As a writer at Voalte, I have the opportunity to work with our marketing team, software engineers, salespeople and support specialists (or BFFs, as we fondly refer to them). It’s especially a pleasure to spend time with our on-staff nurses, who bring a unique perspective to the products we build and the services we offer. For National Nurses Week, I sat down with Melissa Ross, Clinical Nurse Lead, and Kate Cotroneo, BFF, and asked them about their experiences as hospital nurses.

Melissa Ross: I work with patients who are recovering from open heart surgery. The most gratifying part of my job as a nurse is watching how quickly patients progress. When they start out in the ICU, they can’t get out of bed and are in so much pain. Only a week later, they are walking laps around the unit, getting ready to go home and have a whole new attitude toward life.

Kate Cotroneo: I’ll never forget one of the first patients I worked with in the ICU. He was about 60 years old and had a heart attack. He was restricted from eating or drinking anything, so when I finally was able to give him a drink of water, he said to me, “Honey, that was the nectar of the gods!” It was so nice to be able to take care of him and watch him recover, and he was so grateful.

Melissa: Some of my favorite patients are the ones who are hospitalized long enough that I form a real relationship with them. I hear about their life, listen to their stories and get to know who they were before they got sick. We have patients who come back and visit the nurses on my unit. 

Kate: When I’m caring for someone who is hooked up to machines and with tubes all over the place, it’s important to remember that they are still a person. Even if they are not conscious, I talk to them and tell them what I’m doing. And the patient isn’t the only one who needs to be taken care of. Their families are sometimes even more sensitive than the sick or injured person.

Melissa: The hardest part is dealing with patients dying. I feel so down and depressed every time. I’m there as a nurse to help people heal, and even if they are older and sick, it’s still hard. Having a spiritual background helps me deal with the situation.

Kate: As unfortunate as it is, it’s the circle of life. Whether a patient is 25 or 85, as nurses it’s our responsibility to do whatever we can to take care of them. I was working once with a nurse tech who had been on the job for nearly 30 years. She told me, “We’re just doing God’s work until he takes them home.” 

As we wrap up National Nurses Week, we salute all nurses everywhere. We are especially grateful to our own staff nurses, who split their time between caring for patients and helping Voalte create healthcare technologies that make the difficult job of nursing a little bit easier. 

_{Photo from left to right: Melissa Ross, Clinical Nurse Lead, and Kate Cotroneo, BFF}

If you or a family member has ever been admitted to a hospital, you know how important nurses are. They take care of us when we’re most vulnerable, and comfort us with a smile when we’re in an unfamiliar place and facing an uncertain future.

Nurses are the heart of the hospital. They are also at the heart of everything we do here at Voalte. 

When Trey Lauderdale came up with the initial concept for Voalte five years ago, his goal was to make it easier for nurses to communicate with each other. Nurses at our local hospital, Sarasota Memorial Health Care System, were first to use Voalte One smartphones back in 2009. The feedback they provided then and continue to provide today has helped us shape Voalte One into a rich, dynamic solution that’s now used by leading hospitals throughout the country. 

Every year, we pay tribute to our local nurses with a celebration during National Nurses Week. Last Tuesday, we joined our friends at Sarasota Memorial for a Voalte-sponsored game show, where we handed out gift cards from local restaurants and spas, and awarded cash prizes and Voalte goodies to some lucky winners. For us, the prize is always seeing smiles on the nurses’ faces. And those smiles aren’t only reserved for Nurses Week. It may be due to our bright pink pants, but happy nurses are always first to greet us when we visit Voalte hospitals.

While Voalte solutions and our vision have grown beyond bedside communication to include other functions vital to a smooth clinical workflow, nurses know they always come first for us. Whether we’re on-site at Children’s of Alabama, Cedars-Sinai in Los Angeles or here at home at Sarasota Memorial, nurses thank us for making their jobs easier. Considering that nurses have one of the most difficult jobs in the world, we consider it the least we can do. 

Last week, we released the results of our first Special Report: “Top 10 Clinical Communication Trends.” More than 1,000 nurses responded to a national survey sponsored by Voalte and American Nurse Today, the Official Journal of the American Nurses Association. Our goal was to identify the communication pain points that make it difficult for nurses to do their jobs efficiently. Some of the results were shocking; others were reassuring. Be sure to check it out to see what nurses are saying about the struggles they face every day.

At some point, we all may find ourselves being admitted to the hospital. When that time comes, let’s hope the nurse assigned to our care has the tools he or she needs to do their jobs efficiently … and with a smile.

_{Shown above: Voalte Account Manager Nate Levine (center) with Sarasota Memorial Health Care nurses: Kathleen McDonald, RN, Maria Murray, PCT, Sara Campbell, RN, and Karen Van Der Weert, RN.}

Years ago, a wise COO told me, “I can’t help you if I don’t know what you need.” When dealing with a problem or issue, the first step is to understand the nature of the challenge. The same holds true of nursing practice issues or barriers. Speculation or assumptions about the communication, resources and support needs of nurses at the bedside may lead to wasted time, misunderstanding, and even mistrust and loss of engagement.    

In an effort to fully understand the end users of our products, Voalte partnered with American Nurse Today, the Official Journal of the American Nurses Association, to conduct a national survey of nursing leaders and staff nurses. The purpose of the survey was to solicit their perceptions of the work environment related to time available for care coordination and patient needs, devices available for communication, and support for the effective use of technology.  

Now is the time to fully understand the nursing care micro-system and the dynamics of daily communication between stakeholders. Changes in our healthcare arena are challenging hospitals to change their care delivery systems and reevaluate both their basis and paradigm for decisions. The operational strategies that have worked for decades will not necessarily work in this reformed healthcare environment. All previous assumptions must be tested, and rejected if they no longer apply. 

More than 1,000 people responded to our survey. With the assistance of Dr. James Lani and Jeanine Glase, the amazing biostatisticians at Statistic Solutions, we compiled the main findings into a Special Report: “Top 10 Clinical Communication Trends.” For those interested in nursing workflow and communication, this report is a must-read for insight into the clinical communication landscape in the nation’s hospitals. Once you understand the challenges, you can start coming up with solutions.

As we grow, Voalte faces a common challenge: how to expand an already impressive engineering team quickly, without sacrificing quality.  

We’ve attracted some of the most talented software engineers in the industry by opening our search to people from all over the world … and letting them stay right where they are. As a result, we have engineers in Florida, New York and Seattle, as well as Uruguay, Vietnam, Romania and Spain.
 
When I joined Voalte as V.P. of Engineering, I realized that our choices of less common programming languages and new, in-demand technology like iOS meant the number of people who can do that work is relatively small. I also knew that while we might be able to attract a full staff with the correct skill set in New York City or Silicon Valley, that wasn’t going to be possible here in Sarasota, Florida. By finding the most talented, highly educated people who are passionate about this technology and letting them work from home, the entire world suddenly opened up to us.  

Telecommuting is a hot topic recently, thanks to Yahoo CEO Marissa Mayer announcing an end to the company’s work-at-home policy. Here’s how we make it work at Voalte.  

First, I work remotely most of the time, because my family and I live in Orlando, and the Voalte office is a 2-hour drive away in Sarasota. In my experience, attaching a few remote workers to a mostly on-site team is a recipe for failure. Instead, all members of our team communicate the same way, whether one desk away at our home office or 3,000 miles away in Barcelona. With me working as a remote executive, we all have to walk the walk, at every level of the group.  

Also, collaboration tools have improved greatly in the past few years. With our engineers spread across the globe, remote tools such as Google Hangouts and HipChat have become our default methods of communication. We can get 15 people into a real-time video chat, with great picture quality and the ability for people to come in and out of the discussion at their leisure. Our engineers meet in daily morning Hangouts, and every Friday afternoon we host an engineering forum, where someone presents a topic or proposes an item for discussion. All day, every day, we use HipChat as a critical command center for most conversations.  

Finally, we bring everyone together face-to-face on occasion to extend the relationships that make it easier to work together remotely. Twice a year, all of our engineers from around the world gather at an engineering summit in Sarasota.  

It takes a certain attitude and personality type to work from home. Fortunately, computer programmers tend to be well-suited to telecommuting since they are comfortable communicating online. For Voalte, the payoff is in attracting world-class engineering talent that translates into world-class products.

I am thrilled to have joined Voalte as VP of Product and Alliance Management. As the leader of the Product Management team, my primary role is to make sure we build the right product, to be available at the right time, and designed in the right way to deliver a cost-effective, compelling communication solution for caregivers and support staff. Just as mathematicians can’t live without a calculator, we want clinicians to feel the Voalte empowered smartphone is the best tool to help them deliver a high level of patient safety and quality of care. Of course, no one piece of equipment is a silver bullet that solves every problem, but ultimately we want to deliver an increasingly valuable and powerful tool that is reliable, efficient and – most importantly – effective. 

At Voalte, we understand that to be successful at meeting that lofty objective, the product and alliance/partner teams must go out and talk with nurses and physicians inside and outside the hospital. The participation and guidance of actual users is the foundation of everything we do at Voalte. Based on our users’ proactive input and constant feedback, Voalte has built a solid reputation for designing apps with the functionality and usability that has resulted in a quantum leap in solving the communication challenges of today’s healthcare personnel.

We’re also dedicated to building compelling alliances with companies that make related best-in-class healthcare products that are ideally suited to co-reside on the smartphone with Voalte apps. In certain cases, it makes sense for such products to be tightly integrated with Voalte applications, and in other cases to be more loosely coupled, as in basic interoperability. While the majority of such partnerships will be in software applications, we are actively building alliances with hardware vendors to deliver even more effective uses for our compatible and complementary products. 

Done right, the integration of barcode medication administration (BCMA) and radio frequency identification (RFID), integrated with the smartphone hardware and our leading voice, alarms and text messaging capabilities, will demonstrate our commitment to delivering what nurses and doctors need to provide safe, efficient and effective patient care. Naturally, Voalte is fully engaged with the leading EMR vendors to create clinically compelling applications built on the Voalte communication platform … and is open to many more alliances and uses.

Communication is well recognized as a huge challenge for hospitals. The dynamic environment requires the exchange of a plethora of communication types, such as voice, alarms and text, but also is evolving rapidly to include images, video streaming and voice dictation. Add to this the requirement for managing all communication based on work schedules, real-time availability and roles, responsibilities and certification/licensing levels, and before you know it you’re talking about a truly complex communication challenge.  

In my new role at Voalte, I’m looking forward to helping caregivers do what they do best – saving lives and creating positive patient outcomes. At Voalte, we believe that arming hospital staff and caregivers with a single, versatile communication tool is one of the most significant ways to make a positive difference in healthcare for the 21st century.

Do you know anyone who doesn’t use a smartphone? Nearly half of all adults in the United States now own at least one “smart” mobile device, and it won’t be long before those without are in the minority.  

So what does that mean for the way we work, and in particular how clinicians work in a healthcare setting? Many doctors and nurses use smartphones in their personal lives, but few have the same technology available to support their work. In fact, they often still use landlines, pagers and PDAs – technology that was obsolete long ago in most workplaces – to communicate with their colleagues.  

Get ready for a change. The consumerization of healthcare IT is coming, and it’s about to revolutionize not only the way clinicians communicate but also how they care for patients. As mHealth delivers comprehensive, integrated healthcare solutions, traditional boundaries will inevitably break down. The result: onsite, offsite, any time, anywhere communication, collaboration and access to information.  

Clinicians who are accustomed to having maps, weather, news and the latest viral video at their fingertips in their personal lives want the same timely and reliable access to information when treating patients. That includes medical reference apps such as Epocrates as well as access to patients’ electronic medical records (EMR).  

Healthcare organizations that embrace these inevitable changes are moving in the smart direction, improving quality and efficiency, reducing costs and meeting governmental requirements for meaningful use of EMR. More important is the ability to focus on their primary mission of caring for patients. Other benefits will likely include higher job satisfaction and lower turnover among their staff.  

I’m not saying it’s going to be easy. Robust privacy and security features are integral to the successful transition of smartphones into the clinical workplace. And the challenge of working within a hospital’s existing wireless network is not for the faint of heart.  

Fortunately, Voalte has spent the past four years working through these issues at some of the nation’s top hospitals. As we start Q2 of 2013, I’m pleased to announce we experienced record-breaking growth of 280 percent over Q1 last year, with 18 new hospitals signed on to implement Voalte solutions.  

The foundation of our exponential growth is our stellar executive team, made up of the most talented professionals in their respective fields. In my new role as president of Voalte, I’m looking forward to working with this team and our entire staff as we continue to lead hospitals in the smart direction. 

Last week I spent a few days in San Francisco, not simply to enjoy the city and its fantastic restaurants, but to attend a three-day Net Promoter Certification course.

Net Promoter, developed by Satmetrix, Bain & Company and Fred Reichheld, is considered the worldwide standard for companies to measure and improve their customer experience. In January, I attended the Net Promoter Conference in Miami, and was impressed with the management philosophy of using customer feedback to fuel profitable business growth.

As Chief Experience Officer at Voalte, I’m committed to customer loyalty as one of our core company values. While our technology is impressive, nothing is more important than the customer experience we provide. That’s pretty unique in the healthcare IT industry, which hasn’t historically been known for focusing on customer experience or asking for customer feedback.

By contrast, Net Promoter is built around one key customer question: “How likely are you to refer a friend or colleague?” Many well-respected companies, such as Zappos, Salesforce and Apple, rely on Net Promoter’s 0-to-10 scale to classify customers as “promoters,” “passives” or “detractors.” To grow profitably, according to the Net Promoter methodology, you need to turn customers into promoters.

At Voalte, customer feedback is built into our product. Voalte One includes a prominent Feedback field that lets end users contact us directly from their Voalte phones. Our support agents (called BFFs) are always standing by to answer questions and solve problems so nurses can carry on with the important business of caring for patients. We also have Voalte Care Specialists on site at each hospital to allow the staff to ask questions and get problems solved quickly.

The feedback we receive from our customers is more than just a point of interest or a set of numbers we track. It plays an important role in guiding our future development. That means the entire company has to embrace being customer-centric; one department alone can’t make the difference.

As a young company, Voalte has big plans for the future. As I’m learning from Net Promoter, we can’t focus only on getting bigger, we also have to get better. Knowing what our customers are asking for, earning their loyalty and turning them into promoters are all key to our success.

Are today’s hospitals creating an environment that encourages healing and recovery?

A 2012 study from the University of Chicago found average noise levels in hospital rooms easily exceeded the recommended 30 decibels, and peak noise levels sometimes approached the decibel level of a chain saw.¹

That sure doesn’t sound therapeutic to me!

At Voalte, we believe reducing hospital noise can improve the patient experience and positively impact HCAHPS scores. Now, there’s evidence that lowering noise also affects patient outcomes. 

In another study last year, Orfeu M. Buxton, Ph.D., of Harvard Medical School found a correlation between patient health and noise levels, stating that lowering the noise level in hospitals “would decrease patient stays and improve healing, and perhaps even reduce readmission rates.”²

He also found that some noises are more disruptive than others. In particular, patient heart rates jumped consistently due to the sound of electronic alarms and ringing telephones.

This anxiety makes perfect sense to me. Imagine being a patient in an unfamiliar setting, away from home, and facing the unknown regarding your health. You might wonder:

- Why are all these alarms going off? Did someone die? Are they for me?
- Why does the nurse keep leaving my room to talk on the phone? Is she talking to my doctor? Why don’t they want me to hear?
- Why is this machine attached to me beeping? What does it mean? Am I taking a turn for the worse? 

Too often, caregivers and the communication tools they use only add to the cacophony … and the anxiety. Many nurses are given phones as their main tool to communicate with other caregivers, departments and doctors. Yet HIPAA requires they don’t discuss clinical matters in front of a patient, so every phone call causes an interruption as the nurse leaves the patient’s bedside to answer the call. If the nurse is too busy to answer, other noisy strategies such as overhead paging attempt to locate them.

Fortunately, there is a solution. Secure text messaging via smartphone can eliminate up to 70 percent of ringing telephones and nearly all overhead paging. Alarm management tools can integrate disjointed devices and assign levels so all alarms are not treated equally.

As scientific evidence supports the importance of lowering the noise level in hospitals, old attitudes are changing gradually. Maybe what will truly push the urgency of this issue will be the new policies linking hospital reimbursement to patient satisfaction.

<sub>1. Jordan C. Yoder, BSE; Paul G. Staisiunas, BA; David O. Meltzer, MD, PhD; Kristen L. Knutson, PhD; Vineet M. Arora, MD, MAPP, Arch Intern Med. 2012;172(1):68-70. doi:10.1001/archinternmed.2011.603.

2. Orfeu M. Buxton, Ph.D., assistant professor, Harvard Medical School, and associate neuroscientist, division of sleep medicine, department of medicine, Brigham and Women's Hospital, Boston; Gulshan Sharma, M.D., M.P.H., director, Medical Intensive Care Unit, University of Texas Medical Branch at Galveston; June 12, 2012, Annals of Internal Medicine.</sub>

How long does it take your nurses to respond when a patient pushes the nurse call light? Two minutes? Four minutes? Longer?

If you don’t know the answer, you should, because it influences everything from health outcomes to patient satisfaction to financial results.

Patients use the nurse call light for various reasons, but as you can see in this bar chart from the American Journal of Nursing (AJN), the top three calls are for bathroom assistance, IV problems or alarms, and accidental calls that often involve pushing the call button while turning over in bed or trying to turn the TV channel. While none of these involve life-threatening scenarios, your nurses’ response to them has a major impact.

Consider a call for bathroom assistance. If a nurse doesn’t get to the patient’s room within a couple of minutes, will the patient wait or try to get up from bed on their own? If they get out of bed, in an unfamiliar place and perhaps while taking pain medication, the danger of a fall is significant.  

At one hospital, I heard about a patient breaking her hip in a fall while trying to get to the bathroom. In addition to the suffering of the patient and her negative impression of the care she received, the hospital took a financial loss from the cost of the patient’s resulting surgery and the increased length of her stay.



The AJN study found that each patient averages 4.59 nurse calls per day. It’s simple arithmetic to multiply your number of patients by the number of calls per day to arrive at the potential for such negative consequences.

So what are you doing to make sure your nurses respond to calls in a timely manner? In a typical scenario, when a patient pushes the nurse call light, an alert goes to the unit coordinator, who responds by asking the patient what they need, then tracks down that patient’s nurse to relay the information. Depending on the communication system, that could mean using an overhead paging system, making a phone call that may or may not be answered, or using a one-way communication device. The nurse then needs to respond to the unit coordinator to find out which patient is calling and what their needs are. If the nurse is busy, the unit coordinator needs to locate another nurse or nurse technician using the same process.

With Voalte One, when a patient pushes the nurse call light, an alert goes directly to the nurse, who can proceed to the patient’s room or send a text to a technician asking him or her to go to the room to assist the patient. 

When a nurse responds to a call promptly, the patient not only receives the best possible care but also feels well cared-for.  When delays can have such a high price, a couple minutes makes a difference.


_{Source: Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety, AJN, September 2006, Vol. 106, No. 9. By Christine M. Meade, Ph.D., Amy L. Bursell, Ph.D., Lyn Ketelsen, MBA, R.N.}

It seems like almost every day a new vendor announces a HIPAA-compliant text application. Here at Voalte, we consider it our business to know who’s entering the market, and we’re impressed by the steady stream of new vendors. But does the development of an effective clinical communication solution require more than writing an app, labeling it “HIPAA-compliant” and posting it to the App Store?

The short answer is yes. To be a complete clinical solution provider, you need to offer more than text, and you need to venture outside of the App Store and the Google Apps Marketplace. To offer a complete solution, you need the staff, expertise and technology to support on-site integrations with key hospital systems like PBXs, Wi-Fi networks and alarm systems. And after you’ve integrated the systems, you’ll need to be on-site to add real value by consulting on new workflows, training users and supporting the staff when the solution goes live. Finally, you have to keep those hundreds of smartphones you just deployed running smoothly with a continued on-site presence.  

For many industry newcomers, these requirements are expensive, messy and don’t fit into a Facebook-style business model.

In the quest to implement “voice, alarms and text” in hospitals large and small, Voalte has managed successful integrations to:

- Middleware products from four vendors
- PBXs from six manufacturers
- Nurse call systems from four manufacturers
- Wi-Fi networks from three vendors

The result is in an easy-to-use communication solution that reduces noise, improves clinician satisfaction, and allows healthcare providers to focus on what originally led them to their calling.

Things will get even more exciting with our next app, which lets people run Voalte on their personal devices and connect to other Voalte users anywhere, any time. But more on that in my next blog.