How HTM leaders can evaluate when outsourcing is the right call—and how to manage partners, contracts, and expectations throughout the process.
By Alyx Arnett
When Steve Keith, CBET, CET, started his career as a hospital-based biomed in the 1980s, outsourcing was seen as a threat. Third-party service companies were viewed as competitors, and Keith says most in-house biomeds, including himself, “avoided them like the plague.”
Today, the landscape looks very different. Leaner healthcare technology management (HTM) departments, increasingly software-dependent devices, and a shrinking pipeline of trained technicians have pushed even strong in-house programs to rely on outside support in specific areas. Outsourcing is now seen as a tool that can help teams fill skill gaps, manage risk, and maintain uptime when bandwidth or expertise falls short, says Keith, director of technical services at Medical Maintenance.
“It’s more important now than it ever has been,” he says. “Really, when you’re looking to outsource, you want to make sure you find a partner that can work with you to make sure that your technology is safe, reliable, and compliant.”
Questions to Guide Outsourcing Decisions
The challenge for HTM leaders is deciding when outsourcing makes sense and what work truly belongs outside the department. Keith suggests asking three questions: Why do I want to outsource? What do I want to outsource? What do I hope to accomplish by outsourcing?
Most organizations, he says, answer “why” the same: They don’t have the time, bandwidth, or specialized capabilities to do everything in-house. For defining “what,” Keith advises clarifying the level and type of support needed. “Are you looking for someone to do repairs? Are you looking for someone to do predictive monitoring or overhauls? Do you want someone to come in and do calibrations?” From there, determine what equipment it would cover.
“It doesn’t always make financial sense to do things in‑house. If the tools, software, and test equipment for one device cost more than is comfortable for infrequent use, that’s a strong case to contract out,” says Keith.
That reality often leads organizations to the same high-demand, high-risk areas. Matt Forrest, vice president of business development at Renovo Solutions, says that most service spend clusters in radiology, cardiology, oncology, and surgical environments—modalities with steep training requirements, vendor access limitations, and significant parts exposure.
Imaging is the classic example. CT, MRI, cath labs, and linear accelerators require deep specialization and carry high-dollar risks. “You can have a technician trained, but then you have the risk of that $300,000 CT tube blowing,” Forrest says. “Hospitals don’t like those financial blips.”
Matthew Kenney, CHTM, MBA, biomedical equipment service manager at Augusta University, prefers in-house to third-party whenever feasible, but he agrees imaging is often where outsourcing is both necessary and practical. The question, he says, is whether the in-house team has the staff, interest, and long-term stability to support imaging internally or whether a managed service agreement makes more sense. But he cautions against defaulting to send‑outs. “If all you’re doing is shipping equipment out for repair, you’re asking to get [fully] outsourced,” he says.
As for the third question—what you hope to accomplish—Keith says leaders should be clear about the outcomes they expect. That may include reducing load on an overstretched team, improving reliability and uptime, gaining predictable costs, or securing access to expertise.
What to Look For in RFPs: Beyond the Bottom Line
When evaluating requests for proposals (RFPs), price will always matter, but Keith cautions that low bids can backfire if coverage, uptime, and staffing aren’t evaluated with equal weight.
Looking just at price, Forrest says, “has gotten a lot of hospitals into hot water where they aren’t getting what they expected.” He adds, “There are companies that come in low but don’t have the technical expertise or dedicated resources.”
Those gaps, he says, are what RFPs should be designed to surface. He recommends requiring line-item coverage—by asset—and a preliminary staffing plan in RFP responses. The plan should include the number of dedicated technicians, their training levels, and how staffing aligns with staggered OEM contract expirations.
Additionally, key performance indicators (KPIs)—such as uptime, response times, and callback expectations—should be spelled out in the RFP and tied to financial incentives, says Forrest. Typical OEM uptime guarantees range from 95% to 98%, he says, so ensure the vendor matches those commitments. He says his company puts a portion of annual contract dollars at risk for missing performance targets and conducts at least one customer satisfaction survey per year.
Finally, resist one-size-fits-all coverage. Not every device requires a full-service “Cadillac” contract, says Forrest. He recommends using historical performance data to identify which assets can shift to time-and-materials, parts-only, or in-house planned maintenance (PM) with escalation paths. Some devices will still warrant OEM coverage due to parts access, training restrictions, or high failure rates, he adds.
Vet the Vendor—And Their Methods
Vendor vetting should include site visits and process validation to ensure partners follow safe, compliant practices, says Kenney. “We get cold calls all the time, and they say, ‘We can save you XYZ,’” he says. “You don’t realize the steps they’re taking to get to XYZ may not be legal. It may not be ethical. It may not be sanitary.”
Kenney recommends reviewing documentation and verifying certifications and quality systems. Transparency is also essential, he says. Whether a vendor uses a hospital’s CMMS or theirs, HTM teams should be able to track device histories, PM compliance, response times, and cost drivers. Forrest says hospitals should require “complete financial and operational transparency,” including visibility into what it costs the vendor to service particular assets.
Keith advises selecting a vendor that uses electronic workflows, which can reduce “report float” and accelerate throughput. He also says a good partner can adjust coverage as equipment volumes change—up or down—rather than locking the hospital into fixed counts or struggling when workloads grow. Flexibility in contract size and service levels, he adds, is essential for long-term fit.
Additionally, Keith says a vendor’s posture is equally important. “You want to find someone whose mindset is that they’re not out to replace you, but rather to partner with you to help you do your job better,” he says. He recommends checking a vendor’s customer base to understand where they focus—modality-level support, department-level support, or full-hospital takeovers—and calling references to see whether the partner truly complements in-house teams or tends to compete with them.
Managing the Partnership: Communication, Oversight, and Early Testing
Even well-written agreements fail without ongoing oversight, says Keith. “One of the worst things that can possibly happen with any HTM team is they assume everything is being taken care of,” he says. “You can assume that because you’re not hearing from them, they don’t need you. These are incorrect assumptions.”
He says communication breakdown is responsible for a large number of adverse medical situations and advises, at the very least, to have quarterly meetings with the vendor, whether by phone, video, or in person. If the vendor visits less frequently, perhaps once or twice a year, meet immediately afterward. “Just saying, ‘How did things go? How can we improve?’ is a good idea,” Keith says.
Forrest’s teams hold quarterly business reviews to share CMMS‑driven insights on productivity, cost avoidance, training plans, and upcoming contract transitions.
Staffing, Training, and When In-House Stops Making Sense
Kenney acknowledges that workforce and training demands can push some work beyond what in-house teams can support. Hiring technicians already trained in specialized areas is difficult, and developing expertise internally can be costly. “If I send someone through all four phases of advanced X-ray training, that’s nearly a $100,000 investment,” he says. Even then, retaining that person isn’t guaranteed, and without internal experience, the hospital may end up relying on the vendor anyway.
And sometimes staff aren’t interested in specialized training. Kenney recalls a “star employee” who simply wasn’t interested in learning X-ray. “So you’ve got to see, do you have staff that will get that extra training?” he says.
When a team member does receive additional training, Kenney says to pay them accordingly. If something comes off contract as a result, he recommends advocating for a raise equal to 1–5% of the contract cost to help retain them.
Keith adds that when the education, software, or tooling required exceed what makes sense for the hospital, outsourcing may be the better choice. He says decisions should be grounded in a “Ben Franklin balance sheet”—one that weighs the skills required, the ability to source parts, the safety profile, and the likely utilization.
What’s Next for Outsourcing in HTM
Outsourcing strategies will continue to evolve as hospitals confront workforce shortages and devices grow more software-driven and networked. Keith expects to see more electronic integration between vendors and hospital systems, greater emphasis on data-driven KPIs, and a sharper focus on cybersecurity and access controls as external partners touch internal networks.
Forrest anticipates greater standardization across health systems and deeper hybrid partnerships with joint risk-sharing, predictable uptime guarantees, and enterprise-level transparency.
Kenney hopes hospitals will invest in retaining the people they upskill. “You’re always training somebody for their next job,” he says. The antidote, he says, is to pay them fairly, recognize their contributions, and give them a path to grow.
In a tight labor market and a demanding clinical environment, there is no single “right” outsourcing model. But there is a right process, and, when done well, Keith says, outsourcing isn’t a concession; it’s a strategy to strengthen HTM teams and, ultimately, the organization. “Let’s face it, we all are here to improve patient safety, patient outcomes, and equipment reliability,” Keith says.
Alyx Arnett is chief editor or 24×7. Questions or comments? Email [email protected].
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