There is little argument that computers and technology have been instrumental in changing the way biomeds work. Those influences may now also mirror the way biomeds work: Like computer networks, biomedical equipment technicians (BMETs) and clinical engineers (CEs) are at the core of a hospital, with the ability to reach virtually every part of the organization.

But potential does not always equate to action and, in many facilities, biomed shops are still relegated to the basement and thought of only when things go wrong.

“If you ask people to rank the importance of their refrigerator repair guy in their life, he won’t even make the top five,” says Ken Maddock, corporate director of biomedical technology services, Baylor Health Care System, Dallas. “But if you ask them to consider his importance to them after they’ve just bought a side of beef and the freezer goes out, suddenly he’s at the top of the list. I use the analogy to illustrate where a lot of biomed departments are today: It’s not that people don’t like us, but no one thinks of us until they need us. We need to help people understand that while sometimes we are just the repair guy, we also need to be telling you what refrigerator to buy, if it will work in your house, and how to use it effectively.”

This delineation is becoming increasingly important in a field that is changing rapidly; whether or not BMETs and CEs can contribute to the hospital of the future is not a question. Any biomed working today is aware of the high level of technical know-how and experience required just to survive in the field, let alone excel. The challenge, then, is in letting everyone else know those skills exist and exactly how they can translate to other, less-traditional roles for biomeds.

“I think biomed techs need to learn to toot their own horns more,” says Bryanne M. Patail, BS, MLS, FACCE, biomedical engineer at the US Department of Veterans Affairs, National Center for Patient Safety, Ann Arbor, Mich. “We need to let people know that we exist and that we have the knowledge base and the experience to solve problems, that we have the skills to troubleshoot things, that we can do root cause analysis, and we can contribute to patient safety teams when investigating adverse events. There is a saying that hospitals are not well engineered. Well, here’s a resource group that knows about engineering and technology, and they should be utilized to their fullest extent.”

Maddock agrees. “I’m not sure it’s as much tools as it is an attitude,” he says. “In most organizations, we are really small and often we are not considered important. So, we can continue on the path we’re on now, or we can be realistic about where we are. We have to understand that if we offer more to the organization, we are going to have more value to them and, even though we are few in numbers, we are going to be seen as critically important to its operation.”

Getting Outside the Comfort Zone

Biomeds are, and probably always will be, expected to repair and maintain equipment. But, it is becoming increasingly important for those in the field to spread their wings a bit and get involved in other areas of the hospital, even if that means going outside of established areas of expertise.

“It is challenging to do new things now and then, instead of just staying in the same routine, but it is kind of fun too,” says Glenn Scales, CBET, patient safety specialist for the Duke University Health System’s, Durham, NC, department of clinical engineering. He should know: his department was heavily involved in an overhaul of the hospital’s dialysis unit. “Water treatment systems in dialysis clinics are very heavily regulated, and when surveyors noted that the technology we were using for the water purification was out of date, clinical engineering got involved.”

In addition to their traditional roles—evaluating the system in its entirety and assessing vendors—Scales’ team was asked to develop the specifications for a new system, assist with its procurement, and help develop a set of specifications that they could use when soliciting bids. They also put together use protocols and training programs to ensure clinicians and lab staff were adhering to regulations.

“Up to that point, we hadn’t been involved in that pathology before,” he says. “It was sprung on us unexpectedly, so we just had to step up and learn something new. We got involved in a variety of elements in the dialysis process that completely changed how they complied with the Association for the Advancement of Medical Instrumentation standards and, as a result of the clinical practices we put into place, the dialysis department was able to pass their next survey without any problems.”

The BMETs and CEs who established these new processes also changed the perspective of the entire hospital—from the ground up. “It became pretty apparent throughout the medical center, including to the senior administration, that we had done something completely outside of our normal scope; we had provided a level of assistance that essentially kept us from being shut down,” Scales says, who now sits on the dialysis quality improvement committee. “I think the better a reputation you have and the more widespread your reputation is, the more likely you are to be asked to participate in things you wouldn’t otherwise do. If you do a good deed and the word spreads, soon other people are getting you involved in the next generation of the technology.”

Achieving this type of increased, positive visibility is also one way for technicians to enhance their value within an organization and to guarantee their spot in its future, although Maddock suggests that working to become well known throughout a hospital is not a goal in and of itself.

“Your goal isn’t increased visibility or even just being valuable to your organization,” he says. “You have to have a deeper goal than that. If you are not in this because you want to make your organization better at taking care of people, then you should look for another job. We have to minimize the number of people in the field who are in it just because they’re good with their hands. We need to bring people in who care and want to make it better. Our goal should be contributing to making health care better. As long as we’re doing that, everything else will follow.”

Maddock stresses that increased visibility is simply the outcome of a job done well. “What comes with increased visibility and increased respect is more resources, more recognition, and the ability to be more successful in helping make health care better,” he adds. “You can’t get that by itself; it has to come because of the good things you are doing.”

Beyond the Shop

Once in the spotlight, CEs and BMETs can pour their unique set of skills and experiences into clinical situations, decisions, and processes. At the most basic level, biomeds need to be involved in the selection and purchasing process for new equipment.

“If you don’t get involved in the initial acquisition phases of technology, you will not be able to have any leverage in making sure they are safe and that they are repaired in a timely manner,” Patail says. “You will not be able to negotiate for parts and training, either, so the organization has to have a total commitment to involving the techs in the process from beginning to end. You cannot just expect them to take care of one small part.”

While many hospitals have made it a requirement for biomeds to get looped into new equipment acquisitions early, it is not the case universally. Still, once techs are brought into the process, it opens other doors. Because of their analytical approach to problems, CEs and BMETs are often most effective in identifying new equipment that would be beneficial to the facility.

“More importantly, we can help them vet new technologies,” Maddock says. “There are so many technologies out there, we help them figure out which one holds the most value. We only offer a piece of that puzzle, and that’s understood, but it allows you the opportunity to develop a relationship with the business development department, with the safety department, with supply chains—you’re part of the team responsible for bringing the right new equipment into the organization.”

In addition to using their technical knowledge to find the best equipment, biomeds possess a specialized combination of talents that generates unique insight when troubleshooting problem situations in the facility. About 5 years ago, Scales was recruited as part of a failure modes and effects analysis (FMEA) task force focusing on how psychiatric patients were managed in the emergency department (ED).

“At first I thought it must be a mistake,” he recalls with a laugh. The first meeting was attended by a number of clinicians, from the ED physicians to psychiatrists, along with the accreditation team. The director of the FMEA group then explained Scales’ involvement was because he could not only address the issue with a clean slate, but that he came from a background that employs logical analysis and problem solving. “Our day-to-day jobs are solving problems and fixing things, but because I’m an engineer, I look at things from a perspective of how things fail and how things break and how things go wrong,” Scales says. “Engineers tend to look at problem solving in a slightly different way than clinicians do. My viewpoint is a lot different, but it complements the rest of the team.”

Another example of how this type of analytical thinking can help determine the most appropriate workflow for a department or an organization: techs can help ensure that the proper equipment is in place and that it is being used fully.

“If you have workflow that uses medical technology, there is no one better to sit in a meeting with clinicians and help them understand if they are getting the maximum capability out of their equipment, if they are using it the right way, and if it is fitting into their processes appropriately than someone who understands the technology just as well as they understand the clinical side of the business,” Maddock says. “The clinicians are going to understand the technology to an extent, but it is just a tool for them. They may not be fully utilizing the capabilities, simply because they do not know all the different things it can do.”

Focus on Function

Striking that balance between the technical and clinical is a vital component of a tech’s career. Or at least it should be.

“I don’t think we train [new techs] enough to be comfortable in working side-by-side with clinicians and speaking their language, so they are kind of shy [in those situations]. As a result, they like to be in their own shops,” Patail says, who believes curriculum and training for biomed techs needs to be reevaluated so that it includes more of the clinical aspect.

In addition to working alongside clinicians, it is just as important for techs to understand the fundamentals associated with how medical devices are actually applied in the clinical setting.

“One of the things I have seen lacking in a lot of the students coming out of school is that they know how to repair a piece of equipment, but they don’t really know how it’s used,” Scales says. He notes that while they may be very competent technicians, many new biomeds are unskilled at, for example, helping a nurse understand why an infusion pump did not deliver accurately in that particular setting. “If the device is sitting on the bench, they can follow the technical aspect, but learning how that equipment is actually used clinically and how it interacts with other medical devices is a skill set that is difficult to give to people and, because of the time constraints, the schools don’t really have the ability to do that.”

Much of the time that was allotted to anatomy and physiology in previous years is now being consumed with details about technology and how devices interface with the hospital network. Both are undeniably critical skills, but many believe it is being taught at the expense of the patient care aspect of the job.

“I’m not minimizing the importance of learning the technology, but what sets us apart from an IS field support tech is that we understand the clinical side of the business,” Maddock says. “The whole idea of the biomed tech is that we understand the application of medical technology to the human body and the way the equipment and patient interact. Having this type of knowledge provides us with an opportunity to show that we are part of their clinical team.”

An awareness of how equipment is employed in practice can also impact how a tech approaches a repair and diagnoses a problem with equipment. Certainly things break; but, in many cases a device is functioning properly yet still is not operating at the bedside or is not performing as a clinician expects it to.

“You have to know how all of it fits together,” Scales says. “Take an infusion pump as an example. It’s not just a matter of verifying that it’s working correctly; you have to understand that it’s used in an environment comprised of additional pumps, IV tubing, catheters, filters, and a variety of other accessories that all have an effect on how it performs. You have to understand how the accessories are supposed to work together and the difference between how a device functions alone as compared to how it functions as a group.”

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The Bright Side

As with anything, no one can say exactly what the future holds. “The biggest thing I think we have to understand is that our goal is not to make biomedical engineering successful, but to make health care successful,” Maddock says. “There may be no biomed department in 20 years and that’s fine, because it doesn’t mean that we’re going away; it means that we have evolved into something bigger and better and more critical to the organization. Does that mean that we are going to have to become part of IS? How about the risk management department? I can’t say exactly which way it’s going to go, but we are going to change and grow in different ways. We are going to evolve.”

Dana Hinesly is a contributing writer for 24×7. For more information, contact .