By Phil Englert
Everybody knows biomeds and IT don’t get along. Techninjas and Computeniks don’t even speak the same language. Face it, they just don’t like each other. Healthcare technology management (HTM) teams and information technology (IT) teams have a reputation for not playing well together and, as fun as this might be to pull this thread further, the reality is that the cycle must be broken.
In health care, the lack of cooperation can have significant consequences. Delays in getting equipment installed or back online can frustrate staff, delay care, and, in extreme circumstances, result in patient harm. When caring for patinets, any of these results are unacceptable and all are avoidable. Consider for a moment, “West Side Story,” a popular adaptation of William Shakespeare’s “Romeo and Juliet.” This modernized version pits two rival gangs, the Sharks and the Jets, against each other to resolve a territory dispute, with predictable misunderstanding resulting in tragedy. In health care, medical devices are the disputed territory between HTM and IT with both groups of technical experts claiming dominion.
Let’s look at the factors that can cause conflict between technical teams to better understand the friction points and enable us to find the common ground needed to work effectively and efficiently to support the connected medical device environment.
Differences in technical expertise: Technical teams are typically composed of members with different levels of technical expertise. When there is a significant difference in knowledge or skill level, it can lead to conflicts, particularly if team members feel undervalued or overburdened. HTM staff are responsible for keeping medical devices operational and IT staff are responsible for keeping medical devices connected and communicating with other systems essential for health care delivery. This might be servers in the data center, clinical workstations, diagnostic imaging machines, monitoring systems or treatment planning systems. HTM staff are often specialized by type of equipment. There are specialists for radiology systems, patient monitoring systems, surgical services, clinical diagnostics and general biomedical devices. IT staff specialize as well but usually by infrastructure specialties like desktop, network administration, IT support/helpdesk, database administration, backup services and others.
Communication breakdown: Communication breakdown is one of the most common causes of conflict between technical teams. If team members are not communicating effectively, or if they are using different communication styles, misunderstandings and disagreements can arise. HTM and IT use different systems to track the assets they are responsible for and the tasks they perform. HTM staff use work orders to track their work while IT has ticketing systems. The different tracking systems are optimized for the assets being managed and the work being performed. HTM systems focus on physical things like devices and parts. IT systems operate in more ethereal world of applications, operating systems, interfaces, and access and mail accounts. Sure, there is hardware but while the IT team supports maybe 50 types of equipment, the HTM teams support up to 1,500 makes and models with hundreds of specialty functions. For medical devices, both groups often have responsibility for the same device or system. HTM keeps it running and IT keeps it connected. Only by agreeing to work together can the two groups hope to be both effective and efficient. One of the biggest challenges is correlating the data from both asset management systems so that a complete picture of the asset attributes and service events can be assembled.
Lack of clarity on roles and responsibilities: When there is ambiguity around who is responsible for what tasks, conflicts can arise. This can occur when team members have overlapping responsibilities, or when there is a lack of clarity on who is accountable for specific tasks or projects. The connected medical device environment is rapidly changing. Manufacturers are building interoperability into technologies at an alarming rate. Health care thrives on data and medical devices generate a significant portion of it. Automating data transfer to and from medical devices drive care delivery efficiencies. This explosive growth is characterized more by seat of the pants innovation than a well-orchestrated plan. Much of health care interoperability was driven by the desire to share knowledge and improve data capture. These efforts have enabled wonderful innovations in care management and hospital operations. The possibility and reality of connectivity preceded the technical and operational processes to manage it. This disjointed growth can leave technical teams scrambling to get things done rather than working within a choreographed plan. Take time to sit down with all the stakeholders, list the tasks needed to manage technology and come to an agreement of who is doing what. This is a good first step to building a cohesive and effective management plan across all the support teams. If this sounds like a RACI, it is. If you don’t know what a RACI is, ask your IT counterpart.
Resource constraints: Technical teams often must work within tight deadlines and limited resources. When there is not enough time, money or personnel to complete a project, tensions can arise between team members who may have different ideas about how to allocate resources. You need only follow industry news to understand that health care is having a tough time of it. Each week, there are stories of hospital closings, huge revenue losses, services being cut and staff reductions. Health care delivery’s shifting from inpatient to outpatient setting has altered the entire industry. Suffice it to say, when it comes to maintenance activities there are never enough resources to do all the things that need to be done. Newer technology is simply more expensive to maintain. There are new tasks that need to be done, interfaces to maintain, updates to apply, access accounts to manage, perimeters to monitor and recovery plans to develop just to name a few. Without the budget for more resources, we would rather shift the responsibilities to other departments rather than take it on ourselves. Take a moment to consider that your counterpart is under the same constraints and thinking the same thing. This is the time to team up.
Organizational culture: The culture of an organization also plays a role in conflict between technical teams. If the organization prioritizes individual achievement over collaboration or if there is a lack of transparency or trust, it can lead to conflicts between teams or team members. HTM staff work independently for the most part. An equipment issue is usually a one-on-one event – one machine, one patient, one HTM technician. IT departments tend to be more collaborative. Issues are often one-to-many events. Taking down a server can impact hundreds of staff. Seemingly insignificant setting changes can ripple across the network interrupting multiple services. Recognize that you don’t have the same jobs but both groups are essential to keeping things running. We can’t know it all so we must rely on the skills of others. Respect that difference and use it build a better story together.
Recognizing and empathizing the operational norms of your counterparts can go a long way towards building effective and efficient cross-functional teams needed to support the complex interconnected healthcare technology of today and tomorrow. A couple of things you can do to start are as simple as a lunch – no pressure, take a couple of pizzas to the tech center, sit down to lunch and get to know each other. Talk anything but tech. Invite IT to Environment of Care meetings where they can hear how health care manages operational risks. Take an IT counterpart on a “back hallway” tour of the hospital. Show them what an ICU room looks like, how busy the ER is, what an MRI control room looks like and other clinical care areas. Help IT see that the windows box they monitor on the end of the wire is an image guidance system used during spinal surgery. Take advantage of opportunities to work together and collaborate. Find the common ground needed to work effectively and efficiently to support the connected medical device ecosystem. Had the Sharks and the Jets looked for the many similarities that existed in their gangs rather than seeing just the differences, the cycle of misunderstanding may have been broken and tragedy averted.
Phil Englert is the director of medical device security for Health-ISAC.
