Make yourself indispensable to administrators with these tips

It is not uncommon to hear biomeds and clinical engineers complain that hospital administrators do not understand what we do. The blame for this misunderstanding is our problem, not theirs. If we cannot communicate what our value is to the hospital, then we have limited value to that hospital. Getting started and continuing the communication between us and administration is key to our survival.

Nothing gets an administrator’s attention more than money, either coming in or going out. For years, we have concentrated on what we can save

hospitals by purchasing parts from sources other than the original equipment manufacturer (OEM), by performing repairs at a low rate compared to the OEMs, and by being on the spot quickly when a problem occurs. In the March issue of this journal, Robert Dondelinger wrote a very good article titled, “Talking Money.” In this article, he offered some good ideas on communicating with the finance department. If you haven’t already, you should take the time to read it.

Unless you have been in a coma for the past few years, you cannot avoid reading and hearing about the financial crunch in health care. One of the big “targets,” say the so-called experts, is the high cost of technology. What these experts do not mention is that without the technology, health care would be much more expensive and much less patient friendly, and our life expectancy would be lower.

­­What we have to do is communicate how technology will lower costs and improve patient outcomes—not that we can save $100 on a part that keeps a 20-year-old, obsolete device in service. The question is, “Why are there 20-year-old devices still in use when there are so many better devices on the market?”

In the movie Cool Hand Luke, the sheriff said a great line while he stomped on the convict: “What we have here is a failure to communicate.” We are not communicating with our administrators that there are better ways to do things. This is not easy for many of us to do, but if you can show administrators that there is a better way, 95% of them will listen and act. But you have to get them the information.

Be Proactive
As an example, a colleague gave a picture archiving and communications system (PACS) presentation to his administrator that ran some 15 pages long and included costs, paybacks, etc. Another colleague introduced the PACS to his administrator with a one-page summary that placed the cost of the system and its annual operational budget as the top two lines. They were followed by a summary of what costs would be saved, which included water, electricity, sewer, film, chemicals, film disposal, other supplies, and staff reductions. He also mentioned that the film-storage room could be easily converted to clinic space, thereby bringing more revenue to the hospital. Guess which one the administrator responded to?

The point being, keep your correspondence short and to the point. Once you get the administrator’s ear, you can fill in the details. By keeping the correspondence short, it also prevents you from saying too much about any negatives that may have to be addressed. Be prepared to discuss them, but do not present them first. If you do, it will confuse the administrator as he or she may not be sure what your position is on the request. Always make presentations positive!

For many of us, it is difficult to be proactive and not reactive, and this is another limitation that we have to overcome. One of the best ways to be proactive is to publish, before the end of your second fiscal quarter, a list of devices or systems that are reaching the end of their life expectancies. Do not publish a list suggesting that everything has to be replaced in 1 year; rather, provide a 3- to 5-year projection. Base the list on what is going out of manufacturer’s support and is clinically obsolete, and on devices in areas that are being renovated.

Have the detailed list ready for presentation, but do not list every device in the report. Instead, indicate that there are four vents, the surgical intensive care unit monitors, several ultrasound units, etc. Again, keep it short, and do not give prices or alternatives at this time. As the character Joe Friday from the television series Dragnet used to say, “Just the facts.”

Do not get trapped into pushing a pet project for a department that is all cost and no revenue. This can sometimes happen when a physician or department head sees a new technology and wants it more for market purposes than for clinical reasons. On the flip side of this, do not fail to push a project that will improve patient care, reduce costs, and increase the hospital’s revenue because a department or physician is opposed to it.

A good example of this is the “camera pill” for gastric track screening. Early reports on this technology indicate that it is cost-efficient, the patients are more willing to have the test, and the results are getting better. If more patients are screened, more problems would be found earlier; and since the “camera pill” is only a screening device, any problems found would still have to be addressed with our current methods. This could be a significant revenue generator for the hospital, and it provides better patient results.

We also need to look at where the most revenue is generated in the hospital. We should be asking and acting on the question, “What tech-nology improvements are coming that can increase that revenue stream?” Conversely, we need to look at where the revenue generated does not cover the costs and what can be done there. This is a tricky area as egos are often involved, and politically they can be very dangerous.

Know Your Contracts
 Another operational issue that we should be very involved with is the service contracts and reagent rental agreements. It is not uncommon for a 5-year service contract to exceed a device’s capital acquisition cost. We need to ask why, and what is a better solution. We have all heard that service contracts include software upgrades, preventive maintenance (PM), and repairs. When you read all the fine print, you often find that software upgrades to correct a problem are free but that any software that upgrades the capability of the device is not covered and has to be purchased. As for PM and repairs, they are often restricted to certain hours of the day; and if they are needed outside of those hours, there is a charge.

Your administrator does not have the time to read all the fine print of a service agreement, so we should know what is or is not covered and prepare a bullet report for them. Also, look at the parts-replacement section of the contract, as it may state that the vendor can install new, remanufactured, reconditioned, or even used parts. In addition, you should fully understand what each vendor considers a repeat call on the same problem, as it may charge you travel time on the second call—even if it was the vendor’s fault that the problem was not corrected in the first place. When the vendor says that it guarantees a 99% uptime, the problem of collecting on this guarantee is that what it considers as downtime may be very different than your interpretation. Your administrator and finance people do not know, so you must find out this information and present it to them when needed.

In too many hospitals, the service reports on devices under contract never get entered into the equipment database. This lack of documentation will make it difficult if a problem is not solved and the hospital wants to get out of the contract, lease, or agreement. Take some time and get your records in order before going on the attack.

Closing Tips
Here are some closing tips for communicating with administrators:

• Make all reports as short as possible.
• Always include any revenue gain or loss in any report where you are suggesting changes in technology.
• Never communicate in engineering or computer terms.
• Always present a positive outlook.
• Only provide in-depth data when requested, and put a bullet-point cover sheet on the report showing the pages where each topic is discussed.
• Follow up with an e-mail if you do not get a response in a week, unless it is a critical item. If it is a critical item, look for the administrator in the café or corridors and ask him or her what response he or she is leaning toward.

By mastering effective communication with administrators, you will be asked to get more involved with capital planning, as now they know that you exist and that you have the hospital’s best interests at the center of your operation.

Remember, communicate, communicate, communicate, and the administrator will be a friend. Fail to communicate, and he or she will be your foe. 24×7

David Harrington, PhD, is director of staff development and training at Technology in Medicine (TiM), Holliston, Mass, and is a member of 24×7’s editorial advisory board.