Adventures in Sleep : Workplace Management

New Equipment Brings New Anxiety

Penny Mehaffey — Thu, 23 May 2013 14:09:00 GMT

Finally we were able to purchase new equipment for the lab that I have been dreaming about! I am expecting installation to begin next week and training the week after.

The prep work on our end -- checking the existing cabling and wiring connections for compatibility with the new system -- has been going on for a couple of weeks now. And about half of it will need to be replaced since our current system is, don't tell anybody, fairly old.

I have butterflies of anticipation. I am excited to have all new equipment ... and I am terrified to have all new equipment. Gone is the thrill of the hunt and purchase and it's been replaced with te occassional buyer's remorse and, "Oh no, what have I done?"

What if we hate the new stuff and what if it's not as user-friendly as I thought, and nobody can work it? That's the stuff nightmares are made of. I have been going to bed with visions of cable clutter in my head, and counting all the "what if's" that could go wrong. You'd think I would know better than that, and I do, but I just can't help myself. Try as I might, I can't summon those lovely little friends of mine that usually help me fall asleep. I look for sheep and get cable snakes instead.

On a happier, more personal note, my son is coming home on leave from the Air Force this week. He will be home today and here for about 30 days. Yay! I had scheduled vacation for the first week of June, but the delays associated with the new equipment have intruded. Originally the plans were for the installation to take place mid-May, so I have given up the first half of the week to the install, and will take the remainder in another week or so after installation is completed.

So, to answer the million dollar question as to whether things are settling down, nope! And probably not anytime soon. Maybe by the Fourth of July...

I miss my sheep.

The Best Time to Plan Is Now

Amy Reavis — Thu, 07 Feb 2013 13:54:00 GMT

It's still early in the year, and things move a bit slower. I find this is the best time for me to look over what worked and did not work over the last year and to plan a course of action moving forward. This year is particularly important as the economy has changed how we do business.

As I look at the changes in the environment I have to take into account the fact that competitive bid has moved forward and the new requirements for the follow-up of these patients have increased while the reimbursement has gone down for the DME companies. My choices of where to send an order have decreased and service by those companies -- as well as how that company is structured -- is more important.

I have also had to reevaluate how we operate as we have increased business by about 40% during the last 5 months. This change has profound effects on how everything is done from scheduling to CPAP follow-ups.

So how am I going to go about creating a new plan for my department? I happen to like doing a SWOT analysis. It looks at four quadrants: strengths, weaknesses, opportunities and threats. If I put all this on paper it is a great tool for creating a stronger department. My biggest problem in creating a SWOT graph is that I tend to focus on problems and I forget it is just as important to look at the positives. It is also helpful if I have input from others both in my department and those we have to interact with.

Since our department is small we will work together on the SWOT analysis (for an excellent sample and free template clock here), and then our one-year plan. I believe this will help the staff be part of the growth and see how their growth as technicians will play into the growth of the department.

I am also going to focus on how best to market and help those with minimal or no insurance. This is becoming a larger population as the unemployment rate reached 12% in our part of the country. The problem is that people have to deal with their health whether they have insurance or not. But we need to find a way to help these people that is affordable. This is where I think home sleep testing has the opportunity to grow and expand if the doctors do a good job of screening. With the right tools I am sure we may be able to help more patients to be treated in spite of the insurance issues.

I look forward to our growth over the next year and I am sure that with the changes that are going on in healthcare, this year will be as exciting as the last year was.

Make Staff Meetings More Productive

Amy Reavis — Wed, 28 Nov 2012 23:11:00 GMT

Every month we need to have a staff meeting. I personally hate them, but I know they are necessary--and I've discovered that you can create meaningful staff meetings and help meet your CEU requirements at the same time. If you create a yearly schedule of educational topics and have a basic outline of topics that need to be covered, you can get meetings over in 60-90 minutes and make them interesting

The first thing to do is create a basic meeting structure allowing for discussion of things like changes in policy, issues that patient surveys uncover and issues that staff may have brought to your attention. A basic agenda should be mailed out one week ahead of time so that any subsequent information that may be needed can be gathered. Topics of discussion should be general in nature. If there is an issue with one person, it should be handled in private. The staff meeting should deal with wider issues, such as the rooms are too cold or dirty equipment has been left for the next shift. There should be some mechanism allowing for an open review of policies and changes in policies, such as a change in the scoring manual.

It is important to allow time for problem solving and discussion but that you keep the discussion controlled so that it does not lead to name-calling or finger-pointing. You also want the business part of the meeting to be short and concise.

The second half of the meeting should be for learning. You can get CEUs by applying to the AAST or BRPT. I like the BRPT because the application, available at http://www.brpt.org/downloads/CSTE/CSTE%20Application%20FINAL.pdf, is simple. Consider offering a topic of the month or case study of the month. I would assign a tech to do this so that you are encouraging leadership and learning throughout the staff. If a staff member has an interesting patient, they can do a case study of that patient and their disorder.

Here is a sample list of topics that could be covered in a year:

January: Staging
February: Respiratory Events
March: Movement Disorders
April: Parasomnias
May: Medication Effects
June: Titrations
July: Report Creation
August: Women
September: Pediatrics
October: Sleep Hygiene
November: ECG
December: Day Studies

If you are a larger lab you also might want to add an incentive program that offers recognition at monthly meetings. You could honor the staff member with the most positive patient survey or create a "catch someone doing something good" program. You can give out prizes or certificates to those who have done an exceptional job. Incentives and rewards will be a help when it is time to do yearly evaluations because staff will know that recognitions will be considered.

Monthly meetings are an important part of running a sleep lab. They do not have to be the boring exchange of information they have been in the past. Take advantage of the tools and people out in the community and in your facility to create a dynamic learning environment for everyone.

Time for a Change in Work Scheduling

Penny Mehaffey — Wed, 21 Nov 2012 13:27:00 GMT

NURSES BURN OUT ON LONG SHIFTS!!

Well surprise, surprise, surprise, and to quote one of my favorite malcontent Disney characters, Diego, "I am not surprised, I am so not surprised, I think I am going to die from not surprise!"

This article under this headline laments the long 12-hour shifts nurses must work and how dissatisfied they become with the job, how patient care and satisfaction suffer. How many more of these studies do we need before someone takes the high road and stops demanding the workforce comply with whatever crazy schedule the company imposes?

Doctors, police officers, firefighters, and paramedics work long shifts too. In our area it's common for some to work 24 hours on shift. Let's not forget those who do true shift work, and by that I mean swing shifts--a week or two of days, then evenings, then nights, then only a day or two in which to "turn around." How many reports of horrible mishaps by air traffic controllers have we heard about? Tragic trucking accidents where the driver fell asleep? And what about the train engineers? How many more before those long shifts are regulated?

And why is this dilemma going on so long? It's not that we are unaware of the problem. Is the workforce really shrinking that much, the nursing shortage that bad? Not enough new people are entering the work force so we must maximize the time the current staff spends working? All things being relative, I live in a city with five major hospitals and three nursing schools. You would think a nurse could leave one job today and have another tomorrow and that the hospitals would have a new pool of nurse graduates to pick from every year. And while, in theory, that may be true, is it possible the shortage is created by the hospitals' budgets and not the number of available nurses in our workforce? Hiring freezes are in effect at all most every institution and demands to do more with less are our mottos.

Who would not be happy with an 8-hour shift? I remember, back in the day, when three 8-hour shifts per day were the norm. Lunch and 15-minute breaks were mandatory, and you did not skip those under strict penalty. Now, 12-plus hour shifts are the norm and what is a lunch break? I mean you can eat but if your patient calls, you go take care of it. I think that is jokingly called the "working lunch." Those 8-hour shifts sound like a vacation to me. Sign me up!

I know my comments sound ludicrous. But so do these surveys that continue to fall on deaf ears. I am sure the data are true. Surely there is a solution to this problem, but does anyone really care? Are we powerless to control our destiny?

What Can't a Sleep Tech Do?

Penny Mehaffey — Thu, 02 Aug 2012 16:42:00 GMT

Hodgepodge is my word for the day, and if you follow synchronicity, then it's the pattern for my life lately. I guess it's a good thing. That post-vacation funk is gone and in its place is the business of the new agenda.

All of the new hires have moved to night shift, which has quieted my space considerably but created a head-banging concert on nights. Still, we are continuing to do more with less there, so that should be music to our ears right?

The A.W.A.K.E. support group is flourishing ... BIG SMILE!!! Finally, it has a steady cast of regulars who have begun submitting suggestions and asking questions and RSVPing. I am excited for the coming year.

We received the OFFICIAL word from the AASM that we are REACCREDITED. WOOOHOOO! The certificate is beautiful.

I recently enrolled in online university to complete my degree. Now, I am having buyer's remorse. But I am committed to completing my education even if it takes me until I retire to do so. Study tips anyone?

Where was I? Oh right, a hodegepodge, defined as: a jumbled mixture, with synonyms like miscellany, muddle, mess...oh, there's one I resemble.

In the Middle of Patient And Referral Source Disagreements

Amy Reavis — Thu, 14 Jun 2012 13:53:00 GMT

I received a phone call the other day from a patient who wanted a new CPAP machine. His was 10-years-old and knew he needed a new one. I told him to talk to his primary care doctor. The patient called me back and said that his doctor sent him to a pulmonologist who he did not want to see. He asked if my medical director could follow him instead.

I love being helpful to my patients but you run a thin line when you deal with going over a doctor's head. We have to keep our referral sources happy but also need to help our patients. I did make arrangements for this patient because I knew the primary care would not mind. However, there are some doctors that would not have been happy with this patient's choice.

As a technician or a manager or a patient advocate, we sometimes get put in the middle of hard decisions. The one thing that will always be in our favor is that the patient has a choice on who he or she sees. Just like they have a choice of which sleep lab they go to. If we work as a community we can make sure all the patients are well cared for. It is not all about competition; it is about good medical care and patient satisfaction.

Whew! I Survived Sleep Center Re-Accreditation

Penny Mehaffey — Thu, 24 May 2012 14:47:00 GMT

Whew!! What a week. My lab went through re-accreditation this past week. Thank goodness it's over.

While I was confident in our practice habits, I was still a little unnerved at being examined. I guess that is only natural since so much rides on passing. (We did, of course, and I would say with flying colors.)

For the past two years, we have discussed the topic of accreditation and what we needed to do to prepare at least once a week. Then, as the time drew closer, it became all that we talked about. We tend to go directly by the AASM recommendations and that practice has served us well.

Now that it's over and we've passed, I have to say that it was a tremendous learning experience. I now better know the other side of the story: what the examiner looks for, how to interact with them, and how to prepare.

I know that patients receive the highest quality care at our lab, no question. I also know that our techs can leave here and go anywhere to work. They are well trained and get great and varied exposure to not only routine cases but the difficult and very challenging as well.

Our standards are high. I am very proud to serve here.

How Do Sleep Labs Handle Bad Publicity?

Amy Reavis — Wed, 02 May 2012 13:48:00 GMT

In the news this week, a pediatric sleep tech was accused of inappropriate contact with two underage children. The news channels jumped all over his role as a night-time tech who sets up children for studies, even though the alleged contact did not happen at work and he had no criminal record when he was hired five years ago.

Whether the person is guilty or innocent, the accusation will make people worry that something bad can happen at a sleep lab. This makes it essential that as a lab we develop a plan to help patients feel safe and secure. This is especially true when there are male techs and female patients or one tech and one patient at the facility. We need to plan for these scenarios and to work with our marketing people to make sure they can handle any questions that come up.

The biggest scare, however, is how we help to protect our profession. It only takes the misinterpretation of a move like putting on belts to ruin a life. We have to practice defensive medicine to protect ourselves and our futures. We need to make sure we are videotaping everything. We need to remember that it just takes one person who may not have the best interests to ruin a career or a facility.

Why CPAP Therapy is Failing

Amy Reavis — Wed, 01 Feb 2012 16:09:00 GMT

There is a huge failure rate for CPAP therapy; some would even say it is as high as 50 percent. That number is being used by insurance companies, home sleep testing companies, and people who do not believe in sleep apnea to prove that we are testing too many people and spending too much money. But we're not. The failure rate results from our failure to educate and assist people who have started therapy.

Follow up in many cases does not happen because no one will pay for it. Decreased reimbursement and capitated contracts have caused many providers to drop off a CPAP machine and never follow up with the patient. But what those companies and the Medicare competitive bidding program have not taken into account is that trained personnel are essential to raising the success rate. These professionals listen to the patient, examine their issues, and come up with the creative solutions to help them become compliant with therapy. The trained sleep personnel understand how to properly craft a desensitization plan for a patient. They understand the value of proper mask fitting and why different masks work on different faces.

Sleep centers should have the autonomy to change interfaces without a medical prescription. If a patient trials several masks on the night of a titration study, they do not know whether that mask will work long term. The sleep tech does not know if the patient may have issues with skin breakdown or leaking because their pillow is different than the one at the sleep lab. And if a patient loses weight while on therapy and his mask no longer fits, there's no guarantee that he will see his primary care physician and receive a script to refit the mask. A mask change should just be able to happen with a proper fitting at a lab or DME company.

And although many patients are being followed by a sleep specialist, more are being followed by their primary care doctor. Reimbursement amounts do not cover referrals for follow-up by the sleep labs (although many centers do call patients, have newsletters, and host support groups) or for DME companies that set up the patients.

In order to change the issues, we need to make it clear that CPAP failure is truly about failure to interact, and interactions must be reimbursed. We cannot save money on trained personnel in the short term without taking into account the long-term effect on therapy success rates. We, as a community, need to make it clear to patients, the medical communities, and the insurance companies that with proper reimbursement enabling proper care of patients, this therapy can be successful.

Why Every Sleep Tech Should Take Time Off

Penny Mehaffey — Wed, 11 Jan 2012 21:19:00 GMT

Happy New Year, everybody! I hope and trust we have all settled in to our post-holiday schedules, some of us with a big sigh of relief. The extra busy part is over for me for but I am still full of anticipation. I am excitedly waiting the return of my son, the airman, who will be home at the end of the month. I can't wait!

Boy, my week has been a doosie. It all started yesterday. After a four-day weekend off, I returned to a bursting email inbox, a mountain of charts to score, and notes to sort through. But before I could tackle them, I was waylaid by amplifier issues and error messages. You know computer problems always take top priority.

I was able to tackle that and even get everything else done, and it occurred to me as I was crawling under the desk to unplug the amp, the cables, and the power supply that I was actually not hating this activity too much. Hm... I definitely need to plan more four day weekends off. That's a good New Year's resolution.

Today I arrived early to the lab to get a head start on scoring. What greeted me at my desk? A note about the same amplifier and the now failed study it caused. So, I went back under the counter for troubleshooting with tech support.

Tech support is always very helpful and today was no exception, but the amplifier and hardware errors were not responding to the usual tricks. Every time we thought we had the problem corrected the error would start again. I thought I was going to pull my hair out. Truth be told, what I really wanted to do was pull that #$@% off the counter and throw it in the floor...is that too honest?

Two and a half hours later and fifty trips back and forth and up and down with tech support, we determine the amp is bad...DUH. (I know you were thinking it, so I might as well say it) Now I have to go decide who to cancel for tonight and pray that my new amp makes it here in time for tomorrow night.

Excuse me, but I'll take another four day weekend now.

Time to Review Your Sleep Policies and Procedures

Amy Reavis — Fri, 06 Jan 2012 00:16:00 GMT

Once a year I try to do two things. I review and update our policy and procedure manual to meet the new needs of our facility and I do technician evaluations so if there is any new education that needs to be done I can plan for the education during our monthly meetings.

Policies and procedures are essential for any good sleep lab. These are the backbone of every good facility, not just a piece of paper the accreditation companies require us to have. As we change we should update these. I had a friend who is adding HST to her facility and so I shared my P&P with her. If she sees anything that she thinks may need changing I am open to new or better ways to do something.

I also need to change how we do our quality assurance and so that policy should be changed to keep up with these changes for the year. I am fortunate that one of the speakers at the FAST conference gave such great reference material to use for it.

It is also fortunate that this is the slow season so I can take the time needed to rework what must be done. I can come in at night and observe my technicians and see their techniques. I have learned so much from watching others and sometime I may have an idea or two for them to be more efficient.

This is the beginning of the year. Take the time to take a fresh look at your policies, please share any good ideas you might have. That is how we can become the strong field we need to be.

Becoming a Multicenter Sleep Lab: The Challenges

Amy Reavis — Thu, 30 Jun 2011 13:15:00 GMT

Growth is hard. Our lab is planning its first offspring. It is exciting but a little distressing. I am learning that when you work with people who like to have control, you have to stand up for what you want. In the end, you will get what is best for the patient. (It has taken me a while to learn this.)

I have not been allowed to go out and see the building. I have no control over what it will look like. So I have had to let that go.

I do have control over what equipment we will buy and who will be working at that lab. I can insist on a clean and a dirty utility room and on a washer and dryer. I have even insisted on good sheets and blankets and pictures for the walls.

So why do I say growth is hard? Well, there is a certain amount of balance that you get when you have been running a lab for 3-plus years. Adding new beds and new doctors to the mix means you have to accept that there are going to be changes.

There is the increase in work we will be doing based on sales projections (which we all know are basically a guess). There are staffing issues including who can work on their own and what happens when there are no studies.

Mostly, I'm learning to change my leadership style to give more responsibility to people. I hate to micromanage but I like to know what is going on with all my patients. I will not be able to do this with the new facility. I will need to create higher expectations for some of my technicians. I have some great techs who are go-getters and I have some techs who are excellent techs, but do their job and that is it. They do not study and look to improve. So I keep encouraging the go-getters and I try to help the others find their niche. But as we grow, I will need to not necessarily promote those who have been here the longest but those who have made the most consistent improvements.

All I know is that I need to find the balance of moving from a small one facility lab to the next step: a multi-facility organization challenging. I think I am up for the challenge. I know that it will go smoother if I am aware of my shortcomings and learn from those who came before me about how to make this transition successfully.

Personalized Care Improves Outcomes, Grows Business

Amy Reavis — Thu, 26 May 2011 12:51:00 GMT

I had an experience getting some prescriptions filled: The technician was working with me to get a discount card to work that I could not use at another pharmacy. It turned out that the other pharmacy just did not know to make a phone call required to activate the card. It cost them a customer. The extra 10 minutes this person spent with me not only made me a customer but has prompted me to recommnd this particular pharmacy to others.

The same personal care is true with our sleep lab. I spend at least an hour a day on the phone with patients answering questions and getting them the help they need to be successful with their CPAP. Ultimately this time has also resulted in new patients because people talk.

Word-of-mouth recommendations are the best. They will not just attract people who are going for a sleep study already but they will attract people who did not know it is not normal to snore or gasp or feel tired all the time to talk to their doctor. Patients in turn may tell the doctor that they want to go to a specific lab. The doctor hears this from patients a couple of times and begins to wonder what is so special about the lab. This could lead to a new referral source.

Managers must teach night technicians to understand the important role they play in this whole process. It is not just about doing a good study, it is about taking the time to talk to patients and make them comfortable. That little bit of personal time can make all the difference in a patient's experience. The happier patients are the more they will share this information and the busier your lab will become, which gives you job security.

A technician going that extra step should always be rewarded, even if it is just words of praise. An occasional chocolate does not hurt either (M&Ms do not last long in our lab.) Giving techs get positive input results in consistent positive comments on our exit surveys. The word of mouth has resulted in two patients just this week that were referred by past patients. We have also had two new referral sources this month because patients requested they come to our facility.

As this field grows tighter and tighter, only the labs that give consistently exceptional service will grow. Taking time to use praise staff and give small rewards when they go the extra mile will pay for itself many times over.

Evaluate Strengths, Weaknesses, Opportunities, Threats

Amy Reavis — Thu, 20 Jan 2011 12:22:00 GMT

The beginning of the year is usually the slow time of the year. The patients do not want to pay their yearly deductible and many people are recovering from the holidays. I find this is the best time for me to look over what worked and did not work over the last year and to plan for the next year. This year is particularly important as the economy has changed how we do business.

As I look at the changes in the environment I have to take into account the fact that competitive bid has moved forward and the new requirements for the follow up of these patients have increased while the reimbursement has gone down for the DME companies. My choices of where to send an order have decreased and service by those companies as well as how that company is structured is more important.

I have also had to reevaluate how we operate as we have increased business by about 40% during the last 5 months. This change has to profound effects on how everything is done from scheduling to CPAP follow ups.

So how am I going to go about creating a new plan for my department? I happen to like doing a SWOT analysis. It looks at four quadrants; strengths, weaknesses, opportunities and threats. If I put all this on paper it is a great tool for creating a stronger department. My biggest problem in creating a SWOT graph is that I tend to focus on problems and I forget it is just as important to look at the positive. It is also helpful if I have input from others both in my department and those we have to interact with.

Since our department is small we will work together on the SWOT analysis ( http://www.businessballs.com/swotanalysisfreetemplate.htm is an excellent sample and free template) and then our one-year plan. I believe this will help the staff be part of the growth and see how their growth as technicians will play into the growth of the department.

I am also going to focus on how best to market to and help those with minimal or no insurance. This is becoming a larger population as the unemployment rate reached 12 percent in our part of the country. People have to deal with their health whether they have insurance or not. Home sleep testing has the opportunity to grow and expand if doctors do a good job of screening. With the right tools I am sure we can help more patients to be treated in spite of the insurance issues.