Technology, Part 2

In Part 1, I subtly (in huge print) wrote:

We identified a problem.  We looked outside our industry for a solution.  It looks high-tech but is actually low-tech analog.  You might be tempted to do this too.  If you did, you very well maybe throwing your money down the toilet.

Captain Kirk w/ an evolved Secret Service radio

So, before you go Captain James Kirk on me (I don’t refer to Star Trek nearly enough) and start incorporating the latest tech, consider what another Jim says on the subject …

Jim Collins’ Good to Great is used by many companies today for obvious reasons.  Its a compelling premise … what do these companies have in common that went from good to great?

G2G Page 152:

“This brings us to the central point of the chapter.  When used right, technology becomes an accelerator of momentum, not a creator of it.  The good-to-great companies never began their transitions with pioneering technology, for the simple reason that you cannot make good use of technology until you know which technologies are relevant.  And which are those?  Those–and only those–that link directly to the three intersecting circles of the Hedgehog Concept.”

When it comes to the secret service radios I’ve seen facilities throw money down the toilet as they hope for the internal and external momentum described in part 1 from the radios without going through a Hedgehog type conversion BEFORE bringing in the new technology.

BEFORE introducing the ‘math’ or before dreaming of increased census or community buzz that can and has come from the secret service investment, you MUST wrestle together with your staff to identify your identity.  Defining your culture and then drawing a line in the sand CULTURALLY speaking.

That is the basis for the an enduring momentum to build and without it whatever ‘pop’ you experience from the technology will be short-lived and after 3 months your radios will be in a closet somewhere in your facility and you will curse my name.


Technology – The Answer,* Part 1

Let me start with this … I’m a bit of a technofile.  I’m not always the early adopter but I’m an early follower and eager adopter once ‘version 2’ comes out whether that be a new mac, iphone, ipad, kindle, etc.  I regularly hit Gizmodo and Wired.  I like this stuff.  A lot.  Since entering long-term care profession this tech love has turned into a love-hate relationship.

An example of why I love it.

This is an admittedly low-tech example … here’s how a conversation has gone that I’ve had many times with groups of nurses & CNAs:

Me: How many times during your shift do you have to ‘look for someone to help?’  Whether it’s another CNA to help with a transfer or another nurse for pain meds or whatever.  How many times do you ‘look for someone to help?’

Them: 10.  20.  15.  25.

Me: Ok.  Let’s say about 15 times.  Now, think about how long it takes you to find that person.  Sometimes they’re right outside the door.  Sometimes they’re in the middle of helping a patient and you need to find someone else.  Sometimes they’re hiding in a quiet place to get their charting done.  Sometimes they’re in the employee break room.  How long on average does it take?

Them: 3 min.  10 min.  5 min.  7 min.  Etc.

Me: Ok.  Let’s figure out how much time you’re wasting during your shift (time that could be used to care for patients but instead is being used to ‘look for someone to help.’


  • 15 times looking for help x 5 minutes = 75 minutes/shift
  • 75 minutes x 10 (# of nurses & CNAs on a shift) = 750 minutes or 12.5 HOURS/shift of wasted time
  • Multiply that by 2 to cover the other 2 shifts (by 2 instead of 3 b/c the other shifts don’t have as many people as the first shift) and you arrive at a hidden, staggering number:

25 hours of care givers time per day that is not used for care giving.

When the nurses and CNAs see that math on the white board in front of them, jaws drop.  DONs are disgusted.  People shake their heads in frustration.  How do you fix that?

Here’s what we did … we noticed at luxury hotels, some restaurants, even at OfficeMax something they use to improve the speed of communication.  We called them Secret Service Radios.

Secret Service radios in nursing homes

As I researched it, I found out that what looks pretty sophisticated with the sneaky ear piece, but in reality is very low-tech.  You have a small 2-way radio that connects to a ear piece-microphone cable that you wear underneath your scrubs.

My staff’s response was, for the most part, positive.*  They welcomed a way to relieve the 25 hours/day pain that was no longer hidden.

The impact both to our culture and to our care and to our census was significant.

Culturally, the staff, families, and patients saw an outlay of money for one purpose with no financial ROI expected.  That message is powerful.  We’re spending this money to make your jobs better.  To make care better.  Period.

The community ate it up.  The case managers and doctors at the hospital loved it.  We played up the ‘secret service’ angle with corny lines like, ‘if it’s good enough for the President of the United States it’s good enough for our patients and residents.’

We identified a problem.  We looked outside our industry for a solution.  It looks high-tech but is actually low-tech analog.  You might be tempted to do this too.  If you did, you very well maybe throwing your money down the toilet.

I’ll explain in Part 2 of this topic why that is.

*A couple of my CNAs doubted my motives.  They thought I was trying to be big brother so I could always monitor exactly where they were at all times.  So, just between themselves, they came up with a code word to alert each other when I was on the floor so they could look really busy.  “7-11.”  One of them would say, “7-11.”  Others would repeat into their radios, “what?” with no reply.  The code word was only meant for the other person who knew what it meant.  Pretty hard for something like that to stay quiet.  So, when I found out about it I invited one of them into my office.

Me: How are the kids?

Him: Good.

Me: Good.  Everything going well?

Him: Yes.

Me: Great.  Hey, really quick … how did you come up with the code word 7-11?

Him: (Deer in the headlights.  Long pause.)  I don’t know what you’re talking about.

Me: Oh.  My mistake.  Let me just take a minute and talk to you about why I invested $5,000 in the secret service radios.  (I did the math with him.  I shared success stories of better, faster care.  10 minutes.  I excused him.  2 weeks later he quit.  Perfect.)

Innovative Presentation

I spend a lot of time in ‘presenting mode.’ I typically use Apple’s Keynote product.  There’s a lot of do’s and don’ts with slideshow presentations (powerpoint or keynote) that can make or break a presentation.

  • 5 words or less per slide
  • pictures trump words
  • videos trump pictures
  • don’t put on a slide what you’re going to say (you don’t need the competition)
  • many more …

But, today I stumbled upon a truly innovative way to present your message.  The topic was slightly interesting to me, but I stayed glued to it to the end … B/C of how it’s presented.  I wonder if there will be a cost-effective, efficient way for the layman (me) to tap into it?

Here’s the group behind the animation:

Secret Service

One of the biggest complaints in hospitals and nursing homes is how long it takes to get the help you need. A fanatical commitment to world class service is the right way to solve this symptom. AND, there’s a way to cut call light/wait time in half while improving morale between direct-care staff — join the secret service!

Picture it … you’re a patient recovering from surgery. You are experiencing severe pain. You push your call light for the nurse. 3 minutes later, a nurse’s aide walks in and asks what you need. She tells you that she’ll go get the nurse for you. Unfortunately for the nurse aide and for you, the nurse is in her secret hiding spot in the facility where she can actually get some of her documentation done. The aide looks up and down the hall. No nurse. She goes to the med cart. No nurse. How is the aide feeling toward the nurse? More importantly, how are you feeling about the aide, the nurse, and the whole facility?

The best solution I’ve found to that (and hundreds of other) scenarios is a pretty simple technology that the secret service uses to protect the president. And … of course, we have a lot of fun telling the hospitals, doctors, and prospective residents that “if it’s good enough for the president of the United States, it’s good enough for our residents.”

Imagine having each of your nurses and aides with the secret service ear piece in one ear while they work. Then, that scenario above plays out like this … you ask for pain meds. The aide immediately presses her microphone button under her scrubs and says, “Roxanne, Mr. Jones needs a pain pill.” (Everyone hears that in their ear) Roxanne — in her secret hiding place — responds on her undercover mic, “Tell him I’ll be right there.”

Let’s do the math together to drive the point home:

Let’s take a 99-bed facility with 90 residents (high acuity). The day shift has the following in nursing: 5 licensed nurses, 10 nurse aides, 1 RNA. How many times during her shift does the nurse or CNA look for someone for assistance (ie, help with transfers, pain pills, showering, ADLs, wound care, room change, etc., etc., etc.)? Let’s say 20 times. On average, how much time does it take to find the person you’re looking for? Sometimes 20 seconds. Sometimes 10 minutes. Let’s say 5 minutes. Now let’s do the math …

– 16 staff in nursing x 20 searches for help x 5 minutes per search = 1,600 minutes/60 minutes = 27 hours.
LET THAT SINK IN! On one shift alone, your nursing staff is spending a collective 27 hours “looking for someone to help.” It’s insane! That equals:
– 54 hours/day (treating the next two shifts like one day shift due to fewer staff)
– 68 days/month
– 818 days/year

If you really want to pull your hair out, calculate the wage cost of that “looking for someone to help.” When I show this to Directors of Nursing, they have heart attacks. If your nursing staff/DNS is pushing back at all to the idea, do that math with them and you’ll see a change of heart. Just think of how much more care can be delivered if you had 54 hours/day more of nursing time available?!

The radios & headsets we use have benefited us in several ways …
– improved communication between nursing staff
– more efficient use of our time
– created buzz in the patient & labor market
– eliminated the hated/annoying overhead paging

Externally … this has been HUGE for us in our community for marketing. The DC planners, doctors, vendors, etc. are thrilled that a SNF is so progressive/pro-active to this very common problem in healthcare. If you preach/market customer service as your distinguishing characteristic and are able to back it up with the secret service ear piece action … buzz, buzz, buzz.

Post a comment/question or email me to find out more details about this solution. I have no vested interest in any technology solution provider by the way. I just can’t imagine delivering healthcare any other way anymore.