When a User Calls: Just Say Yes

Abstract

In a recent column (BI&T, January/February), I stated that helping users with medical equipment-related problems was my highest priority medical equipment management task. I also expressed the opinion that The Joint Commission (JC) felt that writing procedures for handling medical equipment failures is in their highest priority group of medical equipment management requirements.* If there is a procedure for responding to medical equipment problems, then you are expected to follow it. If that is a top priority policy, then the activity is top priority as well. I believe that, by this reasoning, the JC also thinks that assisting users with equipment-related problems is a top priority activity.What are the elements of helping users with medical equipment related problems? For convenience, I would divide the elements of user assistance into practices and policies.There are various ways to instill appropriate practices into the performance of staff. Different approaches are better suited to certain types of performance than others. For user assistance, I think that the first step is to discuss the topic at a regular clinical engineering (CE) department meeting, and to get agreement on how everyone should handle different user assistance issues. The second step would be for the CE department manager to lead by example. The manager should walk the walk, as well as talk the talk. Next, the CE department manager should be aware of how the staff handles all aspects of user assistance. He or she should observe how trouble calls are handled, including going along with staff on trouble call responses. The final step would be for consistent follow-up. The subject of user assistance should be revisited at CE department meetings. The department manager should counsel staff individually if they are not following the agreed upon protocol. The CE department manager should also check with clinical users to find out if they are satisfied with the support they get when they call for assistance. This can be done informally by contacting the leadership of customer departments (e.g., nurse managers, laboratory supervisors) or more formally with customer satisfaction surveys.As implied by the headline to this month's column, when a clinical user calls for assistance, you should just say “yes” to the request. If the call has to do with medical equipment, and it is something that you can and should handle, you should ordinarily make this new call your top priority. Of course, you cannot always do that. If you are working on something else that is higher priority, you should explain the situation to the caller. Find out if they can wait until you are available, whether you can get someone else to assist them, or whether you have to adjust your priorities. Coming to a quick, equitable agreement should be your goal. If all else fails, however, there are really only two reasonable alternatives: Take care of the problem per the user's request and straighten out the difference of opinion later, or turn the problem over to your supervisor for resolution. In most cases, I think that the former is preferable.What would you do if a user assistance call is for something that is not your responsibility? Would you tell the caller whom to call? What if you did not know who took care of that type of problem? My recommendation is to tell the caller that this problem is handled by so-and-so, and, for future reference, they should call such-and-such number and say you would be happy to place the call for them this time. If you do not know how their problem is supposed to be handled, tell them that you will find out. You will get the call to the right person and you will follow up with the caller to let them know what you have done. Is that going too far? Obviously, I don't think so. You go a long way toward huge customer satisfaction, with minimal time and effort, by placing one or two phone calls. It is also my recommendation that you use the telephone and not e-mail. You will almost always get faster, more accurate, and more complete responses with a voice conversation.Do you have concerns that clinicians may not be reaching out to you when they have equipment problems? Do you have any practices intended to preempt calls for equipment issues? One sure way to help with both issues is to have a regular schedule for equipment rounds by biomedical equipment technicians (BMETs) who can select or be assigned areas, and then meet with the area managers to agree on a schedule for rounds. They should decide on both frequency and time and the BMET should do everything possible to make sure that he or she meets that schedule, including providing backup for days off. The advantages to having a regular schedule of equipment rounds include clinical staff being even more aware of the presence and purpose of the CE department, and greater opportunity for them to get expert assistance with any type of medical equipment question. Also, having BMET eyes on equipment in use can often prevent problems from occurring, either because they spot equipment that needs repair, or because they spot equipment being used improperly.Another way to raise the profile of your medical equipment management program is for the department manager to schedule periodic meetings with clinical area managers and their staff. These could be annual or semi-annual and should be designed to promote communication. The manager could discuss new functions of the CE department or emphasize a function that clinicians may not be fully aware of (e.g., JC standards compliance). The manager should try to reserve the bulk of the time for answering any questions that clinicians might have about medical equipment (e.g., replacement planning).The JC requires written procedures to follow when medical equipment fails. They specifically want procedures for emergency clinical interventions and for backup equipment. These need to be institutional policies—not departmental policies. What should you do about this? I don't think that you can write policies for emergency clinical interventions in the event of equipment failures, but you can offer to draft a policy for backup equipment. You should get advice on the format of hospital policies. You should also consult with the safety committee. At the very least, you would want to include what types of backup equipment you have available, how users can get it when it is needed—including during off hours—how it is maintained, and how it is tracked so that it is returned when it is no longer needed. You might also include a procedure for requesting additional items to be included in the backup inventory.Policy manuals serve many purposes, including providing training for new staff, and reminders to longer-term staff. You do have a departmental policy manual, don't you? It is a good idea to document the practices that you have as policies and procedures. This would certainly include policies for user assistance calls, scheduled equipment rounds, manager's meetings with clinical departments, and any other means by which you manage equipment problems with users. You should also make sure that the CE department staff is aware of the hospital policy on backup equipment. You could have your own departmental policy for backup equipment that provides more details about responding to requests for backup equipment, and how it is stored and maintained.Most, if not all, of this advice may well be old hat and already in place for many of you. That is no reason to rest on your laurels, however. What else can you do to improve and enhance user assistance? A number of CE departments have actively sought ways to do this.The “help desk” is an idea that, in most hospitals, probably started with information technology (IT) departments. Many of us have not approved of the way this was implemented in IT departments (e.g., response times measured in days instead of minutes), but that doesn't mean that you can't tailor the actions of your staff to something more appropriate for medical equipment calls. Consider the pros and cons of a help desk, and make sure that your plan emphasizes the former and eliminates or minimizes the latter.Potential pros in a help desk plan include:Cons to be avoided include:How can you afford to implement a help desk? I don't think that a help desk requires an additional full-time employee—there aren't that many calls that come in to even a large CE department. Manning the phone can be distributed equitably among BMETs and not interfere with regular assignments. Many departments have one or two office staff and managers might think that having an administrative assistant answer the phone is adequate. That is not a true help desk in my mind. A help desk should be able to actually help over the phone. In many instances, only a BMET can do that.Another point that might seem minor is that you should never require the user to fill out any paperwork, whether the “paperwork” is actually paper or an electronic form. The CE staff should initiate work orders, complete them promptly when the work is done, and provide a copy to the user. Not only does the user appreciate not having to do this task, but the quality and consistency of the service documentation will be much improved. That doesn't mean that you shouldn't allow users to submit a work request via e-mail. If your documentation system allows it, users might even be offered the opportunity to initiate a work order via the hospital intranet—but only if they want to.Perhaps the ultimate step in user assistance might be a CE departmental web page that provides real assistance. This could include a description of the department and its services, and an organizational chart with names, titles, functions, contact information, and staff photos. It could provide instructions on how to request service and a frequently asked questions page. If setting up a web page is possible at your hospital, there is probably some professional help for doing so as well. However, designing, implementing, and maintaining a web page represents a large investment of time. I have no hard evidence, but I do have serious doubts that it would have enough benefit to users to warrant such an investment in most cases. On the other hand, if you have someone who is particularly interested in this type of task, it might be a different story.I've clearly taken the issue of user assistance way beyond the rudiments of the JC standard for handling medical equipment failures. However, it did give me an opportunity to elaborate on my highest priority for medical equipment management.