Delivering Team-Focused Technology to the Bedside

Now more than ever, we are seeing the patient bedside as a complex system requiring inputs and interactions from many clinical healthcare teams, support professionals, and technologists. From the perspective of the patient and family, these interactions may seem daunting and overwhelming at times, with lights flashing and alarms sounding as healthcare teams operate the equipment and interface with the patient and family. A renewed and important focus on patient-centered care is reemerging in many hospitals based on the seamless integration of the healthcare team, which includes healthcare technology management (HTM) professionals working to support the patient's comfort and positive clinical outcomes. Our MemorialCare healthcare system has grown into a culture that has adopted lean-based standard work and designs closely aligning with our vision and strategic plan, with the focus ultimately on our patients and their experience.

New initiatives, including electronic medical records (EMRs), fall prevention, alarm management, and other patient safety goals, have increasingly introduced technology to the patient bedside. How do we apply this complex system to the bedside while still allowing for a quiet, clean, and comfortable environment for the patient? What is the role of clinical engineering in supporting positive clinical outcomes for our patients, and how do we, as part of the HTM team, affect care at the bedside?

I had the privilege of posing these and other questions to Judy Fix, RN, chief nursing officer (CNO) at Long Beach Memorial Medical Center and Miller Children's & Women's Hospital. As a member of the senior executive leadership team, Judy oversees all patient care and clinical support processes at our 700-plus bed integrated medical facility. She has developed and chairs the Bedside Technology Task Force, which (in most months) has an agenda involving more than 15 major bedside technologies, including Bar Code Medication Administration (BCMA), deep-vein thrombosis prevention, patient education, and bariatric care, among others. Members of the monthly committee include representatives from nursing, pharmacy, nutrition, facilities, information technology (IT), biomedical engineering (BME), and other clinical and support teams.

If there is any doubt that BME, IT, and our other technical support groups affect the patient outcome and bring much needed support to clinical teams, the following interview will erase that uncertainty.

David Stiles: You champion more than 2,000 nurses, as well as other clinical team members, at our two hospitals. Can you share part of your journey that led you to this chapter in your career?

Judy Fix: Always being committed to the patient and their family led me on a journey from the bedside to executive administration. Over my more than 30-year career, I have been fortunate to have great mentors and teachers. And at this time, I am able to give back to the organization and other leaders as they pursue “perfect care” for the patients and community we serve. Perfect care means providing the “right care, at the right time, in the right place.” This extends the acute care hospital to the community, and we attempt to provide population-based care focused on keeping patients out of the hospital by ensuring that they have a medical home—an outpatient physician who manages their disease processes. I am privileged to represent a tremendous cadre of patient care providers.

What philosophy or mantra do you bring to work each day?

I have a strong belief that healthcare is a not-for-profit business. There should not be shareholder value in the provision of care to patients. Every morning, I can put my feet on the ground and know that I will make a difference for a patient or patients. This provides me with a personal mission about making a difference in people's lives. As caregivers, we are with patients at the best of times and the worst of times. As the senior vice president of patient care services, I have the responsibility to ensure that we do the best for our patients every day. Rather than a village, this requires an army.

In addition to your role as CNO and a member of the senior leadership team, what other roles are you engaged in to promote, develop, and consistently improve the patient care experience here locally and across the system?

I have the privilege of belonging to multiple professional organizations that affect healthcare within the state and nationally. This includes the Association of California Nurse Leaders, Nursing Leadership Council of the Hospital Association of Southern California, American Organization of Nurse Executives, and the American College of Healthcare Executives. At the MemorialCare system level, the CNO contributes to the quality, strategy, and financial resilience of the organization.

In 2012, you formed the Bedside Technology Task Force as a means to manage the many technical initiatives and workflows implemented throughout the hospitals. Describe the function of this committee and its reach to the bedside and patient.

It became very apparent that the best way to improve our provision of care to patients and provide caregivers with the right tools to assist them in the increasingly complex care environment, we needed a team of the “best and brightest” from all disciplines to make the best decisions for the organization and patients. Fortunately, with the support of very engaged facilities management, BME, and IT teams, we have been able to justify important initiatives to improve the patient experience, patient safety, and patient progression.

What are some of the programs being monitored and measured by the task force?

One of our most important contributions was selecting the best bed and surface for our patients. This involved facilities and BME providing their recommendations on the bed technology, durability, and ease of repair, as well as pressure acceptability of the surfaces. The wound care team provided recommendations, including patient comfort; the best surfaces to prevent shear and tear; the appropriate standard bed configuration, including the best height from the floor for individual patients; ease of patient movement in and out of the bed; and bed movement capabilities. Six years later, with a bed replacement plan overseen by BME and patient care services, our organization is in the “zero zone” for pressure ulcers. This is just an example of the improved patient outcomes that can result when an expert team comes together to navigate the market for technology, implements an initiative as a group, and evaluates the outcomes for patients. The task force also has had success with BCMA, interactive patient education and communication using the patient television, safe patient handling systems, and implementing fall risk improvement technology.

As the CNO, why did you take ownership of this task force and how has it improved the delivery of care to the patient?

As I stated earlier, successful patient care takes an army of individuals. If silos exist in an organization, then the loser is the customer, and in our case this is the patient. Our commitment to lean improvement principles emphasized the need for resources from multiple expert disciplines and our value of synergy supports teams working together to improve the outcomes for our patients. My role is to ensure the very best happens at the point of care continually. This requires rigorous commitment to providing best practice medicine and expecting excellence from every department. Our committee includes nurse leaders, IT, BME, purchasing, and any leader overseeing an initiative that requires participation of all team members.

What surprised you about your interactions with your HTM colleagues, such as IT, facilities, and clinical engineering, after the formation of this task force? How about your clinicians? Have you seen improved communications and measurable results in patient care initiatives from the interactions of these committee members?

We have seen a manifestation of our core values at MemorialCare, which we call the iABCs, standing for initiative, accountability, best practice, and synergy. Additionally, the work of the committee fosters relationship and respect, which allows the team to work effectively and seamlessly in an urgent situation. This was best represented by the hospital-wide response to the recent Ebola outbreak. This situation required every department in the hospital to come together and plan how we would provide care to patients. BME was invaluable in determining the best powered air-purifying respirators and working with infectious disease practitioners to oversee the safest process for equipment cleaning. Within a short time, we had two specialized clinical care containment units designed and implemented for both adult and pediatric patients. There is no doubt that the task force has fostered improved communication and respect among departments.

From my experience, nurses have always been technically savvy, knowing that the equipment designed in the last 25 years has required a lot of complex interactions. What are your thoughts on the ability of nurses and clinical support team members to use today's technology at the bedside and in their clinical care areas?

When we started our journey with EMRs, we did hear some collective groans from nurses and other clinicians. However, the EMR implementation went well because of careful planning, design, and implementation strategies. The worst experience comes when a discipline sits isolated in a room and designs or determines the tools that will be used by another discipline. That does not happen at MemorialCare and is probably key to our successful implementation of technology. Everyone's perspective needs to be understood, from the individual who repairs the equipment to the bedside clinician who uses the technology every day. The common factor among all of these stakeholders is the patient. Our professionals are committed to ensuring the best experience and the provision of perfect care. For example, when the physiologic monitoring system or nurse call system goes down, our team—facilities, clinical engineering, and IT—understand the impact on patient safety and are working alongside clinicians to ensure safety is maintained in the operation, performance, and validation of bedside technology.

Some members in the HTM community question whether they are noticed or recognized among senior leadership in healthcare facilities. As a CNO and a core member of senior team leadership, what is your response to this? What's the view from the C-suite?

Our HTM team is involved in a vast array of major decisions for the medical center. They are members of the clinical capital committee, working alongside physicians and executive leaders to ensure responsible selection of capital equipment. The team is relied upon to develop multiple-year replacement plans at our very large facility for key replacement equipment, such as physiologic monitors, beds, C-arms, and infusion pumps. We rely on HTM to know if equipment should be repaired internally or sent out for repair. Should we contract for external service or train internally? Executive leaders rely on HTM, facilities, and IT to present a recommendation on any decisions involving their areas of expertise, and I am not aware of any bedside technology that does not require input from all three during these high-technology times. The integral work of the HTM community is recognized and appreciated each and every day in our complex medical environment.