Why is it so difficult to promote a good device like LV?
1. We work in an hour-by-hour medical environment, but work for a company that is a next-day business.
Whether Zoll acknowledges it or not, the LifeVest business is in an hourly business. The 2x2 system is outdated, and the consequences of this approach are substantial and costly. Below are just a few examples of patient scenarios that require immediate service:
- MI patients: More and more hospitals are requiring 48-hour discharges for patients undergoing PCI. Because MI patients undergo an intervention, a repeat echo is required before discharge to determine if the procedure improved their EF. Only then can a determination of their risk for SCA be made, and thus, a LifeVest be ordered. Even if the TM gets the hospital to order before the SCA determination is conclusive, the notes will state that another echo is planned and Zoll will require that echo in order to dispense. That means Zoll’s 2x2 clock BEGINS when this patient type is being discharged, thus causing significant discharge delays.
- Non-ischemics who are receiving a first-time diagnosis in the office: TMs are called during the patient’s visit so they can get protected right away. However, they must wait most of the day at the office for the order to be approved or be returned home unprotected.
- ICD patients who need their ICDs to be turned off in the office: This determination is made over the phone during a pacer check and an office visit is scheduled for several hours later. We are contacted to fit them at that visit. Since we can’t, the patient sits for hours until we arrive, or are returned home unprotected. The number of providers who watch a patient sit in the lobby all day or return home unprotected is numerous.
- Last minute discharges: While upper management at Zoll may hold the TM accountable for not properly “training” physicians, the truth is, physicians need the flexibility to discharge patients early when the opportunity arises. Further, rounding/discharging physicians change daily. So, if a Monday doctor isn’t a LifeVest supporter, and a Tuesday discharging doctor is and decides to order .. that physician cannot be accommodated quickly. As it stands now, deciding to add a LifeVest the morning of discharge, adds 4-6 hours to the patient’s stay AT BEST. I have literally heard physicians say that because they thought of the LifeVest at the last minute, they chose not to order because “it would take too long.”
Beyond the above scenarios, our own metrics support the need for faster service. The majority of patients nationwide are fit on the same day the order is submitted. You might think this means we are already meeting our market’s expectations. However, behind these numbers lay several grim realities:
- There is a constant tug of war between the field and internal departments. Since the field is under pressure to achieve faster turnaround times, the field is regularly calling, emailing, and otherwise pushing their orders through their ACs, Intake, and their RMs. This pits departments against each other and creates friction. A recent example of this dynamic can be found in Intake, where they have begun refusing to take any phone calls from TMs whatsoever. Clearly, Intake found the calls from TMs burdensome. Yet, their response has further created resentment in the field, has created even longer delays, and now requires RMs to stop their day also to get involved. Given scaled back scheduling on weekends, it is now a regular occurrence to spend hours every weekend trying to overcome dispensing problems. But since Intake will no longer allow TMs to speak with them, it is taking over 24 hours to have simple mistakes fixed,
and many patients are staying a whole additional night OR TWO. Why are we forced to interrupt church, holidays, meals, etc. (and that of our RM) to fix a problem that is (a) not of our making, and (b) easily fixed with a single phone call … all because people who are actually scheduled to work are intentionally refusing to take phone calls from those that should be off? This is insulting to TMs and RMs, let alone a time-soaker for all involved. Worse, it further boggs down a system that is already too slow.
- TMs lose 10-15 hours per week “fighting the system.” At least twice a week, I had to literally stop my entire day to babysit a single order going through the system because I’ve received so many calls from doctors/nurses/discharge planners conveying how upset the patient is about the wait, and how many problems it is causing on their end. This time drain is enormous, and doesn’t even include the time lost on calls between RMs, Intake, and ACs. In additional to the time drain, the distraction that this non-value adding work creates to multiple departments is staggering.
- Stress, anxiety, and resentment are constantly brewing. TMs field endless calls from customers and are left holding the bag on a daily basis – and unfortunately because of scaled back scheduling, this often occurs during times we should be off, like weekends and holidays. In many cases, we are called into Administrators’ offices to explain the delays we are causing. We must make excuses for processes that we don’t agree with and were not permitted to be involved in creating. TMs that try to get patients fit at the timeframe needed by the patient/doctor are often referred to as “abusing the system.” This feedback is communicated from RMs, ACs, Intake, ADs, and is a persistent message. This is discouraging to TMs who are just trying to meet the needs of the current medical landscape in order to meet their sales objectives. It is demoralizing to pour this much energy into “fighting the system,” only to be unsuccessful, still have customers upset with you, and be judged negatively by your own company for trying.
- We cannot meet our customers’ needs. Just because Zoll considers a given fit “same-day” and “under 2x2,” does not mean a patient’s discharge was not delayed. When that happens, it affects the patient’s nurse, social worker, care coordinator, charge nurse, and clinical manager of the floor. Further, discharge delays are counted by the hour and reported to administrators. They are called “unnecessary hours/days” and are a key metric in hospital administration. This affects policy and protocol decisions for all products. Zoll’s 2x2 metrics misses ALL of this – success from Zoll’s 2x2 measure is an abject failure by the hospital’s measure and is a key barrier to continued growth and to establishing hospital protocols.
- Our sales message makes no sense. Does 2x2 and all the above consequences sound like customer-centric selling? Our inability to fit patients quickly - or even the same day - undermines our “belief to create” that SCA is an urgent situation requiring immediate protection. We can’t even deliver on our own message.
2. We are forced to make customers meet Zoll’s needs instead of being able to meet theirs.
In response to the above issues, we’ve been told to “teach” our doctors and hospitals how to work with Zoll so that (a) they don’t expect same-day service, and (b) so they submit orders correctly the first time.
This is backwards. We should not be trying to get the market to meet our needs – we should be trying
to meet theirs. Our backward approach is only employed by businesses with a monopoly on their product. Can you imagine the ICD companies employing this approach? Or pharmaceuticals? The name of their games is to make it EASIER on the physician to use their product than not to, thus lowering the barriers to entry. It is what TMs do every day, only we must arm wrestle with a system that is not set up to do business in that manner and be judged negatively for it.
3. Zoll’s technology dictates our strategy instead the other way around.
Our business processes are dictated by our technology and the lack thereof. This is the definition of the tail wagging the dog. The amount of time that is lost accommodating outdated technology is substantial.
