There is a quote by an anonymous source that hangs on the office wall of Duane L. Hart, MA, BS, CBET, service manager of clinical engineering services at The Ohio State University Wexner Medical Center in Columbus, Ohio. It reads, “We accept responsibility for our actions. We keep our word. We focus on solutions rather than fault and blame. We take initiative to make things happen.”
“That’s our department,” Hart says. The team of just over 30 staff supports 25,000 pieces of equipment across five hospitals and more than 25 off-site locations associated with the center—a role it has successfully fulfilled for more than 50 years. “We are a very old department with a history and tradition of proven success in adding value,” Hart says. As a result, the department is not viewed as a support service or a noncontributing expense center. “We are seen by administration as a value-add partner in the long-term management of our resources,” Hart says.
The mission is shared by every member of the team. Accountability and inclusion are key components for the departmental climate, from the top manager to the newest student. “We are not a deploy-and-ignore organization, but a deploy, maintain, and remain involved group,” Hart says. Involvement occurs on many levels, from participation in the educational mission of the teaching hospital to the care mission regarding its patients.
As part of a university system that offers degrees in biomedical, electrical, and mechanical engineering, the Wexner clinical engineering services team is able to support student positions. Sometimes the students stay on and become staff, though department turnover is low—just under 2% per 7 years. Team members cite the climate as a key reason.
“I’m not just a guy that carries around a screwdriver and fixes things,” says Kenneth Edmondson, BS, CBET, clinical engineering service specialist. “I’m involved at higher levels.”
With growth a constant factor, a lot of the higher-level involvement covers large projects and capital investment. Clinical engineering is charted into the acquisition process by the strategic sourcing and purchasing department, and is a key player in purchasing decisions. The team was involved from the beginning in the expansion of the Richard M. Ross Hospital and is now participating in the development of the James Comprehensive Cancer Center.
The main focus guiding their direction, in acquisitions as well as other activities, is patient care. Customer service is a top priority, but budget matters too, and the department takes a unique approach to growth. “Rather than ask for money to provide another service, we ask how we can provide another service with the money we have,” Hart says. The philosophy has led to some unique solutions and the fulfillment of some unusual requests that could not be met elsewhere. “We like to ask why and why not?” he says.
Signature Programs, Signature Performance
Fortunately, the academic environment offers more flexibility regarding the implementation of new ideas. “That doesn’t mean we accept failure, and we’re very cautious, but the opportunity for managed risk is there,” Hart says.
The team operates proactively, playing to everyone’s strengths to maximize performance and satisfaction. Work within the department is aligned with the medical center’s six Signature Programs—cancer, critical care, heart, imaging, neurosciences, and transplant—as well as a seventh division titled Support Services. The Signature Programs share demonstrated leadership, national reputation, and a potential for growth. These programs are the main drivers behind the organization’s overall mission areas of research, patient care, and education.
Each program within the clinical engineering services department has a lead technician and support members. The department dedicates six service professionals to imaging engineering and 19 individuals to clinical engineering. It shares the four student positions among the different segments. Two technicians cover the off-site locations on a geographic basis (“the inner-belt and outer-belt model,” Hart notes).
When the department underwent restructuring about a decade ago, it assigned individuals to areas based on their skill sets. The expertise leads to consistency in performance, workflow, and service.
“Our advantage is that we’re here every day,” says Jim Hiott, an imaging engineering service professional on the team. “We make our rounds first thing in the morning, physically speaking, with the clinicians to find out if any issues arose overnight.”
Rounding has become a key customer communication method, but however a clinician wants to report a problem is accepted: phone call, pager, e-mail, or face to face. “If they see one of us in the hallway, they may speak to us there,” Hiott says.
After a work request has been made, it is entered into the department’s management software system, which is networked throughout all of the entities. The software is transparent through multiple devices so that data can be captured at the point of transaction. “The days of five slips of paper in your pocket are gone,” Hart says.
The team has embraced technology to its benefit and is considered a thought leader on the subject within the health care organization, along with IT. Formed before IT, the department was trusted with one of the first eight networks at the university. “They give me the tools and the opportunity, and I have to use my skills to meet my responsibilities,” Hiott says.
Passing the Torch
Responsibilities for the technicians include not only equipment repair and maintenance, but also project participation and student education. The department has four student positions at 25% of full-time hours. “We made a departmental choice that four student positions are equal to between one and two full-time employees,” Hart says.
Students define their hours every semester and are paid half the starting salary of a full-time employee. The program is targeted to campus students studying for Bachelor of Science degrees in biomedical, electrical, or mechanical engineering; the positions are not necessarily intended to be short-term.
Typically, the clinical engineering department hires student staff as sophomores, and they stay for 2 to 3 years, which helps to ensure a mix of sophomores, juniors, and seniors. The senior student is given the “hammer of leadership” designation. “There is an actual foam rubber hammer and a mock ceremony of tradition,” Hart shares.
The student positions are treated like full-time employee positions and the students undergo training and supervision. A standard of performance is set based on the hours worked, and their collective effort is reported with departmental productivity in aggregate. However, there are no set curricula, and students go where needed.
Edmondson started as a student and found the experience incredibly beneficial. “It was amazing,” Edmondson says. “I could come and assist any technician that needed help. I learned information on so many different areas of the hospital, and it turned out to be excellent for me because I was hired full-time in a position in the field I wanted to enter.”
Being able to work with students before making a hiring decision is one of the benefits to participating in the program—personality and work ethic are easier to discern over months or years versus a 1-hour interview. Another significant benefit cited by the team is the reward of teaching others. “There is a lot of satisfaction in this environment,” says Bob Howard, MS, the department’s director.
The students benefit from the education and opportunity—and not just those working in the program. Often, the lessons they have learned are shared with other classmates. “A lot of times, students have a hard time bridging theory with actual applications, and I was able to bring that back to the classroom,” Edmondson says.
The program does take staff time, particularly that required for student training and supervision, and the students are expected to work, but the return is valued for the experience and intangible benefits. “The cost and return are difficult to quantify in terms of specific dollars and cents,” Hart says.
What is not difficult to quantify are the dollars and cents associated with capital investment, though again decisions are rarely, if ever, based solely on the calculations. The least expensive option does not always provide the smartest choice. The team has been willing to try unusual approaches to budget and resource allocation, which have met with success.
Performance-based contracting is one concept it has adopted with an eye on value. The use of a third party for certain tasks, particularly large-volume projects, has allowed the team to allocate its resources more effectively.
Using preventive maintenance (PM) requirements for infusion pumps as an example, Hart explains that instead of attempting to enforce a contract that defines a 3-month time limit, incentives are employed to motivate a vendor to complete the PMs within the shorter time frame. For instance, if the vendor completes 95% or more of the PMs within 3 months, it receives $5 per device; if it completes them within 2 months, the rate increases 75 cents. If the vendor finds and updates an expired library, it earns an extra 50 cents per device; find and correct an error, and it is another 50 cents.
Though the costs may seem higher, the strategy is rooted in fact, according to Hart, and more importantly, it has worked. Contract holders have been empowered to take initiative, and there has been added value over the long term. “It seems like we’re always waiting to achieve the PM goal up until the bitter end, so we’ve gotten what we paid for and have seen a higher level of performance and greater efficiency,” Hart says.
The arrangement is implemented only when appropriate; naturally, not all equipment is managed in this manner, though how a contract will be handled is usually decided early, typically during the acquisition process. Service contracts, warranties, and other associated details and options are reviewed alongside a product’s features and capabilities and designed to match the department’s current skills and needs.
“We like to have the vendors bring the equipment in so that clinical engineering, the key administrators, and user physicians can demo the device. We also take notes on warranties and service contracts because we are interested in our role as well as meeting the performance needs of the physicians,” Edmondson says.
Negotiations regarding service contracts focus on the need for service, mitigation of risk, and value. Specifications are developed, a score card is defined, and weighted scoring averages are assigned to clinical engineering, administration, purchasing, user, and physician. Each entity scores its area of content expertise, and the scores are combined to demonstrate the highest value (not lowest cost) opportunity.
Edmondson participates in a lot of equipment demos, often taking the lead for the department and representing the group on the interdisciplinary teams created to evaluate acquisition options; the lead technician for the related Signature Program may participate as well. The strategic sourcing and purchasing department, which selects departments, pull the teams together and crafts group size based on the expected dollar amount to be spent.
Common Sense of Purpose
Naturally, larger projects will have larger teams, but clinical engineering is always included. The department was one of five groups involved from beginning to end in the expansion of the Richard M. Ross Heart Hospital, along with IT, facility services, interior design, and administration. The team specified patient care equipment, negotiated purchase, managed the installation, facilitated training for deployment, and maintained the install base after opening.
It is now assuming the same role in the development of the James Comprehensive Cancer Center. The department has been asked to project—not predict—the equipment needs, including the back-fill of the current cancer hospital with University Hospital services. “This is not a one-hospital move. Rather, this is two hospitals worth of planning,” Hart says.
Because the team has had a lot of experience with project management, this type of work has becomes easier to manage—though it is never “easy.” The biggest challenge is coordinating the efforts of support services that can be isolated from the patient care arena (eg, IT or marketing and communication) as well as the multi-disciplinary team. “With five hospitals and more than 25 off-site locations, the physical task of finding common meeting times and accommodating travel is burdensome,” Hart says.
However, each project is a learning opportunity, for the team and its colleagues. Though clinical engineering may not be the project lead, the staff is happy to share its expertise in project management to help educate and smooth the process. The tips can be big or small; the team has tried a lot of ideas.
A successful one has been the use of a uniform. Staff in clinical engineering services wear shirts that sport the hospital logo and the department’s name, though individuals can pick any color. About twice a year, everyone gets to purchase a shirt. For a large deployment, they will all wear the same color to help identify the team and the project out on the floors.
“We deployed 1,888 infusion pumps in three different waves throughout the health system with a 12-person team,” Howard says.
“All wore the same-colored shirts, which they’d ordered over time, so floors knew who we were. It was easy to spot us, and we looked good.”
Eye on Service
The Wexner Medical Center clinical engineering services team also looks good on paper. Patient satisfaction scores are greater than 80%, and some units rank as high as 97%. If the team can do something to increase a patient’s comfort, it will—no request is too difficult, silly, or insignificant.
Clinical engineering services has brought in computer equipment for an elderly inpatient to check in via Skype with a beloved parrot at home. It has supplied video equipment for a dedicated football coach to review tapes and participate in game review sessions—he had never missed one. “We can take things off the shelf and utilize them in new ways to enhance patient care,” Hart says.
In general, the department has taken this approach to video, with much of the equipment purchased off-the-shelf. After peeling vendor labels off purchased video equipment to discover original OEM labels, they learned the only real difference was a multiplication of price by four to five times. So they got educated and adopted a philosophy of “video is video is video.” There are standards, but there is also a tremendous opportunity for cost savings. “It was a real eye-opener,” Hart says.
The department used the knowledge to implement add-on video capabilities for multiple clinical areas, including OR, electrophysiology, and cath labs. Hiott completed an installation allowing neurophysicians to examine and evaluate the waveforms of epilepsy patients in real time. He has also assisted radiologists with read capabilities at home. Edmondson has implemented conference call capabilities as part of a stroke program, where physician experts can conduct a visual examination of patients in rural locations via video to assist with diagnostics and try to improve patient outcomes.
Video projects are often about improving care indirectly. “It’s not about the equipment, but rather how we can make the equipment accessible to everyone else in the other facilities,” Hart says.
Why do this? Well, why not is the bigger question. After all, at Wexner Medical Center, clinical engineering accepts responsibility for its actions, keeps its word, focuses on solutions rather than fault and blame, and takes initiative to make things happen.
Renee Diiulio is a contributing writer for 24×7. For more information, contact .