Faced with outsourcing, the team at Eastern Maine Medical Center demonstrated its effectiveness and proved that in-house was the best solution
Creative. Dedicated. Inspired. If descriptive adjectives hung on the walls in the clinical engineering department at Eastern Maine Medical Center in Bangor, those three words would offer a glimpse into the department’s hard-working, team-focused approach.
To understand the impetus behind this department’s overhaul and ambition, it is helpful to jump back a few years to a period when the department faced a battle to outsource the group to a third-party service provider. Instead of getting down, the department stood up for itself. With strong support from senior management, the team banded together to demonstrate the department’s efficiency and effectiveness. By working together to find the most cost- efficient ways to handle clinical engineering duties, the department survived and now works toward a common goal to consistently capitalize on its strengths, stay motivated, and display its important role within a variety of settings.
For example, what happens when the hospital is on the verge of opening the doors to a new, million-dollar clinic, but at the last minute, someone notices that the stretchers do not fit through the door?
These small details happen a lot more than many realize, according to Robyn Frick, CCE, clinical engineering manager at the 411-bed hospital. “The department goes beyond in a lot of areas. In the case of the new clinic, the stretcher would not swing enough in the hallway to get in the door. Within a couple of weeks, we had to go back to the vendor, order the smaller stretchers, trade in the larger stretchers, and still open the clinic on schedule. This was possible due to good vendor relationships,” Frick says.
The bottom line in Eastern Maine Medical Center’s case is that an in-house clinical engineering department was the best solution not just for the one facility, but also for the six member hospitals within the system that are now reaping the benefits of a successfully revitalized department.
One Department, Seven Locations
It is certainly a juggling act, but Eastern Maine seems to have figured out the logistics of providing clinical engineering services to six other hospitals, all of which are part of the Eastern Maine Healthcare System. In a state as large and rural as Maine, Frick and his team deal with a host of issues, including distance and the accounting challenges of learning how to pay for cars and test equipment. Of the six hospitals, the farthest is 3.5 hours away while the closest is 40 minutes away.
“From microscopes to mammography, our department is fairly broad and unique. We service over 670 types of equipment. The clinical engineering department is the first contact for calls from the smaller hospitals, including preventive maintenance and repair,” Frick says.
“None of the hospitals are too demanding with their needs. In fact, many employees are willing to try troubleshooting over the phone first,” says John Chase, clinical engineering supervisor. “Some people are used to quick responses, while others do not call you right away. If you have never worked in a place with a clinical engineering department, you may not know to call in the problem immediately. Sometimes we think they should have called sooner, but overall it’s a very positive experience dealing with the hospitals and employees.”
According to the department, there is a tremendous up-front obligation to give the member hospitals the same level of service and support Eastern Maine Medical Center enjoys. As the department has started standardizing equipment and maintenance planning, the workload has become much easier.
“Don’t get me wrong; we still have a lot of work ahead of us. But we’re on the fast track now,” adds Ken Mitchell, the department’s CE. “This is a very exciting time for us because we are in a rebuilding mode. About one year ago I was hired on as clinical engineer with no clinical engineering background. After receiving my bachelor’s of science degree in electrical engineering technology, I spent 8 years as a manufacturing engineer for life-safety devices and 2 years as a field-service engineer for wireless communications. I’m looking at health care as the ‘final frontier.’ I feel that I have a unique perspective. I have tried to implement process-control techniques that are time-proven in manufacturing but somehow have only recently made it to health care,” he says.
Some of the strategies the department has used may also help other clinical engineering departments, and they suggest the following:
• Apply basic statistical-control methods. Gather real-world data from your computerized maintenance software or database. “Don’t just create fancy run charts! Identify, control, reduce, and improve. Control your process; do not let the process control you,” Mitchell says.
• Learn to use your software. Use a software program that will pull information from your database to create reports that analyze and control the variation within your organization to use for ongoing reference.
• Educate yourself beyond engineering and biomed. Learn business management to attack the bottom line. Calculate and control overhead, revenue, expense, return on investment, depreciation, the cost of capital, and cost-avoidance, according to the team.
• Benchmark your department. To remain an asset instead of a liability, justify your department’s value to the organization. “A third-party service group can—and will—replace you,” Mitchell says.
• Create a shared service group with other hospitals in your area. Leverage your buying power. Standardize your equipment, merge your contracts, and help each other to generate cost savings, new revenue streams, new opportunities, and perhaps new friends along the way.
• Begin building (or improving) a call center. Share your technology and ideas with other facility groups at your hospital. Many times, biomeds and IT/IS groups enjoy the latest trends in technology and maintenance planning while other equally important facility teams are left in the 20th century. Help others and foster good relationships, and you will be rewarded.
• Hold everyone accountable. Make all departments accountable for missing equipment.
• Learn from caregivers. If you can speak their language, you will gain their respect. “Really listen to caregivers. They’re the end-user of the equipment,” Mitchell says.
MedSun Shines In Maine
Eastern Maine Medical Center is also a participating MedSun hospital. MedSun, the Food and Drug Administration’s (FDA) pilot program, works closely with facilities to identify, understand, and share information about problems with the use of medical devices in hospitals, nursing homes, diagnostic facilities, etc.
Frick recounts one problem found with an ultrasonic cleaner at the hospital that led to a national device correction. “We hadn’t seen a new device fail an electrical safety check in quite some time,” he says. “The technician disassembled the device only to find there was no ground-wire tied to the ground pin, which the manufacturing company had not seen before.”
The team continued to follow up with the manufacturer until the situation was corrected. The manufacturer issued a returned material authorization form for the return of the equipment and sent out replacements.
Mitchell points out that MedSun gives the CE a tool to improve safety and patient care beyond the boundaries of their local hospital.
“While it is challenging to prove that a single MedSun report initiates a device recall, having an ear to the FDA not only helps initiate recalls, but countless field corrections, upgrades, safety notices, and manufacturing-process changes,” Mitchell says.
What If We Spend Money On Training And They Leave?
More proof positive that this department is on the fast track is in its successful on-the-job training program. The clinical engineering department’s attitude to that classic cliché about spending money on training was, “What if we don’t spend it and they stay?”
“Eastern Maine Medical Center offers world-class opportunity. Training not only improves the quality of care, but it will save your hospital hundreds of thousands of dollars per year,” Mitchell says. “Learn imaging, anesthesia, lasers, perfusion, balloon pumps, sterilizers, etc. Don’t be afraid to get into specialized areas. If you’re smart, you will negotiate factory training into your next equipment purchase or service contract.”
Accordingly, it is in the best interest of all clinical engineering departments to take the time to implement ongoing training. “They have no choice. If you haven’t been faced with an outsourcing initiative, you will. No one wants a third-party service group trying to fill your shoes,” Mitchell says.
Perhaps even more important than its energy and enthusiasm for ongoing education is its belief in recruiting the right people to the department in the first place.
“We can always train and develop technical skills. We are more interested in the person. If they have the right character, that’s what we want,” Frick says. “Only 20% of people typically will admit failure; I want those people. They have the humility necessary to work well with us.”
The department says the team—with more than 200 years of combined experience—is a walking encyclopedia of medical equipment.
“The diversity is unreal. We have folks who have been engineers, diesel and airplane mechanics, nurses, communication techs, Armed Forces personnel, teachers, construction gurus, electricians, you name it. Our department has a great reputation for cultivating CE/biomed techs. Most of the time they come from all walks of life but almost always have a technical background and 2 to 4 years of schooling under their belt,” Mitchell says.
Kudos for the Staff
The biomedical equipment technicians—Phil Andrews, Dan Brown, Jim Wyman, Steve Morin, Ted Parker, James Remeschatis, Jim Joslyn, Curt Wright, Nate Lane, Jerry McNeil, and Erik Michaud, along with volunteers Howard and Carol Glefke and administrative assistant Amanda Mandigo—deserve all the credit, according to Chase.
“I have 21 years of experience, and this is my first time working with a bigger organization. They are willing, at the drop of a hat, to help each other out, willing to jump into a vehicle to go to Presque Isle, which is 3 hours away. They are outstanding individuals. The teamwork is incredible, and I am taken back by that attitude. Everything I have asked them to do for cross-training, they have jumped right in. I feel like they don’t work for me; they work with me,” he says.
In fact, the department delivers personally written thank-you cards to the technicians.
“Just recently, we had two technicians who had to rewire the telemetry floor. It took 5 to 6 hours, so I wrote out two thank-you cards with a $5 meal ticket for the cafeteria,” Chase says.
This level of positive thinking is not entirely surprising, given that the administration engages in a hospitalwide “Splash or Ripple” award to honor unsung heroism—employees that go above and beyond their call of duty to help fellow colleagues or patients. What it comes down to, according to the clinical engineering department, is an overall sense of operational support.
“The administration department is really encouraging. They realize we do a lot of hard work. They trust us, our vision, and out outlook for the future. They are very supportive,” Chase says.
Elaine Rigoli is a contributing writer for 24×7.
