Discussion:
Q: What were some lessons learned from case study? Do you think this author should participate in similar projects in the future? Why or why not? Would you have handled the rollout at the second location differently? If so, how?
Device Selection - No other Phase Is More Important: Mobile Nursing Devices
Case Study: Our story began almost 2 years ago. As a consultant, this author participated in a team that completed a device needs assessment for the selection of point-of-care documentation devices for Big Healthcare System (BHS). Our consultant team was engaged because of an unsatisfactory response from an employee to a member of the facility's board of directors. The question was "How did we arrive at the decision to select these certain machines that you are asking $1.7 million to purchase?"
Our Team defined the following metrics for device selection:
Device form factor analysis (workstations on wheels [WOWs], tables, other handheld devices)
Space availability within patient rooms during use and storage
Provisions for spare machines
Downtime strategies
Analysis of various clinician usage and preferences
Wireless networking capacity and coverage
Integration with bar coding and scanning technologies
Electrical outlet availability (location and quantity)
Reallocation of existing desktop machines for physician usage
In total, this process was completed over the course of eight weeks, and upon presentation to the board of directors, out team literally received a standing ovation. Upon completion of our work, we presented our strategy and success around device selection, and the abstract of this write-up received a national award.
Based on this success, there was great confidence in our processes. In a new opportunity for a similar device selection process as part of a larger project at a Regional Community Hospital (RCH) in the West, we expected to repeat our success. The project was initiated, and RCH built a team of invested, skilled, and knowledgeable clinical and information technology staff. However, the device selection team was scheduled to meet weekly, as opposed to the concentrated "all hands on deck" efforts experienced at BHS. Thus, from the project design stage, the process was changed to be longer in duration at RCH than our process of 8 weeks at BHS. Almost two years later, point-of-care devices were only just being purchased for use by nursing assistants, respiratory care therapists, and some sporadic use in the intensive care unit.
As a result of the slower, comprehensive, and methodical process for device selection, we identified opportunities that would not have been possible in a quicker, more concentrated project. Some of our notable findings are the following:
The emergence of newer point-of-care technologies (tablets with scanners)
Postponement of capital expenditures
Reconciling specific challenges with wireless network coverage and capacity constraints
Resolution of infection control issues related to device cleaning and storage
Planning for medication administration and pharmacy delivery process changes
Configurations of WOWs
This methodical approach created a new challenge to our credibility, especially among the nursing staff. Because significant aspects of point-of-care device selection requires participation from the front-line nursing staff, we engaged the nursing staff early in the selection approval process. Although early involvement provided education and buy-in, it also led to significant delays in acquisition and deployment, which caused frustration among the nursing staff