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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Cancer Sucks

Usually when I arrive at a hospital there is a scheduled meeting with a CNO or there is a team of us looking at some cool new technology or fixing some alarm automation design problem.  I can’t help but be enamored when I walk onto the units and see nurses with wireless devices, call light systems in action, or new EMR being implemented.  I have a slight attention issue – so the movement of people, flashing lights, everything really kind of sends me into sensory overload….but I love it.

However, last week I didn’t visit a hospital for work.  I visited to sit with a friend as her husband passed away.  It’s amazing how still your mind can become when you are looking into the eyes of someone you care about and know they are suffering.   We stepped out of the hospital room for a moment and all I could think to say to my friend was “Cancer Sucks.”   

I hadn’t been exposed to a patient experience in a while and this one really sucker punched me in the gut. 

Yesterday, I saw that HISTALK did a great interview with my dear friend Regina Holiday.  Regina gave Sphere3 our patient voice. I am a proud member of the Walking Gallery.   She inspired me to openly talk about the patient story that launched our company, and to never forget why we started it in the first place.  I must tell you – running a startup is no cake walk – there have been many times that I want to just close the door – but I look at the picture she painted me and am reminded to fight another day. 

This was an excerpt from the interview and it is the epitome of why we need to keep listening to patients.

What would you say to healthcare software vendors?
I want you to think of your parent in that bed or your child or your wife or your husband when you’re designing software. I want you to think of them. Because every single thing you do should be to make sure they get the best possible care. God, I hope you get to that point before it happens in your very own life. If I can do anything or say anything to get you to emotionally that point where you’re thinking about them while you’re designing, then I’ve done my job.
(The entire interview is here http://histalk2.com/2014/03/10/histalk-interviews-regina-holliday-patient-advocate/ ) 

I have learned from e-patients that if we let the story – tear jerking emotional heart felt story – be a momentary event and not impact our on-going development then the battle is lost.  It has to be a part of your development conversations - part of your core values. Ours is easy: The patient is the purpose of the hospital.   

If you are a big Health IT company and you haven’t had Regina in to speak – call her, email her, find her on facebook, send her a tweet…. You owe it to your team to meet her.

In closing…. The morning after he passed away, while I was having my quiet time, I wrote this down.  Eloquence has never been my strong point, but I thought I would share it with you all anyway. 

Cancer Sucks

It does not care how old you are…. You could be a middle aged mom with young kids or a Grandpa with lots of grandkids.  You could be 80 years old or 8 years old…. Your age means nothing.

It does not care how much you weigh, if you are ugly, or beautiful in the sight of others…. Your looks mean nothing.

It does not care about the color of your skin, your race, or how you chose to live.  Those things means nothing.

 It does not care if you have a billion dollars, million dollars, a thousand dollars, a single dollar, or no dollars at all.  Your wealth means nothing.

It does not care whether you are smart or dumb whether you have a degree from the school or hard knocks or from Harvard.  Your education means nothing.

It does not discriminate…its open door policy….
We don’t get to choose whether we walk in the door….Cancer chooses for us.

Your schedule means nothing. Your loved ones mean nothing. Your plans and dreams mean nothing.
It hates…it destroys… Cancer just Sucks

So I say back to you Cancer…. The only thing you can truly impact is time.  The only joy you steal is the joy we let you steal.  You have no impact on faith because it is independent of circumstance.  You have no power over love. You never really win.

 

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 Panel Discussion

Ring….Ding….Buzz……RING……DING……BUZZZ……RING……..

Medical Devices have been created to notify a care team if the patient condition has slipped outside of the desired parameters.  The alarms are essential to provide safe care for patients.  The challenge is that when a device cries wolf (even if it’s reacting the way it was designed to react) that the care team begins to become fatigued….the more fatigued they are the higher the risk to patients.

There have been a number of solutions applied to the issue – everything from large technology investments to seek a better balance of “right alarm, right person, right time” to centralized alarm command centers to reduce the interruptions on the floor to simply creating policies that enable consistency on how alarms are to be treated and reacted too.

Join Commission is focusing on challenges to the care teams caused by ALARM FATIGUE. 

I will be hosting a panel discussion providing the HOSPITAL perspective…no vendors....at the 5^th Annual Medical Device Connectivity Conference

 Panelist:

Jennifer Jackson, Director of Clinical Engineering & Device Integration

Cedars-Sinai Medical Center

Marni Chandler-Nicoli RN, MPH, Intensive Medicine Clinical Program Manager

InterMountain Healthcare Clinical Operations

 

 Click here to learn more and register to join us!

http://tcbi.org/mdc2013/

 

 

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.  

Define the Strike Zone

As a working mom with 4 boys juggling soccer practices, games, school events, and career can be really a challenge….but it’s what I signed up for when I took on this CEO role.  A few months ago, I was fortunate enough to get done early with a meeting in and grab a flight home to make it too Tucker’s baseball game.  I was glad I made it, because there was a great learning moment…..

Tucker (aka #2) stepped up on the mound and took his first warm up pitch….zip! It flew right over the catchers head and smashed into the fence causing the parents to jump.  He shook his head….frustrated….and quickly he took his next pitch…..ZIP! This time harder.   Still over the catchers head.  A mother behind me exclaimed “Someone needs to tell that boy not to throw so hard or he might injure someone.”  I bit my tongue, my response would have been “Lady wrap your kid in bubble wrap and let’s play ball.”  Instead I stood up and walked over to the fence saying “bring it down Tuck” and the mom whispered her remaining comments to her friend. 

If the other team didn’t have such an affinity to swing at high outside balls, then it would’ve been a looong inning.  The umpire held true to the strike zone so every batter went to a full count.  Fortunately, the young batters just liked to swing the bat so the inning ended quickly.  He headed to the dug out – head hung low – and sat down. 

I walked over to check on him “Hey Wild Thing are you ok?” (He didn’t understand the movie reference, but it made me smile)

“My pitches were high.”
“It happens…. sometimes we make mistakes – just bring your pitches down.  He was calling a generous strike zone -”
“But mom, it’s not my fault!” Tucker interrupted me “I didn’t expect to pitch tonight, my Dad wasn’t here to warm me up, and the coach made me clean up someone else’s mess.” 
My eye brows raised….for those of you that don’t speak Kourtney my eyebrows are my “tell” (I will never be able to play poker)… “Excuse me – whose hand did the ball leave? Who threw the pitches?”
 “Me….but”
“Tucker, you threw the pitches – you are responsible for the result.  It’s not enough just to get it over the plate – it has to be in the strike zone.  Now quit complaining and get ready for the next inning.”

Every Pitcher knows that his goal is to throw the ball over the plate in a way that the batter will swing at it (and hopefully not make contact).   It’s a universal understanding for baseball.  The umpire provides the detail on what and where he should focus – the umpire sets the actual strike zone. 

In the same way, every hospital knows that their strategic goal is to have satisfied patients, satisfied employees, and provide quality service….this has been the edict for years.  (Those goals should be the same for every business)  HCAHPS are not a new or revolutionary understanding of providing care that satisfies the needs of the patients.  HCAHPS simply defines the strike zone.  Instead of the general idea of throwing the ball over the plate – we must have “satisfied” customers – HCAHPS provides categories and expectations.  (We can all debate the validity of using “always” but that’s a blog for another time.)

Additionally, HCAHPS defines personal responsibility for our employees and a structure to hold them accountable for those actions.   Tucker threw his pitches high and outside – he was responsible for the every pitch he threw – good or bad.  He had the best intentions to throw a strike, but when the pitch left his hand….it was off the mark.  As his quasi coach that night, I was able to observe be outside the interaction from outside the field.  When he got to the dugout, I provided instruction based on his actions….in essence at the “point of care” I was able to instruct him on his next action.  In the weeks that followed, he pitched to me in the front yard and I could coach him based on his need.  (Did I mention I was a catcher for 10+years…poor kid)

As leaders in our organization it is important to engage during the work day – providing insight into how our team can improve what they are doing based on our outside perspective.   It’s critical that we create coaching moments outside of the heat of battle based on the information collected….Tucker throws a lot of high pitches.  I observed his grip, release, and stance during the game and was able to coach him in the front yard towards a better pitch.  You as leaders need information about how your employees serve your clients - defining not only what your expectation is but what your clients expectation is to find ways to continuously improve.   

 

Are you coaching your team to a better result? 

Do you have the information to be able to do so? 

Do you know what your patients except and are you meeting those expectations? 

Are you depending on post discharge data where the patients view of care has "settled" from the actual experience?

Are you comparing their feedback with the actual to define benchmarks? or do you set arbitrary benchmarks based on your gut feel?

How are you daily engaging at the point of care - gathering data, providing information, and creating coaching moments?

 

Margin

I grew up in a family where the expectation was clearly set that you would advance in knowledge beyond what the teacher was teaching at school, the preacher taught on Sunday’s, or any coach could provide.  It was your responsibility to grow in wisdom.   I have carried that thru into my adult life by maintaining a daily “quiet time” to read, study, and grow - setting aside 45 min to an hour each morning. (which happens to be the quietest time available in a house with 4 young boys.)  

A few weeks ago I started a study called “Balancing Life’s Demands” which discusses mental, physical, emotional, relational and spiritual balance.   The study uses the word “Margin” and defines it as the difference between what needs to be done and the time you have to do it.  I will have yet another birthday soon….not real thrilled about it…..so the identification of what one would call balance or margin is becoming a more focused effort.    

The ironic part of this life assessment is over the past 14 years, I have consulted with dozens of hospitals on defining margin for their organization. I analyze the obscure data generated by specific variable workflow activities and give recommendation on utilizing technology to enhance it.  The software we developed automates much of that process and enables continuous improvement.   Aperum uses data visualization to identify the often misunderstood work load driven form theinconsistent demands on their care teams generated by patients.  

I keep telling myself this life assessment should be a no brainer - life margin should not be elusive or nebulous.  I have built an entire business on designing “at a glance visuals” – where the metric quickly and effectively means something to an organization. However, it’s easy to say “I prioritize my family and church first” but if you look at the quantifiable data of hours spent per week – it’s not really a balanced metric.  (Same is true in nursing if you analyze where they spend the most time – you will find it’s not at the bedside so the perception is the main priority is not “direct” patient care….but that’s another blog.)

Strangely enough, I was a week or so in to this new study when Ed Marx posted his blog Bank Life, Not Vacation Days.  I loved that he had thought of a metric for evaluating whether or not he was in check for his commitment to balance – PTO hours accumulated vs PTO hours used.   A simple and easy to define number that encompasses a lot of information.  That’s the key – everyone knows that you have fewer PTO hours than you do total work hours – so it’s not a 1 for 1 equivalent.   It’s a predefined measurement of additional time away from work. Our payroll company generates that automatically and posts it to our online account – I honestly have never looked at it.  Not because I am pretentious and think the walls would fall down without me (I travel enough to know that my team has the operations side handled).  Mainly, I love work and I don’t really think about it unless prompted by my husband that a vacation would be nice.  I took a look after reading his blog…..let’s just say I booked a vacation next month. 

Thanks Ed.

If you are in Health IT and are not familiar with Ed’s blog  –CIO Unplugged –  he is a consistent blogger that has a way of communicating things that present more than just HIT initiatives – he gets “real”.