Episode 11: Visionary Voices with Carol Davis-Smith, Matt Baretich

Larry Kaiser:
Hello, and welcome to this episode of Visionary Voices. Today, we welcome Carol Davis-Smith from Carol Davis Smith & Associates, and Matt Baretich from Baretich Engineering. On this episode of the podcast, we’re going to be discussing the then, the now, and the future of HTM, aka Healthcare Technology Management.

The conversation today will be led by Optimum’s Principal ServiceNow Advisory Consultant, Shelby Johns. Welcome to the show, everybody. Hope you’re having a good day.

Shelby Johns:
Thank you.

Carol Davis-Smith:
Thanks for joining us.

Matt Baretich:
Thanks, Larry.

Larry Kaiser:
Thank you. Alright, so today we’re gonna jump right in with one of my favorite segments of our podcast, which we like to call Bandwidth Banter, which is our fun take on icebreakers and allows our listeners to get a little bit of a better understanding of who they’re listening to on here.

So, I’m gonna direct my first question to Matt. Matt, I’ve heard you’re an aficionado when it comes to coffee or tea, so what is your go-to coffee or tea drink order?

Matt Baretich:
Oh, my order is Twinings green tea with jasmine flavoring.

Larry Kaiser:
That’s a good one. That’s a good one.

Matt Baretich:
I don’t know.

Larry Kaiser:
And if you go somewhere and they don’t have it, you need a backup. Are you going tea again, or are you going coffee?

Matt Baretich:
Oh no, I go latte. Decaf, low-fat milk, and artificial sweetener. It’s like, why bother?

Larry Kaiser:
Well, there you go. If anybody wants to buy Matt a coffee or a tea, you know what the man likes.

Alright, Carol, you have some background there that kind of leads me to this one. What’s your favorite sports team?

Carol Davis-Smith:
So that’s a tough one. I am probably more aptly described as a sports aficionado. I grew up… I always tell people that was my first job, was playing sports. I went to school and I played sports all season.

But I’m a huge basketball fan. I spent my formative years — wasn’t born there, but spent my formative years in Kentucky — and you pretty much have to learn to like basketball if you’re not born with one in your hands.

And recently my mom was asking me, “Well, who are you rooting for in the March Madness?” I said, “That’s really tough,” because I’m of a vintage, if you will, that I tend to root more for coaches — people that were my contemporaries or came shortly after me that have really taken the program and women’s athletics forward.

So I’m a huge Dawn Staley fan.

Yeah, exactly, so I’m a huge Dawn Staley fan. But I also have a bit of affection for the UConn Husky women. Geno could just make me crazy some days, but the man, along with people like Pat Summitt, really opened doors and kept them open for women going forward, and the UConn players always put on a good show.

Rough March Madness for them, but they put on a good show.

And now I’m very excited because the WNBA has started. We’ve had the preseason games, and we’re back on the court. So I had my three weeks off, and I’m right back in it.

Larry Kaiser:
You know, I find it interesting you mention the coaches. When I was in high school, my junior and senior year, I was in what was called the Coalition for Essential Schools. It was a school program founded by a gentleman by the name of Ted Sizer.

In order to graduate, you had to do what was called a senior project, and in the senior project, you had to prove that you had new knowledge of the topic you were presenting on. Then you had to pick a teacher in the school, and they were your mentor.

So I actually chose our athletic director, and the topic I chose was player-coach relationships in the sport of basketball.

He had connections all over. He got me into various colleges — University of New Hampshire, because I went to school in New Hampshire — but ultimately, he got me two weeks at Brandeis University with the Celtics every day for like five or six hours for practice.

The highlight of the story is I sent a survey out to all of the head coaches in the NBA looking to have them answer five questions. I still have some of them, but I have responses from Phil Jackson, Don Nelson, Pat Riley, because I used his book as the basis for my project, his autobiography.

But I also got job rejections and various other entertaining responses back from that.

And then when I was in high school, after I aged out of recreation, I coached basketball. I actually coached a girls’ recreation team to a championship my senior year in high school.

Ironically enough, a person on that team, her name was Courtney Banghart. She is the head coach now of the UNC women’s basketball team, and she came up underneath Pat Summitt.

Carol Davis-Smith:
There you go.

Larry Kaiser:
So…

Carol Davis-Smith:
There you go.

Larry Kaiser:
So I would like that.

Carol Davis-Smith:
I’ll let you know, softball championships are starting up in another couple of weeks, so no shortage of women’s athletics.

Shelby Johns:
No, there’s not. And you know Arkansas softball’s up there.

Carol Davis-Smith:
That’s right, I noticed that.

Larry Kaiser:
So Shelby, what’s your go-to sports team?

Shelby Johns:
Well, when Carol was talking about Kentucky, I thought she was gonna say the former men’s basketball coach, Coach Cal, who is now the Arkansas men’s basketball coach.

So I’m originally from Arkansas, and I bleed red, and I love all Arkansas sports.

Larry Kaiser:
Very cool. Well, I might have to add a tag to this podcast whenever we’re posting it to include not just business and HTM, but also sports. There’s a really entertaining sports conversation here, so I appreciate all the fine conversations here, and thank you for sharing a little bit about your personal life with our listeners.

But with that said, I think it’s time to dive into our discussion. So Shelby, the mic is yours. Take it away, and I’m looking forward to this interview.

Shelby Johns:
Thank you, Larry.

Alright, in honor of Healthcare Technology Management Week, we are excited to talk about the then, now, and future of HTM.

So I’m gonna start with a then question for Carol and Matt. Looking back over the last decade, what are the most significant shifts you’ve seen in how HTM is measured and valued within healthcare organizations?

Whoever feels like they want to start first.

Matt Baretich:
I’ll jump in because I’m all about measurement.

We’ve had different sorts of measurements for a long time. Some of them are just basic things like, did you get your PMs done on time? That’s because the Joint Commission, for example, required you to report that.

What has been happening more recently is a lot more in the literature and in practice to come up with more sophisticated metrics. That coincides with the development of more sophisticated CMMS products that can generate that kind of information.

Where I think we have not progressed as far as I had hoped over that time is in standardizing how we measure things. I still see a lot of variation from one organization to another.

Carol and I have both been involved in doing some standardization efforts to standardize some of these metrics. Then I follow up and call people and say, “Are you using this new white paper from AAMI, for example?” And they say, “Yeah, but we changed it a little bit here, and we added something over there.”

What gets lost in that transition is if you don’t have actual standard ways of measuring things, you can’t do benchmarking. I can’t compare my program to yours and learn anything from yours because the numbers don’t jive.

Shelby Johns:
Yeah, for sure. I was just talking with a client today that has an independent service organization, and I was like, “Well, did they implement AAMI’s failure codes yet?”

And they were like, “No,” and I was like, “Well, we’ll see how we can map them to the AAMI failure codes.”

Carol Davis-Smith:
Yeah, totally agree with everything Matt said, and it is a bit frustrating we haven’t seen that uptake.

But I wanna look at it from a little bit different angle. When you asked about how HTM is valued, in the last decade or maybe a little more, we’ve seen more executive-level positions for HTM leaders.

So I kind of see these two things in contrast. We have people sitting in executive director and VP-level roles, yet, as Matt said, some of these standards or the effort to standardize has not happened.

To me, that’s a bit of a question where our health systems say that what we are doing is valuable enough to have executive-level management and leadership, yet we still haven’t quite gotten on the boat of what that means, both strategically and tactically.

I find that interesting. I don’t have a good explanation for it, but I think that’s something worth watching and maybe addressing.

Shelby Johns:
Yeah, no, I think that’s a very valid point. Many HTM departments are handling capital equipment nowadays and getting multi-million dollar budgets to spend on things like service and new equipment. So we need to make sure we have the data to back those decisions up.

Shelby Johns:
So today, how central is data to HTM decision making? Where do most organizations struggle to make that data usable rather than just available? I think you guys hit on it a little bit more, but wanted to know if there’s anything else you wanted to add around data today.

Matt Baretich:
Well, one angle on that question is because I know in your audience you have more than HTM professionals.

Many of the people that we work with in the organization as peers or up in the organizational structure don’t know the details. They’re looking for understandable metrics that provide genuine, actionable management information.

I don’t think we’re doing very good at that.

I think that’s a key thing for the value and recognition of HTM and just the profession in general — to realize that’s who our audience is. The people that need to hear that need to understand and be able to get a quick picture of what’s going on.

My interaction with the executive level is that they’re scanning around saying, “Are there any problems out here on the horizon?”

If we can convincingly and truthfully say we don’t have problems in our area, that’s important. But if there is a problem, we should know it ahead of time and tell the people that need to hear it.

Shelby Johns:
Yeah, I think KPIs is a common term we like to use for those key performance indicators that executives want to keep an eye on.

But you also have to have KPIs in place firstly to track them. If not, then you’re staring into an unknown. If there are issues, you don’t know about them.

Carol Davis-Smith:
Yeah, absolutely. I think Matt’s alluding a lot to the operational pieces, which we should be doing a lot better.

We’ve been measuring these things for decades, not just the last decade, but two or three or four decades.

I think that’s an audience thing.

But also looking strategically — you mentioned capital planning, which of course is one of my favorite swim lanes.

Again, being able to be proactive. Just recently, and this seems to be sort of an ebb and flow thing, recently I’ve seen more interest in being proactive, forecasting out two, three, five years, in some cases ten years.

Obviously that’s a pretty fuzzy crystal ball, but the point being looking ahead, anticipating, and trying to align it with construction.

My fear is that the economics of healthcare and the constraint of funds will have people throw their hands up and say, “Well, why bother? We don’t have any capital anyway.”

Which keeps putting us back in this loop of, “We have no capital, why plan? Oh my gosh, look, we have money, what do we spend it on?” Then we run around and react.

So I think that’s a leadership challenge. This goes back to my earlier comment. If we’re going to have executive-level management and leadership, we need to extend those behaviors. We need to exercise those behaviors at a higher level.

And then the other example I’ve been working on recently is staffing.

We all know, “Oh my gosh, we have a staffing shortage, I need more people.”

My response to that has been both when I was in a healthcare organization and now in my consulting role: “Okay, what kind of people?”

I think the more difficult question to answer is what kind of people do you need?

We need the right people doing the right work.

So data on our staff — understanding who knows what.

When I’ve engaged with healthcare organizations, training records are paper files or a certificate the tech has on their phone or shoved in a drawer, or a spreadsheet that has an X or a checkmark but there’s no context.

Did that expire? What qualifications do they actually have?

So our ability to manage the devices, yes. Manage our messaging up to our true audience, yes.

But let’s not forget about our most important resource. It’s not service contracts. It’s not safety analyzers. It’s the technicians and engineers that work on our teams.

Understanding what skill sets they have and are we allowing them to practice at top of their license, as our nursing and physician colleagues would say?

Do we even know what top of license looks like?

I think this is an area we’re going to have to get better at because it’s not like people are coming out of the woodwork.

We have to keep doing what we’re doing to promote the field, but I think we need to understand the tools we already have — the people and resources we already have.

Matt Baretich:
Yeah, so Carol, I’m gonna follow up on some of that. I agree with everything you’ve said.

But if you follow the different HTM podcasts, for example, the hot topic for years and years has been that we don’t have enough qualified people.

The qualified ones we do have are getting old and retiring, and I’ll put my hand up for that.

So how are we going to get more good people in here?

We’ve been saying that same thing for a long time, and we do some good things — promote the field, introduce it early in schools — and all that is good stuff.

But I haven’t seen much progress with that.

I’m not sure the solution to not having the people to do what we want to do is being solved on the supply side.

I know you’ve thought hard about staffing, and I wonder what your take is on it. How do we change that conversation to something likely to be more productive?

Shelby Johns:
Not to interject too much, but I was just at MD Expo in Baltimore, and the Children’s Wisconsin team did a Women in HTM panel.

Anne talked about hiring three female techs in the past few years, and she highlighted that she replaced about 153 years of experience with 9 years of experience.

So I cannot emphasize enough that I think there is a shift in younger people coming in and wanting to be involved in this field, but departments need to be invested in training them and getting them up to speed.

It’s going away from a lot of these biomed schools and into the shops in the basement of hospitals.

Carol Davis-Smith:
Yeah, I would agree. I think there is a huge opportunity for cross-training.

We’ve done it informally for decades. The techs even did cross-training with me as an engineer.

But I think putting some structure around that — not just as a manager expecting it to happen or assuming it’s happening.

I see job descriptions that basically say “fix stuff.”

Or they’re focused on “fix stuff in this building.”

I think having an inventory of skills that we have and skills that we need based on what we’re responsible for is important.

Do we have a complete inventory? Do we know enough about what’s in the inventory?

Do we have the right skill sets?

To the point about Anne replacing 150 years of experience with 9 years, quantity is helpful, but this is very much a quality issue.

What was the quality of that experience? Was it the same thing for all those years?

What is the current skill set need?

What do we not have to do anymore?

Why are you still doing that? One, the technology doesn’t need it. Two, the regulations don’t call for it. Three, you don’t have time for it.

I don’t see the structure there.

We’ll put hours into pressing for PM completion, but we haven’t really looked at whether what we’re doing in our PM program even makes sense.

Do we have the right skill set?

And the thing that makes me completely insane is when we don’t meet PM completion because we’re not managing our vendor.

That’s another skill set.

How do you manage a business partner? How do you manage a service contract? How do you evaluate one?

There is no insourcing or outsourcing. It’s the right mix of insourcing and outsourcing.

I don’t have all the answers to fixing the staffing issue.

I just think we keep saying, “I don’t have enough people,” hoping that people will show up at our door.

And I agree, Matt — they’re not.

We have to figure out what skills we need and whether we can get them from different types of people and then train them.

The thing that always scared me in the past was, “Let’s just go get an auto mechanic and an electronics tech and throw them in.”

Quite honestly, that’s dangerous for both the organization and that individual.

Let’s bring people on with onboarding, with a training plan, with a program — not just throw people in the deep end of the pool and hope they can swim.

Shelby Johns:
It sounds like the first step should be documenting the skills of your workforce — technical and soft skills — and then using that data to justify new FTEs and exactly what that job description needs to be tailored to.

Carol Davis-Smith:
Yes. Yeah.

Matt Baretich:
Yeah, that’s amazing.

Shelby Johns:
Listen to it right here, everyone.

Matt Baretich:
Well, absolutely have to do that.

But if there’s nobody out there, we’re just gonna have to steal from each other.

I have a better recruiting program, or a better lunchroom, something like that, so come work for me.

That’s not a comprehensive solution for the HTM community.

I think this theme will come up again as we go through this conversation today.

Shelby Johns:
Yeah, yeah.

Going back to data, and since a lot of Optimum’s audience here is executives, what KPIs or reporting analytics should these executives go back to their HTM departments and ask them for?

How are you tracking things more than just PM compliance?

Matt Baretich:
It’d take me a bit to come up with a list, but what I want to make a pitch for is having compensating metrics — compensating KPIs.

For example, you can get your PMs done on time if you do slapdash PMs.

So you want something about getting PMs done and something about the quality of the PMs that you do.

That would be failure codes or repeat repairs or things like that.

If you don’t have those compensating factors, it’s easy to game the system.

It’s like productivity numbers. People want to see a certain number of hours in the day recorded as doing something useful.

Well, if that’s the only KPI your staff are rated on, they’re gonna find lots of things to write into the CMMS about what they’ve been doing.

That’s not the same as being busy on useful things. That’s gaming the metrics.

Carol Davis-Smith:
Yes, I would echo that substantially.

I’m gonna go back to the leadership piece in our community.

The whole idea of productivity — I think we’ve gone after it in a way that undermines itself.

As a manager, I have always been more interested in where my staff has to spend their time.

I’ve lived in areas where there were bottlenecks, and I’ve almost always been associated with reasonably large health systems.

As you try to get from one location to another, windshield time is real.

That’s not the technician or engineer’s fault. That’s the civil engineers that designed the city.

But it’s a design constraint.

My job as a manager is not to press for “I want to make sure you’re only spending your time on productive hours.”

My job should be to understand where you have to spend your hours.

If you have a whole bunch of hours spent trying to get from point A to point B, then let’s sit down and figure out how to manage that.

That’s a strategic conversation as opposed to a disciplinary or punitive conversation.

And another one — to Matt’s point about quality — I was recently in conversations with imaging department directors on the clinical side who were sharing that they are being asked to provide visibility into the impact or outcomes of their services in terms of patient outcomes.

Did they have to do repeat scans? Did the patient progress to treatment?

Was something delayed because equipment wasn’t available?

That really resonated with me because I thought we need to figure out how to align with that, probably in collaboration with our clinical partners.

Because we don’t always directly know.

But just because the equipment is down, that may or may not have resulted in a patient outcome, good or bad.

But it probably did.

Matt Baretich:
Yeah.

I think here’s another place where we could talk about standardizing metrics.

If I go to my boss and say, “Here are my numbers for this month,” the next question is gonna be, “How do those compare to the hospital down the street that we’re competing with?”

If we say, “Well, we don’t calculate that the same way,” or “I don’t really know the answer,” that’s not gonna fly.

It’s another reason to standardize.

We can put together a list of the top ten metrics, but these bigger questions Carol brought up are even more important.

The ultimate objective is actionable management information.

Out of all these KPIs and all these numbers, do we know what to do to get better?

That’s the key question.

Carol Davis-Smith:
And that’s not one-size-fits-all.

Every hospital is exactly the same and completely different.

How we calculate things needs to be consistent.

But the metrics and KPIs I need for my health system are likely to be somewhat different than what you need at your place.

And that’s okay.

Shelby Johns:
Yeah, it sounds like each organization needs to sit down with leadership and say, “This is where we want to improve. How do we measure that?”

Matt Baretich:
I remember talking to a Joint Commission surveyor, a senior one, and he was describing a situation where he was asking an HTM professional about some metric.

That person brought it forward and said, “Look at this, we’re always at 99%, 100%, 95%.”

The surveyor said, “Stop measuring that.”

Because you’ve got that under control.

Go measure something where you’re not doing well and figure out how to improve it.

That’s the trap we can fall into.

We want to show good numbers to our bosses, but we don’t want to fool the bosses, and we certainly don’t want to fool ourselves.

Shelby Johns:
Yeah, well said.

One last question about the now.

What are the small but meaningful changes HTM teams are making today to move in a direction of progress beyond basic compliance and toward higher maturity as a department?

Carol Davis-Smith:
Well, I’m gonna jump up and say when I came into this field 30-some years ago, the loud voices in the room were the clinical engineers that were my mentors.

The technician world was separate.

But I would say in the last five years or so, I have been very pleased to see the technicians stand up and not ask, “Who’s gonna do something for me?”

Instead, they say, “Here’s what I’m doing for the community.”

I’m building foundations. I’m building training resources. Helping people find jobs.

It’s self-help.

It’s, “Here’s my problem, and I’m gonna find a way to solve it.”

I think this goes back to the sports conversation we had at the beginning.

I grew up playing team sports. I don’t know how to not work in a team environment.

So it was always a little heartache of mine to feel there was this separation.

I really feel less and less of that now.

Some of the people I get the immediate “Hey Carol” from are the technicians.

The partnering, friendships, professional learning — it feels like culturally we’re getting over what I’ll call the stupid stuff.

We’re recognizing this is a team sport.

Just the other day, I had a conversation with a technician I’ve met in the last year.

He’s fabulous.

I thanked him and said, “Thank you for letting me be the second base to your shortstop.”

Because we’re so much more effective now.

We can do so many more things because we’re collaborating and not worried about turf and status.

We’ve got a job to do, and let’s do it together because we’ll get it done faster and better.

So for me, that’s a change I’m seeing in the last few years.

Shelby Johns:
Matt, anything quickly to add?

Matt Baretich:
No, I think Carol’s got it exactly right.

I’m starting to think about the future.

Back to what we were talking about earlier with staffing and getting people in for the jobs.

The future is going to be continuing to do that.

There are some really proactive, amazing, creative people who are not waiting for someone else to recognize them.

They’re saying, “We’re gonna improve our profession.”

But the other side of the coin is what we need to work on going forward.

I don’t think we’re gonna solve the supply side of getting more techs that are the right match.

We should do everything we can to match them up, but I don’t think there are going to be that many more people in the pipeline.

Where we go forward from here is how we deploy the resources that we’ve got.

All through my career as a consultant, I’ve worked on HTM program assessments, and Carol has done them on her own, and we’ve worked on some together.

What I’ve always seen is there are ways to make better use of the resources we already have available — the human resources, the culture, the money, the machines, the test equipment, all the stuff.

I think that’s where the solution is going to lie.

If we’re just talking pure productivity, yes, we need more technicians, and yes, they need to have the skills that match the equipment that needs to be taken care of.

But are we implementing an AEM program to stop doing stupid stuff?

Someday I’m gonna have a t-shirt made that says “Stop doing stupid stuff.”

We do a lot of dumb stuff.

Carol Davis-Smith:
I pre-ordered mine.

Shelby Johns:
We’ll send one to AAMI together.

Matt Baretich:
Electrical safety testing that hasn’t been required since 2012.

There’s a ton of stuff we can stop doing.

If you run the numbers, even with conservative calculations, it translates into a bunch of FTEs that appeared out of nowhere.

I think we’ve got to think outside the basement.

We need to start thinking about these big-picture things for our own sake and for our boss’s sake, because that’s what they care about.

We need to start looking at these issues globally.

Larry Kaiser:
I think that’s a really good point.

I think that’s a great point to end this conversation by saying, “Stop doing stupid stuff.”

I will happily take one of those shirts as well.

Over my 22 years in healthcare IT, I’ve seen plenty of stupid stuff.

But I really do appreciate everybody’s opinions and insights here today.

So I want to thank our guests, Carol Davis-Smith and Matt Baretich, and Shelby Johns for sharing their insights.

Real quick, any last insights that can top “stop doing stupid stuff?”

Any more cliches or anything like that?

Alright, well, thank you everybody for joining us, and to our listeners, thank you for tuning in to this episode of Visionary Voices, powered by Optimum Healthcare IT.

And remember that the future of healthcare IT starts with your vision.

We’ll catch you next time on Visionary Voices.