In the past, the job description of a hospital-based biomed or clinical engineer was very clear: Any patient equipment housed outside of the wall was in our care. There was little, if any, conflict with the computer people, the maintenance people, or anyone else.

Now, there is encroachment on every side, with other entities thinking they can understand and maintain medical devices better than we—the actual HTM professionals—can.

Because of networking and cybersecurity issues, the information technology department feels empowered to assume a “Big Brother” type role—not unlike the FBI or another federal security agency. Only activities that pass their scrutiny can be performed, and they insist on maintaining rigid control over all of their overriding policies and procedures.

Further, the Centers for Medicare & Medicaid Services (CMS) has exercised their power and unbelievable ignorance to completely undo more than 40 years of thoughtful, collaborative, responsible evolution in the development of preventive maintenance procedures and frequencies.

CMS, through a single memo, has caused the entire country to revert to an archaic system whereby the knowledgeable practitioners of our craft have virtually no flexibility in the maintenance of medical devices.

Moreover, since roughly the ’80s, some equipment manufacturers have discovered that they can make more money from service than from capital equipment sales, so many have embarked upon strategies to practically give away their equipment through deep discounts and tying agreements.

Once sold, they can readily recoup the lost capital through service contracts, consumables sales, proprietary parts sales, technical training, software upgrades, and a myriad of other ways. When combined with restrictions on service tools, parts sales, technical support, and penalties for not having a service contract in place, this situation can create substantial barriers to in-house success.

Moreover, independent service organizations (ISOs) are convincing administration that they can take care of our hospitals better and cheaper than we can, even though they do so by creating a profit for an outside corporate entity. This is supposedly through some “corporate leverage” and “economies of scale.”

I can understand the possibility of limited cost-savings when doing things that a small hospital could not afford to do solo, but delivering better quality than a hospital-based program? If this were really the case, then the previous program would have had some serious service delivery issues.

Then there is the retiring population. Thousands of experienced craftsmen and managers are leaving the field for the greener pastures of retirement. Combined with the lack of suitable replacements in the workforce, many hospitals are opting for service contracts or ISO maintenance, further gutting the profession—at least from the aspect of mature in-house programs.

Strategies for Success

When beset by all the challenges and threats from the entities mentioned above, what is an in-house program to do? Consider these four strategies.

  1. Figure out what is most important. Usually, this involves some aspect of “following the money.” So focus on doing just that. Let go of the unimportant stuff. And figure out who the important people are in your organization—and work extra hard to keep them happy.
  2. Train yourself, your staff, and your coworkers daily. Learn all you can about everything around you. Do the very best job you can in every dealing with your customers. And remember that your customers include not only clinical customers, but also administrative customers and other hospital customers, such as the other support departments with whom you regularly interact.
  3. Tell your story. Let people know about your successes—particularly those that involve saving money and helping patients.
  4. Lastly, if anyone is retiring in the near future, begin succession planning. Determine who is going to pick up the gauntlet when that important person leaves. Remember: A week before someone is due to retire is not the time to scramble to find his or her replacement.

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