Before You Start an RTLS Project – Think It Through

by Joanna Wyganowska, VP of Marketing | Infinite Leap


This week, our featured RTLS in Healthcare Community member is Kathi Cox, Senior Vice President of Integrated Experience at Texas Health Resources in Arlington, TX.


Infinite Leap: Kathi, can you share with us how your journey with Real-Time Location Systems (RTLS) started?

Kathi Cox: Our organization was an early adopter of Real-Time Technologies. In 2008 we started using an RTLS system for tracking our assets. We started with a pilot in an Emergency Department. Our line of thinking was that it is an ED where the availability of the medical equipment is the most critical. For example, even if we could only find stretchers faster, we could deliver better and more timely patient care, and develop a convincing value story to extend the technology across the hospital. However, we quickly learned that as ED patients were admitted, many mobile assets went along with them, and without an RTLS infrastructure covering the entire hospital we were losing the visibility of the assets the moment they left ED area. In short, an asset tracking/management solution doesn’t accomplish anywhere near its full value if it is installed only in a limited area.

Infinite Leap: So what did you decide to do at that point?

Kathi Cox:  As we realized that to truly benefit from the RTLS system you need facility-wide RTLS coverage, we needed to find a way to pay for the larger RTLS infrastructure deployment. The most logical idea was to use RTLS to tackle issues that we knew were problems, and where we could easily and clearly quantify the financial benefit. We decided to focus on reducing our pend on rental equipment by using an RTLS-enabled process along with timely data to optimize our rental equipment process.

Infinite Leap: And… How did that turn out?

Kathi Cox:  It worked! Using Lean Six Sigma methodology, we partnered with the stakeholders, created a lean process and then used RTLS technology to enable it.   This entailed placing real-time location tags on all rental equipment as it entered our facility after being ordered by the unit. When a nurse rolled the equipment out of a patient’s room when usage was finished, she pressed button on the RTLS tag that sent an alert to the rental company to pick up the item. In addition, this signaled the end of the billable charges that were allowed on this particular equipment and put pressure on the rental vendor to retrieve their equipment quickly. Event better, the rental company was able to quickly obtain their asset without having to comb the facility searching for it!  Additionally, we saw another important shift taking place. With RTLS, we could easily measure how often we were utilizing rental equipment which allowed us to more easily perform a value analysis as to whether it was more cost efficient to purchase the specialty equipment rather than always renting. The overall use case provided the facility significant financial benefit and with the help of our Finance team, we were able to measure hard dollar savings and direct them towards expanding our RTLS initiative. For example, the rental reduction provided us with $265,000 in savings in just one year, additional and even bigger savings came from purchase avoidance.

Infinite Leap: Can you share with us some lessons learned from your journey with RTLS?

Kathi Cox:  As I mentioned earlier, we at THR were early adopters of RTLS system. And you know exactly what it means – you experiment, you learn from your mistakes, you assess what you should be doing differently, and you try again. Other healthcare systems were reaching out to us to learn what worked and what didn’t. So I am glad Infinite Leap has created this forum where we can learn from each other and avoid potentially costly mistakes. But yes, let me share with you one interesting lesson learned from my RTLS journey – it is the realization that there could be a significant difference between what we think we know and what the actual reality is.

Infinite Leap: That sounds really intriguing. Can you tell me more?

Kathi Cox: Sure! Let me provide you with a specific example: our nursing staff had indicated that they could never find IV poles and it was at the top of their priority list to tag.  However, after we went live with the technology, and ultimately when we ran reports listing the type of equipment that our staff was searching for, the IV poles were on the very bottom of the list. There were other items searched for much more frequently, such as telemetry boxes and infusion pump modules, so with the use of data, we could validate what asset types provided the highest value from a tagging perspective for the actual users of the system and the assets. We also started taking proactive steps towards reallocating and relocating equipment based on searches done by each specific unit, which resulted in increased utilization of our owned equipment.

Infinite Leap: Any other words of wisdom from the RTLS veteran?

Kathi Cox: As a consulting company, and from working together with many on your team for years, you know very well what I’m going to say, so let me share with others the mantra that I live by: “You cannot throw technology at a bad process, and expect the results to change.” If you don’t figure out first how to fix the process at its core, there is not a single technology that could solve the underlying issue. Technology is an enabler, which allows you to modify process in ways that you couldn’t before, but you need an engaged team, and lean processes that are hardwired to drive change.   


Infinite Leap: We couldn’t agree more. People need to engage, trust and “own” the process. Speaking of people owning… where does the RTLS program “live” within THR? Who owns it?

Kathi Cox:  The aspect of “ownership” is a critical one. Without a clear definition of roles and responsibilities, an RTLS system will quickly deteriorate. Frankly, this is true for any project of this nature, not just RTLS. You need to have a strong champion and engaged leader who is supportive of the system use, goals and ongoing support. Additionally, it is very important that the system has an owner who is able to demonstrate the value that is being received on a regular basis. Without that, people forget what the goals were, and may even become disengaged. Personally, from the wide range of areas that can benefit from an RTLS solution, I believe that the best functional fit, in terms of RTLS ownership, is the corporate COO. COOs have the more global view of making sure that things flow smoothly throughout the healthcare system, and are less influenced by any specific need or department than other leaders may be. Many hospitals however feel that the RTLS solution should live in the IT/IS world, but the reality is that while these real-time solutions “use technology” they are not technology solutions. IT/IS should definitely be involved with anything that impacts the network, or requires servers, and should definitely certify that it meets security requirements, but beyond that, this is an operational system. IT needs to be a supporting arm, but the Operations team can ensure that the most value is derived from the use of the system.

Infinite Leap: Kathi, can you elaborate on this statement?  

Kathi Cox:  Certainly. As I just mentioned, although the IT team plays a significant role in the success of the RTLS initiative – as they are responsible for system infrastructure, system security, integrations – it is the folks who are responsible for orchestrating operational processes in the hospital who should “own” RTLS. They understand the operational processes and the potential impact the technology can make on them. But there also needs to be a multi-disciplinary governance body which oversees this mission critical system.

Infinite Leap: Kathi, can you share with us the most memorable moment during your journey with RTLS?

Kathi Cox: I was really proud of how we were able to integrate our RTLS system with our operational processes at Texas Health Alliance. The day we opened the doors of our new hospital we were able to use our RTLS system to deliver real-time information on patient location and status. When a patient was discharged, the room’s status automatically changed to dirty and a housekeeper got an automated message that the room needed cleaning. That’s exactly what you need to go after when you think about deploying RTLS – how real-time data and automated workflows can enhance existing systems and processes to make the patient and care team experience better and to improve your operational efficiency.  

Another proud moment was when we leveraged our RTLS system when faced with a case of measles. With the real-time location system, our infection control staff was able within a few minutes to identify anyone and anything that came into contact with the infected patient during the relevant time period. We could then take necessary steps to minimize spread of the infection.

Infinite Leap: Any last bits of wisdom that you would like to leave us with?

Kathi Cox: Sure. The first thing to think about before you even start looking at specific RTLS solutions, is to know what problems you are trying to solve and also what information you would need in order to solve them. Spend time asking your teams questions, and only once you understand where their frustrations are – look for the solution that meets your specific needs. And one more piece of advice: don’t rush by trying to deploy all possible uses cases at once – develop your RTLS roadmap, master your initial use cases, and build on your successes. You will gain enthusiasts along the way and organically create the desire to innovate and expand the use of the system.

Infinite Leap: Totally agree. That’s an approach we advise our clients as well. Kathi – as we are building our Community, can you please share with us some of your personal interests?

Kathi Cox: I love spending time with my family, cheering for our Texas Longhorns and Dallas Cowboys teams. And let me tell you, with our great draft – I feel we will win this year’s Super Bowl!  Whoo hoo!  


If you would like to share your thoughts and best practices on RTLS, drop me a note – I’d love to chat with you to capture your experiences. www.linkedin.com/in/joannawyganowska

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