It is no secret that the economic crisis has drastically affected biomedical/clinical engineering departments across the country. The 750-bed Long Beach Memorial Medical Center in Long Beach, Calif, for example, slashed operating budgets by 10% across the board. For the facility’s 11-member biomed team, this meant operating on a reduced budget of $760,000—and the hospital asked all departments to prepare an additional 5% reduction plan prior to the second half of the fiscal year.
Surviving such significant reductions in resources—and often in staff as well—is a heavy blow to any department. But there are ways to rise to the challenge.
“You soon find out that you can still operate efficiently if you reallocate, rehabilitate, and reconnect with what you have and own,” says David Stiles, CBET, biomedical engineering manager at Long Beach Memorial Medical Center.
More than a year into this crisis, clinical/biomedical engineering managers have had a chance to see firsthand what works to boost the bottom line under these stretched circumstances.
John Crissman, CBET, biomedical department manager at Beaumont Hospitals, Royal Oak, Mich, notes that because the economic downturn has directly impacted every department in the hospital, everyone is a lot more understanding when it takes longer to respond to a service call.
“We have a well-defined work order system that helps us prioritize, and that involves customer input,” he says. “This helps us assign the right priority and understand customer expectations. We’re all in the same boat here. We all survive together, or we all don’t.”
While there is no “one size fits all” solution to effectively cutting costs, here are 20 top strategies to consider for your department:
Maximize Staff Time
1. Flex your schedule. Consider staggering your work shifts to make sure you are fully staffed throughout the day. The biomedical department at Beaumont Hospitals—which was reduced from 22 to 18 full-time employees last year—has added a Saturday rotation and a “late-start” shift to the scheduling rotation. This shift begins after 11:30 am so that a full-time biomed tech is always available until 8 pm, when the on-call employee takes over. “It’s been really tough over the years to staff up for a true afternoon shift or a true midnight shift,” Crissman says. “The late-start shift and the Saturday shift rotate around, so that everybody gets a fair share to participate.”
2. Streamline your workload. Cutting out unnecessary steps can go a long way toward promoting staff efficiency. Glenn R. Perry, CBET, manager of clinical biomedical engineering at The Queen’s Medical Center in Honolulu, advises biomeds to take a second look at their preventive maintenance (PM) programs. “If you are trying to justify your current staff with an increasing load or reduced staff with the same load and you haven’t already reevaluated your PM program, you really need to review the National Fire Protection Agency code requirements, risk assignments, and failure history,” he says. “There is potential to reduce your busy work, prioritize, and refocus your manpower.”
3. Offer voluntary workweek reductions. Community Hospitals of Indianapolis has implemented voluntary workweek reductions throughout all departments. This allows employees to work less than 40 hours in a given a week without losing their benefits—which adds up to savings for the hospital without having to resort to furloughs or layoffs. Karen Waninger, CBET, director of clinical engineering for Community Hospitals of Indianapolis, notes that several staff members took advantage of this unpaid time off during the summer months. “It doesn’t change their full-time equivalent status, but they can literally work fewer than 40 hours any given week and choose to take that time off without pay and without using paid time off,” she says.
4. Expand your on-call rotation. Reducing overtime can be a key factor in boosting your bottom line. At Community Hospitals of Indianapolis, Waninger’s team has extended their shop hours and also trained more employees to handle on-call scenarios. “We have more people rotating through, which means less overtime for any one individual and less overtime for the department as a whole,” Waninger says. She estimates that these changes save the department about one 4-hour callback every week.
5. Consider third-party vendors for parts and replacements. Whether you need a part for repairs or replacements for patient leads or blood-pressure cables, don’t automatically turn to the original equipment manufacturer (OEM). Choosing a third-party vendor can be a cost-effective alternative without sacrificing the quality of the part. “A lot has changed from the early days of biomed, when there may have been some less-than-reliable parts providers,” Crissman says. “There are a lot of good ones out there now.”
6. Buy a discounted pool of parts. Some vendors offer significant discounts—between 15% and 20%—for parts bought in bulk at the beginning of the year. Because Waninger’s department repairs about 20 ultrasound transducers every year, they bought the ultrasound probes they would need all at once and received a 20% discount from the vendor. “We’re giving them a pool of money at the beginning of the year, and for that pool of money, we’re getting the value of that pool plus 20%,” Waninger says.
7. Recycle old devices. Stiles’ department has found ways to recycle many devices no longer suitable for use in its medical center by donating them or using a no-charge e-waste pickup. “One example was to include bulk lead acid and alkaline battery pickup alongside of electronic waste disposal services,” Stiles says. “That resulted in $16,000 annual savings compared to our previous system of waste packaging and shipping.”
8. Include third-party vendors in your repair strategy. Evaluate your module repairs to find out which ones are cost-effective to perform in-house and which ones a third-party service provider can perform. For example, if a job will take your team 4 hours to complete, but you can have it done by an outside service for the cost of 3 hours of your labor, you would likely choose the latter. This results in a better strategic decision that can help streamline your workload cost-effectively. “We’re doing more of that now than we ever did,” Crissman says. “It’s one more way that we can pick the best, most cost-effective solution.”
9. Hold vendors and OEMs to their warranties. Perry recommends holding vendors responsible for the warranty repairs and the planned maintenance expectations established at the time of purchase. Make sure to clarify these expectations prior to purchasing the equipment so that your department is not forced to cover for the vendor in a pinch. “If you are remote, ask before purchase what the response time will be before you are stuck in-between the vendor and the clinical user,” Perry says. “Make sure it is clear and in writing for the purchasing folks to use in the purchase agreement.”
10. Rethink your service strategies. Do regular risk-based analyses of biomedical equipment to determine which machines will benefit from regular service and which should be designated as “run to fail.” You may find that some machines that have been serviced for years are not actually benefiting from the service.
“We look at the history of the device,” Crissman says. “We look at its intended function, environmental factors, usage, stated maintenance needs, and consequences of failures. There’s a regular form and a process we put it through. And although we’ve been doing that for a lot of years, it’s just been intensified in its use.”
11. Eliminate extra steps. Taking another hard look at your procedures can sometimes turn up steps that are nice to have but not essential to the safety and effectiveness of the equipment. For example, Crissman’s team has cut back on the cleaning of equipment to free up time for more pressing tasks. “We have scrutinized all of our PM procedures to eliminate all the steps that don’t really add value to making sure the device is safe and effective,” Crissman says. “And all these things come together to shave some time off here and some time off there.”
12. Give your expert opinion. When discussing purchasing decisions, be able to provide input on the right fit for the clinical application. “For example, would less costly portable vital signs monitoring (VSM) work where the user is requesting hardwired bedside capability at all beds?” Perry says. “You could suggest the VSM option with just a couple of portable high-level monitors on roll-stands. You can also provide simple in-house service without contracting on VSMs where the standard bedside monitoring may require service contracting—a potential for big savings both in the initial purchase and future operational expenses.”
13. Take advantage of prepayment discounts. A number of vendors offer a discount to customers who pay up front for new equipment purchases. Waninger notes that a 2% discount on a total quote for a capital equipment purchase is a significant cost reduction—if the hospital can afford the initial cash outlay. “We work with our finance department to make sure that it isn’t going to impact the hospital’s cash flow in a negative way,” she says. “So, we’ve had some soft benefits of that as well, just in terms of efficiency between the two departments working together on behalf of the hospital.”
14. Evaluate the best service solution. During the purchasing planning, ask what the user plans to do postwarranty and evaluate the costs of using an in-house service with training versus purchasing a vendor contract. “Many users don’t see past the initial cost and either assume it’s your problem or they didn’t think about it,” Perry says. “You need to tactfully put on the brakes and explain to the user the need to evaluate the best service solution based on safety, risk, cost, and uptime requirements. Even if your best solution is to use the vendor, you have proved your department’s worth with sage advice.”
15. Negotiate well. Stiles notes that his department has worked to extend warranties on new equipment purchases, as well as to convince ISO support groups to reduce their charges by 15% or more. The department also went through a list of equipment contracts and required a commitment from vendors to reduce the cost of these contracts by 15% or risk cancellation and re-bidding. “Reevaluate relationships with your vendors,” Stiles says. “Ask them the difficult question of why charges for their services never seemed to drop along with your commitment to reduce costs. Shop around, and don’t be shy.”
16. Network with other biomedical professionals. Attend your local and regional professional conferences and take advantage of any opportunity to build relationships with other biomeds, vendors, and suppliers. Waninger notes that her department has been investing more time in these efforts over the past 2 years, and the results speak for themselves. “We’re seeing just excellent returns on the time that our guys have invested in participating,” she says. “We meet vendors that can repair cables that we didn’t know could be repaired, or that have a storage mechanism that attaches cables to the patient monitors. It’s just little things like that that we can pick up to help drive efficiencies in the clinical care areas.”
17. Be an educator. Giving clinical staff basic tips to follow regarding equipment care can not only make their experiences with the equipment easier, but it may also prevent a panicked phone call to your department down the road. It can also help you develop valuable partnerships within the hospital. “Educate clinical staff on the basics of equipment ownership and care,” Stiles says. “Perform rounds with the clinical groups and learn together where savings can be made.”
18. Expand your reach. Perry advises biomeds to promote visibility by going outside of the traditional roles for biomeds. “You should also explore participation in ‘non-bench-and-wrench’ roles,” he says. These areas might include project coordination, contract management, clinical and safety committee exposure, code/alarm/policy committee membership, or even just volunteering to assist with nursing in-servicing.
Find other articles on cost savings in the 24×7 archives.
19. Be a problem solver. Look for opportunities to help nursing managers and other staff head off problems before they arise—even if they are not directly related to biomedical equipment per se. For example, helping nursing managers set up a rack storage system for their patient leads could help reduce the number of lost, crumpled, or broken leads down the line. “Stay visible,” Crissman says. “Become known as a problem solver—and then make good on it.”
20. Be an advocate for the hospital. Stiles recommends promoting your department as advocates for patient safety and caretakers of medical equipment technology. “Be aware of the extreme financial pressures in running these complex medical environments, and promote yourselves as a group that can and will control the costs of medical technology ownership, both safely and efficiently,” he says.
Ann H. Carlson is a contributing writer for 24×7. For more information, contact .