Below, Charles Berberette, senior system director of biomedical engineering at Miami-based Jackson Health System, shares how his department has streamlined operations in challenging times. With more than 45,000 pieces of medical equipment to manage, Berberette discusses various cost-saving measures that his team implements, including staffing optimization, contract management, training, equipment management/selection, and parts procurement.
24×7 Magazine: Wasting money is an ongoing aggravation for you. Can you elaborate on your top strategies to maintain cost savings?
Charles Berberette: Several factors are considered when looking at cost-savings opportunities. These involve evaluating staffing, contract management, training, equipment management/selection, and parts procurement options.
Staffing Optimization
With our biomedical workforce, it’s important to evaluate the equipment fleet, ensure the right staffing levels, and review technician-level loading. I also consider staff hours, another important factor. For example, I reduce workforce cost by placing a few technicians on second shift. This allows those technicians to go into busy areas and complete preventive maintenance, or PM, with ease. We can then reduce the time of repairs and staffing needs during the day as those technicians handle trouble calls and departmental needs because of the PM reductions for their daily tasks.
Contract Management
Contract management is vital to any organization. I take the strengths and limitations of my hospital and leverage the contractual agreements to best suit the organization I serve. For a cost-effective program, I use the buying power of the organization.
For example, I manage a health system, and we have multiple hospitals and many outside clinics. To save money and contracting efforts, I’ve found that combining all my contracts into master service agreements with negotiated terms that best suit my organization has improved my turnaround times; reduced cost; and effectively allowed my procurement partners to focus on only one contract for the specific vendor instead of managing multiple, smaller contracts.
Training
Training is critical to any cost-savings initiatives. I look first at the return on investment, or ROI, on any training and evaluate how much equipment and its service history the training will cover. This will tell me if we have enough equipment to ensure my technicians can grow their skillsets effectively.
As a former technician, I have experienced training on the only piece of equipment within the organization, one that did not often break down. Over time, I didn’t heavily apply that training, and it was harder for me to troubleshoot versus my training on equipment with a larger fleet that allowed me to practice the education received.
I apply this approach to my team today to ensure that they are set up for success, which in turn, allows for an effective ROI for my organization. As I noted earlier, I also try to negotiate favorable rates or include training to allow for partnership agreements. I can then leverage our buying power into my training budget to reduce cost for my organization.
Equipment Management/Selection
Equipment management and capital acquisition are also great ways to save money for an organization. The biomedical team has helped our organization to reduce expenses because we look at fleet utilization to ensure that our assets are properly allocated and implemented.
We use a combination of reporting tools, asset tracking systems, and our network utilization tools to determine frequency of use and cost of ownership for each piece of equipment in our fleet. Then, within our organization, we know which areas overutilize the equipment and where to move it. This reduces the need to over-purchase or underutilize our capital equipment and link management to equipment selection.
Additionally, my organization also looks at standardization of our fleets to achieve the best options for capital cost. The importance of standardization goes well beyond the acquisition costs of equipment. Having standardized equipment allows for greater negotiation power for capital purchases. Training costs are reduced with a similar fleet for capital equipment. This allows the biomedical team to train less staff and grow their competencies, including clinical teams.
For example, if a nurse or technician floats from one campus to another, they will already be familiar with the equipment and not require additional training to use the equipment as described in the instructions for use. Overall, proper equipment selection, along with fleet management, is a foundational driver to reduce overhead cost for our organization.
Parts Procurement
Parts procurement is an area where the biomedical department can drive cost efficiencies. It’s important to understand the equipment and the best way to service the devices. Some repairs should always use new parts from the original equipment manufacturer, while other repairs can use the secondary market to drive cost savings. I find it critical to look at service history, cost of new vs. second market parts when making that decision.
I also find it valuable to partner with vendors that can supply data to help in the determination of the selection process. We leverage a managed service model in partnership with PartsSource, which provides cloud-based data analytics, best processes and logistical support, and an actionable combination that drives evidence-based decision making for parts and services procurement.
From 2019-2022, Jackson Health System saved $1 million annually on parts procurement. This consistent savings comes from data-driven procurement decisions, enabled by the platform. Having this information at my disposal has also driven improved efficiency outcomes for across my department. Ultimately, quality patient care is our primary goal at Jackson and within the clinical engineering department. Knowing we have access to quality parts through the PartsSource platform is vital to meeting clinical needs as well.
24×7: Can you explain how data-driven decision-making among the clinical engineering staff support cost savings at Jackson Health System?
Berberette: By using data-driven decision making, the biomedical team has been able to reduce capital expenditures, training costs, contract pricing, and staff competencies. We also ensure the right parts at the right price to reduce the amount of money spent to maintain and operate our devices.
24×7: Your staff manages more than 45,000 pieces of medical equipment throughout Jackson Health System. What are the primary cost efficiencies in place that keep that equipment operational?
Berberette: Like I mentioned earlier, I look at five factors for cost efficiencies to keep those 45,000 pieces of equipment ready and maintained. They are staffing optimization, contract management, training, equipment management/selection, and parts procurement.
24×7: I know accountability is also important to you as the system director of clinical engineering at Jackson. How does accountability affect the bottom line when it comes to ensuring work orders are completed?
Berberette: Accountability significantly impacts the bottom line for any biomedical department’s cost impact to an organization. If turnaround times are not within measurable and acceptable limits, then less equipment becomes available, which in turn impacts the ability to perform daily clinical operations.
For example, if an x-ray is down for multiple days, this can cause increased use of other systems and the likelihood of additional system failures. This scenario also impacts patient flow, which can start to back up multiple departments. While it is vital to accreditation organizations like the Joint Commission to monitor [preventive maintenance] compliance, the day-to-day corrective repairs keep our systems operational for patient use.
Our organization is tracking to a turnaround time of less than five days for all repairs. We track this through reporting tools tied directly to our computerized maintenance management system, or CMMS, so that any associate or leader in the organization can view information on our team’s performance in real time. This allows the organization to see how we are performing daily.
24×7: How does your alignment with your IT department, vendor partners, and clinical engineering staff help maintain financial stability and overall operational improvement? Why is that alignment important to success?
Berberette: The entire biomedical program at Jackson Health System was built with the help of many internal departments and vendors and feedback from staff. This applies to how we maintain financial stability as well. We use our CMMS operated by my team, maintained by the IT infrastructure and tied in with our vendors purchasing arm to maintain the savings I referenced earlier. My staff monitors and inputs the data that drives all systems, and we rely on the data to make decisions on how to move forward.
For example, we use a cybersecurity platform to ensure that all medical equipment is patched appropriately. Reduction in risk to a malware or virus in our medical equipment has the potential to save countless dollars. The reporting tools from our procurement vendors allow the organization to evaluate and better manage the types of parts for our repairs.
By working with our service vendors, we can use predictive analytics on many of our systems to proactively complete tube changes on a schedule, rather than a break-fix model. This approach reduces expenses for the organization since we plan our downtime instead of dealing with a reactive event. Our IT department also works with us to help integrate our systems for a more-centralized area to view data each day.
