Steve Cunningham recently received an urgent call moments after the line isolation monitor alarm began beeping loudly in the operating room (OR) at Milford Regional Medical Center near Boston. “Are we safe in this room?” asked an anxious OR nurse. She told Cunningham that a surgical procedure was under way. Cunningham, clinical engineering manager at Milford Regional Medical Center, quickly and calmly explained that because the power in the OR was isolated, there was no risk of shock. The alarm could be silenced and would be investigated when the case was over. Reassured, the nurse returned to her patient, and when the procedure was over, Cunningham headed to the OR to fix the problem.
The story reveals some of the critical challenges facing clinical/biomedical engineers when it comes to communicating with nontechnical personnel. Cunningham was not only expected to instantly know what was wrong, he had to explain the problem to the nurse in such a way that she felt informed and relieved and could turn her full attention back to caring for her patient. On top of that, he had to do it all under highly stressful conditions.
“Without question, the ability to effectively communicate technical issues to doctors, nurses, and others has become a key part of a biomed’s job,” Cunningham says. “It is an essential and sometimes complex skill you have to develop.” Whether it is explaining how a device works or sometimes why it is not working, or showing how to protect it from damage, or providing information as part of a device acquisition team, biomeds are increasingly relied upon to provide a bridge of understanding.
In most cases, the burden of communication falls directly upon the BMET and CE. Issues can be extremely technical in nature, and it is up to the health care technology management professional to break them down into lay-language, without compromising the integrity of the information. Since this type of communication is not something that is usually stressed in a technical education, much of it is learned on the job. Here, you will find a team of experts who share some of the lessons they have learned in communicating with nonmechanical personnel over the years. Although many mechanical issues are unique, these tips will hopefully help you refine guidelines for getting your information across in an effective manner, especially during those urgent times when patient care is on the line.
The leadership in your facility can help by getting the clinical departments and biomedical/clinical engineering departments together to define common goals and purposes, all of which would ultimately center on patient safety and customer satisfaction. These kinds of meetings can open lines of communication and generate better relationships between technical and nontechnical personnel. It is also a good time for biomeds to explain what they do—and do not do.
“Without that understanding, most of the other people in the care center just assume that you are in charge of everything mechanical,” says David Meador, biomedical equipment support specialist at the Edward Hines Jr Veterans Administration (VA) Hospital in Chicago. “They just assume that ‘biomed magic will fix it, now!’ For example, not long ago the air conditioning in our building went out and soon people in the center were calling me to complain their computers weren’t working. I explained that the computer system had overheated, and before we could get them back up, they needed to call a mechanic to fix the air conditioner. They were surprised. I was the equipment specialist, wasn’t I? Why couldn’t I fix them both?”
Meador and other experts stress that biomeds should continue to reach out to the clinical personnel they service. “It helps if you take time to get to know the people you will be helping with their technical issues,” says Jim Souza, biomedical equipment support specialist at the Providence VA Hospital in Rhode Island. “I try to be up and in a positive mood whenever I am around them. The biggest issue is that we are almost always on-call in an emergency situation when everyone is experiencing stress. It’s really helpful during these times if you have established a relationship with them beforehand. Everyone will be that much more relaxed, and that makes dealing with the issue much easier.”
Make Deposits Into the “Trust Bank”
“Any ‘pre-emergency’ communication you can have with the nonmechanical personnel should include little bits of education for the customer about your role and the technological process,” Meador says. “The reason for this is that problems with the ‘magical thinking’ process can arise when biomeds make it all look too easy. Nonmechanical workers often discount the many years of training and experience that it took for us to gain this ‘magical’ knowledge. Then, when a problem involves more than a pure knowledge fix, the magician starts to look less magical. Trust is lost.”
Providing ‘bite-sized’ insights into the technology process with customers helps prevent this from happening. “In this way, you share the magic with them and it becomes an exchange of trust,” Meador says. “Now you have a customer who participates in solutions rather than leaving it all up to the magic man.”
Meador stresses that trust is crucial and that biomeds should seek out every opportunity to strengthen that trust. “If you create a track record of quick response and customer satisfaction, you will have built up a ‘trust bank account’ that you can draw upon,” he says.
Keep it Simple
“One of the key things is to make things understandable for customers,” says Sean Keeley, senior clinical engineering technician at the Harbor Hospital in Baltimore. “It’s important to remember that often the new equipment represents a change in the way our customers have been doing their work, and that can be a big psychological hurdle for them. Many don’t like it, and you can feel the resistance.” As the person showing them how to make that change, biomeds can be in the line of fire when it comes to customers venting their frustration.
“With those customers, I work especially hard at explaining, in simple terms, how the new technology can become a useful tool they can use to do their job more efficiently,” Keeley says. He added that being as accommodating as possible makes a big difference in overcoming a customer’s frustration. “I’ll work with them on the phone or in person, whichever is best for them,” he says. “If the issue is technological, I will offer to train them whenever it is most convenient for them. By keeping it simple and meeting their needs, I can develop better relationships with the departments, and that has lasting positive effects.”
Explaining technical processes in layman’s terms is crucial, whether the communication is written or verbal. “It’s important to avoid the overuse of technical jargon and acronyms,” Cunningham says. “The best example I have in my career is the capital equipment consulting reports I prepare for hospital administrators. I start my communication with background information on the device. This is similar to a Scientific American article where nonexperts can read a page or two into the article and understand it from a big-picture view, before the report gets to the point where only someone in the field can follow it.”
Cunningham also uses simple photographs and illustrations early in his reports, and defines standard terms in clear and simple ways. “Once the pictures and definitions establish a clear understanding of the subject, I can proceed to the body of the communication. It’s in this section that I make my recommendations, or help the readers become informed about the decisions they have to make.”
Part of the reason for keeping it simple has to do with the worldwide aspect of many medical centers. “Our lunchroom sounds like the United Nations,” Meador says. “I have had the most success when I restrict myself to a fifth grade vocabulary with simple, short sentence structures. I do this not because workers have poor English skills, but because we have people from all over the planet working here. They may have a PhD, just not in English.”
It is a temptation for technically oriented people to grow frustrated at the lack of savvy of nonmechanical workers. “You have to overcome that,” Souza says. “I work as hard as I can at getting to know the people in the hospital so I can determine with whom I can talk technically and with whom I have to be basic. One thing I always keep in mind is that even the nonmechanical people are usually highly educated. For example, if they would talk to me about the internal workings of the human body, I’ll just have to sit there with a blank stare. Maintaining respect for your customers makes it easier to have the patience we need to explain technical issues until they understand. You have to make them feel their problem is important, and it usually is.”
Listening closely to physicians, nurses, or other clinical providers is critical to creating successful relationships. “You have to always make it clear to them that you understand what is at stake for them,” Cunningham says. “Don’t be dismissive of their complaint, even if it doesn’t make any sense to you. Never assume operator error. If it does turn out that way, make sure you explain the proper process to them in a way that isn’t patronizing. Recruiting them into the process should be your goal.”
This also applies to training sessions. “Make sure it doesn’t seem as though training them is a chore for you,” Keeley says. “They will see that, and you won’t be as effective.”
An important aspect to keep in mind is that you are invested in how well your customers can use the devices. The better they are at it, the fewer problems you will have.
Working With IT
In health centers where software is updated regularly and proper training takes place, working with IT departments does not present a big issue for biomeds. However, working with outdated systems, where the medical devices and software are not coordinated and updated jointly, or where the departments take action in an isolated manner, it can be a nightmare. Sometimes the biomed is expected to fix the IT system, or is left trying to communicate with the software experts to resolve issues the best they can. Proper documentation and training will erase these issues, but sometimes that does not happen.
“We are on the verge of a meltdown because of this very thing,” says one biomed. “It is an exercise in the ‘Law of Unintended Consequences.’ Some of our medical equipment is 10 years old, and we are trying to fit new computer systems to it.” While no easy solution exists in this unenviable situation, biomeds can meet this daily challenge by using the communication tools they have learned and continuing to interact respectfully with all individuals and departments involved to stay on top of the situation.
Communicating During Equipment Acquisition
Biomedical/clinical engineering departments increasingly find themselves involved with selecting which devices to purchase for the health centers. Effective communication during this process is essential. Many, like Keeley, are asked to assess departments for devices that need to be replaced, or to do research on the functionality and cost of equipment to be purchased throughout the health center. Keeley is careful to choose just the right amount of technical detail in his reports. It must be enough to help the department heads make a sound decision, but not so much that they are confused. This thin line of technical communication can be a delicate thing to achieve. Allowing one or more of your savvy, but nonmechanical, colleagues to read it can test your approach. If they do not understand parts of the report, you may want to rewrite those sections before sending it to leadership.
According to Meador, successful equipment acquisition happens when potential end users, the finance department, the biomeds, and administration representatives get together beforehand and decide what they need. Biomeds will benefit from taking an active role in this process, clearly explaining how a device would work, what it will require in terms of installation and operation, and how it fits in with the existing equipment.
To meet these ever-increasing communication demands, biomeds need to build a system of continuous improvement. Listening to colleagues’ feedback about your communication efforts is critical. The goal is to build on the positive remarks and learn from the constructive criticism.
“At a previous hospital, after I rewrote our policy the equipment management committee told me it was the first time they understood their mission,” Meador says. “That was pretty satisfying. But, it isn’t always easy. Biomeds are typically right-brained, and communication isn’t always our specialty. I recommend that, if you are having trouble, find a left-brained communicator and pick his or her brain about the issues you face. Learn all you can, and never stop. I recommend that all biomeds take communication classes whenever possible. Communicating is a big part of what we do, and it’s probably only going to grow more important in the future.”
Michael Bowker is a contributing writer for 24×7. For more information, contact .