Taking the Initiative,” 24x7’s April 2006 cover story, was most refreshing and offered one of the single best examples of how hospital-based biomed departments could gain respect and maintain a positive sense of visibility within their organizations. Specifically, the Dayton Children’s Medical Center’s BMETs’ daily practice of making rounds to their clinical customers sends a tremendously comforting and powerful, yet subtle, message to the clinical equipment users for which you and your department care. Clinicians are often quick to recognize caring and compassionate concern in others. Simply showing up even when you are not needed sends such a message. Once clinicians know that you really care about how their equipment and environment are functioning, they will have more respect for your abilities and a better understanding of your role. Gradually, your regular presence gets to be positively associated with this caring. Once you are recognized as someone who has as much concern for humans as you do machines, a special professional bond becomes established. Alternatively, when clinicians see you only after something breaks or has gone wrong—even if you respond quickly—your presence may now not be received as positively. In fact, you may actually get yelled at for letting the device break in the first place!
Only in health care, it seems, does support staff get reprimanded for responding quickly to an emergency. This may very well be related to the importance and extreme dependence clinicians have on health care technology and the raw frustration they feel when it does not work. Such regular visits, however, should not be merely gratuitously disguised breaks. You need to arrive observant, looking for things that may be out of the ordinary, checking up on previously resolved trouble spots, and simply and sincerely asking how everything is going. Getting out on the floors and checking in with your customers may be an uncomfortable process, especially for the introverted BMET or CE, but the rewards can be substantial.
A serious and somewhat negative consequence of any support service is that the more effective and efficient you become, the more invisible you tend to appear. If equipment users see that everything is working virtually all of the time, they naturally start to take such reliability for granted. In time, the efficient and well-managed biomed department—without having established this positive sense of visibility—will tend to become invisible. It is often then that others may start to ask, “Who are these guys, and what do they really do?” Making regular visits to your customers can neutralize this downside of service efficiency. Once this practice of making daily rounds is started, however, it has to be continued. Clinicians will eventually start to expect it.
Once, about 30 years ago, I didn’t get to the intensive care unit for a few days—while some device sat broken. Later, in exasperation, I asked, “Why didn’t you call me?” Their response was, “Oh, we knew you’d eventually show up.”
Unfortunately, and within many organizations, this practice of making rounds may have been displaced by the now somewhat obsessive and dysfunctional emphasis on productivity and accounting for every millisecond of your day. To be truly effective, the making of rounds cannot be viewed as a “billable service.” You should not be required to document every minute you are out building goodwill and identifying latent defects throughout the hospital. Such a requirement only discourages the practice. Of course, department managers need to be fiscally accountable, and appropriate time recording is essential. The making of rounds, however, should be viewed as a “value-added” service that is associated with your department and its professional responsibilities. This is one activity that you should not worry about having to document.
The BMETs at Dayton Children’s Medical Center are to be commended for keeping this practice of daily rounds alive and sharing it with the rest of us. It works, and it will speak volumes about you and your department.
Larry Fennigkoh, PhD, PE, CCE, is an associate professor of biomedical engineering at the Milwaukee School of Engineering.
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