Another Kind of Circulatory System

In the depths of the hospital, through doors that often go unnoticed by most employees, is a transportation system that plays a huge role in modern health care. The passengers are not people, although some are samples of people – blood samples, that is, secured in a “carrier” and on their way to the hospital lab. The carriers – cylindrical cartridges with a secure latch on each end — race all over the hospital through pneumatic tubes hidden deep behind the walls. Unit nurses can send samples to the lab for testing, or receive blood products and medications to administer to their patients.

Pneumatic tube systems have been used in communications, banking, health care and industry since the mid-1800s to move small things from one place to another much faster than a human could travel — even faster than a car. Digital communication has taken over the conveyance of messages, but when it comes to transporting an actual object across a hospital campus, the pneumatic tube still reigns supreme.

The pneumatic tube system at University of Maryland Medical Center (UMMC) is one of the most complex in existence, according to Pevco, the company that designed and installed it some 20 years ago at UMMC’s University Campus, and has updated and expanded it through the years  The last big upgrade was 2011, when UMMC added two additional miles of pipe, interchange rooms, 25 new pieces of equipment and 10 additional zones.

Before this system was installed, the hospital staff included couriers hired specifically to “run” blood products, lab samples, and pharmaceuticals. They were fast, but no match for the tube system once it was installed. It takes 15 minutes to walk from the two furthest points in the hospital, but only five minutes for a carrier in the tube system.

A pneumatic delivery system transports containers through tube networks using air pressure. The nerve center of the system is a computer that takes up so little space it only requires a small closet. When a nurse or lab technician enters a destination into one of the 99 stations throughout the hospital, the computer selects the quickest available route, waits until the route is clear, then uses vacuum to pull the carrier out of the station into the pipes.

The “whoosh” sound a carrier makes heading down a clear passageway is music to the ear of Richie Stever, CHFM, LEED AP, director of operations and maintenance at UMMC.

“The system is designed like a roadway system,” Stever said. “When the pipe  — think of it as a highway —  is clear, the carrier is lifted from the station with a motor that creates suction, and then it travels through the pipe until it reaches a diverter – like a highway interchange — switches roads, and then is moved with pressure via a motor until it reaches its final destination.”

There are 5.5 miles of pipe throughout the complex, with the average time for deliveries being less than five minutes. To create that kind of power, the tube system is backed by 22 blower motors that push and pull air through the pipes.  There are 22 zones the items can travel through, and 103 diverters. Diverters are used to make bridges from station to station. The diverter is placed at an intersecting point and changes the carrier’s path to a different tube. There are three interchange rooms in the system where the diverters are used to change the direction of the carriers.

The carriers are numbered cylindrical cartridges equipped with two latches on each end as well as foam padding to protect the contents during their trip – sometimes miles at a time.  There are 99 carrier stations throughout the hospital building, with seven in the Central Pharmacy, eight in the North Core Laboratory, seven in the South Core Laboratory, three in the Blood Bank and one at each nurses’ station.

When a carrier comes through to the station, a tone will sound to let those nearby know that a specimen or blood product has just come in. Those 99 stations generate more than 5,000 transactions per day at a speed of around 500 feet per second.

As with any complex machine, things can go wrong, but built-in features kick in to fix them. If a blower is off-line because of mechanical or electrical failure, another blower within the system can do the job. If a cartridge opens up en route and spills the contents, technicians use measurements to figure out where the spill or clog is  before deploying a special “squeegee” — more like a large sponge — that is as big as the inside of the tubes. The squeegee is sent through the tubes multiple times to clean up the spill.

“Twenty years ago, when we installed the first part of the tube system, we never imagined we would be able to send a thousand carriers in a day,” said Scott Kruelle, system operator for the tube system. “Now, we send more than 5,000 carriers a day.”

A Day in the Life of a Hospital Chief Operating Officer

By Herb Buchanan
Senior Vice President and Chief Operating Officer

It is one of the three times a year when we conduct our employee communications forums (ECFs) at University of Maryland Medical Center (UMMC), and these days are always full of preparation, volunteering, long hours, anticipation, rehearsal, execution, feedback, affirmation, surprise, and relief. It is a dreary, rainy morning outside, but inside the medical center is buzzing as the theme of UMMC “all-stars” reminds staff that it is spring, and time for updates and excitement. The medical center is always buzzing, but there is a different kind of buzz during forum time as employees anticipate hearing from our CEO and juggling forum schedules with their busy agendas.

The forums, though, were just one of many things on my plate on this day. Here’s a look at what is a typical day for me, from start to finish.

6 a.m.: Mornings always start at the gym. A hearty workout prepares me for anything. It makes for a long day but, at my age, I need to remain active and focused on my physical and mental health. Once I’ve had the opportunities to get endorphins flowing and chatter with my gym-rat friends, nothing can throw me off my game. Except …

7 a.m.: An interesting start to the morning. We are victims of our own success, in that our new medical center garage has been filled nearly to capacity. This means that during garage prime time (6:45-7:10 a.m.) it can be difficult to find a parking spot. Our day shift patient care staff (and some of our administrators) arrive during this time and jockey for spaces that are in high demand just prior to shift change. Now that the lot is full, we have to adjust processes to keep the flow going and avoid upsetting our late-arriving staff.

A prominent member of our senior team has informed us just how important and urgent this need is.

8:30 a.m.: Our parking manager, Jennifer Servary, and I walk over to the garage and discuss some of the recent volume increases and changes in our approach. I have the opportunity to meet new staff members, hear about how they are adjusting to the increased demand and prime-time urgency, and reaffirm all of the hard work and forethought that has been put into making sure our success does not become a hindrance. They assure me their first priority is improving the flow and, within 24 hours, steps have been put in place (or reinforced) to substantively improve the directing of traffic. (The same prominent member of our senior team sends a rewarding message describing the delightful improvement in his parking experience.)

8:50 a.m.: I check in with our food service crew to see how the transition (to in-house from contractor managed) is going. I can always get the real story from my friends in food services, who update me on rumors, employee concerns, how customers are treating them, and some of the challenges in their personal lives. These will be our new “meal attendants” and “culinary associates” who will make amazing things happen every day for our patients, visitors, staff, and medical staff. The transition is going well and, while there will always be suggestions, staff is warming to the new environment.

9 a.m.: We had the opportunity to dedicate our “Wall of Commitment.” This Wall includes a video display of medical center updates, our “C2X Pillars” (demonstrating the five important pillars of UMMC success), and cards filled out by UMMC employees articulating their commitment to providing excellent service to every patient and visitor. Funding for the Wall was provided by a generous donation from our Great Cookie vendor. Our C2X Communications Team leader, Mike Wertz, our CEO, Mr. Jeff Rivest, and I, had the opportunity to publicly thank the donor, the teams who put in the work, and the staff that make it happen every day. The Wall is located along our major traffic channel and captures the attention and admiration of staff and visitors alike.

10 a.m.: Our first employee communications forum kicks off. Our C2X teams spent countless hours preparing for a perfectly executed forum, and they do not disappoint. The agenda proceeds exactly as rehearsed, and after beginning with some “all-star” related fun and recognition of wonderful winter events, we move through some sensitive and complex items with ease. Staying on task with these agendas is a challenge because there is so much to cover in each forum, and messages need to be clear and comprehensible. The reaction from the audience indicates we are hitting the mark as we move through three major agenda items — CEO update; HCAHPS, a national, publicly reported survey of patients’ perspectives of hospital care (Chief Nursing Officer Dr. Lisa Rowen); and our new initiative to transform our customer service to what you’d expect to find in a top hotel (rock star Senior Director Johnie Carr) — on time, leaving plenty of time for a robust question and answer session.

Forum attendees pepper us with questions about our new customer service initiative and when they can expect changes. This is a unique opportunity for UMMC to impact a service that has been fraught with challenges for quite some time, and taking a new and revolutionary approach to the level of customer service we provide (“changing the game,” if you will) gives everyone new hope and optimism.

10:45 a.m.: The questions from our staff keep coming.

  • Two staff members express concerns about linen services provided to their patients, wanting to ensure quality linens are readily and consistently available.
  • Another staff member expresses a concern about patients waiting to be transported to and from diagnostic testing areas. (Fortunately, we have an initiative underway to better understand and correct this issue.)
  • Another staff member raises an issue about registration delays in the Emergency Department that can cause treatment to be delayed. (We also have ED and registration improvement initiatives underway.)
  • Others ask questions about renovating or sprucing up facilities to provide a more welcoming experience; expectations of health care reform; infection control issues; pneumatic tube transport time; and hours of operation and food quality in our cafeteria.

Our Q&A time can be the most rewarding, enlightening, insightful, and challenging part of our forums. We never know what kinds of questions will be asked, and it seems we are surprised every session. At this point in the game few questions catch us off guard, but there are a few here and there. Sometimes employees arrive “loaded for bear” on a particular issue of interest, and we have to do our best to keep our answers relevant to the broader audience, appropriate, helpful, and devoid of any defensive posture. We want to hear from our employees, and opening that door allows for feedback and inquiry of all kinds. Transparent organizations need to approach sessions this way if they want to maintain credibility with the staff at large.

Noon: It’s time to Go Green! UMMC honors Earth Day with a major celebration that includes informative displays along the main hospital thoroughfare. Mr. Jeff Rivest and I visit all of the booths and learn about a broad array of initiatives, spanning from reprocessing to recycling to environmentally conscience eating. The last topic we occasionally try to skip, because our expert nutritional consultant, Mindy Athas, delights in pointing out habits we need to change that will most certainly rob us of the majority of our culinary enjoyment. She tells us what and where to eat, and we both restrain our taste buds from going on the attack. There is good health and enjoyment in eating green; one just has to be willing to adapt.

1:30 p.m.: The largest forums of the week happen at this time. We get our first true sense of how our day staff will respond to the messages as we present to a standing-room-only crowd. Sometimes the agenda can expand as we adjust to a larger audience, so we are cautious about watching our time to avoid running over into the Q&A session. We move into our Q&A on schedule and the audience is responsive.

  • A unit secretary makes a way-finding recommendation to assist visitors, who are often confused by directions and our complex facility layout.
  • More challenging questions were posed about space, infection control, child-care options, meal prices, proposed city bed “taxes,” and public reporting of clinical performance.
  • A staff member shares a proud accomplishment: she completed the Boston Marathon two weeks ago in personal best time. It only took her one marathon to qualify, and she is within a few minutes of qualifying for her second “Bucket List” goal: running the New York City Marathon. We have all stars of every kind.

3 p.m.: I look up from my computer and spot one of our senior security staff members, Officer Campbell, walking alongside a woman who resembles him so much she has to be his daughter. Officer Campbell, one of our most dedicated ambassadors, just might be the most proud father in the city of Baltimore. For months he has been telling me about his Master’s-prepared daughter joining our medical center team, and she has arrived. He kept me updated on her educational progress throughout her undergraduate and graduate years, and even invited me to her graduation. Every father should be as proud of his daughter as Officer Campbell is of his, and I suspect she will be as talented and dedicated an employee as he has been for years.

4 p.m.: Time for another forum. After a couple of days these all seem to run into each other and there are times when you think they will never end. Yet each forum is unique and engaging enough to attract our attention afresh. Each audience is different, with potentially distinct reactions and outlooks on the material. As have the previous sessions, this one kicks off with “all star” excitement of C2X hats and treats and music and videos, and by the time our CEO is ready the group is primed. The forum proceeds as scripted and we continue to receive positive feedback about our theme, message, and willingness to share. It is rewarding to be able to interact with staff on this level, and so critical to maintain the pulse of the front-line associates.

For part of the week I will wonder what we ever did before we scheduled forums … and by the end of the week I will be asking myself why we do so many of these.

5:40 p.m.: On my way back into the medical center I pass the same gentleman sitting on the wall in the park outside the medical center, in the exact same spot he’s been in since I saw him at 9:50 a.m. The only thing different is his posture … and his request this time for a little help to get home. He was polite and thorough enough to share exactly the amount he needed to get on his way and I, in turn, was clever enough to ensure he’d have the opportunity to meet at least one more sucker (er, generous person) before departing our lovely park. Warm weather and visitors tend to attract these metropolitan entrepreneurs, who have somehow managed to become part of the UMMC community.

6 p.m.: In addition to watching the evening forum I am struck by the seamless way our Vice President of Shock Trauma, Karen Doyle, goes from formal gown entertainment of senators, governors, mayors, donors, physicians, administrators, etc., at our Saturday evening Gala, to explaining patient satisfaction scores this evening to front-line staff in a manner so simple, clear, and instructive, that everyone got the message. We have a number of talented leaders at UMMC, and Karen made us proud this weekend by demonstrating her vast skill set.

One staff member wants to know when she can expect to see the results of the exciting new initiative that will revolutionize service delivery in the environmental services and food services areas. “How will we execute? What types of changes can we expect How will we improve staff performance? What new kinds of meals and meal services will be offered?”

I met the woman in the neighborhood who owns a great dane! She works for UMMC. She asked a question about the external appearance of the facility, with particular interest in dog owners policing their pets.

Another sobering moment occurred when a security officer informed me she was scheduled for another biopsy, dealing with the possible return of a serious illness she had managed through more than a year ago.

7:35 p.m.: Sharron, a patient care tech on the mother/baby unit, is rounding the corner with a smile and has good news to share. She had successfully endured her first daughter’s prom night and was making plans for the required posting of pictures on Facebook (FB, to the enlightened), and was preparing to close on her first house. I refer to Sharron as “the hardest working woman in show business.” She works more shifts that I can keep up with in order to support her family, and simultaneously furthers her education in pursuit of her RN. I am proud that she has been able to accomplish all of this as a single mother, and her commitment to her family and UMMC reminds me how fortunate we are to have such an excellent staff.

9 p.m.: The last forum of the day can be a “crap shoot.” Between the evening fatigue of staff that have virtually an entire shift ahead, and the cumulative affect of as many as six forums in the day, it is a challenge to find the chemistry and energy necessary to make these sessions a success. Somehow we always pull it off. Our leaders rise to the occasion and our audience responds in kind, so that our late forums are as rewarding and insightful as the busy midday sessions. Night-shift workers almost always provide insight unavailable from any other source. We are thrilled when they share and comment on our initiatives, and they do not disappoint.

10 p.m.: Staff files out of the forum with questions and comments that revealed this was one of our most informed audiences. A graduate student asked about a quality-of-care indicator on the public hospital Website, another made a timely comment on a topic covered in the annual competency exam, and a third suggested the medical center use social networking (like a blog?) to expand its brand and marketing reach.

10:30 p.m.: Chaplain Mel is completing a session in the Shock Trauma Center consolation room. A family is wrestling with the critical condition of a juvenile family member in what turned out to be a preventable event. Health care workers deal with all of the difficult situations, including responding to questions from parents that cannot be answered.

10:40 p.m.: Members of my faithful security team are often the last people I see on my way out of the building. They are reliable and friendly (for the most part); a welcome sight on arrival and exit. Their evening greeting is a sure sign another long day is ending for me … and that we are leaving the medical center in capable hands. Our Commitment to Excellence is 24/7, and these are the all stars that make the commitment a reality.