Accruent’s Connectiv Featured in TechNation Podcasts Series 1 Episode 2
How to Transform the Request Management Process and Reduce Waste
Duration: 31:32 | Special Guests: Jason Tessari | Hosts: Al Gresch & Mike Zimmer | Series: TechNation Podcasts Series
In this episode Al Gresch, VP of Healthcare Strategy, Accruent and Mike Zimmer, Senior Solutions Engineer Accruent, sit down with Jason Tessari, Senior Client Success Manager at Accruent, to discuss how automating the Request Management process transforms risk management, safety management and the delivery of care.
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To learn more about Accruent visit www.accruent.com/industries/healthcare
- For more information on Connectiv's Request Management, please visit www.accruent.com/resources/brochures/request-management-healthcare-operations
- Read the blog How to Optimize Equipment Availability as Demand Surges
- Watch the Webinar AAMI Summer Learning Series: HTM Track Are You Listening? How to Improve Customer Service
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Today's podcast episode features Al Gresch, VP of healthcare strategy for Accruent and Mike Zimmer, senior solutions engineer for Accruent. These gentlemen sit down with Jason Tessari, senior client success manager at Accruent, to discuss how automating the request management process transforms risk management, safety management, and the delivery of care. Gentlemen, you may begin whenever you're ready.
Mike Zimmer: Good afternoon. Now we made it to the end of another week. I hope you're able to close it out strong. What've you got going on over there? What do you have in the hopper?
Al Gresch: Well, we're trying to close a lot of business coming up on the end of the quarter. I've also been spending quite a bit of time putting together some presentations for webinars, and of course, we've got this podcast that we're working on. But actually one for AAMI, I'm real excited about that's coming up next week. And as you know, they canceled the AAMI conference, the face to face meeting that was supposed to be in New Orleans, but they're holding those sessions as webinars. So, I'm doing that with Rob Bundick at ProHealth on how to increase your customer service. It's called, Are You Listening?
Mike Zimmer: That's pretty awesome. And I don't think I could have planned a better segue into what the topic of our episode is today. So Al, who do we have joining us?
Al Gresch: Well, Mike, we have Jason Tessari. Jason is currently a senior customer success manager. Jason and I worked together extensively when we were both at MainSpring before we were acquired by Accruent. But there is no one in the company that knows more about the topic we're going to talk about today, which is request management. I thought, who better to join us in this discussion?
Mike Zimmer: Yeah, I agree. Jason, it's great to have you here and I'm really looking forward to our conversation. That's going to occur over here in the next few minutes.
Mike Zimmer: All right. So request management is a little bit of an abstract term at first glance. Could you get a little bit more specific? Could we expand on that? Could we get a little bit more tactical about what we're talking about today?
Al Gresch: Sure. Request management is a platform that allows clinical end-users to literally request anything that they need, whether it's service on equipment, whether it's service on a room or anything facilities related. Whether it's linens or a piece of equipment, a piece of medical equipment, whether its supplies. So, literally, anything that a clinical end user would need to take care of a patient.
Al Gresch: And it does so in a very, very efficient manner. It's set up in such a way where you map the request to who the person is that's responsible for completing that request. It timestamps the call when it comes in, or the request when it comes in, and tracks it through its life cycle. And it's a great tool to literally transform how you deliver care.
Mike Zimmer: Yeah. And so the interesting thing for me about request management, as you just defined it, is, especially given the kind of solution we offer at Accruent within the healthcare space, personally, when I was initially exposed to request management, I would think about, "Well, they're just talking about the work order. They're talking about break-fix that needs to go to facilities or clinical engineering."
Mike Zimmer: But when you really open up what a request is, you're right. It's do you need service of any kind? And then what processes, policies, and procedures are in place to make sure that that work gets the person best qualified to go ahead and take action against it. And so Jason, I'm going to throw this to you, Al feel free to come in and interject, but what is the big enchilada? Why would a healthcare organization care about request management? Al had mentioned that it could revolutionize, it can really help you level up your game with respect to how you deliver services or even deliver care to the actual patient. Go ahead and expand on that for me a little bit, if you don't mind.
Jason Tessari: Yeah, absolutely. Thanks for having me, guys. Great to be here first of all. And to really answer the question, I think I like you said, the low hanging fruit is completing a service. An end-user really needs a service or a thing. That's the easy stuff. I think that the real definition of request management is it really comes down to risk and safety management. When you have solid processes and you're putting the right people in the right place to do these services, you're really making sure that these incredibly important clinical functions are happening in real-time and that they're not being delayed for any reason. So it really boils down to that risk management and that safety management.
Mike Zimmer: Yeah. Great point. Al, do you have anything to add there?
Al Gresch: I think at the end of the day, as challenged as the clinical staff is in doing everything that's on their plate and there's always additional bricks on the load for them that take them away from the bedside. And I think one of the main components of this is to try and mitigate that as much as possible so that they have a single pane of glass to go to, regardless of what they need. There's one application that they go into to literally request anything that they need.
Al Gresch: And then they can forget about it. They can go on doing what they need to do and have confidence that they're going to get what they need when they need it.
Mike Zimmer: Yeah. I think a core tent pole of request management is instilling that confidence in these clinical staff members, that they are going to get what they need when they need it with the most quality possible in the delivery of that service.
Mike Zimmer: So, that dovetails a little bit into my next question. When an organization is designing these processes, where should they start? And it's a little bit of a leading question. I know the answer to it. And then what measures should they institute into these processes to help instill that confidence on the part of the clinical staff? Al or Jason, go for it.
Al Gresch: Here we go again, JT, with the three-legged stool, right?
Jason Tessari: And it always goes back to the same three tenets.
Mike Zimmer: I have no idea what you're talking about. What is this three-legged stool?
Jason Tessari: Our mantra that we've used for many, many years now and it's people, process, and technology. In that order of importance.
Al Gresch: Okay. So, I think going back to your question, Mike, is the first step, what do you do? You have to do an assessment of what current state is, and it's pretty easy when you do that, to identify the broken processes that exist and how you can improve on that. And so that's the first part of it. And so then you help the customer design an optimum process and with request management, given that it's built on Connectiv in the Service Now platform, it is a workflow engine, right? So it's very, very easy to do that.
Al Gresch: And then you have the technology to support and sustain that optimum process. That's really it.
Mike Zimmer: And sustaining is probably the most crucial part of that in my opinion. But I wanted to back up a little bit. So, Jason, you've been in the thick of it with some of our customers when doing these current state analyses around request management. What are some of the common areas or parts points of friction or places in these processes where waste makes itself apparent that ultimately leads to a lack of confidence on the part of the requester in that they're going to have their request fulfilled in a timely manner?
Jason Tessari: Yeah, it's a great question. And from my experience, it really comes down to accountability and that accountability piece is really everybody's responsibility to handle. From the request side to the fulfillment side, to the management of it, the teams and the pieces, the people and processes that we put in place. Everything needs to function together as one unit in order to get the desired outcome. And in order to hold it all together, everybody needs to be held accountable.
Jason Tessari: So using something like a service level agreement to make sure that deliveries are hitting certain times or ensuring that a sterile process is being followed for equipment in order to make sure that the equipment that is being centrally stored is getting cleaned properly so that a nurse knows that they're using a device that has been properly cleaned and they don't need to think about it. The accountability piece on all fronts is really the linchpin that holds the whole thing together because, without it, anybody can just not follow the process. And when you're not following the process properly, then it all just falls apart and that's where trust issues come into play.
Jason Tessari: And then one person or a group might have a certain perception that things aren't happening. And it all just goes haywire. So really accountability is where it really comes back to quite a bit.
Mike Zimmer: That lack of trust, that lack of confidence, nobody's accountable to take action against these things. There are downstream impacts of that above and beyond just a poor relationship between clinical staff and support service. And so one that comes to mind for me is this, and this doesn't happen every time, it does happen in quite a few organizations, but clinical staff will start hoarding equipment because they don't think that they're going to be receiving the requested pieces of mobile medical equipment when they need them.
Mike Zimmer: So, they'll do things like stash it in cabinets or above ceiling tiles. That's another favorite example of ours. If you’re to extrapolate the downstream impacts of that, what is that going to lead to? So Al, what have you seen out in the field when that's in place?
Al Gresch: Yeah. Then, when that's in place, what it translates into, Mike, is overbuying of equipment. There's a constant cry. "We don't have enough of," name your device, right? Because it's not being effectively managed. There isn't enough capital to go around as it is. So, healthcare organizations, especially right now with them bleeding money, I've heard countless organizations, most of them that are customers of ours, where they've completely shut down the CAPEX for 2020 and many leading well into 2021.
Al Gresch: You really can't afford to have that situation take place where you're buying stuff that you really don't need. One of the benefits that this brings is, first of all, going back to developing that confidence. If the nursing staff is getting what they need when they need it, there's no need for them to stow away equipment, right? The other thing is because you're tracking everything, you know what the demand is, it takes away the guesswork and you're dealing now with reality versus perception.
Al Gresch: There are situations where there isn't enough of a given thing to go around, but then you'll have real metrics to support that fact and you can say, "Look, we're getting a higher demand than we have the supply for. We actually need to buy more of these types of devices."
Mike Zimmer: And you have the objective data to back that decision up or the decision not to buy or lease more equipment. But then if you start thinking about this hidden mobile medical equipment, then you have an increase in the number of unable to locates during that device's PM cycle. So, that institutes more waste into your maintenance processes because you have to go out there and try to find it each time that it's not where it's supposed to be.
Mike Zimmer: And then we don't generally want to get into this portion of the discussion, but if it's not being submitted to centralized sterilization or at least a very standardized sterilization process, you could potentially see an increase in the number of HAIs you have within your organization. It does sound like, at the surface, we're just talking about the time between requests being entered and when it's delivered, but when you take these larger downstream impacts of things like this, it brings an additional level of priority to make sure that your clinical staff gets what they need when they need it.
Al Gresch: Well, and as I said earlier, Mike, it takes away the time that clinical staff is having to spend hunting for the things that they need and gets them back to the bedside where they belong.
Mike Zimmer: And we talk about this on the non-clinical side all the time, where we need to optimize the amount of wrench time that technicians have on equipment. Don't we want to do the same thing for our clinical staff that got hired to be at the bedside? Don't we want to optimize the amount of time that they've got available to do that?
Al Gresch: One would think.
Mike Zimmer: One would think. So, Jason, again, you're in the field knowledge about this and providing solutions to some of our customers around request management. You get to see the before and after photos effectively. So, I was wondering if you could think of a couple of examples where you were deployed, for lack of a better term, you did this current state analysis, you were able to implement a solution. And what was the outcome of that?
Jason Tessari: Sure. There's a couple of different outcomes that were actually really interesting to learn in real-time. One of my customers was actually promoted twice. He revolutionized their mobile medical equipment department. And when we started, they were a ... I don't know how to be politically correct. They were awful when we started with them before we put these processes together and the customer came in and was brand new to the organization and just was thrown in headfirst.
Jason Tessari: And nobody was following what he was trying to do. So we came in and we buckled down and we helped and we started to talk about the value and the ROI of doing things the right way and come to find out after a couple of years, the customer was promoted twice, is now responsible for more than just his one department. And an interesting tidbit out of that, he actually went in front of the union and made changes to job descriptions.
Jason Tessari: So, he was showing so much value and was making so much headway with the entire organization in how transformational he was being, he was actually able to go in front of the union and make some really impactful changes to job descriptions to ensure that his processes were staying standardized into the future. So, that was actually really interesting after the effect of one of my deployments. Another one actually got rid of floor rounding entirely.
Jason Tessari: They went ahead and were strategic with some passive technology, specifically in soiled rooms. So that assuming the clinicians were putting their equipment into the soiled terms, that they would automatically be told whenever a certain number of devices was in that room, it would automatically create a ticket, go to the team, and the team would react to that room instead of just walking the entire hospital.
Jason Tessari: You can imagine how many extra steps they save on a daily basis, how much more time they actually have to deliver, and sterilize equipment instead of just walking the hallways, hoping to find one thing. They know that room 502 up on the fifth floor has got eight things in it. I need to go grab those eight things and put those back into circulation. So, their demand for equipment from the clinicians actually went down, but it's because they were driving a proactive process and really changed the way that that group operated.
Mike Zimmer: That is yet another example, Al, of what happens when you take your department that's traditionally viewed as a cost center and elevate it and are able to accurately articulate the kind of value that it brings to the organization. Good things happen when that happens.
Al Gresch: Oh, absolutely. And I want to go back to the idea of metrics and Jason worked with me on another customer where we saw the demand for a certain device or a group of devices that had been fairly constant and all of a sudden we saw drop off in demand. It was through our working with that customer and doing quarterly business reviews where we identified and called that out and my first question was, "Have you had a reduction in your census that would explain that?"
Al Gresch: And they hadn't. So, we quickly concluded that what that meant was that they weren't using the system the way that it was designed and subsequently they were going back to the old way of doing things, that they weren't having the demand because they were keeping that equipment on the floor. Because that came to light, we were able to get them back on track pretty quickly.
Mike Zimmer: That's incredible. So from here, I want to move into, you mentioned metrics. I think that that's a good place to stick for now.
Mike Zimmer: So we've designed our process. We know how we're going to maximize the amount of value that our internal customer, the clinical staff, is going to receive as an output of the process that we've designed. Now, as part of sustaining this process into the future, let's talk a little bit about the metrics we'll put in place to make sure that everybody is adhering to this process and really moving the needle with respect to request management and customer service.
Mike Zimmer: So, Jason, you had mentioned SLAs. I'm familiar with SLAs. I know you are as well as Al is, but there might be people listening to this that aren't familiar with what a Service Level Agreement is and how it fits into this overall request management workflow conversation. So, take us through that.
Jason Tessari: Yeah, absolutely. A service level agreement is an agreement in this particular instance between the group that is delivering on the service and the group that is requesting a service. And they both agree to operate in a certain way, and they are held accountable to those metrics, whatever they may be. There's a customer here in the Northeast that puts some service level agreements together that ensured that certain request types have to be acknowledged and delivered within a certain amount of time. It's a very simple service level agreement and it's agreed on by both sides.
Jason Tessari: So, the requester is also required to put a certain amount of information on the ticket. So the teams are being much more collaborative. So, the service level agreement on the service level can seem to be punitive towards one group. But really the intention is to keep everybody accountable, to make sure that they're delivering the service that the end-user really needs in order to ensure that the patient is being taken care of appropriately. So whatever that structure is is up for interpretation. But you want to make sure that when you do go through the process, that you think about the entire process and not just one piece of it. The delivery time is just one piece.
Mike Zimmer: Yeah, understand.
Al Gresch: It goes to the old adage, Mike, you can't improve what you can't measure. And we've heard that from several customers that until they employed the solution, they had no way to measure how they were performing. And the customer that Jason alluded to that got a couple of promotions through this, they were several hours in completing deliveries and once they have this process in place, they got down to a point where their fulfillment times were sub 15 minutes, which is incredible, right? But they wouldn't have been able to get there without the ability to measure their performance. Look for where the system was failing, eliminate those failures, and optimize the process.
Mike Zimmer: Yeah. And another interesting aspect of that, or angle to take with it, and Jason, you hit the nail right on the head. There needs to be mutual accountability on both the deliverer of the service, as well as the person that's making the ask. Because I get into situations with our customers a lot of the time where they're like, "We never get the amount of information we need from our end user."
Mike Zimmer: And yet they are the first person to pick up the phone and call our department for an update on the status of the service we're delivering. But you're right, yeah. It totally has to be a mutually agreed upon, "If this is what you want. This is how you need to ask for it" kind of conversation to take place. Pretty cool.
Mike Zimmer: I think we've done a good job of covering how this process should be created. Where it should be focused, ways of measuring performance, and how to sustain the performance on the process. Now let's pivot to the last leg of that three-legged stool: Technology. I fall into this trap all the time as a result of what my job is here within Accruent, but I love technology, to quote Napoleon Dynamite, and it's tempting to throw technology at these process problems. Wonder if you guys could talk to me a little bit about why that's not a great approach to taking on something like request management?
Al Gresch: Because if you simply throw technology at a problem, you've literally wasted your money. I've, I've worked with a great number of customers, Mike, who just as an example, have gone out and spent tens of thousands, or in some cases, hundreds of thousands of dollars on RFID technology. Thinking that that was the silver bullet. "If I have something that will show me dots on a map where equipment is, all of my process problems will go away." And that simply has not been the case. If you don't have a good process in place, you've just spent a whole lot of money on something that really won't help you.
Mike Zimmer: You bring up tracking technologies and that's probably the area of this topic that is most rife with throwing technology at a process problem. Because it is tempting for solutions providers to recommend one of their technologies over another, because of the objectives they have to meet as a sales company, as the sales arm of a particular company.
Mike Zimmer: But you really have to understand what the problem is to define what the solution is going to be. And oftentimes when we're talking about process-based issues that we're trying to solve for, something like passive RFID technologies is the way to go. And that has such a lower price point than something that's on the active side. I've just always found that such an interesting component of this conversation. And when a customer really understands what's going on within the four walls of their facility or across their organization, and they can come in and be like, "You know what? No, that's not right. That's not the right technology to deploy here. This is." It's refreshing or invigorating or something along those lines.
Al Gresch: Or if there's a technology that you need.
Mike Zimmer: Right.
Al Gresch: You and I run into this all the time where we have requests from certain customers that want us to make changes to the software, to hold their people accountable. And it's like, "No. You need to hold your people accountable." This is not a software issue. This is a process issue and so if you don't already have policies and procedures in place to hold people accountable to do what you're expecting them to do, then you need to develop those. And again, if you have a good process in place, sure, there are things that you can do from a technology perspective to support and sustain that. But there are many-
Mike Zimmer: It's not always the answer, right?
Al Gresch: No, it doesn't. It isn't. So can you think of an example where you had to inform the customer that we need to right-size the solution here?
Jason Tessari: I've got a couple, one of them is actually amusing, talking about the difference between RTLS active technology and passive technology. Thoughts on a map. My favorite question to ask is, "Great. You have a map. Now what?" Okay. Now what? What are you going to do? You don't have a process built around it to manage those dots. You don't know the status of it. You don't know what's actually going on. But you've got a pretty map. I'm happy for you. Now what?"
Jason Tessari: So one of my more amusing stories is I have a customer that actually put passive tags on all of his devices that was active tagged so that when the batteries would die randomly, he would know exactly where they were because in the background he put a process in place to actually track his equipment, moving through different choke points. So he could actually still see everything in space-based off of a process whenever the active badge died.
Jason Tessari: So, he actually put passive tags on active tags to find them when they didn't operate the way that they're supposed to operate. So, that's one of the more funny stories. Using one technology to mitigate the issues of another technology.
Jason Tessari: And my previous anecdote, the customer that automated their soiled rooms, is probably one of the most impactful stories I can tell about it. Passive technology specifically in soiled rooms, tracking a device just going into the room. And after managing of what's called a par level, how many devices are in that space and then automatically creating a ticket whenever that number, that par level, gets too high.
Jason Tessari: So you're, you're taking a process. The technology doesn't do anything if your nurses aren't being held accountable for taking their devices when they're done and put them in that room. But look at what it does when everybody is firing all cylinders and following the strong process, you've got devices that are going from the bedside into a soiled room. The par level goes up. It hits its mark. It automatically creates a ticket. Goes down to the equipment technicians. They go up and they're proactively taking that number of devices, bringing it down into their central area, properly sterilizing it, properly packaging it for delivery back to the nurses.
Jason Tessari: And then in real-time, whenever a nurse makes that ticket, they've got their 15 minute SLA and it makes this really nice closed-loop process. But it's all dependent on the process and the technology really just structures it and holds the whole thing together.
Al Gresch: It requires what you love to hear Mike, which is organizational change management.
Mike Zimmer: Awesome. Well, Jason, speaking of closing the loop, I just wanted to say thank you so much for coming on here and chit-chatting with us. Al, as always, a pleasure.
Mike Zimmer: If anybody listening to this has any sort of suggestions for other topics to cover, follow up questions, or maybe you want to know more about request management within the four walls of Accruent, what do we have going on with respect to that particular solution, feel free to reach out to us in any of the channels that you have available to us? It might be easiest to just reach out to us at [email protected] or you can contact Al, myself, or maybe even Jason directly, and we'll make sure to get you the answers that you need.
Mike Zimmer: So, Jason, thanks again. I really appreciate it.
Jason Tessari: Thanks for having me guys.
Speaker 1: Thank you, Al, Mike, and Jason. We certainly enjoyed your presentation today. This concludes episode two of Podcast on Tech Nation. If you enjoyed today's episode, you might enjoy our ongoing webinars series Webinar Wednesday. You can find a calendar of upcoming live webinars, as well as an archive of on-demand webinars by visiting webinar Wednesday live. To obtain your certificate for one CE credit from the ACI, please remember to click the link located below the podcast title to complete today's survey. If you have any questions, you can reach us at [email protected].