In May 2017, Norton Healthcare (Louisville, KY) was named a finalist for ECRI Institute's 11th Health Devices Achievement Award for its clinical engineering group's use of strategic planning principles to set the direction for the department and to identify measures for most effectively meeting the evolving needs of the organization.
The Health Devices Achievement Award recognizes innovative and effective initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. For details about the winning submission and other finalists, see The Health Devices Achievement Award: Recognizing Exceptional Health Technology Management.
ECRI Institute congratulates the project team members: Scott Skinner, Doug Elmore, and Neil Feldmeier.
The Challenge
To establish guiding principles and tactical goals to help a clinical engineering group:
1. Better meet the evolving needs of the organization
2. Advance the group's position within the organization
The Landscape
1. Norton Healthcare's clinical engineering group serves 5 acute care hospitals, 13 urgent care centers, 190 physician practice locations, and a for-profit reference lab.
a) The group is structured with centralized leadership on the main campus and distributed team leads for each satellite campus.
b) It supports more than 42,000 devices/systems and offers in-house servicing of a variety of complex technologies, from linear accelerators (linacs) to ventilators.
2. In 2011, clinical engineering leadership recognized that several forces were influencing the future direction of the group and its potential position within the organization. These forces included, but were not limited to:
a) The general trend in healthcare to improve quality, safety, and efficiency
b) The rapid pace of technological change, including increased network/system integration
c) A need to retain clinical engineering staff and enhance their capabilities
3. The clinical engineering group was already a fairly advanced entity at that time, but it lacked a strategic plan to tackle the challenges it was facing. While everyone in the group seemed "busy," their activities often could not be clearly tied back to specific goals.
4. In response, clinical engineering leadership and staff engaged in a structured process to develop a multi-year strategic plan.
5. In 2016, the group revisited and refreshed its plan, with the goal of advancing the plan from "good" to "great."
The Process
1. The 2011 strategic planning effort was assisted by the organization's Enterprise Project Management Office. The structured process involved:
a) Identifying stakeholders
b) Analyzing the current position/situation
c) Identifying external and internal issues and trends
d) Conducting a SWOT analysis (strengths, weaknesses, opportunities, and threats)
e) Developing a departmental vision
f) Road-mapping primary goals and objectives
2. The outcome was a written, multi-year plan that included:
a) A departmental purpose statement
b) A listing of five key goals that would help leadership set the direction for the department:
(1) Goal 1: Improve the safety of clinical equipment
(2) Goal 2: Maintain compliance with all regulatory requirements and changes
(3) Goal 3: Improve the knowledge and abilities of clinical engineering staff
(4) Goal 4: Demonstrate best practices in the clinical engineering field
(5) Goal 5: Minimize operating expense by improving efficiency and effectiveness
3. The effort to refresh that plan in 2016 centered around a department-wide workshop.
a) The group split into five teams, each of which was assigned to one of the five goals listed above.
b) Each team was challenged to identify tactics that the group should employ to better meet its goals.
4. The recommendations from each group were then incorporated into a 2016-2017 road map. The road map listed:
a) The tactics to be employed, and how each one related to the group's defined goals
b) An "owner" for each tactic
c) A target date for completion and, if possible, an associated measure of success
The Results
Norton Healthcare's strategic planning and refresh efforts were pivotal in setting the direction for the clinical engineering department and in identifying the tactics to employ to support the broader organizational goals. Examples of specific tactics—some of which have been completed, and some of which are in progress—include the following (note that some tactics address multiple goals):
1. For goal 1—Improving the safety of clinical equipment:
a) Create and fill a Medical Device Systems Security Specialist position within the clinical engineering group. The individual filling this unique position would assess and manage cybersecurity risks and serve as a liaison between the clinical engineering and IT departments. (Also helps address goals 2 and 4.)
b) Gain clinical engineering representation at the organization's System Cause Analysis meetings.
c) Further integrate human factors analysis into equipment evaluation and selection.
d) Improve analytics and interaction with equipment operators related to use errors.
e) Continue alarm management improvement efforts.
f) Complete the annual clinical equipment replacement plan.
2. For goal 2—Ensuring regulatory compliance:
a) Develop standards for entering data in the computerized maintenance management system (CMMS).
b) Develop a quick-reference guide to help team members enter data into the CMMS according to the established standards.
3. For goal 3—Improving the team's knowledge and abilities:
a) Develop a road map for team development.
b) Discuss personal development planning during staff's annual review.
c) Revise the training agreement to make it more team-friendly.
4. For goal 4—Demonstrating best practices in the clinical engineering field:
a) Review and standardize preventive maintenance procedures.
b) Have a director achieve Certified Clinical Engineer (CCE) status.
c) Engage proactively in construction and other large projects involving clinical equipment.
5. For goal 5—Cost saving/responsible stewardship:
a) Coordinate the design of physiologic monitoring systems as part of a major renovation project; drive cost containment for this multimillion-dollar investment.
b) Bring servicing of laboratory instruments in-house.
Key Takeaways
1. Norton Healthcare found the process of actively assessing strategies and operations and developing an annual (or multi-year) strategic plan to be of tremendous value for a health technology management department.
a) The group's original strategic plan helped leadership and the team identify and focus on the work that truly matters—that is, the work that will help the organization meet its goals.
b) The refresh effort provided an opportunity to take a fresh look at the group's goals and to adjust and refine its tactics to better meet those goals, in light of ever-changing circumstances.
2. Involving the entire team in these processes helped staff understand the trajectory of the group's efforts and fostered a greater sense of ownership in helping to meet the group's goals.
3. Additionally, defining the individuals responsible for each task and establishing target dates for attaining goals has helped keep the process on track.
