By Rick Joslin
Increase efficiency, accuracy and accountability by going paperless.
In today’s healthcare business environment, electronic record keeping is the norm. Patient records, appointment bookings, visibility of upcoming events, personnel records, procurement activities and even food management for patients are all submitted, fulfilled and retained electronically.
Why is it then, that most healthcare facility or plant operations departments still print the majority of their work orders, carry clipboards and pens, record activities on printed log sheets and store completed activities within large three-ring binders in a storage room?
There are several reasons typically given for the continued use of paper, including:
- The ease of carrying paper versus handling a tablet.
- It is faster to write on paper than to scroll through electronic records.
- Paper has worked for years, so why change now?
- Local AHJ requirements.
While each of these may have had merit in the past, the benefits to transferring from paper to electronic records and processes now far outweigh any perceived benefits of paper. Let us take a look at four major benefits of transitioning to electronic records and processes.
Printing and managing paper takes time, effort, space and, perhaps most importantly, money. On average, when using a paper-based work management process, work requests are touched a minimum of four times.
Requests are touched when:
- Received by office staff.
- Given to a manager or supervisor for action.
- Given to a maintenance employee for completion.
Often there are at least two additional touches: when the maintenance employee writes their activities on the paper and gives it to the manager or supervisor, and when the office staff processes paper.
Each step adds to the time it takes to correct any deficiencies and can reduce the efficiency of the department. Consider in relation to paper processes, that there is a (low) average of 70 minutes needed before a maintenance employee can start a job and the end of the work day before the finished job is recorded. The sheer number of steps involved costs money and reduces efficiency, while moving to an electronic records process naturally increases efficiency by trimming the manual effort involved.
Through using an electronic Computerized Maintenance Management System (CMMS), the average processing is reduced significantly. With a CMMS, you have now taken what was a 70 minute receive-to-start process to around 8 minutes. If you have a staff of eight, for example, at 62 minutes per maintenance employee, that is a savings of one full-time employee per day.
On top of the lost efficiency of a paper-based system, the inherent reduction of accuracy often adds to the cost and time to complete a job. Staff often short-hand the information provided over the phone and this can be misinterpreted by a maintenance employee, potentially causing an incorrect assumption of the request needs.
Best-case, the maintenance employee will have to locate the originator of the request, requiring them to contact the office staff for a phone number or contact means. Worst case, however, is that the maintenance employee travels to a wrong location or misidentifies an issue, causing multiple trips to their shop and parts warehouse. If it takes 15 minutes to travel to the job site across campus, and the maintenance employee is forced to do these four times, an extra 30 minutes has been added to the job cycle. If each of your eight maintenance employees performs two jobs requiring 30 additional minutes of travel, that is eight hours a day of unnecessary travel time.
Because electronic requests are composed by the originator, their accuracy is 100% based on the input of the originator, adding accuracy gains to the efficiency gains. There is no shorthand to interpret and there is no communication loss between office staff, managers and supervisors, and maintenance employees, leading to higher accuracy and efficiency. Best-in-class electronic request systems require complete contact and location information, ensuring the entire HFM staff can reach out to the right person when needed. This will reduce the number of trips to a single job site, with maintenance employees having the needed materials for the job. If duplicated travel is lowered by 50%, you have saved 4 hours a day—a savings of a ½ FTE a day.
Other by-product accuracy gains are action taken inputs, root-cause coding, hours worked, parts or materials consumed, etc., due to the originator of that data becoming the inputter of that data.
A healthcare facilities or plant operations department cannot properly maintain its structures, grounds, spaces, and equipment without knowing who is doing what, who has done what and what work is still outstanding. Best-in-class organizations have a consistent process of accountability for every work request, repair job and preventive maintenance action that occurs within their Environment of Care (EoC). Work comes in, is triaged (reviewed for completeness, complexity and skill), assigned to one or more maintenance employees (where it becomes part of their backlog), and is completed by those employees. These processes also apply to work being performed by a contractor or vendor.
Without accountability, a healthcare organization will not be able to distinctly identify when a job has become the responsibility of an individual performing the work, let alone who was responsible. This can lead to delayed work, missed deadlines and increase the exposure of patients, visitors and staff to unsafe conditions in the EoC. When there is little to no accountability, HFM office staff are unable to provide timely and accurate updates to their organizational staff and leadership and management activities cannot be properly pursued to correct personnel behaviors.
Realized by-products of documented accountability include:
- An ability to reach the right person when a question arises about the job.
- Employee workload management.
- Work backlog management.
- Productivity analytics.
- Employee resource management and self-sufficiency.
All the above would be immaterial unless an organization consumes the data and capabilities that come from them. Most healthcare organizations are faced with the annual question of how to decrease costs while increasing efficiency. Although it is possible to develop annual analytics by reviewing 365 days’ worth of paper, it is far more efficient and accurate to review trends and totals monthly throughout the year. Knowing the average number of work requests per month, per day or even instantly via an electronic dashboard allows organizations to properly staff their HFM department—reducing stress and increasing customer service during those periods. Additionally, understanding how many open work tickets there are, either by team or by technician, can increase overall efficiency.
Digital records enable HFM organizations to move from a reactive, costly necessity within a healthcare organization to a proactive, cost-reducing, service-oriented asset. Relative to material management, the ability to forecast preventive maintenance (PM) requirements can enable an HFM department to dramatically reduce finances tied to massive quantities of PM materials and move to JIT (just-in-time) ordering.
Digital records can also dramatically reduce shipping costs by limiting the need for overnight or expedited shipping since now you should be able to see where other sister HFM departments have that material. Additionally, electronic records allow you to see which vendors consistently ship fastest to your organization, as well as provide a means for predictive maintenance by reading trends to order materials preemptively.
Analyzing digital records allows HFM organizations to consume benchmarking data at many levels, by:
- Equipment type, location and age.
- Comparing personnel to industry averages for performing PM or repetitive functions.
- Identifying potentially troublesome vendors.
- Comparing similar vendors to identify the best one.
The ability to determine the average turn-around time for specific job types can allow HFM departments to schedule repair activities instead of always being reactive fire-fighters. Accessing digital records of past maintenance activities and combining that data with a forecast of future scheduled activities also allows an HFM department to provide definitive data on budget forecasts and manpower needs, as often the biggest consumption gains surround budgets and staffing needs.
Moving into the digital age.
Within healthcare facility management departments, it is becoming more and more rare to find an individual without a smartphone or tablet that has not had to use an online site to submit a grievance or problem. As today’s compliance world has shifted into the digital age, so has most critical healthcare systems, with healthcare leadership expecting HFM departments to follow suit. With the benefits to the individual, department and organization increasingly obvious, immediate and visible, it is imperative that HFM departments take the next step into the modern world.
About the Author
For more than 18 years with Accruent, Rick Joslin has helped healthcare systems navigate the ins-and-outs of managing maintenance activities within their organizations. With over 30 years in maintenance management industry, at levels from technician, to director, to inspector/compliance surveyor, he is known for promoting continuous improvement, driving operational efficiency, increasing resource utilization, and ensuring regulatory success. As the Senior Advisor, Healthcare Strategy and as a Senior Solutions Architect, Healthcare, Rick leverages LEAN thinking and Six Sigma processes to guide our customers in the development of short- and long-term goals for measurable, continuous results across a wide variety of healthcare environments, while also helping them to identify gaps and inefficiencies in business processes and driving operational excellence. His broad knowledge of Healthcare operations and regulatory requirements, coupled with an intimate knowledge of the TMS systems, allow him to assist customers in developing easily-implemented solutions to unique, and changing, business needs.