a starting point.   A lifestyle change involves education and understanding, which may require technology and data. Once you have identified the functional causes you can hone in on the decisions and behaviors that are creating the situation and begin to make a change.    I applaud my friends at Cerner for the KC Slimdown challenge and www.cernerhealth.com if you haven’t taken a look pop on and see.  If you are competing with Team S3 – good luck - I like to win and I really like Sporting KC. (It's one of the prizes)

At this point you may be asking – why is this CEO of a patient experience & safety analytics company writing a blog about diets?   Improvement whether its weight or patient experience is all about making a lifestyle change, and managing yourself after the change.     One of the reasons weight watchers works is because you are consistently watching your weight.  Hospitals need tools to consistently watch their weight.   I get on a scale nearly every day which some may find excessive but seeing the number motivates me towards doing the right things during the day.   

S3 Aperum is the like the scale I get on each morning.  It’s providing patient experience and safety data in a "weight management" format to allow leadership to make adjustments and alignments as needed.  I would love to tell you it is the magic bullet, but it’s only part of the puzzle.   Like any weight loss or management program technology is a tool that enables us to succeed it’s not the tool that makes us succeed.    We have developed 4 key areas called pickle points where hospitals have issues surrounding patient safety and satisfaction.  3 of the 4 are not technology based – they are identified using technology but the root is in people, policy, and behavior.

For fun – if you have a “Slimdown” story you would like to share – please post it as a comment.  We would like to hear of your success, your process, and on-going management.  

Today.....

If we are honest with ourselves there are times in our career where we grapple with the business verse human aspects of our products. We seek balance. We balance making money with helping people. We balance “marketing messages” and big picture vision with everyday life in the weeds. We balance heart and commitment to being the change with the work that must be done.

On the 3 year anniversary of Sphere3, I find myself evaluating the balance of building a start up and staying true to my commitment to Make Life Better for Patients AND Caregivers. Today – I focus on the Caregiver.


There were two blogs that caught my attention over the past few weeks. One blog was noted by Paul Levy called “Medical Margins” by Josephine Ensign. Josephine tells the story of a RN who had made a medical error – her blog blasts the hospital for the inequality of discipline levels between Docs and Nurses. Really what struck me was Kimberly Hiatt – a veteran RN with all in all good approval ratings – was dismissed for her error of administering a lethal dose of medication to a fragile NICU baby. After which she committed suicide. (Note there is no public information about linking her suicide to her dismissal)

I struggle with the balance – a bad day for me is I publish something on the blog that irritates someone or my team misses an internal development deadline.  (which is really a bad day for them) A bad day for a RN is someone could be seriously harmed or die. Do we expect perfection? Are we being realistic to apply “lean six sigma” principles to a human based profession – patients are not cars and clinicians are not assembly line workers. The patient advocate side of me really wants to drive every ounce of error out of existence. What if that error was my child – what if that “bad day” affected my parent? Aperum™ was created to identify when workload balances are too great. Is it enough? Do we find that self reporting based EMR systems and other gadgets and gizmos really make a difference in the day of the RN?

When my brain went into over drive trying to grapple with it all another great blog was posted – this time by a Nursing Student named Jennifer-Clare Williams of my home state Missouri. Her heartfelt desire to be the super hero that “saves the world one patient at a time” brings back the sovereignty of unadulterated hope. The blog is beautiful – showing her true desire to be a help to those in need.

I replay my mistakes (“No wonder your patient was uncomfortable—you put the bedpan under her backwards!”), I cry more than I ever have in my life, and I continuously wonder how on earth I will ever learn everything I need to know.

But there is good news. I’m surviving. And I’m learning that perfection is unrealistic. That nursing really is a fluid profession: things are constantly changing, and that’s a good thing. That there are very few things that I’m going to master on the first try, or heck, even the 10th try . . . but that’s ok. I’m learning that the patients who are, let’s just say . . . unkind . . . are not launching a personal attack on me, but are facing a difficult set of circumstances and are unhappy with the situation.

The inspirational heart of this young woman pushes me forward that every nugget of information we can provide back in a visual meaningful way can make a difference to improve her ability to provide care. The S3 team has made linkages to reduce readmissions, show documented improvement to patient satisfaction scores, reduce fall rates and errors, and do all the big picture money saving things that we need to do to sell a product. That’s not what drives me – and technologist – EMR person – industry specialist – big picture lingo laden with catch phrases shouldn’t be what drives you either.

What drives me should be the thought that today – we made life better for Jennifer because we were able to identify that her workload was so great that she may make an unintended mistake. What drives me should be that today we were able to provide information to the charge nurse that over stimulation was increasing the propensity for medication error beyond capacity – so she can engage and make sure her clinicians are in an environment where they can care and not run. What is your “today” statement? What did your product, software, service do today to Make Life Better?

For a moment, stop and focus on how you can make life better. Stop thinking about selling the next big deal and start thinking about the people you are affecting.

Thanks to:

Josephine Ensign’s “Medical Margins” Blog
http://josephineensign.wordpress.com/2011/04/24/to-err-is-human-medical-errors-and-the-consequences-for-nurses/#comments

Off the Charts AJN Notes of a Student Nurse: A Dose of Reality written by Jennifer-Clare Williams http://ajnoffthecharts.com/2011/05/04/notes-of-a-student-nurse-a-dose-of-reality/

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

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.

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 (http://www.rfidproductnews.com/pages/searchview.php?key=konishi&p=issues/2008.03/medical2.php) 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.