Donald Armstrong: Report on Metrics that Matter to Your Hospital

As healthcare technology management (HTM) professionals, we routinely report on many items. I have reported to environment of care (EOC) committees for years, and it seems that we report the same old numbers, such as preventive maintenance (PM ) completion, unable to locate, and recall rates. And while these numbers are still very valid and important, I wonder what else should we focus on and report.

A little background: I am married to a nurse so I get to hear about all kinds of things that are important to the nurses. She knows more about biomed functions and metrics than your average chief nursing officer; believe  me, PM completion rates are not on the top of her things to worry about in the patient care environment. She and her clinical colleagues care about having equipment available at all times to care for their patients (assuming the equipment is in good working order).

And trust me: Do not use or report “user abuse” or “user error” in front of her. She and her nurses cringe at those terms. Consider instead “use error” or “use damage.” It’s her advice and I completely agree with her. (I know what is best for me.)

As an HTM professional, I understand that having up-to-date stickers and PMs are important to the well-being of medical devices, and they satisfy regulatory requirements, but such steps do not really tell the complete story of how HTM is performing. Are we really helping the hospital be the best it could be? Having 100% life-support completions and above 95% completion on the remaining equipment does not mean that all of it is working well, nor does it mean that the biomed department is doing all it can to support the hospitals goals.

Let’s imagine what could help us tell a broader and more complete story. Let’s start with a medical equipment management plan (MEMP) that could include any performance indicator (PI) we could measure and improve. We love hard and fast numbers in the HTM community, but remember I am married to a nurse. Let’s say, for example, we could somehow measure and monitor healthcare-associated infections (HAIs) as it pertains to biomed. HAIs are directly associated with hospital reimbursements and are very important to hospital leadership, but how could biomeds measure that and report the numbers? Good question, huh? I feel we could start by compiling hand-washing stats or glove-wearing numbers. Plus, how we clean equipment, or how we receive equipment, could be tracked. Such numbers would be helpful metrics to report and share with hospital leadership.

How about patient satisfaction, which are also key to reimbursements? I am not sure how this could be related to biomed, but I am sure there is a way, as the facility does track those numbers. Another idea would be customer satisfaction. What do our customers think of us? This is a bit easier, and most of us already do this through surveys and face-to-face meeting with our hospital colleagues. Customer satisfaction is also a good indicator of how the department is performing, and it is easy to measure and monitor.

Other ideas I have would be to measure employee training,, competencies, and retention. Again, these numbers would be easy to measure and monitor, and would tell a story about how the biomed department is doing.

All in all, I would love to see us use all the hard numbers and soft numbers to tell a more complete story about HTM, its role, and performance in any hospital.  A combination of the numbers presented above could tell an interesting tale if we are brave enough to look deep into the woods to find the real and complete story.

Try to picture yourself at your next EOC meeting reporting on something new. What is that metric you are reporting? What ideas do you have? Dream big and be creative because we have lots of room for improvement and growth. Please respond with your ideas, or let us know what you are doing that is a little outside the box.

Donald Armstrong, CBET, CHTM, works at Stanford Health Care in California. He is a member of AAMI’s Technology Management Council.

7 thoughts on “Donald Armstrong: Report on Metrics that Matter to Your Hospital

  1. Great post, Don! In my dream world, we stop measuring things because we THINK they are important — regardless of how experienced, intelligent, dedicated, etc., that we are. Instead, we compile data in a national database (a start on this is being made with the RCM project), and find a way to scientifically tie what we do to positive healthcare outcomes. Once we figure out scientifically what things we do actually positively (or negatively) impact healthcare outcomes, we can stop living in our own little world and actually measure what matters!

  2. Most if not all the metrics described here are reactive in the sense that design decisions at the device level are made well in advance of integration at the point of delivery of care. This is taken for granted in healthcare, but is it in any other domain where safety is of utmost importance? Consider all the user interfaces presented to a clinician when they appear at an intensive are bedside. Would you want an airline pilot to have to deal with the same level of human factors integration? A nuclear power plant operator?

    Metrics could take into account integration issues addressed that avoid having to address use errors in the first place. Equipment not purchased because its user interface did not integrate well with existing systems. Bedside system design changes to enable more consistent users interfaces at the bedside. Human factors issues reported to ECRI, FDA, manufacturers, etc.

    It is difficult if not impossible to measure problems avoided by proactive actions, but that’s the point of PM, no? Compliance is an indirect indicator; what others should be considered? Number of reviews of materials used to train clinicians in the use of equipment, including number of improvements made to the training materials?

    How would you prefer your customers to perceive you: As the person to call when all hell breaks loose or the person to call to make sure all hell doesn’t break loose in the first place?

  3. Lack of documented process and failure to follow documented equipment failure processes are good metrics that encompass many issues biomeds encounter. I’m not saying go full on ISO 9001, but use common sense.

    I ask nurses: If a patient presented wearing a sign that simply said “broken,” how efficient and effective would our diagnostics and treatments be? When would the care team stop searching for health issues that required treatment? How expensive would it be if no health issue could ever be found?

    For biomeds, devices are our patients and PM is the annual physical exam.

  4. I can understand the “I know what’s best for me” statement. I also know that Work and Home are two different things. I don’t talk work at home; my wife does. Today, I would not presume to tell my wife how to deal with the other women she works, and I wish it was likewise for her to tell me about the guys I work with. Mars and Venus come to mind.

    In her rantings, I have learned that “IF” you soft your approach to an issue, you soften the need for correction, and nothing get corrected.

    I am proud to be working at an ASC with 600 pieces with 6 OR room and 10 patient rooms. You’re thinking “cake walk,” and you’re right. I still get my fair share broken, don’t work, it won’t stop alarming, this light is drifting, damaged equipment, damaged power cords. You guys know the stories behind each statement, “don’t know what happened,” ” the nurse that reported is not here,” or one of my favorites, “I tried everything and it still doesn’t work.”

    My matrix show 3% of the reported problems are actually problems. I found during walk-through unreported problems are at 4%. Unreported has dropped from 18% in the last 3 years since I started here.

    When it comes time to report my matrix, I’m blunt even to the doctors — using the term, “Patient Care, Safety and Satisfaction are at Stake.” Please tell me if that is not the truth when it comes to a nurse who can’t make a pump work or when a bag of lactated ringers is pouring out over a mounted power strip and the power isolation alarm is going off.

    Our facility is rated at a 96% patient satisfaction nationally and 98% in our corporation of 160 facilities.

    My point is: Stay blunt, stand by you matrix. If that isn’t enough, work on other matrix points that prove your standing. They will soften your matrix without your input.

    Being politically correct so as to not to offend other only hurts when it comes to: Patient Care, Safety and Satisfaction are at Stake.

  5. One observation about making mistakes (i.e., use error): this, that it’s very difficult to be introspective and over time clinical equipment users have really been an easy target for all sorts of reasons. Over the 29 years I have been involved with biomedical engineering I have yet to hear a biomed or a group of biomeds ( myself included ) talk about the mistakes we have made and so the conversation has always been one sided. I would suggest that’s a metric we start with because once we level the playing field it’s easier to move forward and it’s a metric which is just as important as user error.

    I’ll go first. One which clearly sticks out in my mind is a protective lens which I replaced in a SLT Laser ( mid 1990s ) and on the first patient it exploded (once the cover was removed you could see the glass pieces; I must have touched it or something) and they could not use it. At the time, I was not told about outcome or what happened, but knowing what I now know about what goes on in theater I can only imagine havoc it would have caused at the time. For one thing, the patient would have been under at that point in the procedure.

  6. Hi Donald,

    It might make some of the clinical staff really angry when you use the words “user error,” but I do think you need to consider the consequences before opting not to do that. The link below is an example:

    Rather than avoid difficult subjects because they could make a few or even a group of people angry, HTM professionals should probably consider risks and potential negative outcomes — and tackle those issue head on. In all likelihood, they are the important issues.

    From the link above:

    “The surgeons had a quick briefing, asked a nurse who had never heard of the equipment to put it together, and then didn’t read the manual or safety instructions.”

    I run a company with a focus on making user manuals available to all staff via the intranet — time and time again, I get comments from people who discount the user manual as something nobody ever reads. Professionals at all sorts of levels seem to accept this and yet a significant portion of these devices we use can kill and cause serious injury. I think that is important.

    Remember, Dr. Semmelwis rubbed a few people the wrong way when he introduced the concept of washing your hands before touching a patient; imagine if he never broached that subject.

    • Consider this from the ECRI 2016 top 10 list: #5 Insufficient Training of Clinicians on Operating Room Technologies Puts Patients at Increased Risk of Harm.

      Certain service calls one takes involves correcting a use error then attempting to provide an in-service to the person(s) who initiated and or triggered the service call.

      In other cases, a device presented as “broken” is found to be functioning correctly in the biomed lab.

      The occurrence of calls like these should be used by the safety and QA staff to target improvements in education and caregiver competence to both the care staff as a whole and specific individuals.

      How would the airline industry treat a flight crew who kept forgetting to put the wheels down before landing?

      As biomeds, part of our job is to minimize technology related hazards that can lead to negative patient outcomes.

      If one saw a power cord that was damaged with exposed copper showing, we would repair it immediately before someone got shocked. What should one do if one becomes aware that a caregiver just can’t seem to correctly set up and operate a medical device?

      Both are hazards. One we would fix immediately; the second is the type of “metrics that matter” that biomed professionals everywhere should be talking about. Given that, it did make the ECRI top ten list.

      Can you share your thoughts on how this topic could be translated into a “metric that matters”?

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