"The Immediacy Conundrum"

Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?” Answers: Never, Sometimes, Usually, Always, and I never pressed the call button.


“after you pressed the call button”

Patience is not in abundant supply at Gate’s BBQ. When you walk in the door they shout at you - “Hi May I help you?” you must know to yell back very quickly – there is no patience for Umm or questions – by either the counter staff or the patrons behind you. You must shout back – quickly with full confidence - “Yes, I want a burnt end sandwich, fries, and a Ice Tea.” The food arrives to the counter very quickly – you can watch the man through the cook window constantly chopping and slicing meat to serve – you know it will be good, hot, and fresh.

The Gates atmosphere creates an expectation for an immediate response to questions, there must be no hesitation. I have reviewed reams of data from nurse call systems and 4 years ago when we started – the average wait time before exit of the bed for a patient was about 1:13. Now we see a majority falling under the 30 second threshold. Are people getting more impatient? Maybe…

We live in a world where as soon as I want to be connected my expectation is to have connection. The problem with “after you pressed the call button” is many patients expectation is immediate. Geeky techy stuff – if you have a nurse call system older than 2 years and you are functioning in decentralized – there is a lag time. Depending on the specific system – it can be an “eternity” in terms of immediacy. This is not a reflection on caregivers, it may actually be a reflection on the implementation of technology. Yet, caregivers are under pressure. Just like Gates, the health system and government is creating an atmosphere around hospitals that require immediacy. By its ever- more acute care criteria for entry, there is an equal expectation for immediate response?

Let’s talk solutions to the immediacy conundrum. The Decentralized Nurse Call craze of a few years ago is beginning to subside as hospitals realize the limitations of moving the patient call to an individual who is mobile and has variable task responsibilities on the unit. Decentralizing or sending the “Normal” patient call to a wireless device does not solve for immediacy – it’s actually the most difficult methodology for nursing to utilize because there is no immediate feedback on volume of requests or the “queue”. Immediacy requires the “queue” to be low and the person answering the call to interact and disconnect quickly. Think Economics - Basic Supply and Demand Theory – if you have too many nurses and not enough calls then you are fine. However, what is generally the case at documentable specific periods of shifts, if you have too many calls and not enough staff then you are going to get low scores on question 4.

The trick is the patient has a need and since they are not in their home environment and have very little control of their surroundings – many “wants” become needs. Not to mention the variation in expectation. The patient requires an immediate interaction – not an immediate solution. This is a really important point – so don’t miss it – the patient needs an immediate interaction and a sense that their need has been identified and help is on the way. The second key to this is you must deliver on the promise. So, if you have pushed your button and someone has quickly told you “help is on the way” then help must really be on the way. The only way to manage that is to develop a methodology to alert the needed caregiver with a specific request – data rich. Then Mobilize AND Monitor their action towards delivery. What does this mean – the person interacting with the patients request should be air traffic control – they should be able to monitor the total quantity of requests and estimate a delivery time. If there is a change in delivery time – maybe the patient should even be notified…..

The New Economy

During my visit to San Diego for the NSCA leadership conference Economist Lee McPheters spoke about the economic changes and challenges facing our nation. While the economy seems a daunting – I think that the needed productivity changes are also a huge opportunities for those of us in process redesign and we just need to find ways monetize the work associated. The American worker has been asked to increase their productivity – put in the extra hours – in hopes to help their company make it through the rough waters. The challenge is we can only work so many hours – we can only work at high capacity for so long before it requires an innovation change.

The interesting change is that while businesses have pushed their employees to be “lean” and move faster and do more with less – the American consumer has become more demanding. They expect more, because they are spending less. The American consumer is adopting the Ramsean principals of if you don’t need it don’t buy it - if you don't have the cash then don't buy it.   They are also spending their capital in a more focused manner with a thought process of  you should be treated like a customer instead of a consumer and the idea of disposable society should go by the wayside.

So what does all of this mean for healthcare? It means that the patients – who are customers – should be treated as such and that their demands will become more and more extensive.

Let’s Dream Weave?

If my grandma eats breakfast every morning at 6:30am when she is at home, then when she is in the hospital for hip replacement shouldn’t the hospital know when Grandma would like to eat breakfast? Tools like A-Frame Digital and Parental Health’s Misty can feed into her “record” and begin to create a model of how she chooses to be cared for when she is not in her home. The more data we can drive from the home to the health record the more we can allow our parents to age in place. 
The scenarios of how we function in the home should model how we are cared for in the hospital. The concept of a Patient Communications Platform should encompass more than just request from point A to point B – it should encompass consumer data modeling that preemptively leads to care.

If I document my life in Facebook and am comfortable sharing it with 400+ of my closest friends wouldn’t I be comfortable with sharing my comfort models with the hospital? If I document my food and exercise in My Fitness Pal (ap on the iphone) then why wouldn’t I share my nureotic eating habits with the place that is supposed to heal my ailments? (What if my ailments are caused by my addiction to Latte’s?)

These models allow us to improve patient care. At Sphere3 we use Performance IndiCares™ which are items relating to the behavior and performance of Caregivers and Patient IndiCares™ which are items relating to the behaviors of the patient. We tie the information together to create Risk Models or Risk IndiCares™ clearly finding paths to reduce risk and improve performance. All of these things lead to our three core values Patient Satisfaction, Caregiver Satisfaction, and Safety.

Health IT companies should feel challenged. If the farthest horizon you are looking at is within the walls of the hospital, then you are going to miss the boat.