11 Mar Running a successful medical device implementation
Has this ever happened to you? On Friday you left work for the weekend. When you returned on Monday, there were new IVs. Its 7:00 am and there is a training between 12:00 pm and 1:00 pm. What are you supposed to do for five hours? Is one hour enough training?
Some medical devices are more complicated than others, however, any new device introduced into a hospital creates operational challenges. Of course, if you are buying new Da Vinci robots, no one is going to expect a one-hour training in the break room will be sufficient for you to begin using this complicated equipment. Some new technologies require months to implement, especially if you are switching EHRs. Others are simple. New chuck pads hardly need to be mentioned.
But what about everything in between? New ultrasound equipment, new monitors, new drapes, new vital carts. The list goes on.
How do you successfully implement new devices?
There are a number of reasons why having a successful implementation plan is critical when bringing in a new device. These reasons illustrate why it is not necessarily enough to rely on the rep or the device company to direct your implementation efforts. They may simply suggest hanging out in the break room for the day and if people want to come in and see the new device, they are welcome. Or they will set up a one-hour lunch and learn “training.”
Reasons successful implementation is critical
Patient safety is paramount and comes first at every turn. Without proper training and implementation, though a new device seems promising, patients may be at risk from improper use.
You have had a device for 10 years and suddenly something new shows up. There is going to be a learning curve, even if training is extensive and well executed. Likely, the new device will suggest it is easier to use, and it may be, but that is often the result of training and practice. Because of this, there is likely to be a practice change. And a practice change if not handled well or implemented properly can have negative effects on staff and patients.
It doesn’t feel great when it seems like you have minimal autonomy. It also does not feel great when it seems like others do not trust your opinion. When new equipment shows up without staff input or at least notification, it can be a big blow to morale. It can be argued that morale, an important aspect of company culture, is critical to a high performing team.
The reason you bring in a new device generally comes down to a few factors. Cost or outcomes. The device could allow for higher throughput leading to decreased cost and increased revenue. It may improve outcomes for patients. It may make clinicians’ lives easier, leading to one of the above results. But if the implementation leaves many of the staff untrained or ill-trained, the new cost saving device could have the reverse impact. Longer procedures, slower turnover times, more patients waiting with no services rendered. In short, it could cost you more money.
With these reasons in mind, it is easy to see why a successful implementation is important for your team, for your patients, and for your top and bottom lines.
Implementing a new device
There can be many steps to a new implementation. Many device companies do things differently and offer different levels of service. For implants, there may be relatively extensive training and reps will be present for each case using the new device. A new robot requires extensive off-site training and ongoing education and practice. A new Hybrid OR is an entirely different animal, with workflow impacts, entire teams leading the service line transformation, and hundreds of project hours. Then you have a new IV system or heart rate monitor. Or even new wound care dressings.
While the level of complexity varies there are some common elements of a successful implementation. By no means exhaustive or detailed to the exact needs of every new device or system, it is a basic framework you can apply to your next implementation.
Define your outcomes
It is always important to start with the end in mind. Why did you purchase the new device in the first place? Is it to improve efficiency, reduce wait times, improve outcomes, or for another reason such as a cost savings?
Once you define the outcome, the reason why our brought in a new device, you can define the metrics for a successful implementation. The next key component.
Define outcome metrics
Closely tied to defining outcomes are defining the metrics. Improving efficiency is a wonderful goal. But what does that mean? Get very specific in this instance and you will be in a strong position to run a successful implementation.
For example, if your outcome is to improve efficiency, you may further define that by narrowing scope to reducing nursing time at the bed side on a particular activity. You can then put a metric to the outcome. In the end, your metric is “reduce nursing time on this task by 5 minutes.” With a clearly defined and measurable metric, you can ensure your upfront activities match your desired outcome.
Identify critical factors
Now that we have a new device with an outcome in mind and associated metrics, we need to know how to get there. You will likely know how this device is used and the critical factors in achieving your defined metric.
Continuing the above example, if our new device is an IV system that promises less erroneous alarms, thereby reducing nursing time on erroneous alarms by 5 minutes, we can quickly see what needs to be done to ensure the team knows what to do and how to use the device. In order to meet this goal, the team will need to know how to use the device properly as a baseline, in order to not increase time on IVs. They will also need to be trained on the new alarm system. Are there new settings or new sounds? Do they need to be informed about the new alarm triggers, so they don’t miss a critical alarm?
By knowing the critical factors, you are in a better position to design training for the new device.
This is where most people start the implementation. While it makes sense, without context when you jump right into training you may be faced with a disengaged staff. Let’s assume there is adequate context and you have defined outcomes, metrics, and critical factors. If that is the case it should be relatively straightforward as to what needs to be the focus of training.
The issue here is time and resources. Three things to consider when launching training on a new device:
- Include the educators on your team
- Work with the device vendor to give you the training you need, not just the training they suggest to ‘check a box’
- Putting in time up front will save you headaches later
It is understandable that given the hospital environment, it may be hard to devote mandatory 2-hour training to a new device. It is much easier to have the rep hang out in the break room all day or conduct a lunch and learn. However, making training mandatory and giving your team enough time to become competent in using the new device, will reduce issues later.
Work with your team and the resources you have, to set up dedicated times so your team can learn up front what they need to know for successful use of the new device. If you have done the first steps, the training will be well organized and clear. Use your reps. It is their job to make sure you have the training you need. Don’t be afraid to make them train each shift and come back multiple days to ensure everyone on your team is comfortable with the new device.
It is easy to suggest that after you have accomplished all the above steps to call it a day. The team is trained, and you can move on to the next pressing issue. However, an ongoing evaluation is beneficial in multiple ways.
First, when you continue evaluating the device and its use, you can identify issues and determine if more training is needed. Second, this becomes part of your planning for further improvements to workflow, efficiency, new device procurement, etc. Lastly, it helps you keep a pulse on your team’s morale. If things are working and the team is happy with the change, then wonderful. If not, it is important to know this and adjust. You can’t know everything upfront, and if something isn’t working, change it.
An ongoing evaluation can be as simple as a questionnaire given to your team 2 months after implementation. Here’s a helpful hint: have your rep make one for you. It will pay dividends on your team.
Despite this being the last item on the list, there is no step more critical than communication. It underpins the entire process.
Going back to our first example, imagine showing up to work Monday to new IVs. The training will be held that day and despite a well thought out implementation plan, you feel blindsided and immediately defensive. This may lead to a disengaged team.
When you communicate early and often it will be far easier to get team buy-in. You will also get more engagement, faster adoption, and realize the benefits of the new device earlier and more completely. Not only that, you will probably end up with a better purchase decision in the first place. By communicating with your team even before the purchase decision is made, you will get valuable insights into the type of device your team needs before committing to something.
There are many types of implementation depending on the device. Some are highly complex and others relatively simple. No matter the level of complexity, it is important to have a well thought out plan to run a successful implementation. Use your team and available resources, communicate early and often, and have clearly defined metrics. With some simple procedures and framework in place, you can run a highly successful implementation.