In 2011, Ashley Simmons, a data-focused consultant, took an RFID tagging system previously used on oil rigs and adapted it to track movement and work habits of nurses at Florida Hospital Celebration Health, in Kissimmee, Florida.
Three years into the experiment, she and her two-person team now badge 50% of nurses and the patients they serve. They’ve collected enough data to build a case for changing the layout of a new hospital unit. They’ve also used it to give overworked nurses a break and change hospital operations.
The system they’ve built is a sophisticated one. It uses STANLEY Healthcare technology, ceiling-mounted ultrasound receivers (called exciters) that interact with the tags, and an analyst to quickly turn around the data received.
But the tech was easy in comparison to the human side of things. The biggest challenge: how do you help nurses feel good about a system that sounds creepy? What helps people not only accept wearing data-collection devices, but also like it?
Simmons puts the problem this way: “The biggest area of concern was adoption by the staff. This is Big Brother galore,” she says. “The first question they ask is, ‘Do you know I’m in the bathroom? What do you know? Can you hear me on this little speaker?’ Understandably, there were all these fears that came with it.”
As they’ve rolled out the system, Simmons and her team have had time to refine their approach for helping people feel comfortable about the badges—and ensuring that they are actually used for good. Here are her most important pieces of advice:
The most important part, Simmons says, is making sure the data is regularly seen by everyone. “You have to constantly be transparent: showing the data, telling them what you see, making them feel secure,” says Simmons.
One way they do this is through quick and dirty data visualization that the nurses can access themselves. “Based on feedback from the nurses, we have a web-based tool where they can pull it up and look at it themselves. They can log in and see their own information on a spaghetti map at any time during the day. They have access to all the data my analyst runs.”
This includes charts showing much time nurses have to spend at the nurse station charting versus moving around. Maps showing their path around the unit–how they travel from room to room and where they spend the most time. And images that show the flow of patients by patient type, to help nurses understand if, for example, neuro or ortho patients require more time and care.
“They asked us for the data in that segmented fashion,” says Simmons. “They really look at it.”
As part of improving hospital ops, Simmons and her team look at things like how floor layout impact nurse’s effectiveness and whether or not nurses are getting downtime. All that has fed new management practices. But the ultimate goal is to help the nurses with their jobs.
“Before in our nursing staff, there was very much a culture of ‘I can’t leave’ ‘I can’t take a lunch,'” Simmons says by way of example. “The data showed that they didn’t leave the unit at all. Or that they weren’t in the staff lounge part of the unit. What we discovered that is that the staff lounge was being used to train patients to get ready to go home. They didn’t even have a space for a 30-minute break. And it’s a 12 hour shift. When we found out, we changed.”
They also changed the way the hospital ward was laid out. The new hospital unit designs were based specifically on nursing feedback. “Originally, we mirrored the unit—if you drew a line down the middle it would be the same on both sides. What we found with the RTLS data is that’s not how they used it,” says Simmons. “We were able to turn it into a whole different workspace in the back which now is functional for them, versus before. We’re starting to track it—it just opened last week.”
The other thing Simmons and her team have done consistently attend staff meetings, once a month or a quarter. “My co-worker or I will go to the meeting and bring the data. We’ll ask questions. ‘Here’s your data for today. Does it feel right? Does it really make sense? Did you go to this particular room or not?’ We want to make sure it’s accurate. And that’s one of the lessons. When I wasn’t able to go to staff meetings as consistently, I found out that you start to lose engagement. They start going, ‘Why isn’t she coming? Is there something that she doesn’t want me to know?’ You’ll quickly lose the ground you gained if you don’t stay on it.”
Simmons also discovered that nurses wished to know how far they traveled during the day, running from room to room across the ward. “What we’re adding to that now is how many feet they traveled—that they went 10 miles today or whatever on the unit. It’s their Fitbit if you will, which they love,” says Simmons. “That’s what we want to do—make it meaningful for them and change their work. It’s ‘tell us, what do you need? What do you want more of?'”
Understanding how and where more staff are required, how much time nurses allocate by patient type, and how day and night schedules affect patient satisfaction can improve efficiency and make patients happier. It might also help avoid serious slip-ups, by keeping track of important tools or patients who need to remain quarantined, for example.
Similar systems could be used to improve effectiveness in any large-scale service business—restaurants and hotels, for instance. But it makes particular sense for hospitals, since reimbursement for Medicare and Medicaid is tied to patient satisfaction.
“If our patient satisfaction scores aren’t at 75th percentile or better in terms of how they felt we delivered their care, our reimbursement for Medicare and Medicaid goes down,” says Simmons.
“Now we actually know where they spend their time,” Simmons explains. “How did that correlate to a patient’s time and need? And how did that correlate to a patient’s perception of their care after they left? We’ve been bringing all those pieces together. And it has opened the eyes of our leadership team insanely.”