Note to readers: This is a bare-fisted observation of a significant problem that exists in many (most?) hospitals today. If your hospital does not fit the model I speak of in this article, I commend you. If it does fit, photocopy this article and leave it on the desk of your boss or the CIO. It may open someone’s eyes.
I don’t know of a single Healthcare Technology Management (HTM) professional who thinks that the Information Technology (IT) department in their hospital represents an efficient, effective operation. And I do not know of anyone who believes that if HTM were to adopt the values and operating principles of the IT world, that we would be able to improve our performance, effectiveness, cost reduction and customer service.
To the contrary, the IT departments in healthcare are almost always (if not universally) held in contempt and looked down upon as embodying inefficiency, poor customer service, unresponsiveness, and tremendous waste of healthcare dollars.
Am I overstating the situation? I do not believe so. The culture and power of the IT world is doing at least as much to destroy healthcare and increase costs as they are to move us into a technological future. I believe in the value of electronic records, patient portals, CPOE, PACS, anesthesia charting systems and all the other sophisticated medical reporting, storage and data analysis systems. I believe in HIPAA and security. What I don’t believe in is the selection, implementation and management of these systems by a department and people who are very new to healthcare, and who have always worked behind the scenes, in the closets and data centers, without venturing into the patient care areas and who have not experienced healthcare alongside the caregivers. It is only here on the front lines that healthcare is delivered, not in data closets or remote monitors or from behind a telephone at a “help” desk or from a computer monitor, dialed into someone’s computer to ascertain the nature of a particular problem.
In HTM, (or Clinical Engineering or Biomed, as we are more often called), we work exclusively in the realm of the patient. Although we do not touch the patient, we are there, beside the doctor or nurse, observing their techniques and providing ongoing advice about the best way to utilize complex technology to make patients better. We understand the frustrations of the caregivers. We see them at their worst, when an uncooperative piece of technology doesn’t perform as expected. We are called at nights, weekends, holidays and during the middle of surgery cases to make things right.
We do not repair or troubleshoot medical equipment remotely. Experience has told us that the overwhelming odds are that the problem is not a hard failure, but most likely a combination of machine complexity, user inexperience, and operator overload. In order to effect an equipment repair, we must go to the equipment, speak with the person operating it when the “error” occurred, and take as much time “fixing the customer” as “fixing the equipment.” Because we assume total responsibility for the proper, safe and reliable operation of medical equipment, we are not content to merely try to find a reason to exclude ourselves from the problem and shift the resolution to somebody else. We always go above and beyond, to make sure that when we are called about a problem with a medical device, that we stay with the problem until it is resolved and the patient is properly treated.
Contrast this to the IT department’s operation. First, the customer is not allowed to speak to a real person. They are instructed to submit a “ticket,” which allows some unseen person to evaluate, categorize, prioritize and schedule the proper response. If a user (we call them customers) does speak to a person, they are subjected to a cadre of questions, similar to placing a tech support call to India. The person on the other end obviously does not know who you are, what your history is, what sort of criticality your patients may be experiencing, or how to do anything other than follow a script and do what the script tells them to do. The person asking the questions could be brand new to the hospital, have no skills or IT knowledge, much less any healthcare or biomedical knowledge. Manning the “help desk” is the lowest paying job in IT and if a person has any real skills, they are not put on the “help desk.”
Well, these 20 questions only serve to frustrate an already stressed caregiver. Instead of being able to call Duane directly and tell him, “Room 2 is doing it again,” they are required to repeat every minute and insignificant detail, with no context or short cuts from the “help desk” person.
Then, after the call is successfully submitted, the troubleshooting usually occurs from behind a desk, logging into the user’s machine in an attempt to rule out the IT department’s role, so that they can close the ticket, implicate another department, and post some impressive efficiency numbers. Is the problem solved? No. Is the customer able to treat a patient? No. Is the customer satisfied with the response, process or outcome? No. Has the problem been shifted to someone else? Yes. IT is off the hook because they proved that it was not their problem. Call someone else.
This is not the way to run a service business. Sending different responders for each call. Making the users wait in a queue, sometimes for days or weeks for service. Not taking total responsibility for solving the problem. Passing the buck, and often being incorrect about the source of the problem. There is not a business in America that would remain in business if they operated this way.
After having observed hundreds of hospitals, and collecting anecdotal opinions from IT users and Biomeds, I have come to believe that one of the reasons that IT insists on making such rigid use of “tickets” and scripts for help desks it to insulate themselves from having to respond. These tactics buy them time to consult, think, talk about possible solutions, and even allow the customer time to fix the problem themselves.
You see, in HTM (Biomed), each and every one of us has all of the knowledge to help a customer, no matter what the problem. If the equipment is truly broken, we can fix it, or provide a loaner. If the problem is with an accessory or disposable, we can troubleshoot the system and resolve the problem. If it is some sort of user problem (as is 70 percent of all calls), we can identify the problem and gently instruct the user on proper technique and equipment operation.
In IT, there are numerous people who possess training in a very narrow part of the technology. No one has the entire answer. There is no single person who can take any problem call from anywhere in the hospital, ask intelligent questions, and resolve it. It always takes some sort of specialist. This is why a “help desk” is necessary – to get it to the right person.
The message I am trying to deliver here is that the culture of HTM is a superior way to manage the user issues with technology in healthcare. The IT model is dysfunctional, costly, ineffective and not in the best interest of healthcare in regards to the caregiver or the patient. HTM and IT should try to align themselves closer, but not for the reasons you might think. The IT department is in serious need of some cultural education, customer service skills, and some better models for delivery of customer-facing services. I believe that IT needs HTM much more than HTM needs IT.
Please feel free to agree or disagree. Share your thoughts with the TechNation community on the listserv by sending an email to list@1technation.com.