|Methodist Health System team members, from left, Scott Sovocool, BS, director, biomedical engineering; Duff Burkes, team leader; and Mike Douglas, senior imaging repair technician; service a Siemens Sensation 40 CT scanner.|
The bottom line for those tending to a hospital’s equipment is to provide exceptional service as quickly as possible. But they can never forget the literal “bottom line,” and staying within the monetary limits set by budgets and administrators can often feel like performing a balancing act.
For experienced biomeds and clinical engineers, hitting both of these marks is possible, thanks to techniques developed through experience that help them meet both types of goals.
For the biomed team at Methodist Health System, one of the biggest money-savvy decisions they have made over the years is eliminating the vast majority of service agreements. Scott Sovocool, director of biomedical engineering services for Methodist Dallas Medical Center and Methodist Health System, Dallas, led the effort to shift away from the wide use of vendor contracts.
“When I came here, almost every piece of x-ray equipment was under contract. Today, the only contracts we really have are for service software or backup support on some specific systems,” Sovocool says. “As a general rule, we only purchase agreements for high-failure items: devices that give us a lot of problems.”
Such temperamental systems include open magnetic reson- ance imaging, which is more susceptible to vibration and noise problems, according to Sovocool, making them less stable than their more traditional counterparts.
First Things First
Determining which systems get any type of vendor contracts is as straightforward as performing a cost/benefit analysis on each modality to identify the exact savings that might be realized by handing the maintenance responsibilities to the in-house team.
|When service contracts are required, Methodist makes a point to purchase only what is required to get the job done. Here, Duff Burkes (L) and Mike Douglas troubleshoot a problem with a Siemens R&F room.|
“Look at the overall picture instead of a machine-specific picture; for example, don’t look at one CT [computed tomography], look at all of your CT scanners,” says Mike Douglas, senior imaging repair tech. “If you think you’re going to lose three tubes a year out of your six CT scanners, you’re looking at about $300,000. But $300,000 isn’t that much when you consider the cost for a full-service contract for all six CT scanners, which may actually cost about $850,000.”
Having these figures handy can prove beneficial in purchasing negotiations as well—an area where biomed departments can really make a difference in the hospital’s capital investment on new equipment.
Pulling together these numbers is an ongoing process. The biomed crew at Methodist created their own database, which they use to track historical data on each machine—recording how often it needs repair and how much getting it back online cost the organization. When completed diligently, this type of record can make the decision of whether or not to buy a service contract a quick calculation.
Even when contracts are required, Methodist makes a point to purchase only what is required to get the job done.
“Most of the time, we negotiate partial contracts. It could be for parts only, or first call,” says Duff Burkes, team leader. “It greatly reduces the cost to the hospital, and we get there a lot quicker than the vendor can.”
For the crew at Methodist, a timely response is one of the biggest benefits of being responsible for their own equipment.
“What our hospitals want is immediate response to their needs, and the fact is, we can be there so much faster than vendors, because we are in-house,” Sovocool says. “Our response time on equipment is minutes, where it may take a vendor several hours to get there.”
In the Loop
Stepping away from vendor service has the potential to save copious amounts of cash, but it also has the potential to cause serious headaches if the biomed team is not adequately trained or available to take on the workload.
Biomed departments should take into account off-site locations that may not be readily accessible to the in-house team, making response time an issue. Also, consideration should be given to specialty equipment. In both cases it may be beneficial simply to pay the vendor to take on the responsibility.
“It is important that you deal in quantity when you are eliminating contracts,” Sovocool says. “If you have an individual open magnet, for example, or a system located where there is no one readily available, that equipment is more subject to contracts than others.”
Before letting a service contract lapse, it is also necessary to gain the confidence of both the department using the equipment and the administration. In some cases, earning their trust requires overcoming negative information they have received over the years.
“We have to gain the confidence of the staff, because so many people in hospitals have been told by every single vendor that no one can do the job better than the vendor,” Sovocool says. “People are also naturally resistant to change, so part of gaining the confidence is one-on-one communication with the departments; being there and being able to handle their every need. Do that and slowly but surely that confidence will grow.”
Sovocool believes building rapport with the medical staff is central to a successful biomed program.
“We have specialized techs for each given department, and they not only make rounds, but they periodically go back to the department throughout the day to make sure everything is up and running—it’s not just a one-time visit,” he says. “You have to build their trust, and that takes time. It can’t happen overnight, and you need to let your techs help promote what you are doing.”
Developing a relationship with the users of a particular system also goes a long way toward making life easier for the biomed assigned to that area.
“They’re the ones who see the problems, and if you fix something for them in a couple of hours or less and they’re back to work, then they start to trust you; and that is an important aspect of it,” Burkes says. “You have to be able to use your customer service skills and not make them feel bad or that they were negligent; you should never do that. Always make them feel like there is a problem and I can fix it. I want them to see me as the solution to their problems.”
Douglas concurs. “If you don’t develop a relationship with your customers and identify their needs, then it won’t matter how good you are or how knowledgeable you are with equipment; every time you work on something it is not going to be enough,” he says. “But if you see the people when the equipment is working right, you talk to them and develop a professional relationship, then they will share with you more about what’s going on with the equipment, and whatever they can do to help you out, they will do.”
The Right Stuff
Building that allegiance from hospital staff stems directly from the biomed team’s performance. Making the transition from contracts to in-house support will not be flawless, but the more slowly a facility moves through the process, the easier it will be to handle any issues as they come up. For Sovocool, it boils down to having a team you can depend on.
“It’s all about training: continuous training, all the time,” he says. “We don’t attempt to train every individual on everything. Instead, we have people specialized in each area of the hospital.”
The department has also developed online “cookbooks,” compiled by that system’s primary tech, which detail the most common problems of a machine and the steps required to correct them. These manuals are started after the tech attends the vendor-sponsored training associated with the machine.
“With training comes responsibility,” Burkes says, noting that the Methodist techs come back from training and immediately host a class to pass along their knowledge to the rest of the team. “If there’s longevity in a shop, there has been training.”
Getting a tech to the formal training course is done as soon as possible after the purchase of new equipment. Not only does it allow the tech to learn the basics of the system, but it also provides an opportunity for the in-house team to work with the vendor while the machine is still under warranty.
“My techs shadow the vendors during the warranty period, so when it comes time for them to take over, they already have experience on the machine,” Sovocool says. “It also sets up a bond between the vendor field rep and the service tech who typically would handle the machine.”
The organization’s policy on vendor-performed maintenance is straightforward.
“I don’t care if it’s 8 am or 8 pm, when a vendor rep walks in the door, our people are there. One of the biggest mistakes is to say, ‘The vendor is here, I’ll go home,’ ” Sovocool says. “You have to be strict about that. It’s a matter of having one-on-one time with that rep. It does us no good to hire somebody to come in if we don’t learn anything from them.”
Working together not only provides in-house techs with valuable information, but can also develop a symbiotic relationship between the vendor representative and the hospital.
“Vendors are relying more and more on dialing into your equipment and having the equipment tell them what’s wrong,” Douglas says. This approach often isn’t effective on malfunctioning equipment that is unable to transmit the appropriate information. “There’s a lot to be said about using all of your senses. Sometimes you hear something, sometimes you smell it, and you can’t do that over the phone. We can work with the vendor in these situations, to save them a trip and get the machine working quickly. Vendors know we have a relationship with their customers, and without that relationship, service doesn’t exist.”
Training is not the only thing Sovocool aims to provide for his team: He wants to give them careers as well.
“A high percentage of our people stay a very long time, in part because we have a progressive system. I don’t care if I have all ‘senior techs,’ it’s based on the person and his abilities,” he says. “People don’t have to wait years and years to get into a higher position, and that’s very important. People who progress quickly and become more valuable to us are promoted faster.”
Sovocool also believes trust works both ways and does what he can to empower the biomeds in his department with decision-making authority. One example is the ability to request purchase orders without a time-consuming trip through the chain of command.
“My staff can issue a purchase order 24 hours a day, seven days a week, 365 days a year, and that’s critically important because if they are forced to wait until management comes in, it can mean hours of unnecessary downtime,” he says. “You have to trust your staff and support their decisions. You need to empower your staff at all levels of their capabilities.”
In addition to eliminating the majority of service agreements, the biomed team at Methodist works to save money in a myriad of ways, either by purchasing parts directly from the manufacturer (instead of the system’s vendor), or by locating quality training through online courses. The focus, however, is always on the end result.
“We not only provide speed of service, but we provide a relationship with our customer,” Douglas says. “If there is an issue, we can be there before the doctor steps away from the table. When we provide that level of service, we’re able to impact patient care.”
Dana Hinesly is a contributing writer for 24×7. For more information, contact .