Guardian Case Study Naval Medical Center, Guam
NOTE: Information contained in this case study is the opinion of the software user and beta tester at Naval Hospital, Guam, It does not in any way reflect the views of the United States Navy or the Federal Government and is neither endorsed or opposed by either.
Introduction:
Naval Hospital, Guam is a mid-sized military medical facility located on the island of Guam. It has approximately ninety practicing physicians and two privileging specialists.
Selection
Naval Hospital, Guam was selected by dBx Software in late1999 as the beta test site for the new generation of Guardian software. The beta test period lasted approximately six months. The criteria for selection was:
Naval Hospital, Guam easily met each one of these criteria. A request was submitted by dBx Software to conduct testing of the Guardian software package in that facility and permission was granted.
Before Guardian:
The criteria that the beta test site must have a system currently in place for managing privileges allowed dBx Software to establish a baseline level for many aspects of the privilege notification segment of credentials management. Guam was using the standard Navy Medical software system (CCQAS) to manage credentialing information. CCQAS does not currently provide a privileging interface, therefore Guam was using a combination of a paper-based system and emailed update notifications for privilege distribution.
Although they reported no technical problems with distributing information by this method, they did report that it required one to four hours per day to insure that all privilege information was current. In fact, the number one drawback that was listed on a survey of privileging methods was the “time spent making copies of privileges”. Lower on the list of needed improvements was availability of information.
Since a paper based system was in use, privileges were maintained in a binder that had to be kept in a secure area. As updates were made, revised privilege information was added to the binder. Of minor concern was the lag time that was inherently present because of the time it took to update privileges. For example, if a provider’s privileges changed on a Friday, the update may not be added to the binder until Monday or Tuesday. This created a “gap” in the accuracy of the information contained in the binder.
Installation:
Guardian was installed at Naval Hospital, Guam in January 2000. Since Guardian 2.0 was a completely new software version and Guam was slated to be a beta test site, some installation and configuration problems were anticipated. A pre-installation survey was completed and some preliminary instructions were delivered and carried out prior to the installation date. These instructions, mainly handled by the IT department, consisted of creating and setting up permissions for an Intranet folder on one of the central Intranet servers.
There were no problems noted in setting up this folder. Installation did not require a visit to the beta test site by dBx Software. The installation files were made available for download on a web server and instructions were provided for installing and configuring Guardian. According to the beta tester, the time it took to download, install, configure, and begin using Guardian was two hours. No configuration or installation problems were encountered.
When the dBx Customer Survey asked “How did installing Guardian compare the installation of other networked applications in your facility?”, the beta tester replied “It was pretty simple.”
Using Guardian:
he screens in Guardian are designed to provide easy navigation of all information. The design goal was to never require more than three clicks of the mouse to accomplish any single task. While it is impossible to satisfy this goal completely in a complex application, striving to meet it helps to guarantee very user-friendly software. Instead of having to work between multiple screens overlapping each other, or having to constantly open and close screens to do basic tasks, Guardian uses a “tabbed” screen format that allows simultaneous access to all pertinent areas of the application on a single screen. This dramatically cuts down on the number of “clicks” that a person must make to use the program.
When asked, “What is your opinion of the screen layouts of Guardian”, the beta tester replied, “The screens are very easy to read and navigate.”
Another goal of the designers of Guardian was to provide the right number of features. This is not as simple as it may sound, since more features aren’t always an improvement. The goal was to create enough features to make usage as easy and intuitive as possible without overloading the user with unnecessary options. To conform to this design philosophy, any new feature was evaluated with great scrutiny to determine if:
The most difficult of these goals was making sure a feature really belonged in Guardian. Many items were suggested and evaluated, but eventually rejected because although they were good ideas, they did not enhance the core job of Guardian…to provide timely, accurate privilege information to providers.
When asked if he thought Guardian has the right number of features, the beta tester replied: “Yes, I do. For example, if I need to check for privileges that will expire in the next thirty to ninety days, all I have to do is right-click and select that feature from a menu.” This feature is an example of an item that was added to Guardian once it was in the beta testing stage.As the beta tester used the software, great care was taken to evaluate any shortcomings of the software or screens. These shortcomings were then overcome by adding specific features during the early stages of the beta test.
Benefits:
The real benefits of Guardian are not always immediately obvious, but after using Guardian for over a year, Guam’s privileging director had the following answers to our survey:
Q. What is the main benefit you have enjoyed by using Guardian?
A. Twenty-Four hour access.
Q. How has Guardian helped to reduce your daily workload?
A. Since I have been using Guardian, I don’t have to generate paper listing of all privileges. All the staff has to do is access the program [through their web browser], click on the provider that they want to check, and they are done.
Q. How has your facility benefited overall from the usage of Guardian?
A. Paper usage has been cut by 90%.
Q. Do you feel that patient safety has improved through the use of this tool?
A. Yes. One of the features of Guardian is being able to see a picture of the provider in question and further provider identification can be made by the last four digits of their Social Security Number.
Q. How much easier has Guardian made your job?
A. I have more time to work on other projects.
Q. How much time does Guardian save you in a typical month?
A. About 40 hours.
Q. How has Guardian improved your job on a daily basis?
A. I no longer have to maintain [separate] privilege listings in the office.
Conclusion:
The Guam beta test is considered to be a great success by dBx Software. It proved in a real-world setting that there are great benefits to be realized by using a centralized privilege distribution system, and it has proven that the technology created by dBx Software and used in Guardian is adequate for Intranet distribution of privilege information.
The time savings and increased patient safety alone are worth making the initial step of installing Guardian.
Since great care was taken to ensure that Guardian requires no external software such as web servers or database servers, installation and maintenance is made extremely easy. Additionally, no special web browser is required to make use of the Intranet Agent pages since they use only very basic HTML and JAVA scripting, which all current browsers support. In a time when most online software applications require immense infrastructure and support, Guardian requires only the very simplest of networks and web browsers.
Since it will work in any 32-bit version of Windows, and since the Intranet Agent pages are accessible from any HTML browser, there is no need to upgrade existing systems in most cases.
Additional Notes
After the Guam beta test was completed, Guardian was installed in one of the U.S. Navy’s largest medical facilities, Naval Hospital Bethesda. Their usage of Guardian has further underscored the immense timesaving and improved access that this system can provide by managing many hundreds of providers and their privileges. A separate case study will be available detailing Bethesda’s experiences with Guardian.
Update – 01/02/2002: Naval Hospital Guam has reported a very successful JCAHO inspection thanks in part to their usage of Guardian. The following is an exact excerpt of a letter from their credentials department to dBx Software:
We had our JCAHO and our facility received a 97%. The surveyor was really impressed with the Guardian program. Each area he visited, he asked the question "How do you know a provider is privileged to perform a certain procedure?" Each time the person on duty went to Guardian to pull up the provider in question.
Our specialists at dBx Software as well as our customers have known that using Guardian improved patient safety, but the fact that this critical check by a JCAHO inspector was so easily met also shows that using Guardian may improve your hospital’s overall JCAHO score.
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* Please Note: The information provided about any JCAHO inspections is not intended to imply that JCAHO endorses dBx Software or any of their products. JCAHO is an independent organization that does not endorse any particular product or company. Our conclusion that Guardian may have played a role in the excellent score received by this facility is based on the opinion of the customer providing the information and the circumstantial evidence surrounding the inspection.