The economic downturn has impacted the biomedical community in a myriad of ways. Hospitals are short staffed and underfunded; reimbursements and capital expenditures are down; equipment is being kept longer; and the hiring of new biomedical personnel may not be in the offing. As a result, clinical/biomedical engineers today find themselves in a constant time crunch.
“We’re going to have to start adapting to this new environment,” says Izabella A. Gieras, MS, MBA, CCE, Aramark Healthcare director of the clinical engineering department at The Mount Sinai Medical Center in New York. “More things are coming toward clinical engineering, which is good because we are becoming more recognized and being given more responsibility. However, we are going to have to come up with new methodologies to balance the additional workload.”
Finding the time to balance that workload can be challenging, to say the least, particularly for biomeds who already feel overwhelmed.
“People in our department are so busy that they don’t want to hear about new ways to budget their time,” says Dan Dudley, director of medical engineering at Indianapolis-based Wishard Health Services.
One of the big problems that biomeds can face in time management is getting caught up in minutiae and forgetting the big picture. “People like to cross things off their list, so there is a lot of thought of getting to the low fruit first to look productive,” Dudley says. “But I think you have to move forward on a lot of things.”
And, without question, biomeds are finding themselves confronted with more and more challenges every day.
“We are no longer just fixing things,” says James R. Knight, CBET, Net+, supervisor of clinical engineering services at Adventist Health, Sonora, Calif. “The projects have a much greater scope now.”
He points to RFID technology as one example. “Ten years ago, no one was using RFID technology,” Knight says. “Now, we are incorporating it into the OR and into hospital rooms. This is another piece of technology that biomeds have to maintain.”
Addressing a greater scope of work is a trend that Gieras sees continuing. “We are no longer just a repair shop,” she says. “We are at a far higher advanced level of medical technology, and the clinical engineering role within a health care environment has certainly been elevated.”
Be Smart in Your Approach
To manage all these changes, and to approach time management in the most effective way, biomeds need to take the time to think about what they are doing and what they want to accomplish on any given project—and then prioritize accordingly.
“To some degree, you have to prioritize and allow some things that aren’t important to drop off,” Dudley says. “Everyone is working with the same criticality, and it’s a daily process of looking at your day, finding out what is squeaking at the time, and taking care of those things.”
Dudley also emphasizes the merits of beginning early and working on several things, a little at a time, over time.
“You need to budget some time to do a little more each time, but don’t let it become a time vampire that completely robs you on a particular day,” he says.
For Gieras, prioritization also means keeping healthy boundaries. “You have to know your limits,” she says. “You don’t want to compromise the quality of the work you will be delivering at the end of the day.”
She recommends making peace with the fact that you just cannot check everything off your list all the time. “You need to be realistic,” she says. “There are certain things that have to be accomplished during the day, and they should be at the top of your list. Other things will have to be shifted to the next day.”
Considering Psychological Management
While much of time management revolves around the actual, physical aspects of managing paper, electronic databases, and workloads, psychological time management is just as important.
First, there is the importance of using your time efficiently to think about your priorities.
“Keeping things fresh in your mind is useful, even if it’s just brought up for a very short time,” says Dan Dudley, director of medical engineering at Indianapolis-based Wishard Health Services.
In other words, taking the time to think things through before launching into a project can shave off valuable time that might have otherwise been wasted.
However, thinking too much about the job, and allowing it to flood into your thoughts while watching television, spending time with friends and family, or trying to sleep, needs to be curtailed.
“I have talked to biomeds that are worn out because they had a list of repairs at the beginning of the month, and they busted their tail all month to get that done, and, lo and behold, the first of next month, they’ve got another list,” Dudley says.
Before burning out, biomeds need to step back and take a breather. “In one way, we think we are superheroes, but we have to be realistic,” says Izabella A. Gieras, MS, MBA, CCE, Aramark Healthcare director of the clinical engineering department at The Mount Sinai Medical Center in New York. “Maybe that meeting can wait until tomorrow or next week.”
Accept that you will not ever be done, and have the discipline to occasionally turn off the psychological chatter.
“You need to turn on the stereo, go to the movies, or do something that forces you out of the [mind-set],” Dudley says. “The trick is learning how to make yourself do that.”
Perhaps one of the biggest black holes in time management can be paperwork and e-mail. Technology claims to save time, but, if not carefully managed, the very things designed to save us time can distract and overwhelm.
“You need to organize your electronic data,” Dudley says. “The e-mail that we use here has the ability to attach a flag called a follow-up. Every morning I print out my follow-up flags to remind me of those things that I need to be looking at.”
Gieras finds that e-mail and electronic scheduling are now driving much of the way biomeds are managing their time, so those electronics need to be up-to-date and synchronized.
“If that data is not correct, that might impact how you plan your day or the week ahead,” she says. She underscores the importance of becoming familiar with e-mail notification and the management features offered by electronic systems. “The tools and resources that are available to us are important, but we also have to make sure that we understand how to manage them effectively.”
Knight also agrees that electronic data needs to be thoroughly managed. “Biomeds are involved in the process of improving workflow throughout the hospital, and workflow is now being automated in most departments,” he says. “If you handle things electronically, instead of through paper, then paperwork will occupy less time. If you’re still filling out paper POs and documentation of your work orders, then paperwork is going to be a problem.”
Doing More with Less
The days of biomeds doing one or two things are long over. Today’s clinical/biomedical engineers wear many hats and are expected to fulfill many different functions. With departments strapped for resources, biomeds are expected to know more, do more, and be in more places. To achieve this efficiency, cross training has now become the norm in most workplaces.
“We do a tremendous amount of cross training in our department,” Dudley says. “If somebody becomes ill, or they find another job somewhere else, we have people at some level that can step in. Biomeds here could be working on a ventilator one minute and a bed the next. They are having to constantly reprioritize.”
Cross training can cut down on manpower shortages and free up time to other departments. Knight has also seen a trend where biomeds are now managing medical equipment networks, work that used to be managed by OEMs. “There is an increase in the number of hospitals that have in-house imaging and in-house anesthesia ventilator service,” he says. “It’s much more time and cost effective to hire an in-house biomed and cross train them into a higher skill set.”
Dudley’s organization saves time by sending biomeds on “house calls,” where each rotates through different departments. “For instance, today Jonathan has all the phone calls, regardless of what they are,” he says. “He has to determine what is critical, and which is more important, as they come in.” Other biomeds are then free to work on pressing projects without having to worry about the phone.
While efficient, the setup requires constant reassessment to meet customer satisfaction goals. “A nurse may be waiting, who thinks her problem is just as important as the ultrasound waiting over in the emergency department,” Dudley says. “She wants her needs taken care of because she is trying to take care of her patients. That’s the constant reassessment.”
A Variety of Claims on Time
Everything from meetings to socializing to constant interruptions can create problems in managing time for biomeds. Smart participation in these things can mean engagement, without being swamped.
“Biomeds do go to meetings, and it’s important that they be there, but the entire meeting might not necessarily pertain to them,” Dudley says. “I use that time to review my follow-up list, read documents, and think.”
Dudley also believes that it is important for biomeds to take some time to socialize with fellow co-workers—to a degree. “If your bench is next to somebody else’s, you develop a relationship, and you have to allow a certain amount of time for that,” he says. “But it has to be tempered because you are being paid to do a job.”
Interruptions can also be a time killer, but Knight’s department has come up with an effective way of handling some of those interruptions. “One of the biggest problems we find are people calling or stopping by the shop to ask about the status of a repair,” he says. “So we came up with a Web request for all work orders.” Someone who needs a repair simply logs on and submits an online work request. As soon as a technician accepts the work order, the requestor is notified. When a part is ordered and received, they are again notified. When the project is completed, they are notified. “It has stopped all the unnecessary phone calls,” Knight says.
Educational Time Commitments
Education—although relevant and important—can also claim needed maintenance time. One way Dudley has handled the scheduling is to make the offerings on alternative days and times.
“You have to look at multiple in-services of the same class, so that you can accommodate biomeds who are taking care of their customers,” he says. “Managers have to try to match the versatility of the staff.”
The continuing training of biomeds has been an emphasis—and concern—in Gieras’ department as well, especially when a technician needs to attend a class away from work for a week at a time.
“It’s great that they are being trained, but at the same time, we are losing them for a whole week, so we have to make appropriate plans so that the work continues to flow while they are away,” she says. Managers, she feels, need to be more creative in addressing the challenge by finding ways to offer online and on-site classes, which can cut down considerably on travel time. She also recommends collaborating with hospitals and other organizations in the area and offering a convenient on-site training for everyone.
Knight has seen a tremendous increase in third-party service and equipment providers, especially refurbishment companies. “Because reimbursement rates and profitability of hospitals has gone down, we don’t have the capital funding to purchase as much OEM equipment as we did before,” he says.
While this can be seen as a negative, Knight sees the trend as a way for biomeds to get better control of their time. “There are plenty of third-party service providers that can do your PMs for you,” he says. “If you are hard-pressed to get all of your PMs and other work orders done, doesn’t it make sense to outsource the lowest level of work like PMs? This is a workflow benefit.”
Despite the availability of third-party providers, electronic scheduling with whiz-bang features, and the opportunities provided though cross-training personnel, the increased paperwork, repair requests, and PMs are still going to be clamoring for attention. In many cases, time management will simply involve investing more time.
“Everyone has just 24 hours in a day, and, sometimes, you have to find the time to do things,” Dudley says. “Where does that time lie? It could lie in thinking about things when you’re driving to work.”
Gieras couldn’t agree more. “We need to be flexible,” she says. “There might be days where we need to stay a little longer, and there might be days where we might be able to leave a little earlier.” Still, there are some days, she believes, when putting in more hours is going to be necessary to get the job done.
“I think our profession is becoming very technology driven, and there are higher expectations for clinical engineering,” she says. “That elevated level of responsibility is driving us to put in extra hours, compared to what we’ve had to do in the past.”
Ultimately, biomeds will have to come up with a variety of ways to manage their time to be as effective as possible. This has never been more important.
“We really do have to get a handle on our time management,” Gieras says. “Without it, given the amount of e-mails and requests that we get, we can be so easily buried. We might lose control over everything that’s going on, and that’s never a good thing.”
Cynthia Kincaid is a contributing writer for 24×7. For more information, contact .