Embodying the meaning of “Ohana”

Many people dream of quitting their jobs and escaping to Hawaii. For personnel at the Honolulu-based Tripler Army Medical Center (TAMC), however, the idea of living in paradise and working in paradise collide. Below, Ramon A. Pagansantiago, CHTM, CRES, CBET, CW3, MS, chief of TAMC’s equipment management branch, sits down with 24×7 Magazine to discuss how the hospital’s location is both an advantage and a challenge from a device management perspective and how his team embodies “Ohana”—the Hawaiian word for “family.”

24×7 Magazine: What differentiates Tripler Army Medical Center’s clinical engineering team from other clinical engineering departments?

Ramon Pagansantiago: There are many differences between our “Ohana” and other clinical engineering departments. Some of our unique distinctions derive from a culturally mixed shop of military and civilian personnel permeated by the local Asian Pacific heritage. We have one goal and purpose: to be the gatekeepers of patient safety through medical device services for Tripler Army Medical Center (TAMC), supported clinics, and supported medical units.

Addressing the differences, I would also like to mention our location. Regardless of the weather, day or night TAMC’s location provides breathtaking views of the Pacific Ocean. Our tropical views don’t set us apart from other clinical engineering departments however; what sets us apart is the drive and resourcefulness of our staff to overcome the hurdles of supporting one of the largest Army medical treatment facilities, remotely located several thousands of miles away from the Mainland in the Pacific Rim.

Our efforts make it possible for TAMC to provide safe patient care in support of 264,000 local, active duty and retired military personnel, their families, and veteran beneficiaries. In addition, the referral population includes 171,000 military personnel, family members, veteran beneficiaries, residents of nine U.S.-affiliated jurisdictions (American Samoa, Guam, and the former trust territories), and forward-deployed forces in more than 40 countries throughout the Pacific.

Another distinction is our ability to support our customers within a 52,000-square-mile-footprint. Our shop has the responsibility to support the maintenance of more than 17,000 pieces of medical, dental, and veterinary equipment. We process an average of 35,000 work orders yearly while maintaining a 100% completion rate of scheduled services and Joint Commission Certification Standards.

The true reason for our uniqueness is our passion for our profession and our incomparable commitment to patient safety. We manage every piece of equipment as if the life of a loved one depends on it.

24×7: What are some of the biggest challenges TAMC’s clinical engineering team has faced in recent years and how has the department worked to overcome them?

Pagansantiago: In a phrase: location, location, location. Our remote location has posed one of our biggest challenges impacting the overall servicing of medical devices. For most, living in Hawaii seems like paradise. For us, isolation from the mainland and the time zone difference complicates the overall parts process and hinders some manufacturers’ abilities to provide immediate services for some medical devices.

Specifically, the time zone difference was a factor that made it difficult to communicate with vendors for technical assistance or parts information. To overcome this problem, we staggered our parts procurement technicians’ schedules to allow more available time to contact vendors on the U.S. East Coast. Our clinical engineers adjust their schedules, as needed, to meet the challenges as they arise. Consequently, we improved our lines of communication with manufacturers to ensure we received prompt responses to our service needs.

For our military personnel, serving in Hawaii is a privilege—but that blessing is time-sensitive. Our enjoyment of the warm environment of this international melting pot quickly comes to an end. Military personnel, on average, serve a tour duty of two to three years. In perspective, TAMC personnel relocate at a rate of about one-third of the staff each year, which complicates the clinical engineering department’s efforts to train staff on how to use equipment.

The length of tour for military personnel has been detrimental in maintaining trained and proficient military biomedical equipment technicians. The solution? An instituted training plan and enhanced training budget.

24×7: How does the clinical engineering team work with IT department members to promote device security and combat cyber threats?

Pagansantiago: We constantly corroborate with our IT department. After all, the clinical engineering field has evolved to the point that it is mandated to have a relationship with the IT department. And our relationship and drive from our biomedical equipment technicians has helped clinical engineering develop technicians with systems administrator credentials and training. In fact, our BMETs with systems administrator credentials manage most of the IT requirements for our medical equipment.

24×7: What would members of the clinical engineering team say are the greatest issues affecting the healthcare technology management community?

Pagansantiago: Again, cybersecurity. Cybersecurity threats and the increased dependency of medical devices to operate on a network environment require more involvement from biomedical equipment technicians. Fortunately, bridging the gap between the information technology department and the biomedical equipment department has proven to be a rough, but achievable, path.

Also, advancement of technology has outpaced training; sometimes, it feels like technology advancements and training are not going hand in hand. And receiving training on a new piece of equipment might take a while based on budgets.

Another issue that is affecting the HTM field is the increasing demands that are being placed on biomedical equipment technicians. Increasing workloads and a shortage of personnel are big problems for the field. As more people leave the field or retire, the amount of people entering the field has been scarce. So we need to promote our craft.

24×7:  How does Tripler Army Medical Center promote education/training among members of the clinical engineering team?

Pagansantiago: Training of personnel is one of the pillars of every shop. With fast-emerging technologies and the increased IT requirements, it was necessary to establish a robust training program. Our training program includes on-site manufacturer training, in-house training, study groups, and test preparation for professional certifications training, such as A+, Sec+, CBET, CRES, CLES, CHTM, and more.

Also, our proactive approach has proven to be one of the solutions to many of the hurdles we have faced. We encourage our technicians to pursue certifications and training—and consider their education as a value added to the team.