Paul Schulz is no stranger to process improvement, and in recent years he has come to understand the potential RTLS has to make hospitals more efficient than ever.

HealthCare Business News sat down with him to learn more about his background with real time location systems and what insight he can share with healthcare providers to help make their adoption of the technology go more smoothly.

HCB News: Real time location systems (RTLS) can be the key to unlocking significantly improved workflow efficiency in healthcare. In your experience do most hospitals and health systems recognize the value in RTLS or is it still something that is misunderstood or flying under the radar?
Paul Schulz: Hospital systems are starting to understand the value of innovation and need to innovate deeper into operations will push RTLS data and deployment in the coming years. Recently the advent of business intelligence challenging the current state of operational reporting is helping people consumer larger data sets with greater understanding. Historically RTLS has been a great vehicle to understand location, status and provide notifications to help automate workflow steps but information about care process workflows are providing leaders improved views. The phrase, “flying under the radar” actually fits well into the potential for teams to create improved patient care processes.

When systems improve the need for more accurate data to run the system usually runs in tandem. Health care budgets are investing anywhere from 50-65 percent of total cost into care resources. In most cases the measurement of care resides in hours per patient day. RTLS helps us understand minutes in the care cycle unlocking visibility and the opportunity to ask more intelligent questions from the data presented from RTLS systems. For the patient and the care team, optimizing care minutes because wasted steps become evident can be a game changer within the care environment.

HCB News: Can you tell us about your own background and how you came to be an expert in RTLS?
PS: Let’s hold off on expert status with early stages of full RTLS still alluding us but the value it has brought to an industry needing operational data has been exciting. I’m thankful for the 20 years of process engineering and the lesson’s provided striving to be ‘world class’ to compete. The past 11 years in healthcare started by helping organizations build improvement models based on lean, six-sigma or leveraging proven models or Studer principals.

Operations always have tools and the experience I tend to lean on (no pun intended) is when manufacturing started using Enterprise Resource Planning (ERP) systems like SAP or some other brand for production steps. We pulled massive amounts of data and took years to fully optimize. The implementation of Electronic Health Record (EHR) systems is totally different but similar so walking that path in a previous life has been beneficial.

Seven years ago, we started looking at RTLS as a workflow tool compared to asset tracking which at the time was ground breaking. That started the process of continuously challenging metric sets and striving to deliver a better data story around resource allocation. RTLS workflow visibility and improved data reduce random changes which can be frustrating for all; patients, customers, staff, providers, and the organization to the point where it no longer seems worth it. The last three years at Eide Bailly we've invested a great deal of time and talent utilizing new tools for large data stream management. With this piece of the puzzle coming together, elements of RTLS continue to evolve into a necessary component of organizational innovation.

HCB News: You have helped some big facilities, such as Altru Health System, implement RTLS systems. What are some of the most valuable lessons and experiences you've taken from those partnerships?
PS: The first is to understand is that care cultures need time to adapt the new technology. Most of the learning happens in the first couple of weeks of system start-up and process modeling before go live helps relieve start-up stress. We’re finding the amount of effort put into data structuring on the front side helps providers consume information sooner and start the innovation cycles on a better note. The RTLS system and reporting functions designed need to be flexible, so they grow with the teams capacity to learn and challenge the current state.

The term 'real time' migrates quickly into staff vocabulary and the ability to quickly recognize the flow of work from the system builds engagement. Another contribution to engagement is providing your team a fixed point in the stream of data that unites the RTLS effort with strategic goals. At Altru we focused on cycle time of patients and that has evolved into a more mature understanding of work flows.

Leaders have to get in and roll up their sleeves. They need to be the first to learn the data, understand the system, and answer questions so the team can trust the system by trusting the leaders. This helps with innovation as trust builds freedom to explore and dream. Cultivate better conversations with front line leaders based on information compared to assumptions.

HCB News: With so many RTLS systems (including RFID systems) on the market, what factors should a facility consider when selecting the right one for their needs?
PS: RTLS systems are vying to find a home in the health care world and new technology makes the decision process a little difficult. Primary to the process is investing in a hardware system that is fast and accurate. Latency time between the action of care and the visible displays are important for the team to see and trust the system. Another element of speed is when integrating with EHR's they sometimes have a latency timer to not exceed a certain amount of seconds before the software 'times out.' Always test drive what you may be buying.

They key for software is capacity for rules and data management. As you expand the system make sure the system expands with you. How is data organized into what kind of database? Is the data base accessible? Will it generate custom reports? How? Can you export data into business intelligence tools or similar technology for reporting? Be careful that your teams desire to innovate is not harnessed by system capabilities.

Health systems regard RTLS as a technology application to solve a certain business case needed today. It makes sense to provides an ROI focal point, but once that business case is solved, then what? An organization should consider how RTLS can be used for operational learning, innovation and overall productivity. We believe the ROI to be a reduction to the cost of care per incident of care provided over a specified period of time.

HCB News: How should a provider or facility prepare for installing an RTLS system in their hospital?
PS: Considerations should be applied to what the organization’s appetite for process improvement is and the maturity of the improvement model. The organizations we are working with are starting with ambulatory flow and stepping into ED management, hospital asset management (including bed management and nurse work flow) and then into the OR. The OR is probably the Super Bowl of RTLS deployment and the organization will need a mature and educated team to tackle those processes. However, there is much to be gained in that environment when looking at OR suit utilization and surgical case flow.

HCB News: What are some of the most common (or most dire) mistakes that facilities sometimes make when introducing RTLS to staff member workflow?
PS: Being afraid. We always tell staff that what you did yesterday, last week, last month works but we need to improve. RTLS on its own won't change the world. Nor will it end it. Move forward with it. Get used to the functionality of button presses and work flow rules that help staff perform their care steps. Staff adaption is a simple bell curve. You will have early adaptors on one end and nay-sayers on the other with the majority of those in the middle waiting for the bell to tip in direction or the other. Leadership plays an intrinsic role managing the bell curve of staff engagement.

On the technology side you need a solid WIFI system that has available bandwidth. Uptime for the system needs to be high. A transparent tech team will need to monitor and manage the system while communicating with staff when issues arise. Overall, we've found the RTLS system to be stable but when outages happen front line staff miss the RTLS functionality and how important the system has become in day to day functions. It really does work in the background so the tech is not intrusive but the functionality is missed when issues arise.

HCB News: When you look at what providers can do with RTLS today, do you feel like the capabilities of these tools are being optimized or are there greater benefits that we've yet to tap into?
PS: We've only scratched the surface. It seems that the additional technology added to health care over the last decade has decreased productivity with some gains in quality and safety of care. it's time to reduce the amount of time needed to transfer information, find people, find things, understand stages of workflow and get ourselves out of the space of not knowing and into the arena of knowing. RTLS helps us know where the patient is, status and location of equipment and where staff members are when you need them. It helps us to be predictive and understand when we need to be somewhere before the request arrives and reduce patient wait time which is expensive to everyone.

If you are a provider rounding in the hospital without RTLS and you go to a patient room only to find they’re not there, what do you do? How much does that cost? Is the patient discharge process accurate and timely? If not, what is the cost of that each time it happens? How much nursing time is spent with the patient? How can you, or how do you know? Did environmental services spend enough time cleaning? How do you know? If someone is admitted to the ED and walks out because they have been waiting too long, what is that cost to the health system? Time is opportunity in health care for patient care and safety. Understanding how we can better use time may be the most important piece to innovations needed in the healthcare industry.

HCB News: Anything else you want to mention about RTLS trends that I have not asked you about?
PS: Leaders find it difficult to measure the magnitude of return from different investments opportunities. Losing the intellect, or wasting the innovation that could come from one of the more educated and passionate workforces is a cost that should not be overlooked. In the words of Sakichi Toyoda who helped develop Toyota Industries, "The most detrimental of these if not followed (elements of lean production thinking) is not growing your people." Feeding an intelligent workforce better and more accurate information helps grow their operational intelligence and improve care processes. RTLS is a great source for this information.