KPIs and Data Best Practices for Every Biomed
Sep 14, 2023
Mon, Sep 11, 2023 11:52AM • 29:37
work, htm, orders, turnaround time, documentation, patching, data, set, patches, service, vendor, contracts, program, metrics, pm, department, vulnerability, document, cmms, good
Arleen Thukral, Chyrill Sandrini
Chyrill Sandrini 00:12
Welcome back to HTM Insider, we’re so excited about our guest today. Thanks for tuning in. My name is Chyrill. I’m with MultiMedical Systems and the host of the podcast. We’re just so excited to talk to Arleen, Arleen is that your powerhouse in the industry. I’ve been so lucky to know her and follow her since 2016 when she was in Fresno, California. And now she’s in New York managing, I think at least nine facilities. So without further ado, I’d like to introduce our guest, Arleen.
Arleen Thukral 00:43
Oh, Thank you Chyrill. My name is Arleen Thukral, the VISN 2 Healthcare Technology Manager in New York and New Jersey health care system. So I oversee on nine healthcare systems in the VA. And I started off in my career in the technical career field program in Milwaukee. And after I graduated from that program, I moved to Fresno where I was the Chief HTM at Fresno. Then I moved on to VISN 20, where I was the staff biomedical engineer at the VISN. And now I’ve been in my current role for over four years.
Chyrill Sandrini 01:29
Amazing. Let me ask you real quick, how did you get into the HTM industry? What was your pathway.
Arleen Thukral 01:35
So I heard about the clinical engineering as a discipline when I was in college, and very close to graduating actually my last semester. And there’s email from the Career Center about this technical career field program in the VA. So I applied, did an interview and was really excited by the opportunity because it was a good intersection of applying a lot of different medical technologies. And having kind of pursued my master’s and done a lot of research work and tissue engineering, I was more interested in seeing a faster lifecycle of projects. And I knew that I could see that through with working with clinicians in the clinical setting.
Chyrill Sandrini 02:27
I just have really enjoyed watching your career and following you being a female in the industry as well, I think you’re a great role model for younger women who want to get into the HTM field. So thank you for all you do. And being a powerhouse.
Arleen Thukral 02:41
Thank you so much. And thank you for having me on this podcast. Very excited to be here.
Chyrill Sandrini 02:48
Oh, it’s our pleasure, our honor to have you on. So today, folks, we’re going to be talking about that data, data in the HTM industry. You know, we all have it. We have CMS programs. We’re always organizing the data, tracking the data, but what can we do with the data that can make things better overall. And I find this completely fascinating because I think we have the evidence. And I think the data provides the evidence where we can make change. And that’s what we’re going to talk about today. One of the things we’re going to try to do is this hits a broad spectrum of listeners, is really to go over the acronyms too. So Arlene, if you can think about the new biomed. Let’s just break down the acronyms for everybody when we’re talking about them. But starting off, I know we all talk about KPIs. Right? What is the data that you’re using? And let’s just jump into that data and how KPIs key performance indicators are beneficial in the HTM industry.
Arleen Thukral 03:53
Yeah, so KPI or as you know, you define the acronym Key Performance Indicator are really those key metrics that you want to trend. And it should be something that’s important that’s going to help you steer your department if things are not, you know, if you as a department is not meeting those key performance indicators. So, of course, the number one KPI that departments are tracking our preventative maintenance completion rate. So our policies should define how we’re calculating your you know, the pm completion rate. Sometimes it’s based on when the pm work orders generated, sometimes it’s based on the due date of the pm work order. So, you know, there are nuances to how we’re measuring that indicator, but we definitely should be consistent with how we’re measuring so that we can compare month to month and trend over time. Joint Commission does require 100% preventative maintenance completion rate, that doesn’t mean that you have to do everything every single pm work order has to be completed, it means that you have to document you know, exactly if the pm was, could not locate or in use and close out and follow your health care policy on however you handle those deferred preventative maintenance. Another really key performance indicator that most departments are following would be your corrective maintenance turnaround time. So this is where you have those repair work orders coming in from your customers. You know, typically you’re measuring it from when the customer puts in the work order to when you resolve that work. So you know, the VA has a target that they’ve set for what this set Corrective maintenance turnaround time should be completed within we target seven days turnaround time. Of course, we’ve had supply chain issues in the past several years, and it’s a good idea to be able to break down if you’re not meeting the metric, what might be contributing to that. So a good way to, to analyze that might be seeing the top assets or asset types that are contributing to the longest turnaround time. And, you know, looking at that documentation, trying to figure out, you know, is anything that you can action to, you know, head down that turnaround time, so, perhaps you’re waiting parts, perhaps there are things that are outside of your control, like you need to work with contracting, you know, some of those things, just being able to explain to leadership, okay, I’m actually meeting nine days turnaround time. But, you know, a significant portion of the work orders are better contributing to that longer turn around time are x. And, you know, maybe you have a secondary monitor, such as your work orders that are completed in three days. So this is a percentage that you can keep track of to see. All right, well, if your department is hitting 70% of its Corrective maintenance within three days, then it means it’s fairly efficient, that only a small subset of work orders are actually, you know, taking longer. And you can also keep track of number of work orders open over 30 days. So that’s going to give you a good indication of if that’s starting to go above perhaps 50 Work Orders, then maybe you need to start looking at additional staffing and overtime or bringing in third party support to make sure that that’s not going to continue to creep up and you’re getting a handle on that.
Chyrill Sandrini 08:25
Yeah, and I would imagine that, at your level, this is something that you’re able to spend some time and to focus on and affect change. Right.
Arleen Thukral 08:37
Absolutely. So you know, any department that we see that has for at least one quarter, not match pm completion rate, we’re going to take a look at what are their open pm work orders that are overdue. So if they go ahead,
Chyrill Sandrini 08:56
so let’s talk to the general biomed. Your payment one you’re a payment to you’re handling PMS and repairs, you’re on the floor. How important is it to have those notes in your work orders. So director, a manager a regional person can really identify what the issues are. I know we open and close work orders every day. And you’re talking about that workers are open longer. How important is it for the BMET to affect change from your perspective?
Arleen Thukral 09:30
Yeah, we really rely on our staff at the frontline to document on a daily basis. We actually have states of our work orders in our CMMS that increase this visibility. So one example is that a work order can be put on hold and then the sub state can be selected is the work order waiting parts or awaiting, you know, organizational need has changed. So maybe you can’t complete the incoming inspection because there’s some construction aspects that need to be taken care of first from outside of our department. So it’s really nice to have that visibility for the manager or even the regional director that, oh, we can actually ignore the things that are on hold. Similarly, a pm work order has been completed, then the state can be moved to Pending documentation if it was especially vendor performed, because we’re, we know, we’re still waiting on the service report from that vendor. And, you know, it’s in the process of getting uploaded. And, again, we can rest assured that the work has been completed. And it’s timely, but we just have some finishing up documentation to be done there. So definitely super critical that the front line is documenting daily, it also helps the customer stay up to date on things because they can also often in CMMS, is check in from their side on whether the work has been done.
Chyrill Sandrini 11:09
Now, I’m thinking about how does this play with cybersecurity. So doing patches and updates, I can imagine that can slow down maybe your process or your documentation and make your KPIs not look as great or have to dive in, tell us about how that correlates.
Arleen Thukral 11:30
So we have started to measure a lot more with cybersecurity. One example is percent of devices that are unsupported out of all of our network medical devices. So the reason this is important to track is because unsupported devices, if they have a failure, oftentimes the manufacturer will say you need an upgrade on the spot. And that’s going to then, you know, really be a rush job that typically setting everything up on the medical device protection program does take time, you have to, you know, make sure that the ACL has Correct, that’s access control lists, or firewall, maybe on in the private sector has to have the correct ports open through the firewall. And, you know, just setting up the device in a secure fashion. With antivirus and everything, all of that takes time. So you know, you’re going to be affecting and patient care while you’re getting the system set up in an emergency situation. So in order to be proactive, we need to be starting to plan upgrades or replacements for that unsupported OS. So we’re really looking at what you know, what’s the percent of devices in our fleet that are unsupported? Whether or not we have been planning for replacement or upgrade. We also look at vulnerability patching, so percent of Windows vulnerabilities that are patched within 30 days. So the VA has this really wonderful tool that’s Windows based called smack. And it’s basically a registry edit that allows us to collect information about the operating system, MAC address, what patches are on that device automatically into our network medical database. And so if we have set up automatic patching or doing manual patching, we will be able to know whether or not those patches have been done and kind of keep track of if they’re within that 30 days. So we don’t really have a great correlation yet between the patching activity and how many Corrective maintenance work orders that’s preventing. But it is widely accepted in the field that, you know, keeping up with the patching does help prevent issues and downtime. And so, only one time did we have a patch where we ended up spending two hours having to kind of reinstall without was vendor approved patch. And you know, there may be more that I’m not aware of. But you know, whenever that does happen, we document the time that we spent on the vulnerability patching activity. We do have now in our Nuvola CMMS, a vulnerability work order type where we can document those types of things.
Chyrill Sandrini 14:46
And that’s great. How is it to work with on this? Are they are they on the same page with clinical engineering?
Arleen Thukral 14:54
So within my region, you know, and in the VA In general, htm is much more involved in the cybersecurity than may be the case in the private sector. So we are, you know, fully responsible for the vulnerability patching where we correspond with it would be having them apply the ACLs. So we put in their request for ACL modification or the request for new VLAN. And they actually set it up on their side. And, you know, I think that the collaboration is really good in VISN 2, you know, I’ve always been able to talk to an area manager, if an issue comes up and see if we can either elevate it to the national level or get it resolved at our level.
Chyrill Sandrini 15:50
That’s amazing. And that’s great to hear that you guys are all working together. Bottom line is patient care. So what let’s let’s talk to, like you say, the private sector, let’s talk to those htm directors who may just be me managing one hospital right there in house? Or maybe there’s three in their network? How can they adopt some of what you’re doing at their level?
Arleen Thukral 16:15
Absolutely. So I think the key is to first start with deciding what area to focus on for improvement. You have to take a look at the data quality that you have. So is your inventory accurate? You know, are you naming things? And are you even able to pull out the pm completion rate for high risk versus non high risk. So if you don’t have a defibrillator, that’s called a defibrillator in your inventory, you know, you’re not going to be able to separate that into your high risk pm completion rate. So first, measuring the baseline of your data quality and seeing if you’re able to get that baseline, you know, based on where your inventory is at is the first step, then it’s really important to get the team involved. So, you know, something I’ve done in the past at my sites is something called the “Wins and Woes” exercise. So Sigma healthcare actually pitched this at our national level. And I really liked this. So I adopted it. And the concept is to have your team identify what are the things that they’re proud of? And what are the things that they find are challenges and need improvement. So by going through this activity with the whole team, you’re definitely going to get a really good idea of what the current state is, that will help you you know, identify what are the areas that need focus and improving. And then once you, you know, come up with the goal with the team, you can start to come up with your timeline for improving it. And, again, identifying the metrics that can help you improve the area that you want to focus on. So we talked about a couple of key performance indicators, some cybersecurity metrics, maybe what you’ve decided you want to focus on is in the fiscal arena. So you know, your hospital budget is constrained. And your leadership is telling you that you need to figure out some cost savings. If that’s the case, a really good metric is your annual cost of service ratio. So this is the cost that you’re spending on your equipment. So whether it’s your contracts and times and materials, divided by the medical equipment, asset value of that equipment. So we like to try to aim for 9%. But it’s really hard to do. Some of my facilities are in the 11 to 12%. And, you know, we were constantly looking at is there an area where we can send somebody to training and, you know, what’s the return on investment for? Can we reduce a contract down to first look or remove a contract? So we’ve done that with things like motivators? Certainly, we’ve sometimes that people to train just to have faster turnaround time, and still keep the parts contract. Because the parts can be costly, and you do have to factor that. And, you know, tracking over time usage is another good fiscal metric to make sure that you do you have visibility on that as well.
Chyrill Sandrini 19:51
I’m going to pick your brain and this is you know, definitely your opinion how you see things but there’s a lot of third party companies out there that manage A lot of hospitals, how, as a director, would you make sure that they’re performing and they’re providing this data with to your system? Does that make sense to you? What I’m asking? Yeah. So how do you how do you manage that? How do you who police’s that if you have a third party in there in there?
Arleen Thukral 20:22
Yeah, so all of the departments are able to get, you know, multiple quotes and make that determination at the frontline level of whether or not, you know, to go to a certain vendor. And there might be, you know, advantages and disadvantages that need to be considered. So, for example, it’s a good idea to always look at the ISO compliance of third parties to make sure that the work will be done, according to a quality standard. You know, we do ask vendors for training certificates as well. Especially, you know, sometimes if we’re going to be contracting with a vendor, we ask them for their resumes, to ensure that, you know, they have the level of work that we’re looking for maybe technician, one, or if it’s an imaging a higher technician level. And ultimately, there, we don’t have an integration with third parties for documentation. There’s some government requirements with authority to operate. So we haven’t been able to set that up as of yet, definitely want to move in that direction in the future. So what we’re looking at, is just collecting the service reports and then getting that uploaded.
Chyrill Sandrini 21:53
So what if you actually as a health system, you’re a big IDN. And you bring in a full service asset management company, to be your HTM, right to manage your clinical engineering. Now, you’re the director of the in house director of, let’s say, it’s 15 Hospitals. How would you hold that third party accountable who’s actually providing your HTM service? I would think that you would still want that data to know how you can improve and if they’re living up to what they promised.
Arleen Thukral 22:32
Yeah, and I think quality assurance programs are a great way to, you know, triple check that the quality of work is correct. So what I mean by that is, you set a certain percentage of work orders that you’re going to look into, so maybe that’s 2%, whatever threshold you set, and you would then, you know, go through the service report and cross reference that against the service log on the equipment, and actually ensure that the documentation is exactly as the manufacturer specifies. We, you know, might, for example, require the centrifuge speeds to be documented for centrifuge PM, or an EKG might want to document information from a manual battery discharge test. So whatever, you know, work order comes up that you review, you would first look up the service manual, then you would look up the Service report that’s attached to that work order, and ensure that you don’t have any findings.
Chyrill Sandrini 23:47
Yeah, that’s a great idea. And I kind of go back to this “Wins or Woes.” It’s just circling in my head. I’m thinking, Gosh, I can implement that in my in my area of expertise, you know, what a great way to get feedback from your team who’s actually doing the work, instead of always telling them, this is how we’re going to do it. Right. From your perspective.
Arleen Thukral 24:10
Oh, yeah, we got so many good ideas. You know, it kept us busy too, because then we had to make sure that we worked on those improvements that people suggested. So one example was an environment of care TMS class for our clinicians. So we do have one specific to our CMMS for clinicians on how to enter work orders, but we didn’t have something comprehensive about our entire program. So that was a great suggestion that came out of that exercise. But you know, we captured a lot from that.
Chyrill Sandrini 24:48
Do you continue to do it. Is it something you do semi annually, or how do you implement it?
Arleen Thukral 24:54
So last year was the first time I did it, and it’s something I’m looking to do on an anti all bases, we do also conduct program assessments on an annual basis. So I think, you know, we have a good idea from that as well of things that we may not be meeting.
Chyrill Sandrini 25:13
What a safe place to have your staff come and be able to, like, let you know their perspective. I think that’s, gosh, you’re talking about building a company culture. That is like saying, We want your opinion, and really valuing what they’re doing with their workers and not just having expectations. I really love that. I think that’s going to be a big takeaway for me from this episode. So what’s anything else you can think of with the data? What would you like to do in the future? Do you have any gosh, I hope to make this change or affect this in the HTM industry? What’s the future hold for Arleen? And collecting data?
Arleen Thukral 25:58
You know, that’s a great question, because it really is something that we continue to reflect on, we have an environment of care quarterly report. And we really do add new metrics on that or remove ones that we no longer need to monitor on an annual basis. So we we do look at this on a recurring basis, I can tell you that we want to keep a closer eye around our contracts for the coming year. So the new CMMS allows us to keep our contracts with n terms and conditions for those contracts within the system. So that’s a huge, a huge improvement for us. And we’ve added a couple of ideas, I don’t want to call them metrics, because they’re really more self reported things rather than, like automatic metrics that will allow the manager to keep a closer eye on, you know, things that they could update their leadership on. And as well, you know, make sure that the whole team is communicating regarding, you know, especially when you have on-call programs, you know, you can’t just rely on everyone knowing everything, and you need to have good documentation and checklists that people can refer to. So this is where having an up to date CMMS on your contracts is super vital.
Chyrill Sandrini 27:36
Yeah, I think it is, especially when it comes to the forensics of clinical engineering, when we do have some that happens, is just having that documentation. Right. That’s key. Well, I’ve really enjoyed having you on today. And now we always close with our Wow word or Wow, words of wisdom. So Arlene, what do you got for us?
Arleen Thukral 27:58
All right, well, um, I think I just want to go back to, you know, if you’re a new manager somewhere, you need to kind of get the 30,000 view and figure out what are the most important things that you need to focus on? So, you know, like you said, it’s really good idea to ask the team, so use that Wins and Woes exercise and ask the team what their thoughts are, because that’s a really good place like effecting change where it will affect the frontline first.
Chyrill Sandrini 28:38
Yeah, I like that. That wins in rows. I mean, celebrate the wins and take the woes as how can we improve? Right? What can we do better? Not personally, but just just always looking and focused on patient care and patient safety. That’s what we’re here for. Right?
Arleen Thukral 28:54
Chyrill Sandrini 28:55
Listeners and watchers, if you guys want to tune in, you guys can find this anywhere you listen to your podcast, whether it be Spotify, iTunes, YouTube, and if you go and check out this episode again, on tech nation, you’ll actually receive one CE credit, which is an amazing partnership that we have providing you with that credit to continue to your certified biomed education. So thanks again, Arleen for having you on today and thanks for tuning in. And we’ll see you on the next HTM Insider