Robots in Hospitals (.com)

What is the purpose of this webpage?

To give insight to hospital functional leaders on how to effectively deploy various types of transportation robots within a health system. 

Those hospital functions being pharmacy, laboratory, food service, EVS, facilities, logistics, and shared services.

Basically, I want you to walk away from this webpage thinking: 

“I’m a 90% expert on hospital transport robots. I’m ready to talk to our system CEO about this tomorrow.” 

I define “effectively” as:

• Robots provided a financial ROI that the CFO blessed.
   

• Hospital management did not receive too much pushback from staff about robots (there will always be some pushback.)

• Robots are deployed in a department that can get comfortable with robots sooner than later - not necessarily in the department that may get the highest absolute dollar impact from robots. 

An additional purpose of this website is to help hospital functional leaders sell the need for robotics to health system executives. I’d like to help you to go beyond “knowing enough to be dangerous.” 

What is the other (selfish) purpose of this website?

I have Teams/Zoom meetings with hospital leaders every week about how we can work together to deploy hospital transport robots. 

Much of the information we cover in introductory calls is written on this webpage. 

I think this webpage would serve as a good pre-read before our meetings 😎.

This site will cover the below topics:

• Basics about hospital transport robotics. 

• How to pick the right first hospital within a health system.

• Departments that can use robotics and specific tasks. 

• Elements of an ROI.

• Developing a CFO-friendly business case. 

• ELEVATOR INTEGRATION (this is all caps for a reason). 

• How to engage the other departments that need to be involved.

• Making sure implementation is reasonably successful. 

• Responding to “I don’t know if that will work here. We’re different.” 

You could skip ahead to these sections by using the Table of Contents on the top left, but I don't recommend it. 

Disclaimer

This website is not static. I will update it as I spend time on the ground with more and more systems.

If you ever want to add color to anything I wrote, or disagree with anything, just let me know. My contact information is at the very bottom. 

You might be thinking…“I’ve seen robots in hospitals before.”

Yes, you probably have. Hospitals have been deploying non-clinical transport robots for about 20 years. Not a lot of hospitals. Very few. But they have been. 

These robots have moved pharmacy items, large trash carts, and linen carts. 

They have also been clunky and slow. And get stuck often.

The Basics

Hospital transport robots are sometimes referred to as AMRs: Autonomous Mobile Robots. If you hear someone say AMR, you know they’re serious about robotics. If you hear someone say “rover,” you know they're willing to learn more! 😁

At the most basic level, a transport robot in a hospital does one thing: 

move items from Point A to Point B and then later on, back to Point A. 

That’s it. 

So why is this impactful?

Time in motion.

If you were to conduct a “time motion^” study for pharmacy technicians, and front-line EVS, food service, and some facilities personnel, you would find that over 50% of any given shift is spent walking.

A single department likely has its personnel walking over 1,000 miles per month. 

That’s great for an individual’s ability to hit 10,000 steps per day, but perhaps not the best for the department’s productivity and P&L. 

This means a healthy chunk of payroll budget is being spent on walking.

And walking is a task that can be cheaper and faster by rovers robots.

Why do health systems consider robots?

There are a few reasons: 

• Cost savings via reducing FTEs, reallocating FTEs, or removing open job postings. 

• Operational continuity during callouts and tardiness → reduce impact to patient care.

• Protect against the impact of labor trends (e.g. high turnover, average age of some staff being 55+.) 

• More face-to-face interactions with patients. 

• To be “innovative.”

We're brand new to hospital robots. How do we start thinking about it? 

Well, I’ll first tell you how not to start thinking about robots. 

Don’t start thinking about the technicalities (e.g. hallway width, elevators, doors, etc.) 

That comes later - and is way more flexible than you’re assuming. 

Start thinking about this in terms of people. 

(I acknowledge this sounds kind of funny because this webpage is talking about robots.)

For front-line colleagues in various departments…

How often do hallway conversations turn an 8-hour shift into a 6.5 hour shift? 

How often does bad weather in your geography turn a 10-person shift into a 5-person shift?

How often are managers filling in for staff and having to neglect their own work? 

What’s your first year turnover? How does that impact your P&L? 

How many repetitive strain injuries and other workplace injuries do you have each year?

And then think about what you’ve tried to solve the above problems. Were they fresh ways to tackle age-old problems? Or bandaid attempts like the below: 

• Performance bonuses. 

• Hiring bonuses.

• Retention bonuses.

• Employee “tracking” devices.  

• New spreadsheets to track new KPIs.

Here's a complex diagram to show a potential before & after:

Our system has multiple hospitals. How do we decide which hospital to start with first?

Don’t default to the main campus. 

A theme you will see in this website is that cultural change is sometimes required before installing robots, depending upon your health system. 

What does this really mean? It means take the path of least resistance. 

To describe what I mean, here is a drawing that looks like my toddler made it, but in fact, I made it:

After you reach the end of the cascade, you want to figure out which specific department(s) within the hospital would benefit the most from robots. 

And that’s where we get to the next section.

Hospital Departments that can use transport robots

PHARMACY

Tasks: 

• Inpatient pharmacy meds to units.

• Replenish floor stock.

• Prevent nursing from calling down to say "I never got that!"

Type of robot needed: 

• Robot with password protected compartments that log who put the item into the compartment and who removed it (i.e. chain of custody).

LABORATORY

Tasks: 

• Specimens from units/OR to laboratory.

Type of robot needed: 

• Robot with password protected compartments that log chain-of-custody.

• Robot with cold storage or space for cold storage unit. 

NOTE:  For both Pharmacy and Laboratory,  consider whether a 1-compartment robot or a 4-compartment robot is ideal. A 
4-compartment robot allows you to deliver to 4 units in one single trip, and prevent nursing staff from accidentally taking the meds for another unit. A 1-compartment robot, if following strict chain of custody, can only take  the meds for one unit at a time.


FOOD SERVICE

Tasks: 

• Patient, guest, and late trays to units.

• Replenish floor stock.

• Employee or visitor cafe/bistro orders (e.g. order via POS app).

Type of robot needed: 

• Platform robot that can slide underneath a cart or tow a cart.

• Robot with locked/password protected compartments.

FACILITIES

Tasks: 

• Pallets from loading dock to various hospital areas.

Type of robot needed: 

• Platform Robot that can slide underneath a cart, tow a cart, or lift a pallet (at least 1,000 lbs capacity).

EVS

Tasks: 

• Laundry carts from dock to units.

• Soiled linens from units to dock. 

Type of robot needed: 

• Platform Robot that can slide underneath a cart or tow a cart (at least 600 lbs capacity).

If you were to talk to the heads of each of these departments, you would probably hear things like: 

“Turnover below 50% is a good year.”

“Managers fill in for front-line staff a lot.”

“I don’t know what my staffing will be like until I get into the building.”

“If there’s bad weather, I know that I’m going to get callouts.” 

What did you notice?

All of the above departments have the same concerns. 

This is what’s important to understand: 

Some departments may have more acute operational problems and therefore need robots more than other departments. 

A strategic budget allocator (you) would say: 

“Our first robotics deployment should be in the department that is experiencing the most operational problems!” 

And that’s how we should all think. Usually. 

But like any strategic thinker knows, there’s an exception to every rule and finding those exceptions is what separates exceptional orgs from just-okay orgs. 

As we mentioned earlier, cultural change is required for a hospital to bring in robots for the first time. Your colleagues, regardless of hierarchy, need to feel that robots can work in their space. 

It may make sense to deploy in the department that would have a relatively easier time deploying robots. 

For example, the pharmacy and laboratory departments could utilize a robot with secured compartments. Something like the below:

It’s a fully self-contained robot. 

Whereas, a food service or EVS robot would need to connect to your existing food tray carts or EVS carts. 

That connection isn’t difficult - but it’s still an extra step. 

But wait. There’s an exception to the exception. 

You can just go ahead and deploy :) 

If you’re gotten this far, you’re likely a hospital leader that cares about doing things differently from how they’ve been done before.

Elements of an ROI

Nothing new gets done without a legit ROI analysis. 

And that’s especially true with robots in hospitals. 

First - let’s define “ROI” as:

• Breaking even on a robot’s monthly lease payment relative to reduced or reallocated FTEs, or

• “Making money” from robots after FTEs were reduced (who doesn’t love this kind of ROI?!) 

Here’s the overly simplified math: 

Note: I am fairly opposed to giving out ROI calculation spreadsheets. It doesn’t capture nuance and there is difficulty in factoring in other associated financial savings and impacts.

Let’s start with a hypothetical pharmacy example. 

A hospital pharmacy operation has 5.5 pharmacy technician FTEs.

• Across all shifts, 2.5 of these FTEs are generally allocated to delivering meds and floor stock to the units.

• After discussion with your chosen vendor, you’ve determined that 2 transport robots are required for executing deliveries on an around-the-clock basis. 

• Today, those 2.5 FTEs cost you as follows: 

  • $20.80/hour ($16.00/hour + 30% fringe)

  • $108,160* yearly cost ($20.80 * 2,080 hours per year * 2.5 FTEs)

• Robots will have an opex expense of $68,400/year.

  • $2,850 per robot per month lease * 2 robots * 12 months

• Let’s assume a one-time elevator integration cost of $30,000 for 2 cars.

• Year 1 robot expenses are $98,400. 

• Year 1 cost savings are $9,760.

• In Year 2, cost savings go up to $39,760.  

NOTE: We did not factor in all of these financial costs:

• Recruiting and ramp-up costs after FTEs turnover.

• Cost of managers ($50+/hour) filling in for front-line ($22/hour) duties.

• Financial impact to delayed patient care and discharges. 

• Negative impact on HCAHPS scores. 

Again, we’re keeping this simple - just like the design of this webpage. 

Here’s a simple chart to show you how robots can provide ROI in functions that run 24/7:

Now - does this chart reflect a robot being down for whatever reason? No. 

Does it also reflect a person showing up every single day, on time? No. 

Even if you do factor in 1-2 days a month of a robot being down or being serviced, the difference is still stark. 

Here is some pushback you may hear, or pushback you’ll have for me: 

“Well, no one has food service workers / pharmacy techs / lab employees 100% dedicated just to transporting. A robot would be a net new monthly expense.”

My Response: Yes, you’re right. But note:

A robot (depending upon the vendor you choose) will operate 16-18 hours per day. Some types, like the ones that pharmacy, laboratory, and retail food service orders use, can run even longer. 

That means your 1 robot payment is working across multiple shifts - and taking away time-in-motion from multiple employees on each shift.  

As we talked about at the beginning of this webpage, it’s worth asking these questions: 

• What percent of an average shift is spent on “time in motion.” 

• How often are managers filling in for a front-line time-in-motion tasks?

• What else could staff do if their time-in-motion dropped by 80%? 

• Would reducing time-in-motion help reduce turnover by increasing job satisfaction?

• In the event of turnover and periods of short staff, would robots help you still be able to be on-time for critical functions? 

Let’s go deeper: 

Math breakdown: A food service worker with an all-in cost of $22/hour who spends 40% of their shift transporting results in $8.80/hour in transport costs. Over a full shift, that's $70.40, or $18,304 annually per FTE. 

Now multiply that by the number of front-line food service FTEs you have on any given shift. 

This general math applies to pharmacy, laboratory, and facilities FTEs. 

ROI also comes from these places: 

Productivity multiplication: How often are higher-waged colleagues filling in for $22/hour tasks? How often is a nurse ($45+/hour) doing a transport task? That means the department is paying an extra $23/hour for a higher-credentialed colleague to do the transport. Robots can result in opportunity cost recovery. 

Overtime reduction: Transport delays tend to create cascading overtime. Labs get delayed, discharge planning extends. Medications get delayed, nursing shifts run over. What could a 50%+ reduction in transport-related OT do for your P&L? 

Risk mitigation: What's the cost of a single medication or food error due to rushed transport? These are rare, but when they happen, they’re likely six-figure events. 

At the very minimum, a properly implemented robot program will make your staff more valuable to the system.

“Well, I’m already short on techs (or food service workers or EVS workers). I have open job postings. Robots would be a net new expense. They’re not replacing anyone.” 

My Response: Once we go through our analysis, you’ll see that some of your open job postings can be removed. That means you won’t be using that budget which has already been allocated. Robots, due to their cost and ability to give at least 18 hours/day of labor, would likely use up less of that already allocated budget. 

And this is where I usually hear:  

“Our system requires a hard ROI. Not the touchy feely ROI.” 

My Response: I agree 100%. That's why I gave you the framework here to develop that hard ROI. And as you know, even a hard ROI is not enough for executive approval. The math above is just one part. That brings us to… 

Developing the CFO-Friendly Business Case

I want to say something upfront. 

The CFO doesn’t always care if the product/service you want to bring in saves money or makes money. 

You know that your health system has a thousand (figurative) fires. You can’t extinguish them all. Some are left to burn. 

Which ones get put out first? 

The ones that cause the most downstream operational headaches and the ones that impact patient care. 

What does this mean?

You need a business case that your CFO will bless.

An impactful business case answers these questions:

• What has changed recently to make this a problem today?

• How often does this problem occur?

• What are the significant downstream consequences of this problem? 

• What is the financial cost every time the problem happens?

• If there’s not an immediate financial cost, what can become the financial cost if the problem happens enough times?

  • e.g. expensive patient adverse event, insurance reimbursement impact, regulatory fines, etc.

• What have we tried in the past 12 months to solve this problem and why aren’t those solutions working?

The ROI is listed out as “target outcomes.”

For example, you don’t say “we will remove 2 job postings with the robots.” 

You say: 

“By October 1, after a 4 week ramp-up period, we will be able to remove 2 open job postings for Food Service Worker I, and be able to reallocate 3 Food Service Workers to a Host role for 100% of the shift.”

And then a business case talks about the robots in very specific ways:

• How and why the robots will work inside your building. 

  • Facilities requirements are all met:

    • Space to dock the robots.

    • Access control systems will open for the robots. 

    • Hallways, transitions, and thresholds have all been confirmed to work with robots. 

  • Elevator requirements are all met:

    • The minimum required elevators have been identified, model numbers and upgrade dates obtained, and confirmed to integrate with the robots. 

    • The service company has issued an SOW to perform the work, with a start and completion date. 

• The time and human resources required to implement robots. 

  • This is really important. Every new implementation - whether it’s a new napkin holder or a transport robot - requires organizational bandwidth to implement. Your CFO needs to know that the project sponsor (you!) has a plan to resource the installation. 

    • The robot vendor will be onsite for a sufficient amount of time to work with facilities and test the robot’s maps and routes. 

    • All team members who will interact with the robot will have a shift during the installation period so they can be properly trained. 

    • 24/7 remote support is offered for any and all issues. 

Here is something really important to understand. I contemplated making this it's own section, but for now, it's here. 

To see ROI, you DO NOT need to have robots take over the entire function. 

This is especially the case in food service. 

You do not need to bring in robots to deliver trays to ALL of your units.

There can be significant value in delivering only to farther out units, or to the few units that need multiple carts, or to the few units that only need one 12-15 tray cart. 

This makes getting started easier, while still seeing a CFO-approved ROI. 

To wrap up this section, I will repeat this again: 

If you do the math and the numbers work - it's not enough. CFOs also care about internal and external strategic positioning and readiness: 

The investment into transport robots:

• Hedges against labor market volatility which is never going to go back to pre-2020 levels. 

• Makes your system a more attactive employer.

• Demonstrates a forward-thinking mindset to the community (i.e. new patients). 

• Creates a scalable foundation and culture for future automation and innovation. 

Business Case Template

Your head might be spinning. 

So here’s an easy to fill template for this business case. 

Nate Nasralla of fluint.io is the pro at this. See his 1-page template here. Let me know if you want help filling this out. 

Business Case Common Questions 

Here are two common things we hear about obtaining the greenlight for transport robots. 

Common Thing 1:

“If the same robot can be used by 2 departments, it will be a lot easier for us to get budget approval.”

This comes up a lot. Why?

Because technically, it’s easier to go to executive leadership and say “this 1 robot will work across pharmacy and lab” or “this 1 robot can deliver tray carts during the day and handle soiled linen at night.” 

2 departments, 1 monthly payment! 

Yes, you can totally do this (depending upon the vendor you choose). 

Just don’t do this on Day 1.

And whatever you do…do not let executive approval depend on Day 1 multi-department use of the same single robot. 

We’re not setting ourselves up for success this way. 

Think about it. If robots are brand new to your health system, do you really think you should be implementing in 2 unrelated departments at the same exact time? No. 

And it doesn’t matter if those departments are both under your system’s Shared Services organization. 

Common Thing 2:

“Ok, I can see how transport robots would help us. But we just missed the budget window. I won’t be able to consider this for a year.”

Maybe. Maybe not? 

Talk to finance. What happens if you remove an open job posting? Again, job postings are only up if there is budget. 

Also, most vendors don’t have an upfront capex. And some will even roll in the elevator integration into opex payments. 

This is why we talked about a business case earlier. Health systems equipped with the right information will make smart decisions.

But even if you do have to wait until next year, start talking to other stakeholders now. What should you talk to them about? Glad you asked… 

Getting other departments & stakeholders onboard 

Let’s state the obvious. Just because your department needs a transport robot, has the budget, and has a CFO-blessed business case…doesn’t mean that you can install robots tomorrow. 

For something like this, there are other departments that need to be bought in. 

This section will detail those departments, what they care about, and some ways to get them comfortable early.

If you only take away ONE THING from this section, PLEASE let it be this: 

Do not delay talking to these departments until you’re ready to submit the vendor’s contract to Legal. 

In fact, talk to these departments after you’ve read this webpage and have started noodling on where you can use transport robots. Heck, show them this webpage. 

Here is a far more polished diagram to show the general timeline of when to talk to each of these stakeholders. 

Ok, now that I got that work of art out of the way, let’s go through what each department cares about and will expect to hear from you or the vendor.

Facilities

• The robot will not create traffic jams. 

  • It moves at least at the same pace as a person. 

  • It can turn corners easily. 

• Multiple robots can play well together. 

  • They won’t look at each other in the hallway and then stop and require a person to come and separate them (basically, they shouldn’t be toddlers.) 

• The robot vendor spearheads and executes the elevator integration work. 

  • Facilities does not want to get involved in the nitty gritty of figuring out elevator integration. 

Information Technology (I.T.)

This department cares about a few things:

• Cybersecurity.

• Cybersecurity. 

• Cybersecurity. 

And here’s what they expect to hear: 

• The robot can operate if connected to an equipment-only WiFi. Or it has an LTE network that can utilize the repeaters the hospital already has installed. 

• The robot vendor is open to the hospital conducting penetration testing. 

• The robot vendor has SOC II certification. 

• The robot vendor’s elevator integration does not result in vendor lock - other robot vendors can use the same elevator hardware‼️ 

• The robot vendor has fleet management software that can show you where any robot is at any given time. 

• Also importantly, this fleet management software can be used by other robot vendors (vendor lock is a big no-no for IT). 

• The robot vendor has software developers to resource required integrations to Epic, Cerner, a POS system, or any other health system software and won’t burden the hospital’s team. 

• The robot vendor can provide uptime/downtime metrics via a dashboard.

• The robot vendor offers 24/7 support (because I.T. does NOT want to be fielding tickets for hardware provided by a third party…) 

Nursing

• Nurses will be properly trained and training will be provided periodically to new team members. 

• Nursing management should have an easy and rapid way to enter newly hired nurses into the robot database (for retrieving meds/labs/etc from the secure compartments) and a way to quickly remove nurses. 

• Nurses can be alerted in multiple ways of a robot that’s on it’s way (audio cues, phone calls, and texts).

Patient Experience

• Patients, visitors, and robots can interact safely within the same hallways and elevators. 

Legal

• Service Level Agreements! The vendor is required to fix and replace equipment within a certain amount of time.

• If the vendor consistently does not fix equipment within the SLA-mandated timeframe, the health system has an out clause from the lease or RaaS term.

All this brings me to my final point for this section:

Change Management.

Change Management is a "cost" for any new implementation in a health system. Doesn't matter if it's software or new pavers. CFOs ask about it and attach a cost to it. 

I wrote the list of various stakeholders above, but the real task is organizing them to make a decision. 

If your health system does not have a dedicated program management office, can someone in your department serve as a part time project manager? Or at least be someone that can serve as a go-between for your chosen vendor? 

The good thing is that a well thought out business case makes change management much easier. 

But don't underestimate the "cost" to your CFO. 

ELEVATOR INTEGRATION 

This is in caps for a reason. It’s the joy albatross when putting robots in hospitals. 

Let’s get some big things out of the way. 

Elevator integrations… 

• Cost money. Budget ~$12-15k per elevator car. (we already incorporated this into our ROI calculations earlier). 

• Can be a pain to coordinate with your building’s local elevator service company.

• Have timelines that can get out of hand if not carefully managed.

The goal of this section is NOT to scare you off from robots in hospitals. 

This section is meant to help you prepare for it. 

Hospitals have integrated robots with elevators before. It’s been done for 20 years. 

It is what it is. 

Hospital facilities should not be the primary project manager for elevator integration work. 

The primary job of hospital facilities when it comes to elevator integration is: 

• Provide the elevator make/models and permit numbers to the chosen robot vendor. 

• Connect the robot vendor to the local elevator service company. 

• Push the elevator service company to meet the required timelines.

That’s it. 

A skilled robot vendor knows how to work with all of the major elevator companies, and has experience working with service companies in different geographies and of different experience levels.  

AND - that robot vendor should not be pushing integration hardware that only works with their robots. That’s not cool.

Closing Thoughts

If you’ve gotten to this point, you know pretty much everything I’ve learned after several years of doing this work. 

My one takeaway from working in this space is the classic phrase many of us heard growing up:

“If you do things the same way they’ve always been done, you’ll get the same results you’ve always been getting.”

I genuinely hope you walk away from this webpage feeling that you can confidently assess, advocate for, and oversee the successful implementation of robots. 

The benefits to the P&L, operational continuity, staff satisfaction, and patient care are enormous. 

Over time I will be adding in implementation how-to’s for specific departments. Tell me if there is anything else you want to see. 

However, if after reading this you don’t feel fairly educated…can you let me know? 

Do you think I missed a few key sections? Do you straight up disagree with how I talked about creating a business case? Do you think the website design is dumb?

Or did any of this resonate and you want to chat? 

Email me anytime at: 

neelesh@baysideops.com, or message me at

linkedin.com/in/neeleshmittal