The recent press has not been kind for the Veterans Administration’s deployment of Real-Time Location System (RTLS). The investigators highlight improper planning, testing, and an overall mismanagement of the program. These mistakes cost the VA (read: taxpayers) millions of dollars, and the heated debate over whether the VA should continue or cease their RTLS initiative seems to rage on.
As I think about it, especially after reading recent article “Ohio Veterans Affairs Facilities Have ‘Lost’ More Than $1.1 Million in Medical Equipment Since 2014,” it reminds me of our family struggles with managing my father’s diabetes. (My Dad approves using his story for the purpose of this post.) I realize that what I am saying here is a huge mental shortcut and just a sliver of experiences, but there are so many similarities between managing care programs and technology programs that certain “lessons learned” seem applicable to both.
We suspected for a long time that my Dad might have diabetes, as he displayed typical symptoms of the disease. The biggest obstacle to getting him the help that he needed was convincing him that he might have a problem, and that if left untreated he might experience some very dire consequences.
The VA decision to deploy an RTLS system was based upon a sound premise. VA leadership recognized that they had issues with managing their massive inventory of equipment and needed to take steps to get it under control. This alone was the driving factor behind their massive project to implement RTLS across the VA enterprise.
A Pill is not a Solution
When my Dad finally accepted that he needed help, he was put on medications and we naively believed that it would solve all of his health problems. Of course, it didn’t, as he was not taking his medications regularly, he did not monitor his sugar levels, and what is most important: he did not change his lifestyle. Having a physician provide a prescription did not turn out to be the magic pill that we’d hoped it would be.
I think the same mistakes happened at the VA. The VA found a “pill” that claimed to cure their equipment management problems, but beyond installing a RTLS infrastructure, I would question whether they took the operational steps to use the technology effectively and efficiently. Implementing an RTLS infrastructure did not turn out to be the magic pill that they’d hoped it would be.
A Care Team Approach
I had to admit that my Dad’s diabetes got worse, even though he was taking his medications. It took us getting involved and finding experts who not only explained the importance of the medication, but helped him turn the rest of his lifestyle around as well. With help of his care team, comprised of many skilled professionals he received the required support to face daily challenges of the new life regimen. He now has regular health checkups with his care team, and they set him up with a system that makes it easy for him to monitor his sugar levels. They also proactively contact him if things look as though they may be approaching unhealthy parameters. When that happens they don’t wait for the next scheduled visit, they dig immediately into possible causes and implement solutions: Does the medication dose need to be adjusted? Does he need to eliminate something from his diet? And so on.
I believe that our VA has wonderful care providers and that each individual is doing the best they can to serve our Veterans. I also believe that if the VA partnered closely with an experienced RTLS technology care team, they would achieve success from their RTLS program.
The “RTLS care team” (as we often refer to ourselves) would be able to remotely monitor the health of the RTLS system and advise if any adjustments to the technology are required to achieve better outcomes. The care team also focuses on such critical success criteria like education and design of best practices that blend technology and process. They also monitor ongoing results of the program through various metrics delivered by the system and provide insights so that both front line users and leadership can see the benefits as they occur.
Continuing with my analogy, I see what is being called a “failure” of the RTLS program within the VA as more a lack of expertise and experience issue than an indictment of the technology. Sort of like blaming the big pharma companies when my Dad’s health didn’t improve after receiving medication for his diabetes. The pill, and RTLS technology, alone aren’t ever going to deliver the success that we hope for. There is simply not a magic pill. Patients, and organizations, must make changes to get the results that they are desire.
We are sometimes discouraged by the progress my Dad is making as he still falls back into his old ways. However we never forget where he was at the beginning of his journey. For some reaching 200 blood sugar level sounds alarming, in my Dad’s case, it meant huge progress.
I feel like this type of situation is similar to the experience the VA had with the use of RTLS. While the referenced article laments about the failure of the system and the lack of the outcomes due to a discovered $1M+ loss in equipment, I am encouraged that the VA has solid methodologies and tools to quantify their problem. Without the RTLS system in place would they even know what and where they lost the missing equipment? Furthermore, and I’m not saying this is the case, but does the VA know how much equipment they lost before gaining visibility into asset location? What if it was $2M? It would mean that they actually have reduced their equipment shrinkage significantly. That’s just conjecture of course, but it is based upon years of experience of seeing these types of situations within healthcare. When deciding to deploy an RTLS system, we agree to expose operational deficiencies, but at the same time we create a tremendous opportunity for operational transformation.
So while others point at the VA RTLS deployment as a failure, I actually believe that the VA has a great foundation for addressing their asset management issues, leveraging RTLS as a tool. They also have a lot of additional opportunities to leverage the RTLS system to optimize workflows and increase patient and staff safety. Yet, from our experience we know that it can only be accomplished when people, processes, and technology are all in sync with the deployment of technology being the easiest piece. The problem of course, is that it seems the VA likely thought the solution was the technology itself. From this perspective, the VA is much like nearly every single one of the projects we have been involved in… only larger. The good news is that with the realization that the technology is only the starting point, and that some guidance and assistance from people who have a proven record of success with RTLS (using the exact same technologies that are in use there), the VA could turn this around and begin sharing press releases promoting their great successes, instead of publishing what might appear at first glance to be a failure.
If we’d given up on my Dad’s health after he struggled with taking his medications, his life would have quickly gotten much worse, but we persevered, and now we experience a tremendous results. We wish the same to the RTLS team at the VA.
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