By Matt Skoufalos
At any healthcare facility, a capital project represents a sizeable budget, a business opportunity and a diversity of stakeholder interests. When that project involves the installation, relocation, or expansion of medical imaging equipment, it can become even more complex. So why don’t more facilities solicit the perspectives of the people who operate, maintain and repair those devices when they’re creating the spaces in which they’ll function?
Traditionally, biomedical engineers and imaging technologists have been absent from project management conversations related to imaging installations and site remodeling. But when they’re invited to become active participants in these discussions, healthcare decision-makers are discovering that their professional insights and the practical experiences gleaned from their work can add greatly to the conversations and improve the overall outcome of the project.
Glen McQuien, chief operating officer at Emeritus Clinical Solutions of Richardson, Texas, describes healthcare technology management (HTM) leaders as “break-fix kind of people” – capable, professional, but all too commonly siloed in their focus. That kind of specialized expertise doesn’t always lend itself to the lateral thinking from which facilities projects benefit.
“In today’s world, everything is integrated,” McQuien said. “Not only does an HTM professional need to know their trade, but knowing the clinical application of the technology is more and more critical. What is the patient experiencing? What monitoring is going on? What diagnostic systems are happening? To understand those, not at a physician or a nurse level, but a workflow level, becomes critical.”
If those questions aren’t asked until after a project is completed, “we’ve missed an opportunity to add value to the process,” McQuien said. To his thinking, bringing imaging professionals in for project planning conversations is “the natural next evolution of IT and biomed joining together.” It reflects a commitment to comprehensively considering a project from its earliest stages, so that when a new imaging space is delivered, everyone understands not only how to best leverage the technology at its core, but the behind-the-scenes workflow considerations that will dictate how that space optimally functions.
McQuien’s interest in learning to yoke the institutional memory of his imaging professionals arose from time spent as a biomedical director. He witnessed plenty of individual vendors advocating for priority on a job site, but no one coordinating their discrete technologies on the receiving side.
“That’s when I recognized that we had a huge gap,” McQuien said. “Many biomedical groups or departments are never involved in the construction until it’s over. Large organizations get that perfectly right, but anyone who’s not a large corporate hospital with these resources needs someone to step into the gap.”
To McQuien, bringing imaging technologists and technicians into the conversation helps avoid cost overruns by tapping into a resource that already exists within the institution. Asking the people who work with the technology for their perspectives in designing the environment in which they’ll work can help improve their overall efficiency.
“From a construction perspective, if it isn’t done well, in comes the cables; in comes the power cords running across the floor,” McQuien said. “It presents itself not only as not the best design, but as a safety hazard.”
“Those things become critical,” he said. “When one piece is missing, healthcare is interrupted, and the patient pays the price. We can eliminate the sacrifice the patient is making because of poor planning.”
To that end, McQuien believes that the earlier imaging professionals are brought into the budgeting process, the more meaningful the impact can become, especially in helping to translate among different departments, or offering insights that come from an insider’s perspective.
“Technology is evolving rapidly, and sometimes we get ourselves into a corner where we only know one way to do it,” McQuien said. “‘This is the way we’ve always done it’ is a statement I absolutely despise. I’ve met with physicians; I’ve met with cardiothoracic surgeons. All of them gave me their perfect lab, and none of them was the same. You have to develop consensus.”
One of the most significant issues around which to build consensus, McQuien said, is that of patient and workplace safety. A hybrid operating room, for example, includes a variety of technologies, from medical imaging systems to surgical robots to patient monitoring devices. Physical real estate is at a premium, and “there’s only so much geography” to manage competing interests, he said.
When they’re able to converse with each other fluently, however, “that’s where you start building capital.”
“I’ve never seen a control room big enough for what you want to do in it,” McQuien said.
“Everyone needs what they need, where they choose to stand, and it changes according to hospital workflow. The users will help you integrate it into that space.”
“[By adding in imaging professionals], you’re going to make it better – and other times, you’re going to make it excellent.”
Angelica Jaramillo, manager of program operations at UT Southwestern Medical Center in Dallas, Texas, summed up the estimated savings that her project oversight work has preserved for her employer as “the argument for due diligence.” A radiologic technologist with a background in radiation safety, Jaramillo knew she could help eliminate over-spending on jobs by creating a more robust front-end vetting process and facilitating conversations among different departments within the institution.
“I’m the advocate for the tech and the facility,” Jaramillo said. “Healthcare professionals and facilities professionals speak different languages. I translate for both sides; I don’t pick sides. I try to break it down so they understand why we can’t do something or why we have to do this.”
“It’s all about letting everyone know that we’re a team,” she said. “We all have the same goal: to build this for patient care, and so a tech can work in there.”
Jaramillo said, “I always make sure I get an end-user in the discussion because they know what kinds of procedures they’re doing, and how they’re doing it.”
“You have to include the end user,” she said.
Prior to the establishment of that deeper, multi-stakeholder planning process, Jaramillo said that new facilities installations often would begin as duplicates of an existing instance of the same technology elsewhere in the system – whether or not rolling out an identical site plan in a second location made sense, or was physically feasible. Sometimes that impulse, which might have begun as an attempt to save time and effort, led to oversights that resulted in costly setbacks and lost weeks.
“Two things you have to consider,” Jaramillo said: “one, what are you installing, and then, is that space even adequate to meet those requirements? MRI are the touchiest – very heavy, so you have to make sure you have the structure to support it, to get it there, and that there isn’t anything that’s going to cause artifacts in those images. You can’t have elevators too close, because any vibrations will distort image quality.”
“If we want to put a PET-CT somewhere, let’s make sure that space is strong enough to support that equipment,” she continued. “Some whole-body scanners can weigh 35,000 pounds, so you have to be sure that where you’re putting it can support it. You’re also looking at all the lead shielding that goes into the walls, the ceilings; and PET-CTs have to support all the other rooms required in the workflow.”
One of the most commonly overlooked considerations that Jaramillo said she has internalized is a commitment to charting the end-to-end path of travel a piece of imaging equipment will take as it’s moved throughout a facility.
“Will you have to demolish rooms to do it?” she said. “What’s in those rooms? Once, we got to a good portion of our design, and discovered a tiny part of the hallway was a chokepoint where, for no reason at all, it became smaller for about 10 feet. The only way this equipment would have fit was cutting the walls down to the studs, and demolishing a corner of a room that turned out to hold the fire suppression system.”
Jaramillo works to incorporate a diversity of perspectives from multiple stakeholders in a project; those of everyone from medical equipment managers and facilities directors to technical supervisors, vendors and service specialists. When they’re all around the same table, she acknowledges that sometimes it can be intimidating for imaging technologists, in whom it is instilled to not shake up the chain of command, to advocate for what they believe is best for a project. That’s why Jaramillo works to create pathways for everyone to contribute their insight when it’s needed, regardless of their job title within the institution.
“I work with the smartest people in the world,” Jaramillo said. “A lot of my job is research to explain to them why something isn’t a good idea. There are so many times that you’re in the ER, and if you don’t speak up, a problem could happen. If an expert is wrong, you’re worried that you’re going to get chewed out. In reality, you’re the one who works in the space; if anything, you’re the expert here.”
When those conversations arise, Jaramillo said she typically falls back on a shared value: that patient care is the highest and best priority of any healthcare system. A poorly designed imaging suite would be detrimental to that priority, and so that’s ultimately the common ground most stakeholders can find in working to advance the goals of any project.
“Working in a hospital setting, everyone knows that patient care is the utmost priority,” Jaramillo said. “Everything we do is for patients.”
Children’s Hospital of Los Angeles Executive Director for Imaging Mario Pistilli credits his radiology project manager, Ruth Rizzo, with supporting his role by helping to coordinate and facilitate high-level, necessary conversations around construction projects and process improvement.
Instead of multiple members of his team needing to walk other decision-makers through imaging operations, Rizzo can field their questions, debrief afterwards with other department heads, and determine when to bring them in as needed.
“Now, instead of teaching five people, I have one person in my operation who attends all our meetings, once a week, to talk about departmental issues,” Pistilli said. “She can go get that information, or might already know it at a high level.”
In the decade she spent with the radiology department, Rizzo’s talent and versatility was indispensable. When Pistilli asked how he could support her professional development, Rizzo said she had an interest in project management, but lacked the credentials to pursue it. Pistilli supported her efforts to get the schooling she needed, and created a role in which she could leverage it to fill needs within the department.
“As far as projects go, I’m a firm believer that form follows function,” Pistilli said. “You have to build something according to the function you want it to serve. If you don’t have the right folks at the table, you’re prone to doing it completely wrong.”
“[Ruth] can attend meetings, escalate, sift through, and find the right people,” he said. “Prior to her dedicated position, I did everything myself. Now she’s involved from the very first submission for a project to even happen, all the way through completion.”
Rizzo helps select designers, contractors, and medical equipment; identify stakeholders before design begins; and negotiate among them all. When the success of a project hinges on the time, effort, and energy of its participants, realizing that everyone’s professional lives are intertwined is a key place from which to operate, Pistilli said.
“Everyone brings their experiences, so it just makes the chance for success greater the more heads you put into the equation,” he said.
Rizzo said that her professional self-confidence is strengthened by the support she receives from her boss. She said she’s leaned on Pistilli’s example for building cross-disciplinary consensus by welcoming a variety of perspectives to get to a better outcome.
“Understanding that the people at the table are experts in their areas doesn’t necessarily mean that they’re experts in our department or our operations,” Rizzo said. “They’re seeing it from a much more macro perspective, which is their job, but sometimes that [viewpoint] needs our perspective to make that work.”
“I’m no expert, but I can tell when somebody needs to be brought into a conversation,” she said. “You don’t have to be a subject-matter expert to be a successful project manager; you just have to be curious, ask a lot of questions, and find those areas where the subject-matter experts need to be brought in.”
