Transforms Mobile Equipment Management To Improve Service and Slash Rental Costs
March 2011 | download PDF >
Oregon Health & Science University Hospital (OHSU) is one of the leading research institutes in the United States and is recognized as a world leader in health care. With over 560 inpatient beds, OHSU resides primarily on a sprawling 116 acre academic campus, serving the entire state of Oregon and conducting research in almost every field of medicine. Located in the scenic hills surrounding Portland, the usual complexity of hospital architecture — over 30 buildings of varying profiles, ages and layouts — OHSU features unique logistical challenges. These include having the entrance of the main building on the ninth floor and a sky tram between the main hospital and their outpatient location in the South Waterfront district on the banks of the Willamette River.
"Deploying St. Croix's Logistics Manager solution has allowed our Equipment Pool to significantly increase equipment availability, gain the trust of the caregivers, and reduce rental costs by as much as $80,000.00 per month."
Rita Wells, Manager Equipment Pool and Nursing Procurement
Four years ago Dennis Minsent, the Director of Clinical Technology Services at OHSU recognized that the management of mobile medical equipment (MME) was not as effective as it could be, leading to low equipment availability in the units. OHSU had a software system in place, but it was not effective and no longer in use. The equipment handlers had a difficult time locating equipment and caregivers were frustrated because they did not have the equipment on hand when needed. This highly reactive approach to equipment management, led to ineffective equipment utilization, high staff turnover in the Equipment Pool (EP), low nurse satisfaction and ever-expanding rental costs. And, without a robust system in place, there was no quality control to assure the equipment was being properly cleaned between patients — a leading contributor to equipment-based hospital acquired infections (HAI).
In response to these challenges, a combined team from Central Sterilization and Clinical Technology Services selected the Logistics Manager (LM) solution from St. Croix Systems. A key criterion for the team at OHSU was to have tight integration between the MME management system, the clinical equipment management system and the Admission-Discharge-Transfer system. Logistics Manager and St. Croix's Asset Manager applications leverage the same clinical equipment database, ensuring that both groups have visibility into equipment that needs planned maintenance inspection, repair or removal from service due to a recall. This made the selection process fairly straightforward for OHSU.
In addition to the Logistics Manager system, OHSU invested in an real time locating system (RTLS) system to help reduce the hours required by nurses to look for lost equipment that was not centralized in the Equipment Pool. The team estimated that the payback on this system would be under one year with a zone-level, facility wide deployment. By pulling the RTLS location information into the St. Croix applications, equipment handlers and clinical technology services technicians find it easier to locate specific equipment which is tagged but not currently being managed by Equipment Pool. And now that the Equipment Pool operates an on-demand order-delivery-pickup model, nurses spend very little time searching for equipment.
Said Minsent, "At the departmental level, asset management is a key piece of being able to better manage equipment with an expanding census, without adding equipment and people. The objective is to maximize the utilization of our existing resources and to appropriately and prudently spend the capital dollars that we do have. To do this, we need to focus on quick turns on the equipment and high availability."
With the centralized process built on St. Croix's Logistics Manager solution, OHSU's Equipment Pool has converted from a reactive approach to a proactive, on-demand system. When a department needs equipment, they call the EP and the order is created in LM. Some departments create a daily order based on census that they provide to the EP at the beginning of the shift. Others call for patient-specific equipment orders as needed. The equipment handlers use barcode scanners to track all of the Equipment Pool's mobile equipment through the hospital and supplement that with location information from the RTLS system for tagged equipment. The EP manages between 4,000 and 5,000 mobile devices including IV pumps, transport monitors, crash carts and SCDs as well as rental equipment such as wound vacs and air mattresses. Having Logsitics Manager allows OHSU's Equipment Pool to ensure that caregivers have the right equipment in the right place at the right time, virtually eliminating searching.
- Equipment Availability and Safety
One of the key benefits of the Logistics Manager solution has been significantly improved equipment availability and safety. "Nurses now spend very little time searching for the assets they need and we can very closely track equipment cleaning cycles to avoid HAIs." The impact on the organization has been dramatic: "Since implementing the system, staff satisfaction scores have skyrocketed," said Ms. Wells.
- Reduced Rental Costs
By using Logistics Manager to drive an efficient mobile equipment management process, OHSU stopped renting infusion pumps altogether and rarely rents food pumps. In fact, the organization estimates that the system saves as much as $80,000 per month in total rental costs. These savings are expected to increase as the EP expands the scope of centralized equipment management to include wound vacs and specialty beds.
- Departmental Efficiency
Using the rich device-level utilization information collected by Logistics Manager, it became clear that the day shift was busy with outgoing equipment orders and swing shift was bogged down with pick up requests due to patient discharges. The result was a flood of dirty equipment that could not be handled by the skeleton crew on the third shift, creating a bottleneck that made it difficult for first shift to respond to new orders. The EP shifted some resources to night shift to ensure that a sufficient supply of cleaned equipment would be ready to meet the next day's demands. Because the team has become both reliable and efficient, and had the data to demonstrate it, the EP has taken on an increasing scope of equipment to manage at OHSU. Having recently tackled the management of rental wound vacs, EP is now taking on bariatric beds to ensure that owned beds are fully utilized before any rentals are called in. Recently, OHSU approved an expansion of the EP footprint in the hospital, despite an acute shortage of real estate, to further enhance efficiency. Again, the data and reporting features of Logistics Manager played a key role in supporting the business case for the expansion.
Said Wells, "LM gives us the ability to figure out where and how improvements can be made to improve workflow and reduce manpower and equipment requirements, realize huge cost savings by tracking equipment — even the equipment without RTLS tags — to reduce lost equipment and unnecessary billing, and track staff workflow without RTLS tags to justify our staffing levels, which were left untouched during facility-wide cutbacks."
Copyright © 2011 St. Croix Systems Corporation
890 Winter Street
Waltham, MA 02451
Centralizing Parts Procurement Saves Money, Increases Technician Productivity
Article by Jill Schlabig Williams | August 2009 | download PDF >
Based in Milwaukee, Wis., Aurora Health Care is Wisconsin's largest, fully-integrated, not-for-profit healthcare delivery system.
Established in 1984, Aurora has become a nationally-recognized leader in efforts to improve the quality of health care. Over 90 different communities benefit from Aurora's integrated delivery network, comprised of 13 hospitals, over 100 clinics, and 120 community pharmacies. The 25,000 employees and 3,400 affiliated physicians who make up Aurora work together with one goal in mind — to always provide benefit to the patients and communities they serve.
Operating with Efficiency
Like many healthcare providers, Aurora faces enormous pressure to improve the quality of care and manage to a healthy bottom line, while maintaining an eye towards growth. Declining
reimbursements and climbing capital expenses are also a reality and are continually factored into the financial and operational plans of the health system. Aurora's not-for-profit status means that the organization cannot obtain funding through private sources or shareholders. Thus, funding quality and growth has to be the result of more innovation and efficiency at all levels of business operations.
For Patrick Trim, director of Capital Equipment Services, and his Clinical Engineering team, efficiency coupled with service value was already part of their operational day-to-day standards. Having led the centralization of all of the health system's 44,000 pieces of mobile equipment into a single asset management solution, Trim could site numerous examples of the cost savings the health system derived from this approach. Through one single capital asset system, St. Croix Systems Asset Manager solution, Aurora's capital equipment team is able to deploy, track and maintain assets, consolidate and evaluate vendor contracts, review asset performance, calculate total cost of ownership and useful life, and plan for and budget capital for new and replacement equipment. And because it is an enterprise wide solution, as Aurora grows, inventory is seamlessly integrated, giving visibility to every piece of equipment owned or leased — from the enterprise, to a hospital, to a clinic. With an asset optimization infrastructure in place, the only other place the Capital Equipment department could look to for driving greater efficiencies was through more strategic use of personnel.
Innovation to Support Growth
When you're a prominent and growing health system such as Aurora, overall operating objectives inherently include incorporating process improvement and innovation, and leveraging economies of scale. It's quite possible, however, that these objectives might not always be met through internal resources.
"When you have a health system the size of Aurora, you are mindful of outside organizations positioning to executive leadership the value of their outsourced services," says Trim. "With that thought in mind, I saw it as the department's role to determine how we could add to the efficiencies and service standards that we were already contributing — and to do so with a level of innovation that could be easily implemented with greater value than what could be provided through externally-contracted resources."
If you are Aurora's Capital Equipment operations, responsible for managing over 44,000 pieces of equipment, your first priority is making sure all capital equipment is safe and operable. Your next priority is ensuring that clinicians, and more importantly, patients, are not inconvenienced by having to wait for the delivery or servicing of this equipment. As the executive leader of the operations, Trim mobilized his department's leadership team to develop a plan that would prioritize responding to the health systems' geographical expansion, manage and maintain more sophisticated equipment and technologies, and add to the 100% visible. 100% measurable. 100% productive. 100% visible. 100% measurable. 100% productive. service standards the patient care resources had become accustomed to.
At first glance, an easy choice would be to hire more resources, enter into more third-party service contracts, or both. But what was the long-term gain? "We could have hired additional engineers and placed them within the various regions, but to get to the next level of efficiency in support of the system's growth, we needed to implement a model that allowed us to meet demand, reduce costs, and support standards needed to deliver safe and quality care," stated Trim. "By approaching the health system as a whole, versus different geographically based
entities, it allowed us to rethink our existing processes. We were able to leverage the data provided through our enterprise asset management system to determine where specific expertise was needed, where dependencies on third-party service agreements could be reduced or terminated, and how all of this could be managed so we could maintain a higher level of service throughout the entire environment of care."
With these guiding principles, a plan was devised that would use a centralized service management call center to facilitate the intake of all service requests, dispatch resources, and manage technician scheduling. This integrated approach would provide the catalyst for reorganizing the resources and ensuring resource productivity for both the existing and new headcount they would add to address geography, modality and expertise. Confident in the value that would be derived from this approach, Trim assured senior executives that he could reengineer his organization, add headcount without adding costs, lower costs by reducing or eliminating reliance on specific vendor service agreements, improve the overall service to all hospitals and clinics within the network — and do it all within eight months.
Eight months later, Trim and his team delivered. Aurora has a fully-engineered Capital Equipment department; a fully-deployed centralized service and dispatch center, complete with all the metrics necessary to measure service performance; 19 additional headcount and a $1.5 million dollar contribution to the bottom line — all funded by the $3.5 million dollars in contract savings.
Creating a Foundation for Consolidated, Centralized and Integrated Operations
The decision to consolidate and centralize was the right strategy for Aurora. Their success was a result of a solid foundation of proven business processes, a focus on asset and resource optimization, and a defined list of requirements. They were looking for a solution that would:
- Allow for a centralized service center that tracks and manages the intake and assignment of requests and the dispatching of internal and external service personnel.
- Integrate with their existing Asset Manager solution and leverage the single database of equipment records and contracts.
- Enable comprehensive reporting and tracking of specific metrics not seen in non-healthcare related call center solutions.
- Deliver a platform for multi-user operations and system-wide deployment that is easily supported by IT.
After an exhaustive search, Aurora found only one off-the shelf program that met some of the call center requirements but very little of the healthcare service dispatch functions. With an eight-month timeline, the customization and integration efforts would be too large and too complex, and would still not be specific enough to Aurora's healthcare environment.
Having already built their enterprise asset management strategy around St. Croix Systems solutions, Aurora had strong trust in the software company's products. They decided to partner with St. Croix to develop a solution that would set the standard for centralized service requests, resource assignment and dispatch in healthcare. This proved to be a worthwhile partnership, as eight months later, on time and on budget, Aurora was live — with St. Croix's Service Center Manager solution driving the innovation that was now optimizing both assets and resources.
Aurora has reengineered its capital equipment department; centralized service and dispatch; added 19 employees and contributed $1.5 million to the bottom line. And it was all funded by $3.5 million in contract savings.
For Aurora, Service Center Manager consolidates previously-dispersed calls and requests for service and resources. It also delivers a means to track important data at the point of origination, such as type of service, location, and urgency, to more efficiently and effectively dispatch the right resources. Immediate visibility into service requests is helping Aurora speed resolution, benefiting the patient care resources, the Clinical Engineering department, and ultimately the patient — all of which have a positive effect on hospital operating costs.
Combining Processes and Technology
Configured to receive requests electronically or via the phone, a clinician needing service can call into the centralized service center where their telephone number and location is instantly displayed. The caller can present a previously-assigned control number, or, if the request is new, be assigned a new number. The request is documented within the software based on level of urgency, and then a technician is dispatched via a pager, email or PDA, from which acceptance or replies can be transmitted.
If accepted, the technician then acknowledges arrival at the requesting site and again upon completion of service delivery. Given that Aurora is operating from a single database of records for all assets and equipment, the technician is able to use their PDA to update any associated work orders in the Asset Manager system and log any notes regarding the piece of equipment which they have serviced. Upon closing out the work order, the service request is automatically closed within the system.
Automated service requests are only one part of the story for Aurora. Managing to resolution is where the real resource optimization and efficiencies take hold. Service Center Manager offers flexibility, as technicians can be associated with assets in a variety of ways. Equipment is put into a modality classification system, and then primary and secondary resources are assigned to each classification, enabling auto escalation or reassignment when a primary resource might not be available to accept or respond. Calendar and scheduling functionality allows for logging and managing technician schedules and scheduling future assignments based on availability. Urgent calls are assigned to a technician, then acknowledged and responded to within fifteen minutes or less — a standard that was decided upon through a series of interviews conducted with key department stakeholders.
For emergency requests, Service Center Manager offers "quick-page" functionality to send out broadcast pages or emails for rapid response to critical needs. Response time has become an important and visible metric that the clinical engineering regional managers, analysts, and
supervisors measure and monitor. The results support increased efficiencies and service responsiveness and help compare performance to third-party service vendors.
For equipment-related service calls, Service Center Manager instructs the system to create a work order and facilitates the dispatch function via Aurora's existing communications infrastructure, which includes Blackberry devices and mobile phones. The entire process is seamless and takes but a few seconds to execute, eliminating the need for duplicate data entry.
At the completion of the service delivery, lifecycle information is automatically documented in the equipment record via integration with the Asset Manager application.
"Now we have a means to gather important data such as the number of service incidents, types of services, mean time between failure, length of service calls, and costs associated with service — both labor and parts," states Al Gresh, corporate manager of Clinical Engineering.
"Having a single record from which to operate for all equipment and associated service is invaluable to optimizing hospital assets and resources."
Measurable, Ongoing Results — and More
From a variety of perspectives, both financial and operational, Aurora Clinical Engineering has succeeded in getting to another level of efficiency. In the process, they've strengthened associated standards and service levels. Among the significant outcomes cited by managers and executives:
- Consistent capturing of the complete lifecycle of
service metrics, including type of service calls per
type of modality, service calls by location, service
response times (from when they arrived on site until
the equipment was repaired), labor and parts costs,
and change in dependencies on third-party resources.
- The ability to escalate to outside vendors without
losing critical time, review vendor contracts prior to
dispatching, log actions related to vendor work, and
enable vendors to self-track time, parts and labor.
- Acquisition, technology, clinical projects and clinical
engineering are all centralized under one management
structure. This allows for complete asset lifecycle
management and the ability to utilize performance
data, life-time costs and other financial and utilization
data in the capital planning process.
- A shift in the Clinical Engineering department away
from duplicative manual tasks, such as creating work
orders, towards more strategic and timely service
delivery — experts versus generalists.
- The ability for Clinical Engineering to accommodate
organizational expansion and higher call volumes
without corresponding increases in staff.
- Completion of reorganization of resources, revision
to business processes, and end-user acceptance
training all prior to go-live.
Delivering Capital Asset Lifecycle Management
Unfortunately, asset optimization remains an elusive goal for most healthcare enterprises. Fortunately for Aurora, this is not the case and they are now able to boast asset and resource optimization. Their enterprise approach to capital asset lifecycle management provides complete visibility into the inventory, location, history, utilization, life-to-date costs, predictive and preventive maintenance schedules, performance, safety, and remaining useful life.
Executives are armed with the strategic data and information needed to optimize the health system's asset base — from asset management to capital planning. This kind of transparency is what has lead Aurora Health Care to achieve efficiencies, cost savings, operational improvements, and a safe and high-quality environment of care needed to sustain their growing network.
Patrick Trim is currently the corporate director of Capital Equipment Services for Aurora Health Care, a not-for-profit Wisconsin health care system. His current responsibilities include all aspects of the capital supply chain, including:
- Clinical Engineering
- Contracting and Negotiations
- Equipment Disposal
- Project Equipment Management
- Service Contracts and Leasing
- Technology Assessment
Patrick has been in the healthcare supply chain for the past 27 years. He holds a BBA in Business Administration from Northwood University, in Midland Michigan, where he graduated with cum laude honors. He has achieved lifetime certification from the Institute for Supply Management (ISM) with a designation of Certified Purchasing Manager (CPM).
Patrick specializes in process improvement and system integration.
Automated service requests are only one part of the story for Aurora. Managing to resolution is where the real resource optimization and efficiencies take hold.
Copyright © 2006 St. Croix Systems Corporation
890 Winter Street
Waltham, MA 02451
When Hennepin County Medical Center got a clearer picture of the equipment usage in its system, it was able to optimize capital spending, boost operational efficiency and increase charge-back revenue. The Minneapolis hospital took that high-resolution picture—thanks to a software module from St. Croix Systems that tracks the utilization and location of mobile assets. St. Croix Systems developed its Asset Logistics and Utilization application in partnership with Hennepin County Medical Center.
That innovative application allows the hospital to boost patient revenue and control costs. Moreover, a clearer picture of its assets allowed the hospital to make smarter capital equipment purchases as well as reduce its amount of rental equipment.
A Provider in Transition
Hennepin County Medical Center (HCMC) is a premier academic medical center and public hospital located in Minneapolis, Minnesota. Named among America's Best Hospitals by U.S. News & World Report for seven years running, HCMC includes a 420-bed acute care hospital, three primary care clinics, and Minnesota's third-largest non-profit medical research organization.
Serving as the third-largest not-for-profit medical research organization, HCMC records approximately 7.30 percent of the total discharges in the Twin Cities of Minneapolis and St. Paul. Its Emergency Department is the largest in the state with an annual volume of more than 98,000 patients.
Like many other healthcare providers across the country, HCMC's operating costs are growing more rapidly than its revenues. As a result of that financial squeeze, HCMC struggles to keep pace with the capital investment required to sustain high levels of quality care. In order to respond to this challenging business environment, HCMC has undertaken a transition to a more market-responsive operating model with defined priorities for creating new revenue streams and instituting rigorous cost management. In fact, HCMC has set a target of demonstrating at least $4 million in annual sustainable savings within three years.
A Sophisticated Approach to Asset Management
Because HCMC has a history of innovation in asset management and capital sourcing, the hospital was an ideal partner for St. Croix Systems. HCMC was previously using a home-grown mainframe solution to record asset utilization and location. Phillip Gill, bioelectronics supervisor, recognized that a server-based application would allow the organization to more fully capture the potential of automating the logistics and associated utilization of equipment. Such a solution integrated with their equipment work order system would mean even further automation, a streamlining of manual intensive tasks and access to accurate, relevant, and real-time data for reporting and decision making.
HCMC set out to find a software company with whom it could partner to develop this solution. Having implemented and utilized St. Croix Systems' Asset Manager solution since 1996, HCMC had an appreciation for the company's technology and experience in healthcare. Because of that prior positive relationship, HCMC approached St. Croix Systems to be its partner in developing a solution.
HCMC and St. Croix Systems began their work together in March 2004 and had a beta system up and running in November of that year. HCMC went completely live with the Asset Logistics and Utilization application in May 2005.
Since then, HCMC has seen hard financial gains on both the revenue and cost side:
- Increased Revenue—By allocating equipment usage to specific patient bills, hospitals can substantially increase charge-back revenue. As indicated, HCMC documented a 10 percent increase in charge-back revenue after beginning to track utilization of equipment by patient.
- Reduced Capital Spending—In combination with St. Croix Systems' Asset Manager, Asset Logistics and Utilization delivers visibility into which assets a hospital owns, where they are located, and how they are utilized over time. This information can have a tremendous impact on providers' capital purchasing process. When it comes time to approve a facility's order for 150 infusion pumps, for instance, the purchasing group can quickly determine the asset inventory on hand and whether the utilization is approaching capacity and there truly is a need for the additional equipment. "Asset Logistics and Utilization transforms the way capital purchasing is done at hospitals," explains Gill. "Between 10 and 15 percent of capital purchases on equipment can be eliminated through the improved visibility associated with Asset Logistics and Utilization," Gill adds.
- Optimized Rental Expenses—Improved visibility of asset location and utilization also enables providers to reduce rental expenses. By understanding the current inventory and utilization of each class of assets, providers can avoid keeping a surplus of rental equipment on hand and ensure that rented equipment is returned upon patient discharge. To handle daily patient volume, HCMC supplements its 9000 pieces of owned equipment with rentals. Because Asset Logistics and Utilization application provides detailed reporting, the biomedical staff and finance departments are able to quickly review needs, identify the cost benefits of purchase versus rental, and cancel rental agreements when equipment is not being used. In fact, HCMC estimates that its equipment rental expenses have declined by roughly 10 percent as a result of tracking asset utilization. Anecdotal evidence suggests that this may be conservative, however. When HCMC began tracking the utilization and location of pulse oximeters, the provider reduced rentals by 3,300 days in the first year, cutting rentals for this asset by approximately 50 percent.
- Visibility to Available Inventory—HCMC moves thousands of pieces of mobile assets throughout the hospital each day. With Asset Logistics and Utilization HCMC can track the movement, financial history and preventative maintenance record for every piece of equipment. Now that The Joint Commission for Accreditation of Health Care Organization (JCAHO) is seeking more accountability for equipment management, HCMC can electronically produce service records for any piece of equipment.
An Unprecedented Level of Business Intelligence As HCMC has found, Asset Logistics and Utilization provides an essential solution for healthcare system personnel to understand how and where expensive clinical assets, whether leased and owned, are deployed.
Asset Logistics and Utilization furnishes patient care and hospital service staff real-time data indicating the location of the device and its availability for use—in effect, automating the process of getting the right equipment to the right patient at the right time. For hospital executives, Asset Logistics and Utilization captures real-time and historical location and utilization data. This detailed level of information, in turn, drives more strategic asset purchasing decisions. Furthermore, a clear picture of the hospital's asset management can lead to reduced capital expenditures, reduced rental equipment costs, more accurate patient revenue capture, and an increased confidence in Food Drug and Administration (FDA) and JCAHO compliance.