If your clinical engineering department is involved in the first discussions about all-new equipment purchases in your hospital, consider yourselves fortunate. If it is a given that you are the primary resource for equipment planning, then congratulate your department and thank your boss; you have succeeded in cutting through the political quagmire of hospital red tape. For the rest of you still striving to reach this pinnacle, you will likely need to hone your efforts on developing strong interpersonal communications in unchartered departments and sharpen up your office skills to stockpile weapons for your planned offensive. For those who succeed, you will not only assure yourselves a good seat at future equipment-planning sessions, but you may even find yourselves leading the discussion.
Basic assumptions about who will lead equipment-planning teams at your facility may be increasingly challenging, depending on where you work, who you work for, how long they have worked there, and on distinctions between the IT and clinical engineering territories. While it is our long-standing expertise in the clinical device arena that has most often been leveraged for early opinions, this will be a fleeting memory if we are no longer viewed as the long-term support provider postinstallation. If recent equipment-planning sessions in my hospital are similar to yours, you can no longer safely assume that your seat is guaranteed because of prior involvement in some departments. Our recent planning for a new Philips OB TraceVue system immediately comes to mind.
It is safe to assume that IT leads most clinical engineering departments in its role as project managers, and while many of us stand to learn much from this model, the time to act is now. Not that some large-scale biomedical implementations have not used this approach over the years, it just was not part of our mantra. There are not many biomed shops that hold meetings and discuss every angle of a project 10 times before implementation. So, before all of you IT/biomed hybrids get your hard drives revved up by this last fact, turn down your sound cards for a second. There are good reasons for all of these meetings, and I am actually trying to defend the practice. While most clinical engineering departments have only recently adopted these skills and narrowed the gap with recent acquisitions, it is apparent that IT will continue to receive a much-deserved automatic invitation on almost all future clinical projects, while clinical engineering may not necessarily register foremost on administrative leaders’ minds. It is, therefore, our greatest need to get on that bus now if we expect to find a seat in the next equipment-planning process.
Developing our project management skills is predicated on understanding a variety of IT applications, but earning a permanent seat at the planning table relies upon our ability to maintain strong relationships with the right people, demonstrate our expertise on IT systems and products, and on our communications with key personnel throughout the implementation process. And that is only part of the equation.
To stress one very important, albeit nontechnical point, clinical engineering directors must identify those key leadership roles within their organizations that need to know our intrinsic value in order to retain a leadership position on the equipment evaluation team. What exactly is our intrinsic value? Ask yourself one question: What is your knowledge of every clinical device in their departments compared to their knowledge? You probably know their devices better than anyone else—including them.
Anyone who has worked in hospitals longer than 5 years should realize that leadership roll-calls change at least as often as this for most high-profile positions. Furthermore, any newcomer’s perceived expectations between IT and clinical engineering can be vastly different depending on their last tour of duty. We do not see this type of migration in biomed, and while I am not sure why this is the “ca$e,” ahem, it is our responsibility as clinical engineering professionals to inform them at every turn why they need us to manage their devices from cradle to grave. Pound your chest if you have to, but make the message clear that clinical engineering provides comprehensive solutions for all of the clinical applications in their area, and we will produce results on problems before they are even made aware that they exist.
Before a purchase ever gets to an administrative level, it is the upper-level directors and managers who take the first steps and therefore play a pivotal role in the equipment-selection process. Directors and business managers in cardiology, radiology, surgical services, and even purchasing all serve “pseudo-administrative roles” by virtue of their high-profile responsibilities. Having a regular dialogue with them affords us the opportunity to peck their thoughts for what is new on the horizon and to demonstrate everything else we know. Arrange to meet with these department heads on a monthly basis, and plan an effective agenda when you sit down. These meetings should focus on service and planning. Also, dig for feedback on what is working well, what is not working, and where there might be opportunities for growth. Additionally, collaborative meetings with chief information officers (CIOs) are no longer a nicety but a must. We simply cannot expect to install any device of even marginal clinical impact without some collaboration with IT. These meetings should be proactive and used to discuss projected acquisitions, current installations, and anything else we know about shared “clinical” systems—even those currently not slated for replacement. The takeaways are invaluable in terms of choosing point people for future system evaluations on projects involving clinical/patient care applications.
Clinical engineering directors also need to carve out time for simple meet and greets with sales representatives, ensuring that they come to us first when they have a product to sell. Do not discount how vital it is that the sales reps come to us before unit managers or IT. It may take away time from other things, but this is a key component to selecting those devices that will make the biggest impact in the capital cycle. Department directors should count on clinical engineering to guide them in making the right choice for their areas. If we know the products and the sales managers, then we can help to steer them toward departments where there is a strong clinical need, rather than leave those directors to formulate isolated opinions about whom, what, and where.
I have been to hospital biomed shops where the techs did an about-face when I walked in because they thought I was “just another sales rep.” We want salespeople to call on our department, and we all need to introduce ourselves and get to know them. That is where our business starts, and we all need to understand that. Our facility might not need a device today or tomorrow, but eventually we are going to need it, and knowing where to go and who to call ensures early involvement in the selection process. Sales reps also think of “service sales” too, and that should translate into training schools in the long run.
Another way to ensure early involvement in the equipment-planning process is to round interdepartmentally with front-line staff to learn about the equipment they are using. We should already know where the expensive repairs are starting to occur, but we should also have knowledge of whether or not the staff is satisfied with their current devices. The staff may work at more than one site, and they are keenly aware of what else is out there from a technological perspective. It is our biomeds who have the most opportunity to round with other staff to discuss those differences and advantages of other manufacturers, and they can provide that feedback to clinical engineering leadership. It is always a good idea to know if the staff is satisfied with equipment, and it is a good point of reference to use with their unit managers because sometimes their own staff members withhold information about devices they are using for a variety of personal and/or professional reasons.
Another great exercise for honing your planning skills is regular attendance at local biomed societies. The New England Society of Clinical Engineering (NESCE) is just such a place that we utilize for that. NESCE’s quarterly meetings are successful because of the committed roles that our officers and members display. The topics are relevant, the guest speakers are varied, and the meetings are consistently well-attended. Professional committees go a long way in keeping biomeds and directors informed, which also ensures that we stay plugged into relevant topics. Still, it will never achieve its full potential unless others at your facility share this experience. Use your professional society meetings as an opportunity to invite other department managers and administrators, because they will see firsthand how committed we are to increasing our exposure throughout the organization. They may not come to the event, but at least we can show them that we care about our field beyond the walls of our own site. A little effort up front goes a long way to drive home this point.
Last but not least, it is our relationship with administration that leads to a full complement of planning tools. Whether the chief operating officer (COO), chief financial officer (CFO), chief medical officer (CMO), or the nursing VP is steering a major equipment acquisition involving an outpatient care site, we want them to call us when the discussion turns to capital equipment. At the very least, outpatient settings with purchasing decisions always require some advance form of leadership authorization before approving any capital outlay. This implies that you need to get in their office any way you can and show them that you know what you are talking about and will be prepared when that day arrives. Learn what they want, where they want it, and how much they need. Acquaint yourself with all of the key players: directors, physicians, and local officials (if applicable).
Get the salespeople with whom you have developed a rapport on board, and immediately start developing a matrix that you can use to compare models, systems, training, and education. Do not make the mistake of considering only clinical engineering’s needs, but rather use this as an opportunity to demonstrate how the overall selection will benefit patients, community, departments, nursing, end users, and the facility as a whole. Take the lead, and use whatever resources you can find to illustrate these points. Work with your purchasing director to leverage services from your group purchasing organization, as they most likely already have comparative models on the manufacturers involved. Use your time and office skills to pinpoint variations between each vendor, especially when large systems involving hardware and software options, training, education, and travel are all part of the selection process.
Lastly, to be effective in the life cycle of equipment acquisitions also means that you understand the long-term strategic plan at your facility so that you can plan for end of life devices in each area. There is no better way to get a great seat at the table than to know when the table is getting set. You should share life cycle information regularly with finance, your CFO, CIO, and all of your unit managers because they are the leaders who will ask you first when the opportunity to purchase a new device next presents itself.
Ted Barbeau is the director of clinical engineering at Saint Mary’s Hospital, Waterbury, Conn. For more information, contact .
Making Rounds with a Purpose
Making the rounds and interacting with other departments represents a way to connect with other colleagues, get in the loop about potential purchases, find out about potential device issues, and learn what clinicians think about the equipment they are using and also thinking of buying. An important practice for both clinical engineering directors and staff to develop, the checklist below will help get you started.
Clinical Engineering Director
1) Departmental Rounding
- What is working well in our department?
- What is working well in other departments?
- Are there any processes that need improvement in our department (opportunities)?
- Are there any processes that need improvement in other departments (opportunities)?
- What equipment failures are the most time-consuming/repeat failures?
- What tools do you need?
2) Coach for expected behaviors and outcomes.
3) Interdepartmental rounding with a purpose.
- Plan a productive agenda, and stick to it. This is not about having a quick cup of coffee with someone.
- Meet monthly with directors/business managers in cardiology, radiology, surgical services, and purchasing.
- Meet quarterly with the COO, VP of nursing, VP of surgical, CIO, and finance.
4) Make time to meet with sales representatives—make it proactive. Do not wait for them to schedule a meeting.
Clinical Engineering Staff
- Meet weekly with the frontline staff.
- Ask: What do you dislike about the equipment you are using?
- Ask: What other devices have you used elsewhere that you like more, and why?