What's in this episode?
In Season 1, Episode 9: Al Gresch, Mike Zimmer discuss the impact of COVID-19 on HTM and HFM departments nationwide and what Accruent is doing to help, including new free Reporting Packages to track related activities and our new COVID-19 Part Predictor for Ventilators and Anesthesia Machines.
Welcome to the Healthcare Chats podcast where your hosts Al Gresch and Mike Zimmer will bring you insights to take your HTM and HFM from the basement to the board room. Healthcare Chats podcast starts now.
Mike Zimmer: This podcast is going to touch on COVID-19. Anybody that's listening to this probably knows quite a bit about what's going on, but we are just going to briefly talk about what are we seeing today and what are the impacts going to be for the healthcare industry. What kind of steps can be taken to cap the downside of the effects of this pandemic?
Al Gresch: Mike, as you can imagine, it varies quite a bit. You have what's going on in hot zones, and I have a friend who works in New York and is heavily involved with both the CDC and the White House. He's on a task force, so ... I've spoken to him and what they're experiencing and what their issues are are very different than the rest. What they're starting to experience now, which you've seen in areas of Europe, is a shortage of ventilators. That's been the biggest issue and what the non-hot zone areas are into right now is a state of preparation. And it's interesting, I've got friends that work in healthcare organizations in those non-hot zone areas as well and what they're talking about is their patient volumes are down due to fear, patients who just don't want to go into the hospitals, but also hospital recommendations. So literally every elective surgery or elective procedure, is not happening.
Al Gresch: The other thing I've heard that impacts everyone is the surveying or accrediting agencies, particularly the joint commission and DNV have postponed all surveying for the time being. That's sort of a breather and yet I read yesterday a Q&A by Herman McKenzie, who is the guy that eventually took over for George Mills. People are asking him, "What about you know, the requirements, are you going to ease up on those in light of what's happening?" And Herman's response is, "I can't, that's not up to me. We're deemed by both us and DNV are deemed by the CMS. And unless CMS changes their rules, the rules are going to stay the same."
Mike Zimmer: And it seems as though like any breathing room that healthcare organizations are able to get with things like the suspensions of surveys is immediately consumed with meetings from sunup to sundown.
Al Gresch: Absolutely. Again, I think that information, at least for now until CDC reviews and responds, is that better understand that the rules are going to be the same until further notice. And yes, it's extremely difficult. But if you think that there's going to be a hall pass because of COVID-19 at least, for now, there won't be.
Mike Zimmer: Part of me thinks that that makes a lot of sense though because they wouldn't be much of a standard if ... you know, during a situation like this, even with as extreme as it is if it were to just be adjusted I kind of feel that voids the intent of having these regulatory requirements in place, to begin with.
Al Gresch: Sure. If you think about it in terms of keeping equipment safe and effective, that's more important now than ever. If you think about things in terms of infection control, that's more important now than ever, so ... I agree with you 100% on that front.
Mike Zimmer: And of course hats off from everybody here at Accruent and from Al and myself to the people that work in those healthcare organizations, both on the clinical and non-clinical side.
Al Gresch: My son works at a local hospital in environmental services and I talked to him last night and I shared with him how proud I am of him. I said, "Dude, you're one of the heroes. You're one of the heroes that are keeping things going so that you can continue to take care of patients".
Mike Zimmer: So Al, let's talk about vents. What are we currently seeing around ventilators in their supply? What are the challenges?
Al Gresch: I would say that what we're seeing is most suppliers are out of stock. I talked to a friend of mine whose organization went out and ordered a bunch of disposable ventilators. There is no electronics. They're fairly simple devices, a couple of hundred dollars. The few companies that supply them are out of stock. So that was something that was identified as a source and very quickly dried up. Rental companies are-
Mike Zimmer: Their inventory has to be depleted, right?
Al Gresch: They are depleted, right. So what that calls out, Mike, is the importance of getting the most out of what you have. That's two things. Considering alternatives and anesthesia machines have ventilation capabilities and could work as a ventilator if needed to do that, certainly, they're not built to be used as ventilators, but they can do that. If you think you won't need the vaporizers and the mixers that take the anesthetic agent and blend all that as part of their function, but it can be used.
Al Gresch: It's critical to have optimum workflows from a service perspective, making sure that your response time on things like vents and beds are optimal turnaround time. If something's down, certainly those are things that should be at the top of your list of priorities. And so you need to do appropriate triage and prioritization of those kinds of things that are in critical need. And I'll talk a little bit more Mike about what people can do to optimize that turnaround time. The other thing too is, and I think it's true of all equipment, not just ventilators, but it's critical here to keep staff safe. And it's not just clinical staff, it's your staff too, the people that are providing the service. And so I think people need to think about the chain of custody from the request to the service itself.
Al Gresch: The response to that in turning that around and making sure that stuff is cleaned and disinfected when it comes to you, but also that you're doing everything that you can to make sure that that stuff is clean and safe when it goes back to the end-user. I talked to one of our customers yesterday that has reviewed their infection control policies with their staff. I think that is a best practice. Certainly. I know firsthand that every year entire hospital staffs go through compliance training and infection control is one of those things that they review and people have heard ad nauseum wash your hands, wash your hands, wash your hands. Right. I'm not sure that in my experience the service staff is as diligent about that as they need to be.
Al Gresch: The other thing that I've seen and read in different publications is all the nasties that reside on hospital floors and making sure that as you do complete service or you do pick up equipment and move it, you make sure that it is clean. You think about going into sterile areas, there are rules and regulations around that, that people should be following. But I've talked to some that actually keep a set of tools in those sterile areas to minimize cross-contamination. And I think that's a good idea as well. That's a good, best practice.
Al Gresch: One discussion I had and as we talk about what things we can do, one organization asked if there was a way that we could put a reminder on the request screens to remind people to do those things, to wash your hands and make sure that equipment is clean. Would it be annoying? Absolutely.
Mike Zimmer: That's kind of the point, isn't it?
Al Gresch: It is the point. It is the point. Yeah. It's like somebody complaining about an alarm being annoying. Well, that's kind of why it's there.
Mike Zimmer: Yeah. So I think this is a fantastic learning opportunity for every industry. But specifically healthcare. One, the people that are going through these processes. One, it's going to reinforce the fact that that training was necessary and they know what to do in this particular situation, but it's also going to highlight other steps that they can take into the future. So, keeping the toolset in the sterile area to prevent cross-contamination.
Al Gresch: What I did, Mike, when I was leading a couple of different in house groups and that was pretty effective is I did my best to put a patient's face on every single thing that we did. And I think more effective is to put a family members face to everything that you did and imagine how people would be inclined to comply with an infection control policy if their mother or their wife or one of their kids were in that bed or in that room that they're about to go in.
Al Gresch: And if you can instill that in your staff, they're much more likely to have that front and center and to get them to think about it constantly. One of the things that I did just as a time management thing was on the door exiting the department there was a sign on the door that said, "Don't forget..." And so, it would cause you to pause and think, "Do I have everything with me that I need before I go respond to the service event?" I would take that same kind of idea and post something on the door leading out of the department to remind people, "Did you wash your hands? Did you wipe down equipment?"
Mike Zimmer: That's a pretty high tech solution there, Al, which just goes to show sophisticated software systems or solutions aren't always necessary. They're not always the solution to the problem. So you had brought up, and correct me if I'm wrong, I think it's a good time to talk about this, maybe you disagree, but making sure that you I’m going to throw a bunch of buzzwords at you. You optimize the utilization of what inventory you do have, and what processes should or can be in place to make sure that you're taking advantage of every single asset or device at your disposal, the most efficient way possible. So let's talk a little bit about those processes. You said from the chain of custody of that particular device, what are the things that folks out there should consider when looking at this process with the end goal of, again, maximizing the utility of their existing inventory?
Al Gresch: I think it's important to have a mechanism to be able to capture the time that a request was made and be able to measure your response to that request. However you do that, you may have tools in place that allow you to do that, and I was able to do that long before the modern CMMS platforms were available. But again, I go back to what I said earlier. You can't improve what you can't measure, so you need to be able to measure how you're performing, particularly as it relates to these things. I would say that ... I'm going to make recommendations and we'll talk about this in a little bit, some of the things that we're doing to help with this, but I think it's going to be important to proactively identify the work that you're doing that's related to COVID-19 so that you can appropriately prioritize those things.
Al Gresch: I would look at any processes that you have in place that would allow you to optimize that turnaround time. When you're looking at optimizing workflows, you should be looking at what your response time is, but also looking at what your turnaround time is and doing appropriate prioritization. Certainly, anything that falls into this category of being related to the COVID-19, I would say that ventilators certainly are at the top of that list. I think when you're in the facilities engineering realm, there were some recommendations that came from ASHE talking about they were recommending to people that they review their current processes and intervals around literally any equipment that impacts the air quality and thinking about whether or not you should up those intervals, especially for things like filter changes.
Mike Zimmer: Sure. That makes a lot of sense. And I think it's important to focus on that response time and the turnaround time. Because to me, that seems like the lowest hanging fruit, any inefficiency, any time that's wasted in that response or that turn of that device across the entirety of your inventory, that begins to aggregate as the day wears on. And so any moment of unavailability is you're effectively keeping that device away from somebody that could potentially need it.
Al Gresch: Here's the other thing, Mike, if it were me, I would look at what opportunities does this present. So an example, if I don't currently have staff that is trained to service this equipment in house, is there an opportunity for me to start down that path?
Al Gresch: Because if you outsource that service, and let's say...OEM and if you have something go down, one of two things is going to happen. Either you're going to package it up and send it out to them. Well, think about the turnaround time on something like that. Oh my God, you can't afford that time. You know? Even if it's not that, even if it's having a service engineer come in and service those things on site. There's going to be issues on that front as well, and potential delays because of the availability of qualified service staff. Some companies have limited people's ability to go anywhere, let alone into healthcare organizations. I think that's something that I would look at is just in order to optimize that turnaround time, would it make sense for me to try and get a couple of people trained ... or if I already have people trained to expand that and potentially cross-train others so that you've got more people that have the ability to do that.
Mike Zimmer: Yeah. And so you bring up something that's kind of interesting because yeah, outside of working within a hospital or a health system, I feel like everybody's still in reaction mode. And so when you first stated that you would look at this and find what opportunities that presented, my brain immediately said, "How's anybody going to have any time to think through that?" But you're right, it's not like this is going to resolve the next month or maybe even the next six months.
Al Gresch: Oh gosh, no.
Mike Zimmer: Yeah. It's a perfect time to start evaluating this and saying, "What can we move in-house? What makes sense for my inventory, my environment, etc." That brought some gravity to this situation for me. Is that we're going to have some time to think through this. What is Accruent doing currently to help out the healthcare industry during this time?
Al Gresch: Yeah, I'm extremely proud of our team, Mike and the things that we're doing. One of the things is to leverage the data that we have access to ... those who don't know, we have a tool called Data Insights and with the fact that we have 55% of the CMMS market, we have access to a lot of data from...empirical data...from real-life work orders and have been able to provide valuable information around equipment reliability and typical life of a device versus AHA’s useful life [American Hospital Association (AHA) Estimated Useful Lives of Depreciable Hospital Asset]. That tool, I think some of the things that we're going to be able to do and these are things that are being worked on as we speak, is determining ... first of all, from PM requirements, what levels of PMs are due when and with that, being able to identify the PM kits that are required for each level so that organizations can be proactive.
Al Gresch: I talked to one customer that has already ordered the PM kits that they needed for the first six months of the year. And so they're able to have on hand what they need and won't have any delays in getting those kits. And the thing that I would be concerned about is people or suppliers running out of those things. So if we can identify what it is that you need well in advance and give you the opportunity to get those things on order and have them have on hand when they're needed, I think it will be extremely beneficial. And the other thing is, is failures. Being able from the data we can see when things will likely fail. One example is there's a particular make and model of a ventilator that at the five to six-year mark, you need to replace the battery, the lithium ion battery.
Al Gresch: And so identifying those types of things and alerting our customers, here's your inventory, here's where this thing is sitting in its life cycle. And by the way, based on what we're seeing, you're going to need these parts, so making sure that people reach out to try and obtain those parts before things fail. Again, going back to the thought of optimum turnaround times. If you have to order a part and run the risk that that part may not be available, you may be taking an additional device out of your inventory as a result. And that that can't happen.
Mike Zimmer: Right, and is very difficult for these devices to function without a lithium ion battery. So it's quite the limiting reagent in this formula. So yeah, that's an excellent part to call out as something that will be failing in the short term. You want to make sure that you've got the stock available to replace that.
Al Gresch: Some of the other stuff that we're doing, Mike, I've got a couple of folks on my team that are working on reporting packages to help manage COVID-19 related activities and actions, things like adding an additional designation for documenting all COVID-19 related work orders. People are going to want to be able to report on that.
Mike Zimmer: So let's talk about that reporting real quick. What will they be reporting against that COVID-19 related work for?
Al Gresch: First of all, I'd say it's just having the ability to code and identify all work that you're doing related to CV-19 but also the delivery efficiency of those work orders and you want to call them out. Again, going back to the idea of doing appropriate prioritization, you obviously want to put those things at the top of the list, being able to track turnaround time compared to the results. How much time is it taking to try and fix something?
Al Gresch: Would you be better off replacing it? Do you have parts available? Again, looking at what some of the delays, the reasons for some of the delays would be, and by having those reports you can identify what those roadblocks are and then work to eliminate them.
Mike Zimmer: Okay. Yeah, that makes a ton of sense. I just needed some additional clarity around that.
Al Gresch: Some of the other things are for PM forecasting, being able to forecast tech workload, re-prioritizing to free up skilled techs. Again, we talked about doing some cross-training. If you think that's going to be a challenge at forecasting vendor involvement because I think in light of what's going on, it's the time that's going to take to get somebody on site is going to be longer.
Al Gresch: The further out you can forecast that and be proactive the better. You know, looking at the location of those PMs...date last touched. One of the things that I've heard too, Mike, is that especially in the hot zone areas, that hospitals are expanding patient's locations to things like universities, you know, there are no students there now, so taking advantage of that additional space. How are you going to be able to track the movement of equipment to those spaces and then back again? Creating some reporting tools around that I think will be helpful.
Mike Zimmer: It makes me proud that that is why you and the rest of your team are working these late hours is putting together these projects or these bundles or whatever you want to call it for the healthcare industry. It's very cool stuff and thank you for doing that.
Al Gresch: It's not just us either.
Mike Zimmer: Oh absolutely.
Al Gresch: We're also leveraging some of our partnerships. Yesterday, our data insights team had a call with PartsSource and they're a business partner of ours. We're sharing our data with them so that they can be well-positioned to have the necessary parts available that they can deliver in a timely manner. PartsSource has recently become much more of a resource company versus just a parts company. And so some of the things that they can help with as well is, you know, access to the service grid for on-demand service. They can facilitate a depot repair, perhaps reduce the turnaround time, repairs that you would need to send out, they can help with finding rentals.
Al Gresch: You may have a contract with a particular rental company. I know for the contracts that we had in place while we were committed to renting from them if they didn't have something available, that opened a door for us to go elsewhere and I think that's something that, that they can help as well as identifying qualified used equipment, vendors, parts, suppliers if it comes to that. Like I said early on in our discussion, access to additional equipment is becoming very, very limited. We also had a call yesterday with another partner of ours, Attainia, and they were able to supply us with a list of suppliers and budget numbers for both ventilators and anesthesia machines. Some of that information is what we used to be able to run our reports and identify the things that are going to be needed.
Mike Zimmer: It is heartening to see these different organizations partnering together to solve this unprecedented problem or at least in our lifetimes. I don't think we've ... we've come across a situation like this.
Al Gresch: I never have, no.
Mike Zimmer: Back in 1918, Al, maybe you ... and the more I think about this, and I know this is most likely obvious to a lot of other people that are listening to this now, but this is not just a healthcare emergency or an economical one because obviously it's going to have a tremendous impact on our economy, but it's also a logistics problem that needs to be solved. Now, it's just interesting how interconnected all these various aspects of healthcare delivery are. And that's really being highlighted by this current situation. It's, I guess, morbidly interesting in that it's not a great situation, but it's fascinating from a workflow and problem and solutions perspective.
Al Gresch: Well, and it's interesting, Mike. I remember quite a few years ago when I was at Aurora, I was on my way to an executive team meeting, walking along with our chief nursing officer and she was lamenting something that she was challenged with at that particular point in time. And I looked at her and I said, "Sue, you think back over the last 15, 20 years, everything that we were forced to do either due to regulatory requirements or, or economics. If you look back objectively at those in retrospect, would you not agree that those ... in almost all cases there were things that we should have done anyway? Kind of look into it, yeah, you're probably right on that. So I hate to say this, but there will be some positive things that come out of this. I think that we'll find ways to make improvements in our processes that hopefully won't go away once this is all over with.
Mike Zimmer: If we went through a process or went through a situation like this and didn't learn anything, I think that would be the real failure. Right? So, there's no problem with calling out the fact that there will be some positives that come out of this.
Al Gresch: Well. And with that in mind, Mike, this is the first podcast that we've done on this topic. We did push out a blog a couple of days ago that people found helpful. But we're going to be doing a lot more of that.
Al Gresch: I know that Rick has written a blog that I think will come out very soon. So we'll have continued blog posts and podcasts on this topic and we're planning for a webinar as soon as we possibly can. I think the tentative date for that is the 26th but there'll be information that'll be coming out on that once we finalize the date that'll allow people to register. And I think with that, some of the stuff we talked about today will be on there. We'll certainly have updated information, but by that time, these reports that we talked about will be available and we can actually show people what we're talking about and give them the opportunity to see what we're trying to do to help.
Mike Zimmer: And if anybody listening to this wants to be a part of a podcast episode, a blog post, or a webinar with us and our team so that they can share helpful insights or information with the rest of the industry, the community that we have here, please feel free to reach out to any of us and we'll make sure to make that happen.
Mike Zimmer: Like always, thank you so much for listening to this. If you have any suggestions for other topics or questions, feel free to reach out to Al and myself, firstname.lastname@example.org and email@example.com. Al, stay healthy and we'll talk to you later on.
Al Gresch: Thanks, man. You also.
- Blog: Adapting Your Healthcare CMMS & Asset Management Solutions to Track COVID-19 Activities
- Blog: Healthcare Asset Management Strategies for Effective Infection Control
- Accruent’s COVID-19 Special Report: Part Predictor for Ventilators and Anesthesia Machines
- Accruent’s Data Insights (unbiased equipment reliability data)
- Watch the 10 Steps to Make Your Healthcare Technology and Facility Departments a Strategic Asset webinar
Feedback is hugely important to us because we rely on followers to plan our next episodes and topics. Leave your suggestions and feedback here.
Your Accruent Healthcare Team