As a hospital operations consultant I spend countless hours in health systems large and small engaging with clients who suffer from frequent shortages of mobile equipment like infusion pumps. In most cases, what I find is a redundant cycle in place where nurses cannot get pumps when they need them so they end up hoarding and hiding them which in turn leads to ‘perceived’ pump shortages, more time searching and more equipment hoarding. In these cases, the nursing staff have taken matters into their own hands to make sure that they can meet patient needs; in other words, they put themselves into the pump management business and I can’t fault them for doing what needs to be done to ensure quality care for their patients.
Perhaps some of you reading this are nodding your heads saying, "Phew, I thought it was just us!" Rest assured, you're not alone.
Most nurses don't lay awake at night thinking about where they need to hide their own personal stash of pumps but for some reason pump shortages are plaguing nurses and hospital operations staff alike which ultimately leads to buying more, renting more or both. Simply stated, nurses hoard pumps because they don't trust that the next time they need one, it will be available. I'm sensing a breakdown in process that leads to a lack of trust.
Cause & Effect
Being naturally inquisitive, I like to ask lots of questions about who, what, when, where, why and how things happen. Lean Methodology has taught me to keep asking these questions in order to flush out why a particular business process isn't functioning as well as it could be. When I start asking questions about how pumps and other types of moveable medical equipment are managed in a particular hospital, whether they are centralized, decentralized or a combination of the two, what I typically find is lots of finger pointing. Meanwhile, at the point of care, nurses remain in the pump management business.
RTLS to the rescue?
Some hospitals go as far as putting Real Time Locating System ‘tracking devices’ on all their pumps and other moveable medical equipment, instantly "knowing" where all their equipment is but yet the hoarding and hiding continues and sometimes worsens. Why?
The common theme amongst these health systems is a lack of transparency, governance and overall accountability as to how moveable medical equipment is managed. Simply tagging equipment with tracking devices has proved widely ineffective other than further exposing there are underlying broken processes tied to medical equipment distribution which need to be addressed.
Understanding Demand & Capturing Utilization
Taking the time to identify and fix the sub-optimal business process of making sure the right equipment is available at the right time will build back trust with nursing. To accomplish this we must start with capturing demand for pumps and other moveable medical equipment across service lines. Understanding who needs what, when, where and how often will help us effectively manage the supply of equipment to meet demand and capture utilization. Understanding demand and utilization allows us to become predictive about equipment needs based on seasonality, spikes and drops in census and patient acuity levels. Understand demand and utilization helps us determine if we have too many or if we need more. Understanding demand and utilization helps us make informed buying decisions when it comes to replacing the fleet. These metrics are extremely difficult to capture by simply tracking movement. Visibility doesn't drive workflow optimization. It's just the opposite!
Culture eats strategy for lunch
Creating a culture of transparency and accountability between support services and nursing for equipment distribution has been proven to build back trust. With trust in place, nurses will release equipment to designated soiled holding areas when they're done using it. By applying the smart use of tracking technology, passive or active, we can proactively drive the soiled rounding process and ensure equipment is being picked up, cleaned and returned to service in a timely manner.
Let's work together to fix broken process THEN introduce the smart use of tracking technology to get nurses out of the pump management business so they can focus on more important things like the patients they're caring for.