By Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE
Since HTM, or biomed, teams came on the scene in the ’60s, we’ve traditionally reported to the facilities engineering department. Most departments grew into separate departments, however, reporting directly to administration, materials management, or even nursing. But now more and more HTM departments are being housed under the umbrella that is information technology, or IT.
HTM managers often ask me what to expect from this transition and how to prepare their department—and themselves—for such a change.
Below is a list of changes and differences that you may experience. (Note: I am speaking is generalities. If you do experience these changes, they may be more minor or major than indicated.) Also, you should have a trained professional evaluate your individual situation to help you prepare your transition plan.
The first thing you might notice is that all service calls are routed to a central desk for logging and prioritization. Individual BMETs are no longer allowed to take calls directly from the nurses in the departments. This is based on the belief that control is the mother of efficiency. Allowing individual technicians to receive and close service requests without any administrative intervention undermines the IT department in several ways:
- It does not guarantee that all work orders will be captured in the computerized maintenance management system, making work documentation less than 100%.
- Important work is often overlooked or delayed in favor of BMETs doing work for friends and/or favored departments.
- If workers can manage themselves, why is management needed?
Unfortunately, the Help Desk and its 20-questions approach to call logging and inability to respond to immediate needs often (always?) causes more problems than it solves. Clinical users have long depended upon directly contacting BMETs and getting an immediate response, without having to answer any questions. With the Help Desk, this is long gone, as anyone who has ever had to call the manufacturer for computer help can attest.
Relations with Clinical Staff
Since HTM is a partnership with clinical users, we must spend a certain amount of time in the clinical setting. There, we can learn new equipment operation, patient setup (just like the users learn it), and observe how the equipment works during actual patient cases. After all, being familiar with the correct and proper operation of equipment is the only way we can respond to issues that arise in a patient setting. Most IT departments, however, view this approach as wasteful and unproductive.
Their focus is on completing work orders—read: the things they can charge somebody for. Attending in-services and remaining close partners with the clinical users is frowned upon.
HTM professionals are well known for the extra work that we do for everyone in the hospital. Whether tightening the screw in a surgeon’s eyeglasses or lifting a heavy box for a nurse, we always go above and beyond. We are the ones who get the calls that begin with: “I know you don’t normally do this, but…” We are the “go-to” people.
People know that we can—and will—do whatever it takes to help, even if it isn’t in our traditional scope of service. This, however, won’t fly if we report to IT. Under the IT umbrella, if something isn’t covered under a service level agreement—which spells out exactly what we will do for each customer—then it isn’t something we are going to do. Hospital staffers will have to find someone else.
The IT department, in the quest to streamline processes and lower costs, may decide that a centralized HTM budget is ineffective. After all, if HTM pays for all parts and labor, what incentive do the individual departments have to treat their equipment nicely and reduce abuse? Note: There is no evidence that this is the case.
So, they may break up the great, centralized HTM budget and parcel all that money back into the individual cost centers. This reduces HTM’s control over service vendors, purchasing vendors, and even the ability to repair equipment.
It also affects HTM’s ability to stock commonly used parts since there is no budget to build a stock supply. It likely even increases the hospital’s costs; rather than having the HTM department make large purchases for the entire hospital, each department makes smaller purchases—thus increasing the amount of purchase orders.
Cost of Service Ratio
Cost of service ratio, or COSR, is the main metric by which we measure efficiency, compare departments, and monitor our effectiveness over time. Even though our inventories change—as do our staffing and service delivery models—COSR is a constant metric that remains true.
COSR requires only two numbers to calculate—the cost of your medical equipment and how much it costs to maintain the equipment for one year. If the budget is broken up, however, it is virtually impossible to measure COSR—and the hospital loses the only metric worth measuring for HTM.
In summary, the changes above are probably inevitable. Not that all changes are bad, however. With change comes opportunities for growth, expanded responsibilities, additional visibility, and new horizons. Still, we must educate our new bosses about how our existing culture makes us valuable to the hospital.
We cannot become another clone of the IT department. We need to retain our responsiveness to emergencies, closeness to the patients and clinical users, and understanding of healthcare delivery—right down to the knife cutting the flesh and the x-ray penetrating the skin. In other words, we have to remain biomed.
Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE, is a biomedical manager with 40 years’ experience. Questions and comments can be directed to 24×7 Magazine editor Keri Forsythe-Stephens at [email protected]