From the October 2005 Issue

Better Business, More Money

Deals on Wheels: Case History

Five Trends Impacting Hospitals’ Business Processes and Financial Health

An Ideal Disc Storage Solution: Case History

Managing the Business of Surgery: What Works

Deals on Wheels

 By Robin Blair, Editor

The best technology buys represent a strategic combination of thinking outside the box and coloring inside the lines. At Brazosport Memorial Hospital (BMH) in Lake Jackson, Texas, the proverbial box has no borders, but the coloring lines are clearly drawn. They are, in fact, crafted, designed and supported by all employees who subsequently must use and live with the technology that is purchased, regardless of whether they are clinical, administrative, financial or IT employees. At Brazosport Memorial Hospital, every end-user has the opportunity for a say.

Brazosport Memorial Hospital is a 165-bed not-for-profit community hospital that serves the nine-city population comprising Brazosport and 70,000-plus residents in southern Texas. The hospital is about 50 miles south of Houston. Unlike many community hospitals, BMH is not affiliated with a larger healthcare system or an integrated delivery network. It stands alone in competing with several other community hospitals, all within easy driving distance, and also with multifacility and nationally recognized integrated health systems in Houston. Just to survive, and certainly to prosper, Brazosport Memorial Hospital must do everything right.

“Patients want to see technology that builds their confidence in the hospital, and they want to see hospital clinicians using that technology with confidence.” —J.J. Cruz Brazosport Memorial Hospital

Information technology is one of those “right” critical success factors in the hospital’s three-year strategic plan, begun in 2002. “Our mission is not just to compete. It’s to be the provider of choice for this community,” says Jesus (“J. J.”) Cruz, BMH’s database administrator. “Technology figures prominently into our plan.”

According to Cruz, clinicians and patients alike want to see modern and efficient IT at work in their hospital of choice. “From the public’s perspective,” he says, “if the hospital’s technology isn’t state-of-the-art, the hospital might as well be treating patients with leeches. Our community’s perception of our ability to provide quality care is largely driven by the technology we apply. Patients want to see technology that builds their confidence in the hospital, and they want to see hospital clinicians using that technology with confidence.”

101 Leading Providers of…
BMH devoted the first year of its three-year process to building a suitable infrastructure. The IT department in particular, comprised of seven employees, felt that the hospital should be ready for anything, ready to embrace any hardware, software or platform that the enterprise evaluated and decided was critical for success. “We need to be able to pivot and turn in any direction the administration wants to head,” says Cruz. “We felt this capability would be part of our competitive backbone.”

The second year was dedicated to necessary upgrades with large-scale replacement of servers, switches and PCs, and including deployment of new Wyse thin-client technology for the hospital’s clinical tethered and mobile bedside computing initiatives. The third year, 2005, has been dedicated to identifying some of the big-ticket purchases BMH will make to keep itself on the competitive map. These include a fully automated emergency department information system, imaging and forms automation, and new mobile carts so doctors and nurses can document patients’ treatments at bedside.

Brazosport Memorial Hospital is no newbie when it comes to mobile computing. The hospital has used Stinger Medical’s Levitator carts for about five years. While clinicians were pleased with the products, Cruz says everyone agreed—it was time to modernize. “We had old laptops on old carts. The latest equipment offers a narrower base, lighter weight and easier maneuverability. We needed increased user-friendliness in our carts.” But Stinger was no shoe-in simply because it enjoyed a successful history with the hospital.

Cruz proudly describes the development of a due diligence process, along with a specially designed weighted matrix, that he says BMH’s technology team uses for all purchases, even when it maintains a favorable and long-term partnership relationship with a vendor. “Our process and matrix allow us to make an unbiased selection based on indisputable criteria, and these tools are so easy to use and so customizable that they lend themselves to the selection of hardware, software and beyond. One of my coworkers even used the tools to buy a car.”

Cruz knew that BMH was headed down the weighted matrix road after speaking with a handful of mobile cart vendors. The IT department began exploring Web sites. They talked to suppliers. They looked at carts. “Without fail,” he says, “everyone we talked to said their cart is the best, their battery life is the longest, their company is the industry leader in this sector. We could have talked to twice as many vendors, and they all would have said the same thing.”

The Ultimate Test Drive
With clinical and administrative input, the IT department narrowed the short list to four vendors—and then set the stage for a one-day, hands-on dueling carts event, a technology fair in which the ultimate end-users could test-drive all the likely cart candidates and evaluate them for future use.

First, says Cruz, “We gathered key clinical, administrative and IT staff to develop a cart-specific matrix. ‘What’s important when you look at a mobile cart?’ we asked. ‘What factors should we compare from one cart to the next?’” The team identified nine specific factors that warranted evaluation and comparison (see box).

On Jan. 26, 2005, BMH invited in its four vendor candidates of choice, along with their wares. From 10 a.m. to 2 p.m., the vendors were available for hands-on demonstrations with all hospital employees who attended the technology fair. The hospital employs about 500 people overall, with about 250 on the day shift. Cruz said the technology fair attracted 100 employees from all disciplines including nursing, pharmacy, respiratory therapy, administration and beyond.

Each employee through the door received a survey to complete, providing feedback on every product he or she examined, and each attendee was required to complete and submit a survey. Cruz says the IT department garnered about 85 workable surveys to analyze. With seven products to evaluate and nine categories to cover, “that’s a lot of confidential feedback for the IT department to assess.” But assess it did. “Our technology fair created a huge buzz in the hospital about possible technologies and how IT was involving healthcare providers in the selection process and not just ramming its own recommendations down anyone’s throat. That’s the right way to work, and it strengthened the department’s image and credibility.”

Real Life Strikes
The final analysis pointed to the Levitator Flat Panel Mobile Workstation as the cart of choice for Brazosport clinicians. “We went through every single survey, and we tallied up every score,” says Cruz. “We wanted our clinicians, administration and vendors to know that we conducted accurate and thorough due diligence, and we took users’ evaluations to heart.”

The final analysis was just as thorough as the survey itself. The IT department scored all vendors and all equipment—and then, having made its selection, provided feedback to all the participating vendors, not just Stinger. “We wanted to say to vendors, ‘even if you don’t earn our business on this round, we can give you feedback on how your cart rated and how it was perceived in comparison to competitors’ carts. That may be useful to you as you compete for other business.’ Vendors were thrilled to get this kind of detailed information.”

BMH had intended to purchase 15 to 20 carts from Stinger shortly after the technology fair evaluation concluded, but real life intervened. A couple of key personnel changes—positions and titles of managers who would want to be involved in a purchase of this magnitude—compelled Brazosport management to again take the high road, even at the risk of temporary inconvenience for clinicians.

“We have never wanted to be in a situation of having the IT department choose a product, such as a mobile cart, bring it to the nurses and then hear, ‘but you never asked us.’ We didn’t want to put ourselves in that situation with other key managers either.” While the make and model of the carts is already decided upon, Brazosport Memorial Hospital has postponed its purchase until two key personnel have been hired and are on board with the decisions arrived at by group and clinician consensus. Cruz says the hospital expects to purchase and have the new Stinger carts on site by December 2005.

The Benefits of Leverage
Although Stinger Medical carts were the top-rated carts by BMH end-users and the hospital’s IT department, Cruz says another vendor placed a close second. “We’re not saying that one cart is the single best cart,” he is quick to add. “We’re saying that based on our hospital’s particular needs and requirements, the Stinger Levitator Flat Panel carts were the best suited carts for us.”

Having a close second choice helped BMH to negotiate what it considered an equitable price for the purchase: Stinger knew there was a close-second competitor, and the competitor knew that only one company’s product was rated higher. Cruz doesn’t say so, but clearly the trick to leverage is recognizing when it’s on the table.

Cruz remains enthusiastic about BMH’s weighted matrix for managing due diligence. He says the hospital’s HIS and core technology is from MEDITECH, but that Brazosport also supports a best-of-breed mindset. “If technology exists that will provide superior functionality and results—for example, within the ED or OR—that’s the direction we will think in. The hospital just selected a new emergency department information system (Picis) and used a due diligence assessment approach including a weighted matrix to make its decision. We use it for everything—SANs, servers, mobile carts, imaging software.”

Cruz stresses that through this kind of unbiased, team driven, due diligence approach, “The IT department at BMH has established itself as a valuable, reliable resource that is rarely questioned anymore. Everyone in the hospital knows we do our homework—and that we always invite their input and recommendations. The process may be more time consuming than the healthcare industry is accustomed to, but when the time comes to make a financial investment, we rest well at night knowing that we have made the right decision. When you consider our competitive market and the challenges facing healthcare providers today, it is clear that we absolutely cannot afford to make a mistake.”

With such a detailed and intense evaluation process, that’s not likely.

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