|Left to right, Todd Poor; Karen Waninger, director, clinical engineering; Kelly VanDeWalker; and Steve Erdosy.|
“Listen to your employees” is one of the most tried-and-true pieces of advice for managers. Yet, in many organizations, it is heeded about as often as the recommendation to not eat too much at Thanksgiving dinner.
For Karen Waninger, who assumed the role of director of clinical engineering at Community Health Network, Indianapolis, about 6 months ago, it is more than simple hyperbole. Among a myriad of other changes she put in place, in December her e-mail address started doing double-duty as a suggestion box.
“I think one of the most important things I can do is just ask for their ideas,” Waninger says. “They have a lot of insight into how things could be better or how we could do something differently. They know if a process is working at one site, but that another site doesn’t want to try it, for instance. So we have implemented a little prize each month for the individual technician who comes up with a suggestion we can implement for standardization, within our own department, across all of our facilities.”
Techs can e-mail her ways they think the department, or the service it is providing, could improve, and then the team votes on whose idea has the greatest impact. Not only does it net the idea’s originator a prize (the current reward is a 20-piece screwdriver set), but it also helps her biomeds understand that she really is listening.
And it’s working. The first handful of entries included a proposal to unify how the team puts due dates on equipment. If a piece of equipment was inspected past its scheduled date, some techs listed the next inspection a year from when it was actually examined—in effect putting it on a floating schedule—while others wrote in a year from when it was originally planned, essentially letting it remain on a fixed schedule.
“As a result, we had different people implementing different scheduling strategies on the same device,” Waninger says. “Because of this suggestion, we were able to work on finding a way to make our work consistent.” She adds that such small changes can make the difference in a department’s efficiency. “They are the ones who are living those processes every day and every month, so rewarding them for offering suggestions really pays off.”
The biomeds are just as happy about the newly opened forum. “We’ve never had anything like this before, but it’s working out very well,” says Kelly VanDeWalker, a senior biomedical technician BMET 5 at Community Health Network. “And she doesn’t just ask the upper techs, she asks them all. The part we like is that she’s going back to the techs and asking their opinions—and then actually applying what they have to say.”
Beyond improving the processes in place within the department, this one simple move has done wonders for the team’s morale.
“The first week, we had one idea,” says Steve Erdosy, technical site leader for The Indiana Heart Hospital, a part of Community Health Network. “The next week, we had seven ideas.” He credits more than free screwdrivers for the up-tick in the team’s enthusiasm. “It’s more about the approach to putting it into effect. She put a positive spin on it, and by doing that you get more buy-in from the staff. I think the energy in the department has increased since she’s been here—and people are excited about that.”
Waninger also feels the increased enthusiasm among her crew. “They had always been a very, very dedicated group of technicians, but I think even that is a little bit renewed,” she says. “We have a renewed sense of team.”
A Welcome Invitation
Another new routine Waninger introduced to each of the four hospitals within the Community Health Network was the delivery of a large bag of assorted candies to each biomed department on the first of every month.
“If you know anything about biomeds, you’ll know that keeps us happy,” Erdosy laughs. “But the other thing I didn’t realize would come of it is, on the first of the month, I’ve noticed other departments coming around more often. It gives us a chance to have people come to us and interact more, so we’re actually improving our relationships with other departments.”
Working closely with other departments within the facility is a key component of life at Community and something Waninger was eager to encourage. Notably, the clinical engineering department is part of the acquisition process, so much so that they actually determine which pieces of equipment are evaluated by the clinical staff.
“We are involved with purchasing and evaluating the equipment that is utilized at all facilities before it even goes to clinical trials,” Waninger says, noting the novelty of this approach in a health care system. “I have been involved in clinical trials, but it has always been after the users have narrowed it down. Here, that process is transposed: We can narrow it down based on which pieces meet the technical requirements, and from there the clinical teams make their choices.”
Part of the responsibility accompanying this method of acquisition is the need for biomeds to fully understand the clinical needs a device is satisfying, and to be careful not to narrow the field too severely. The team has also worked to erase the “gray areas” that often exist between CE and IT.
|The department is involved with purchasing and evaluating the equipment that is used at all facilities, basing the final decision on which pieces meet the technical requirements.|
“We have a very good relationship with purchasing and facilities, but the big one for me is with information technology,” Erdosy says. “There is a lot of overlap, but we have been able to get in there and really erase some of the gray areas.” He credits the affable relationship with IT, in part, to putting an open structure in place. On any project, one person may be primarily responsible, but if they need help they can always call the other department for assistance. “That was a goal,” he says. “We tried exceptionally hard to earn their respect and show our value to them as a whole. We started getting into discussions about how our departments are very similar, as well as what the impact some of their systems have on patient care, and that helped as well.”
The IT department also employs registered nurses, who take on a liaison role between techs and others in the hospital. The nurses have encouraged IT’s awareness of the clinical side of the technology.
“It has helped the IT department understand overall that these are not just computers, it’s not just data; somewhere at the end of this data there is a real live person who could be your mom,” Erdosy says, who developed this fundamental viewpoint early in his career. Three weeks after his first day on the job in clinical engineering, his grandmother was admitted to the hospital. “The first thing I saw when I entered the room was an IV pump I worked on the week before. That really set the stage for how I needed to apply myself in my career.”
Another priority for Waninger and her team is standardization across locations, which, in addition to the four hospitals, includes a number of off-site clinics, surgery centers, and physician practices spread across 30 miles of metropolis. Not only do similarities throughout the network help physicians, nurses, and techs who move between locations, but it also aids in the clinical engineering team’s work with risk management, a department they interact with very closely.
“We have a great relationship with the risk management team,” Waninger says. “A lot of what we do with them is following up on any safety issues, incidents, and recalls—all of that is coordinated through risk management and then communicated between our department and theirs.” Fueling this collaboration is the fact that the risk management team is structured similarly to how clinical engineering is structured: Specialists are responsible for each facility, with individuals in specific service lines who have responsibilities across all facilities. “We end up getting involved with a number of different members of the risk management department depending on what the issue is, where it is physically located in the building, and what clinical service line it may impact.”
Taking on incident investigations is one of the main areas where CE interacts with risk management. Over time, it has become a symbiotic relationship in which each team’s strengths are allowed to shine.
“We perform very in-depth investigations, and risk management looks to us for that input,” VanDeWalker says, who is often involved in these inquiries, where he is on location alongside the nursing department. “At the same time they are filling out their paperwork, we are interviewing them, securing the equipment, and trying to get a handle on exactly what happened so we can make a determination about whether we need to get ahold of risk management immediately.”
In addition to on-site investigations, the biomeds bring a technical aspect to the investigation, researching the background information necessary for context.
“We will go to ECRI and perform the research to determine if anybody else has ever had a similar problem,” VanDeWalker says. “We will also quiz other hospitals or other biomed departments close to us to see if they have had a problem with a particular piece of equipment.” This is especially important when a system or device is employed in multiple Community Health locations. “We do quite a bit of background work to try to get a handle on whether this is a localized issue or whether it has a bigger picture to it,” he says.
As part of any investigation, the CE team also works with any involved vendors to ensure the proper outcome on that piece of equipment. They are also responsible for securing the equipment after the investigation and taking the pictures for documentation. By fine-tuning these skills, the biomeds have made themselves an asset outside of equipment failure situations.
“Over the years it’s gotten to the point where it’s valuable to the hospital for us to be involved in other investigations they may have, because we provide them with a really good snapshot of what the problem is,” VanDeWalker says. “And if we need to call in a vendor or a third-party company to look at it, we will work with them also.”
Making Change Happen
An open door policy and bowls of candy are just the tip of the iceberg of things that have changed since Waninger took the helm. In fact, one of her first achievements was to take on the hospital licensure rules established by the state. No small task, to be sure.
“We tried to get a waiver from the Department of Health as part of the Indiana Biomedical Society (IBS),” VanDeWalker says, who currently serves as trustee for the IBS and has also acted as the president and vice president in previous years. “We tried to talk with the state, but we were not successful. So the fact that she was able to get it done was pretty impressive.”
Essentially, Indiana requires that every piece of equipment within a facility be maintained regularly. Unfortunately, this rules out the possibility of dividing the biomed team’s time using a risk-based program.
“In Indiana, the hospital licensure rules are very specific in stating that all equipment must have evidence of periodic inspection,” Waninger says. “That ‘all equipment’ includes televisions, vacuums, and office equipment, in addition to the medical equipment that actually benefits from inspection.” Most states across the country have been able to follow The Joint Commission recommendations of evaluating the organization’s service history, physical risks, incident history, and maintenance requirements to identify which systems require regular maintenance. “But in Indiana, we technically could not do that without violating hospital licensure rules,” she says. “The only way around it was to actually take the time to draft what our processes are and demonstrate that we meet the intent of the hospital licensure rules.”
To sway the Department of Health, Waninger outlined the procedures clinical engineering was already following at Community Health. She noted that the safety and security processes include a monthly walk-through, with biomeds looking for any physical safety issues. And she explained the work of the safety and security team, which is very proactive in looking for any out-of-date equipment or in identifying equipment that may have been installed, but was not tagged and inspected.
With the details recorded, the vice president of quality and risk management submitted all the documentation to the state, requesting leniency on certain sections of the Indiana rules.
“And we were very successful in obtaining a waiver, so now we are able to start utilizing the more traditional clinical engineering approach of equipment management,” Waninger says. The waiver stays in place as long as the hospital service strategies stay the same. “I just learned last month that the state surveyors are now telling other hospitals, ‘If you would just get your waiver, you wouldn’t have to worry about being written up for a sweeper that is not inspected.’ So the state surveyors are now pushing this process forward.”
For VanDeWalker, who has been at Community Health for more than 15 years, the waiver represents a critical change in procedure. “It has a huge impact, because that has always been a fight for everybody in Indiana,” he says. “Certain organizations tell us we can run under a risk-based program, but the state was telling us something totally different. We have always understood the state’s rationale for that; we just wanted them to listen to us and look at the impact that was having on our department.”
This type of progress is especially gratifying to Waninger because it marks the second time she’s taken on the challenge of winning a waiver from the state. More than 2 years earlier, with a previous employer, she made the same petition and achieved the same result.
“It was a huge hurdle initially, when I started having the first conversations with them, so this was just a reassurance that it does make sense and that we are on the right track,” she says. “The state has come around to understand that their intent, as well as our intent, is to promote patient safety in a manner that makes sense. There is value in providing support to the users that help them improve patient outcomes, and that is the kind of activity we want to be involved in.”
Getting a waiver has also meant a cost savings to the hospital. The hours biomeds previously spent tracking down vacuum cleaners can now be spent in training, making it possible to bring a number of costly maintenance contracts in-house.
“What, to me, is of the most value is that it allows me to look at my department and the services we are providing to the hospital, and better utilize our time,” Waninger says. “In the past 2 months, we’ve had technicians attend ultrasound school and we are getting ready to send some to anesthesia school. We are also cross-training some of the newer technicians into entry radiology.”
Aside from saving money by eliminating vendor contracts, offering biomeds the training they want has several other benefits. One notable perk is that it opens up opportunities for the staff within the facility, according to Waninger, who is getting more proactive about rotating people into different facilities and job duties. This not only implements a better sharing of resources, but it goes a long way to alleviating job burnout.
“Not being afraid to lead people out of their comfort zones is important, as is doing it in a way that they know there is a safety net,” she says. “Not only does this address turnover and staff retention, but if we didn’t get the training it creates a potential risk for our department and for the hospital, so it helps us manage our internal risks as well.”
Read other department profiles in past issues
The Bigger Picture
From implementing staff suggestions to getting a state government to change, “or even waiver,” as Waninger notes with a chuckle, she believes the most valuable example she can set for her team is that if you don’t like the status quo: change it.
“A lot of what I have seen in our profession is people just keep doing what they have always done,” she says. “We have to be more confident that we can step outside of doing what we’ve always done—if stepping outside of that is the right thing to do. In this scenario, I was able to not only tell people we should do something different, I was able to take the lead, get the support from hospital administration, and demonstrate to everyone: look, we can do this differently.”
Dana Hinesly is a contributing writer for 24×7. For more information, contact .