By Todd Britton
A trend has emerged in healthcare technology management (HTM), which is to become a High Reliability Organization (HRO). Documentation is a key component of high reliability, and the heart of good documentation is meaningful data – lots, and lots of data. Admittedly, documentation can be tedious and time-consuming. However, improved health care system documentation facilitates higher productivity, improves patient care and, ultimately, saves lives.
Consider receiving repeated requests for service regarding the same issue. Nothing is more effective than consistent information indicating the root cause of a problem. It can potentially indicate a new approach. It shows where action should be taken to permanently resolve the issue. For example, a customer reports that they briefly lost network connectivity on a system. They claim that this happens all the time and no one seems to fix the problem. They bring up the dreaded fact that “this is adversely affecting patient care.” The equipment history doesn’t appear to support their claim, since there is only one other record of this issue. During a follow-up conversation with the customer, they mention that when the problem happens, they typically pick up the phone and call a specific technician, and the problem goes away. The technician, says that he is aware of the issue, and he takes care of the customer every time they call. He tells you not to worry because he simply resets the network switch in the telecom closet and the issue is resolved. This situation occurs every day across all industries. Now try to picture an alternative scenario unfolding after the initial event occurred. Instead of finding the work order history mostly undocumented, the service history shows that the customer has been losing connectivity every Wednesday morning for three months and that it occurs around the same time each day. Coincidently, this is the exact time that the hospital tests the emergency generator. Let’s say that for this example, the telecom closet network switch was connected to the wall outlet, and not to the rack UPS, which is what is causing the issue. Problem solved. This actually plays out weekly in the field and it is an example of how good documentation guides troubleshooting.
Consider a system so old that local schools and museums are offering to pay to take it off your hands. One of the best ways to support replacing old and worn-out technology is by utilizing documentation. A list of service events occurring over time can show that a system is no longer economical to repair. Instead of believing that a request for a replacement system isn’t justified, management is listening, since the information is being presented in a way they understand and appreciate. The desired result is a direct outcome of a strong commitment to documentation. Good documentation shows that a $80k service agreement for maintenance is better than a $200k unexpected CT tube replacement. Management wants proof that they are getting their monies worth. Trying to explain to leadership why the $220k unexpected expense wasn’t included in your yearly budget can be a difficult conversation, but an even worse situation is having to explain to staff why there will not be any Christmas bonus this year.
Joint Commission inspections can evoke fear and their visits are not typically considered a fun time. Does this always have to be the case, or are there things we can do to alleviate some of the discomfort? The following example happened recently. During a JC inspection, an inspector asked to see the preventative maintenance (PM) history for every medical imaging device belonging to the radiology department. Now I work at one of the largest VA hospital networks in the United States. I confess, the first thought that popped into my head was retrieving that much maintenance information was an impossible task. We performed a database search and within minutes had a record of every imaging system, every PM and all work order notes. But then, we noticed that one PM was apparently missed. It caused panic. However, after reading the detailed notes on the original work order (Hooray for Documentation!), we discovered that there were extenuating circumstances. The PM was performed off-schedule. The off-schedule work order had the original PM work order number, with a detailed explanation of the situation. The inspector was happy. The technician’s thorough documentation not only showed their commitment to excellence, but they also helped navigate a stressful situation. This reflected positively on our department, our clinic and our entire organization.
As a biomedical engineering supervisor, I am looking for the following in documentation:
- Complete sentences with accurate spelling and punctuation. Anything less can reduce the effectiveness of the message, and negatively influence how the information is received. Everyone makes mistakes, but good documentation should not be characterized by errors. Your extra effort will influence the reader to believe in you and increase the credibility of the information.
- Be truthful, concise and to the point. Do not attempt to manipulate people by obscuring the truth. It rarely has a positive outcome. Maintain the trust of your intended audience, so they continue to listen to what you have to say. Include just the facts and leave out your personal feelings. Take a moment to ask yourself how the message would be received if it was read by the company CEO.
- Be strategic by understanding the purpose of the information you are providing, and document with that goal in mind. What are you trying to accomplish? Is the reader getting inundated with unnecessary information that interferes with their ability to clearly understand your message? Are you providing the key information that potential readers are needing? Too much irrelevant information can simply create more issues.
In conclusion, documentation is a great equalizer. You might not be the greatest technician in the world, but if you are able to reliably record an accurate picture of events regarding the history of a medical device, you are a hero. Your work is instrumental to the success of any organization. Good documentation makes everyone who prioritizes it an extremely important part of a team, that exemplifies high reliability, great customer service, accountability, compliance and, ultimately, the best possible patient care.
