In his landmark book, Hospital Materiel Management, Charles E. Housley described the state of the art in the late ’70s when he chronicled the exchange cart distribution system that he had implemented at St. Anthony’s Hospital in Columbus, Ohio. The purpose of the system was to (1) reduce the number of supplies carried on any nursing unit, (2) monitor the usage of those supplies daily so levels could be kept at the appropriate amount and (3) immediately reconcile any issues associated with possible lost or missing charges.

Like many other progressive institutions of the time, Baptist Hospital of Miam-uh (correct pronunciation for old-time Floridians), opted to join the exchange cart revolution and I, as director of central processing and distribution (CPD), was given the challenge of establishing and implementing such a distribution strategy for the organization.

Actually, it was quite a simple exercise. All you had to do was figure out the 100 to 150 key items for a given unit (mostly patient charge, of course), calculate average daily use (in the days before the now ubiquitous automated materials management information system), pop on a 30 percent fudge factor to accommodate spikes in activity, decide whether the items should fit on one or two Metro wire carts, go to the nursing units and try to find appropriate places to leave the monsters, buy the carts, buy covers for the carts, fill them up, making sure to put little yellow stickers on each and every one of the patient charge items, devise a delivery schedule, bring the old ones back to CPD, take a daily inventory, match up what was missing on the patient charge items with what was charged for on the 5-inch-by-8-inch patient cards, go to the floors and haggle with the nursing staff over shortages, type (on a typewriter) nasty memoranda (a word that was used before e-mail) to head nurses, sigh in resignation and despair, go home and repeat the next day — 365 times a year!

To say the very least, the process was one that begged for a cost benefit analysis. Ah, but this was the ’70s — the Good Old Days. I didn’t have an MBA degree yet; I didn’t need one. If it looked like things were going to cost too much, we’d just boost the charges another 5 percent – simpler place and time.

But we at Baptist Hospital of Miami (BHM) were forward thinkers. We decided to build an addition to the hospital. In the new section, all the rooms would be private, and each pod of four rooms would have a nurse-server. The nurse-server was a component of a patient-focused design concept devised by Gordon Friesen. The central concept to the design was to keep the care-giver as close to the patient as possible. Therefore, decentralized supply niches, called "nurse-servers" were carved out adjacent to a "pod" of rooms. These niches would hold supplies and linens outside, yet proximal to, the patient rooms. A floor with 36 patients would have 9 pods. As you can imagine, the concept screamed of labor intensity as well as supply abuse.

But it was very popular with the nurses, and BHM decided to implement it.

Also included in the design of the new patient tower was an electrically-powered messenger system called "Telelift," which could be programmed to run around the hospital in the overhead spaces. It could deliver reports, medications, lab specimens, etc., and for the princely sum of several hundred thousand dollars, it could somewhat replace a $7,500 per year messenger.

Telelift was manufactured by a German company whose worldwide renown had come from the manufacture of safes. BHM was on the leading edge of Telelift implementation, and as a result, was offered the opportunity to trial another of the company’s creations — the Transcar.

The Transcar was a remote controlled distribution device, run by a "space age" digital controller about the size of a brick. It looked like an Old West coffin that had been squashed down to a thickness of about six inches and placed on wheels. At each end of the machine there was a metal post that would fire upward and engage a specially-built wire supply cart. The cart would follow a trail of one-inch-wide metal tape placed on the floors. The tape led to the service elevator. Once at the elevators, the car would signal the elevator, drive itself on, exit at the selected floor, drive itself down the hallway to the clean utility room, make an audile signal announcing its arrival, wait for someone on the unit to disengage the cart, remove it and put the one to be refilled on it. Then the posts would pop up, the cart would make its way back down the hallway, call the elevator and return to CPD.

What a concept!

It only had a few problems, like:

• It was programmed to come to a complete stop if anything got in its way (did I describe the rubber "feelers" it had fore and aft?), and anything from a bucket of water to a person wanting to have some fun could hang it up for hours.

• If the elevator did not come up exactly even with the floor, it would either run into the elevator edge and stop or speed on to the elevator and crash into the back of the elevator and stop.

• It didn’t always go where it thought it was sending itself.

• People didn’t always respond to its summoning beeps in a timely fashion.

Still, with all its shortcomings, it was a marvel of modern technology, and since there were only two people in South Florida who knew how to operate it — myself and my Linen Supervisor, Robert Collier — the Transcar soon picked up the rather predictable appellation of the "Cranscar." Staff members enjoyed following us around during our trials and adding humorous observations and comments.

After a couple of months’ trial, the experts from the parent company announced that they would be coming to inspect our progress. Robert and I were in a panic because we had quit using the machine after three weeks. We had two days to refresh ourselves. But we were professionals and we were ready when the German executives came to visit.

It was 8 a.m. The Transcar was clean and polished and ready for action. Brian Edward Keeley, the hospital’s rising star and my boss, showed up outside my office with the two
German executives. For the occasion I had worn a sung-fitting chocolate brown suit with two-tone brown shoes that sported two-inch heels (remember, it was the ’70s... the day before I had worn my robin’s egg blue leisure suit).

As we prepared to launch, Robert Collier handed me the digital controller. The key was taped to its end, and as I demurely squatted down to insert the key, I heard this sound: SKITCCCCCCCCCHHHHHHH, after which I felt a cool breeze in the Netherlands (no geographical pun intended).

Wisely, I remained in the "down" position as I assessed the damage. The rip in my trousers began at the point where my zipper ended and extended to the point where my belt loops began. If I were to have stood up immediately there might have been an international incident.

Quickly I summoned Brian Keeley. "Brian," I said, "Robert’s gonna have to take these guys around."

"Why," he asked.

"Are you freakin’ deaf," I responded. "I just ripped my pants out!"

"Well, you’re wearing a suit coat," he said, "that should cover the rip."

"Brian, just get up, stand in front of me and take a good look."

Robert Collier escorted the German executives.

I went to the Linen Room, got a pair of scrubs and asked Larcie Hall, our seamstress, to fix my pants. She got laughing so hard she pricked her finger three times…