VERY Key Metrics – Ignore At Your Own Peril

Tel-Tron powers the systems technology at roughly 1,000 retirement communities, improving the quality of life for over 100,000 residents. We work with over 200 senior living clients and have a very long-term understanding of the good, bad and ugly of senior housing management.  I’ve been tempted to start a blog series on things I would do if I owned a senior living company or community.   Given the challenges we’ve helped folks through this week,  that temptation is growing harder and harder to resist.

Let’s consider this post the prologue to that series, which will provide a behind-the-scenes, outsider’s, perspective on some very fundamental changes senior living executives could implement that would change everything for them.  Here is an example.

Visual Management of Staff Response to Resident Emergencies

Here are a few snapshots from a daily dashboard – available to any Tel-Tron user – from Auditrak.com.  Check out these statistics and see if you agree with my recommendations.  This is a real-life 80 unit assisted living community, with a fairly aged population.  The staffing levels are similar to sister communities of similar size, but the needs here are apparently greater than the staff can handle effectively without intervention.

Take a look at the activity level for just the last 24 hours on this real-life emergency call system.  What we see is a disaster. If I were the Executive Director of this community, this would have my undivided attention.  What I see is that in the last 24 hours, there have been 74 emergency calls, most of which originated from a resident pushing their wireless necklace pendant.  The balance were from pull cords in the bedroom, with only a small number of alarms originating from a pull station in the bathroom.

Daily Activity Snapshot

THE AVERAGE RESPONSE TIME IS 42 MINUTES!!!!  The longest alarm took 6 hours.  One has to assume that the 6 hour alarm has some explanation, but the average is 42 minutes.  In fact, a resident living at this community would be far better served by calling 911, rather than using the emergency call system installed in the community.  What, I ask you, other than poor training, indifference, lack of understanding could cause the people responsible for caring for these residents to think this average is acceptable.

Let’s look at a Chart 2, also for the last 24 hours, which will show us the call distribution by hour for the last 24 hours.  What we see is that the average number of calls per hour is approximately 4.  There appears to be a peak before the dinner hour, and again between 10pm and midnight.  Even still, these peaks only represent 7-9 calls an hour.  Not a very heavy workload by any measure.

Chart 2

Next, let’s take a look at some performance gauges that this community has set for itself, using their own targets, in the three areas relative to staff response.

Performance Gauges

We already discussed the average response time.  Notice their own internal target is 5 minutes, with 8 minutes being allowed.  The longest response time has been discussed already, too.  The last metric, % of responses outside their target threshold, 72%.  An overwhelming majority of their resident emergencies are taking staff longer than 5 minutes to respond.  I know.  Not every alarm is an emergency.   However, there is no way to know the real alarms from the non-emergency alarms until staff responds.  It is imperative to treat each alarm as the real thing, or else when there is a real alarm it will be a disaster.  Worse yet, an avoidable one brought on by complacency.

Last chart.  This one is about profitability, which may make hiring more (or better) staff a reality for this community.  This is a chart that shows the top users of the emergency call system.  Take a look.

Frequent Users (and abusers)

Remember, there were 74 emergency calls in the last 24 hours.  These 7 residents alone accounted for 71% of the calls placed over that period.  They should be paying more than others.  Whoever is in room 218, if this is continuous over time, should be paying even more than the other 6.  They are using the emergency call system 3X as often as the person who is number 3 on the list.  Assuming each alarm takes 5-10 minutes of staff time, this single resident is getting 1-3 hours of staff time  – daily – that other residents aren’t receiving.  I’d charge for that somehow.

Surely there are a number of factors that go into determining how much a resident pays for assisted living services.  The amount of staff time consumed by excessive use of the call system should be among them.

These are just a few examples of the kind of data that is available on the Auditrak.com service.  These 4 charts are on a daily dashboard that is emailed to executive directors (if they request it), making review of the numbers almost effortless.  Failing to review these numbers – which is apparently the case at this community – results in poor performance across the board.  My guess is that their resident surveys aren’t that great either.

Training the Trainer – It’s As Easy as Staying at a Holiday Inn Express

All of the latest and greatest technology, coolest software and state of the art reporting capabilities are nothing more than really expensive paper weights without proper training.  I’m always amazed at how many people think that just because they use something they are somehow now an expert on how to teach other people how to use the product.  The fact that I watch the Daytona 500 every year, drive a car to work, have seven speeding tickets to my name and look great in a fire suit and helmet doesn’t make me a race car driver and it certainly doesn’t make me capable of teaching someone how to drive a race car.  We often get familiar with the products that we use daily, even comfortable.  Our understanding of those products grows the more we use them.  That’s great; we all need to learn more about the tools we use.  The problems start when our confidence exceeds our knowledge.  Knowing how to use a product in a limited scope is far different than understanding a product well enough to teach any user how to use it in any application.  Remember, just because you stayed at a Holiday Inn Express last night doesn’t make you a trainer.

One of the traps that non-professional trainers fall into is that they assume everyone uses the product just like they do.  The person that trained them probably felt the same way.  The conclusion of this informal passing down of knowledge is that things get distorted through perceived experience rather than fact.  Observation can be a great tool in understanding something but often a misinterpretation of some coincidental event gets wrapped up into the “myth of operation” that is passed down from person to person until what new employees are learning barely resembles the information that was originally introduced with the new product.  Things get lost in translation, people hear what they want to hear, short cuts are taken and people without a passion or interest in training treat the endeavor accordingly diminishing the product delivered to the people that need it most, the newest members of your team.

How do we combat this?  How can we ensure integrity of the information being disseminated and confirm that the people that need it most not only comprehended what we taught them but also can implement it now?  How can we continue to reinforce these lessons?  How do we keep that base of knowledge growing?  All relative questions that operators deal with everyday, turnover isn’t going away.  Tel-Tron Technologies has a training program called “Train the Trainer” that addresses all of these problems and more.  It’s free to you and our involvement with your team NEVER ends.  We are always there to help you grow and continue to support your onsite trainer provide the best professional training practices to your staff the day they start and reinforce those lessons throughout their careers.  Let’s get down to the details and see how it’s done.

We help identify a trainer at your community if you haven’t already.  Trainers are a special breed and not everyone is right for the job, we can make sure you get the right person in the right spot.  Once we have identified the right person we make sure they have the right material and ensure they use the right process.  We start out by ensuring that five basic concepts are put into practice:

  1. There is a difference between listening and learning!  I see people paying attention almost every time I teach a technical class.  If I’m not on my game, continuously involving the learners then it is almost a guarantee that many won’t be able to retain or use the information I provided in as short a time as an hour later.
  2. Not everybody learns the same way.  Unless you have years of experience and a lot of familiarity with your students your probably won’t be able to figure out how your students learn in enough time to be effective.  Do your students learn better through visual examples, auditory examples or tactile examples?  We teach you to provide examples in all formats and ensure that you have the material, produced and provided by us, the manufacturer, to meet your employees’ needs.
  3. Asking good questions is more important than providing all of the answers.  We help your employees use the Socratic method of critical thinking to ensure that these are lessons truly learned not just taught.  Using a dialectical method that involves discussion and logic rather than a recitation of facts is always more effective for long term retention.
  4. Keep the lectures to an absolute minimum.  Slides too.  We provide you talking points and PowerPoint presentations but more importantly we teach you why you should use them sparingly and how to teach your employees using other medium that are more effective.  Interactive learning, games, role playing and other techniques are at your fingertips and provide a much richer experience for the learner.
  5. It isn’t about what you know but what your students learn.  Proving how smart you are to your audience is not conductive to a great learning environment.  You don’t have to be a college professor with a PhD in a given subject to be a great teacher.  In fact many “teachers” with those credentials are awful.  Focusing on the needs of your students, understanding how they learn and keeping them engaged are far more relevant than your technical base of knowledge.  We help you develop those skills throughout our partnership.

By providing your onsite trainer with the tools they need to be successful and self-reliant your life gets much easier.  Cost of ownership goes down.  Over 80% of all calls to our technical support center are related to operational instruction.  Over half of our onsite service is related to operational misinformation.  Imagine saving 70% of your employees time related to technical issues and 50% of your annual cost on service.  Remember, we provide this service free with every new installation or upgrade.  Consistency of delivery is no longer a problem, we provide you the training materials, hands on tools, DVDs, quick guides, testing materials and online learning services that ensure the technical materials you need to do your job are current and consistent.  We’re with you every step of the way, you’ll have a personal “Train the Trainer” mentor that guides you through the process for as long as you need and is standing right by your side the first time you’re in front of a class.  That’s what a partnership is about and that’s what you get every time you do business with Tel-Tron, your partner for life.  Don’t just take our word for it, listen to what our partners and training participants have to say.

It’s your building. How will you know…..

. . . . if something goes wrong.  

If you are like me, silence is golden.  It means that the world around you is running like it is supposed to.  It means that all of your staff members are operating in full.  – But — What if something isn’t right?  What if your staff screwed up their response to an emergency call last night, but didn’t tell you.  Wouldn’t it be nice if you were alerted?  After all, you are in charge.  

I speak with many executive directors who manage their world with a flow that seems organic in nature.  With the help of a Tel-Tron, enterprise level emergency call system, they are able to do their tasks with the confidence that their staff is working as hard as they are and no stone goes unturned throughout the day.  The Tel-Tron system, alone, does not allow them to achieve this, but it frees up their mind from worrying about one small problem that comes with life threatening consequences. 

 From time to time, all of the staff is tied up with other functions and an emergency call may take longer to respond than normal.  Nobody likes to talk about it, but it is a reality.  Sometimes, things go haywire. 

The calm, cool and collected ED has a notification set up in Auditrak that sends a message if that e-call is not re-set within 7 minutes or what ever time frame is appropriate.  This is the time when the ED wants to be involved.  That Ed may go the entire day or week and never have contact with the wireless emergency call system that was installed in the building.  However, when things go wrong, it’s time to act. 

Daily Summary Report - Emailed Automatically

The Tel-Tron Auditrak management reporting tools are especially valuable for the corporate Director of Nursing or Chief Operating Officer.  Again, a silent nurse call system means that emergency calls and personal emergency response calls are getting their responses in a timely manner.  It means there is nothing to worry about in that one small category of their lives.  In short, it means the people that they have spent time and money to hire and train are doing their jobs.  Of course, the COO is not going to run and respond when his/her Iphone starts beeping with a text or email that alerts of the situation, but they will know that something is off and perk their ears up to pay attention.  Maybe repeatedly late e-call responses are a signal that more training is needed? 

That is what the Auditrak event notification system is all about.  Whether it is a late response to an emergency call or a low battery condition in a wireless call station, Auditrak is customizable for the user.  A Tel-Tron emergency call system is not only used to notify the staff when there is an emergency.  It is used to notify management when something in their world has gone wrong. 

Does your nurse call system, call bell system, emergency call system, wireless emergency call system, or personal emergency response system, (PERS) Notify You?

Throw out that PC based system and get in the CLOUD!

Once upon a time, senior living communities paid someone to be at the front desk 24 hours a day.  They did this because the emergency call system consisted of a panel of lights and buzzers mounted on the wall.  If a resident needed help, a light would turn on and a buzzer would sound.  Someone had to be within earshot of this panel at all times, or calls for help would go unanswered.  Once they heard it, though, alerting the care givers that someone needed help was another inefficient and labor intensive task.

When Tel-Tron introduced pocket paging to the wireless emergency system call industry (100 years ago…) both problems were solved.  Care givers wore pagers and were alerted right away when a resident needed help.  This eliminated the need for panels of lights and buzzers, and the need to pay someone to watch them 24 hours a day.  This was a transformation of the way senior living providers operated their buildings and provided care to their residents.  Really, it would be hard to imagine not having pagers or some other mobile staff device today.

Portion of Auditrak Dashboard

What does this have to do with cloud computing?  Everything.  When Tel-Tron introduced Auditrak.com, another senior living transformation began.  With the release of the ethernet gateway for our CompanionOne product line, Tel-Tron’s nurse call system has completed it’s migration to the cloud.  What is the cloud and how does it help senior living, you ask?  Let me explain. (click here for the wikipedia definition)

In the pocket paging example above, people were slaves to the front desk, because that is where the alarm panel was located.  The “data” they needed to respond to resident emergencies was accessible from only one place – the front desk.  The same is true on PC based system today.

System programming information, resident usage metrics, audit trail reports, maintenance notifications, resident check-in data, even changing resident pendant codes is all located, stored and managed from the personal computer located on-site.  You have limited or no access to that data or functionality from outside the building.  You have limited or no way to keep all of that data backed up on a real time basis.  You have limited or no way to integrate that system with other systems located outside of the facility, such as your accounting, or resident management software.

Worst of all…..Once you buy a computer based system, you are saddled with never ending upgrades, maintenance contracts, having to replace the computer itself every couple years, your staff uses the computer to play games or surf the web (see previous blog about that particular nightmare), Microsoft changes operating systems routinely, loss of functionality during a power outage…  Really, the list of downside risks to a PC based system are endless.  What’s the answer?

Enter the cloud!  Instead of your entire emergency call system being controlled and run by a software program on a local PC, host all of that functionality in the cloud (on the internet).

Your on-site system includes all of the devices in the resident rooms, all of the mobile devices used by the staff, one or more alarm consoles, the wireless or hardwired monitoring infrastructure.  But the activity data, programming information, reporting software, charting and graphing software, trend analysis, and system monitoring is “hosted” offsite.  You access this site through an internet browser like Internet Explorer, Firefox, Google Chrome and Apple’s Safari.  Which means you do NOT buy a dedicated PC for the emergency call system.  You use any PC (or iphone, blackberry, ipad, etc) you want, from anywhere you want, whenever you want.

  • There is no software to upgrade on site, ever.  The hosted software is always current.
  • You don’t have to keep back-up disks, or tapes on site.  Your data is always on line and backed-up continuously.
  • You don’t have to worry about your staff breaking the computer, surfing the web, or otherwise messing up the PC.  Because THERE ISN”T ONE.  I know this is a mental leap.  But it is literally transformational to the industry.  Senior living CTO’s, IT managers, even maintenance people are loving the fact that their systems no longer are PC based or dependent.

Sample Report of All Alarms with a "Resident Wait Time" of more than 10 minutes

In addition, once your secure data is in the cloud, you don’t need to run reports any longer.  Establish operating parameters and reports will be automatically sent to you (or anyone else) whenever something occurs outside those parameters.  Two small examples:  Many Executive Directors get a report emailed to them every morning listing any emergency call where the resident’s wait time was longer than 10 minutes.  Regional Operations Directors have this same report sent to them monthly for all communities in their territory.  Regional Maintenance Directors get a weekly report automatically emailed to them of all system trouble items that have occurred, and not resolved in the appropriate time.  I know, that was three examples, but the possibilities are endless.

Last one..any notification can be sent via email, or text message.  Some Operations Vice Presidents want to know right away if there is an elopement activity such as a window alarm, or “screen removed” alarm in an memory impaired section.  Elopement is a big deal these days and an early heads-up is helpful.

I know this is a lot to take in and understand, but having your emergency call systems data hosted and managed in the internet cloud, means a whole lot less headache for on-site staff related to computers, and an almost limitless opportunity for growth and integration in the future.  Just as pagers changed the industry in the late 80s, cloud computing will change senior living over the next few years.  Just browse on over to Auditrak.com and you’ll see what I mean.

I didn’t talk specifically about this, but having a single hosted location for systems data and management is exponentially more valuable if a senior living operator has multiple sites.

One day we’ll look back and say…”Remember when we used to have a PC run our emergency call systems.  How did we ever survive?”

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