Editor’s noteThe opinions expressed in this article are solely those of the author and do not necessarily reflect the views of 24×7 Magazine.

I had a realization when I was in my 20s. Yes, that was 40 years ago, but my realization is as true today as it was in 1979. Here it goes: Workers change when they reach about age 45. Before that, they are risk-takers, and their main focus is sharpening their craft and doing the very best job they can for both themselves and their employers.

But as they reach 45 or 50, their focus and priorities tend to change. Once they have retirement in sight, their main criteria for decision-making changes from doing the best job possible to merely surviving until retirement. They quit rocking the boat, taking chances, and pressing to do the right thing, regardless of the consequences. Not getting fired or demoted seems to be the main priority.

When I was under 45, I saw this in the managers and workers around me. As I approached 45, I kept closely examining myself to make sure that I was not adopting this trait. As I have long passed 45, I still look around today and find that my observations from 40 years ago seem to hold quite true today: Workers over 45 tend to make decisions which are designed to preserve their station in life, rather than trying to do the very best job that they can—or even the right thing, in many cases.

Reluctance to Take on New Technologies

One example is not reaching out to aggressively attack new technologies when an expensive service agreement could be eliminated simply by receiving a little training. I saw this in the ’70s when the first lasers appeared in surgery.

Many older managers simply declared them “too complex” and the risk “too great.” So they signed service contracts for their lasers, having convinced administration that the high costs were justified because of the extreme complexity and high cost of parts. And this scenario has been repeated with anesthesia, diagnostic imaging, microscopes, and laboratory equipment.

Younger and more risk-tolerant BMETs eagerly attacked these new technologies and proved them to be no more risky (either cost or incident risk) than anything else in the hospital. But the older, “wiser,” and less risk-accepting BMETs decided to preserve their pensions by convincing administration to sign contracts.

Today, this is seen with CT, MRI, cath labs, ultrasound, anesthesia, ventilators, laboratory analyzers, and many other medical devices. I’d bet that if a survey were taken, there would be a startling correlation between the number of service contracts in a hospital and the age of the manager. I’ve witnessed many older managers who let contracts creep up in quantity by avoiding newer technologies and, instead, focusing on service of older, established, and low-risk devices.

Facing the Person in the Mirror

Are you over 45? Would you dare calculate your in-house service ratio? This is simply the value of the medical equipment that you maintain with in-house labor divided by the total value of your medical equipment. This yields a number from zero to 100. The lowest—0%—reflects that none of your medical equipment is maintained in-house; instead, everything is outsourced. The highest possible number—100%—means that everything is maintained in-house and that you never use outside labor.

From a cost and efficiency perspective, the higher the number, the better. Note: Every in-house HTM department should have an in-house service ratio of 70% to 90%. If your ratio is less than this, my guess is that you’re probably over 45 years of age and have your sights firmly set on retirement. In fact, I propose that you are already partially retired.

HTM managers are hired to reduce costs, aggressively attack new technologies, and reduce service contracts—not to simply be contract managers. After all, anybody can oversee a bunch of contracts. HTM is charged with eliminating contracts and making sure that the few remaining ones are necessary and well-priced. HTM professionals are also tasked with ensuring that the contracted services are delivered as promised.

If you are not doing this, you might as well change your title to “contract manager.” Otherwise, you’ll embarrass real HTM managers.

Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE, is a biomedical manager with 40 years’ experience.