RE-ENGINEERING PBX SYSTEMS

The January 2,1995, issue of Modern Healthcare magazine had over 20 items related to affiliation, merger or purchase arrangements among hospitals and medical centers. This topic will be a primary agenda item for many health care organizations in the coming years and most hospitals will admit to at least having discussions on the agenda for 1995. For some, it may mean survival.

Those hospitals entering into one of the above arrangements each have their own telephone system and their own computer system. Often, it is desired to have a single voice system and a single computer system to meet the operational needs of the new entity. This can be difficult to accomplish. It is often practical to throw out the existing systems and start all over. Our firm has been involved in several projects where existing systems have been re-engineered to meet the new objectives. The old systems can often be re-engineered to look as though they are one new system.

This brochure will address re-engineering the telephone system, but other brochures address data or computer applications, as well as video.

OBJECTIVE

The new entity wants the combined telephone systems to function as one system, providing seamless coverage of all campus locations. If the attendant function is centralized, the attendants should be able to verbally identify any campus to a calling party while being able to dispatch a call to any telephone at any campus. Attendants should be able to continue performing those special functions such as voice page, alarm and fire monitoring, etc. A telephone at one location should be able to dial another telephone at any campus without inserting special access codes. Oh, yes, we should reduce operating cost at the same time.

CONCERNS

Physicians, nursing staff and others will have legitimate concerns. If requested, can the telephone identity (read this to mean telephone number) of each campus be maintained? How will codes, Stat notification and voice page be handled? Where will physicians pick up batteries for their radio page units? Who will monitor fire alarms? These and other concerns must be resolved prior to initiating the consolidation activities.

BENEFITS

Our experience on several projects indicates that successful re-engineering does provide substantial benefits to the new entity.

A seamless telephone system covering all campus locations is easy to use, promotes a sense of harmony that helps overcome cultural barriers and is usually less expensive to operate than multiple systems. Telecommunication policies and procedures can be redone to replace existing fragmented policies. Voice page procedures, radio page access and Code designations can be improved and standardized.

Combining two campus locations under a re-engineered system can actually reduce personnel operating costs substantially, assuming the attendant function is consolidated. However, a consolidation can occur without combining the attendant function. Managing and maintaining the re-engineered system is usually less expensive than managing two or more systems.

RE-ENGINEERING PROCESS

The first step is to establish a joint Task Force including decision-makers from Telecommunications, Information Systems, Administration, Engineering, Nursing, Security, Code Committee, a representative group of physicians and possibly others. The key is to have this working group define all problems, determine alternative solutions, make recommendations to Administration and determine budgets and time frames.

The seven activities of the process are as follows:

Telephone Equipment Changes - Each system must be reviewed to determine existing capabilities, as well as determining what equipment must be added to perform new functions. This could be as basic as adding T-1 Carrier cards or as sophisticated as adding Intelligent Attendant Consoles. Are the central processing units and memory capable of handling re-engineering or must they be upgraded?

Telephone Software Changes - Software must usually be added to facilitate a consolidation. Some examples are 4 Digit Dialing software, CAS or Centralized Attendant Service Software, management control software for generating reports, etc. Adding telephone equipment or software takes time and must be coordinated with a vendor or vendors.

Auxiliary Equipment Changes - Often overlooked, this component is critical, especially if the attendants are consolidated. This includes getting fire alarms and other signals transmitted to a central location, re-engineering gas alarms, physician's registry, voice page interface, radio page interfaces, etc. Consolidation cannot occur until these systems are redesigned.

Transmission Network - Each campus must be tied to every other campus via some type of transmission facility. Usually, T-1 Carrier is the protocol of choice, using fiber optic cable, leased or owned copper cable or microwave transmission. Distance, volume of traffic and cost will determine the medium used. It is probable that the same connecting media will handle voice, data and television. The network must be designed, installed and tested. This takes time.

Staffing - Staffing of all functions must be evaluated. This includes attendants and the repair function. Generally, consolidation means personnel downsizing. This should only occur when it will not have an adverse effect on service. Models exist which can be used as a starting point.

Managing - Managing telecommunications for a network of hospitals is more complex than managing the function for one hospital. The function of the Telecommunications Manager must be revised with a new job description written. This person must be a manager with good controls and reporting procedures in place. Accountability will be even more critical.

Policy and Procedure - Since this area is often weak or in need of upgrade in many institutions, a total rewrite is usually called for. This written document will cover every aspect of telecommunications and be approved by the COO or CEO. This will not only ensure efficiency, but will assist in crossing cultural lines to bring an early sameness to each campus in the area of telecommunications.

There are other areas to be addressed, but the above seven will start you where you want to go. Each step must be documented and proven. This is the only way to make believers out of the people involved in using telecommunications; employees, physicians, your clients, payors and the public.

SUMMARY

Correctly re-engineered, the revamped telephone system will help maintain campus identity, if required, tie all campus locations together in a coherent manner, provide a seamless system to all users, standardize policies and procedures and possibly reduce operating expense. Sounds like a pretty good choice.

Your affiliation or merger may or may not decide to centralize the attendant function at one location. This is a sensitive decision that must be balanced against other administrative decisions. While it is cost-effective to do so, it is something that may be done later in the process. Frankly, consolidating the function does make for a smoother operation.

The different campus locations do not have to have the same generation or the same manufacturer of PBX systems to tie the systems together. While having the same systems does make it easier to engineer a solution, any two systems, or more, can be tied together in a re-engineered fashion. Sometimes, depending on the systems, certain operator limitations can be expected if centralized console operation is used. This may or may not affect your decision to consolidate that function.

Please contact us if you have questions or wish to discuss a Re-Engineering project.