Does Work Really Ever Go Away?
By Jim Fedele
Reporting to the CIO has given me a bird’s eye view of all the systems and programs that are being implemented and planned for on a daily basis. As I look at the list it is breathtaking to see so many things going on. Many of the projects have a common purpose, to make us more efficient. As I think about these items and the projects my team has completed lately, I am not so sure that the “efficiencies” ever actually exist.
Computers, software, networks and equipment have enjoyed significant advances. These advances have opened the doors to innovations that we never dreamed of before. In today’s world, we can connect a computer to just about anything to gather, analyze and report data. Almost daily I hear about a new product that will interface medical equipment to a computer, collect vitals and electronically input data into a patient’s record. The promise is efficiency and accuracy; no longer will pen and paper be needed in your organization.
However, as I look at the growth of the IT workforce and my own experiences, I wonder if all these things really save time? I am noticing the advancements seem to do more shifting of labor than actually saving it. It starts with the project planning; a group of stakeholders and technical folks are convened to implement the software. This group is never less than six people and some projects here have had as many as nine. The time commitment is usually a one or two hour meeting plus homework for 90 to 120 days. The man-hours to get a project implemented can easily exceed 250 depending on the complexity of the project. However the largest demand and transfer of labor is in the form of technical support.
We recently implemented a surgical information integration program to capture vitals electronically during surgery and recovery of patients. This system eliminates human entry errors and allows the users to be more efficient. It also increases the focus on the patient. However to achieve these gains super-users and a program administrator needed to be created to manage the system.
When the system doesn’t work correctly, someone from IT or my team is called to help identify and fix problems. I have discovered that the problems quickly become complex because a single department/service line doesn’t own the system. We all have parts of the system, my staff is called for the medical equipment, IT hardware is called for the interface computer and IT software or super-users are called when there are program problems.
The OEM also complicates the issue by falsely indentifying whose problem it is when staff calls them. When I add up all the time needed to solve problems on this system, I think we spend more time on it then the time it took to manually document it. So, essentially we just moved the labor to someone else. I have other examples, including our wireless temp monitoring. Before wireless temp monitoring staff members checked the refrigerators every shift and recorded the temperature. Now, it is done automatically so they do not have to write it down. However my staff has to assign, calibrate and replace batteries on the tags. The labor to do this is quite substantial; I would bet it is more than just writing down the temps.
I am not advocating that these projects are not worthwhile; removing the human element from recording data improves consistency and accuracy. This translates into reliable records that improve patient care. I am just stating that advocating for these systems on the premise that they save time and labor is flawed.
Another element to all this automation is people are slow to change. Imagine spending a million dollars to implement a system that is designed to do a function automatically. To remove a tedious task of writing entries or filing papers, to collect data without user intervention. Then, imagine after six months of implementation the staff is now using both the old written system and the new automatic system. I have witnessed this, the staff doesn’t trust the new system, or the system doesn’t exactly address their need which causes them to keep using the old method. Sometimes it is an interpretation of a regulatory requirement that also prevents people from giving up the old system. When staff members continue to run both systems the work load increases and nobody wins, money is wasted and ultimately the vendor supplying the product will receive negative feedback as well.
My purpose for writing about this is to share with you that these advancements in integration and technology may impose a labor demand on your operation. This fact is seldom pointed out by the vendors when selling systems to our customers. Most of the requests I see for these types of new products always include labor savings in their justification. However, as I have pointed out, the savings may only be within the using department because every system needs support. I am not suggesting we should resist these advances, we should be engaged and ask the question “Who is going to support it and how much time will it take?” There is a higher success rate asking for labor before implementation than after, especially when you are the only one suffering because of the workload. I think we need to be ready to address the labor shift that is sure to come as healthcare continues to be squeezed and people start trying to capitalize on technological advancements to reduce labor and be more efficient. We need to be ready to address the labor shift that is sure to come.
Jim Fedele, CBET, has been with Medical Dealer magazine for more than 12 years. He is currently the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments by email at email@example.com.