In a time of deep economic crisis, employers are reacting to budget shortfalls by cutting expenses, scaling back production, and restructuring and reevaluating their business philosophies. With little exception, the first expense bucket that employers evaluate is the labor pool. Unfortunately, as hospitals reformulate their organizations they are looking very closely at staffing of clinical engineering teams and expecting them to “do more with less,” or in some cases “do less with less.”
This analysis typically involves comparing technician performance to benchmarks such as device counts, bed counts, time utilization, and turnaround times. Although these may be necessary steps, we must be careful that we do not ignore the added value that this group of professionals can provide to the cost-savings efforts.
Technicians can keep old equipment going longer when capital budgets are tight. They can provide guidance on technology redeployment within an organization to avoid unnecessary purchases. They can help prioritize the replacement plan for aging equipment to maximize equipment useful life. They can negotiate service and training at the point of sale to realize savings. They can assess the implications of implementing the various options of a purchase to determine the lowest integration and installation costs.
Even though capital budgets are tight, or in some cases nonexistent, it is essential now more than ever that technology assessment and acquisition follow a carefully formulated process to avoid unnecessary expenditures and provide an accurate projection of the total cost of capital. Technology assessment is not just, “What is the price?” There are important factors that are often overlooked such as supply cost, quality, safety, integration, ease of use, and support structure. Clinical engineering is in an ideal position to lead a hospital’s technology assessment and acquisition program. They have the relationships with the clinical staff, the suppliers, and the hospital support services. They also possess the knowledge base to tackle the technical questions around service, support, and integration.
There are at least three reasons why hospitals may bypass clinical engineering in their technology acquisition process: There is no process, they want what they want, or they are uninformed of the value.
In a case where “there is no process,” decisions may be made by clinicians or administrators who may not take it upon themselves to do a full analysis of the purchase being considered. If a physician decides they want a specific device, the hospital may determine that clinical engineering involvement is a moot point. In reality, the questions of integration, installation, service support, and technical training all need to be addressed prior to the supplier even perceiving an imminent sale. This provides the hospital leverage in negotiating these added costs up front. The risk of not having a process in place is that not all the right people are involved in the discussion and roadblocks are not in place to prevent irrational decisions from being made. It should also be noted that having a process in place is a requirement of most accreditation bodies.
This leads us to the second point where, “they want what they want.” Whether there is a process or not, many times a clinical department will avoid any potential barriers for fear that their purchase may be delayed, altered, or simply found to be unjustified. In a hospital where this occurs regularly, it is likely that changing this practice will be not only a firm process change but also a difficult cultural change. All entities with a vested interest in the purchase, use, and support of the acquisition must be at the table.
In some cases the hospital is “uninformed of the value” of clinical engineering involvement. Hospitals need to stop looking at clinical engineering as a pool of labor whose sole purpose is to operate a repair depot with fast response and quick turnaround. This perception leads to poor decisions in tough economic times where hospitals are willing to sacrifice the efficiency of their service operations based on benchmarks rather than looking at the full value of the technical resource.
Technicians need to get involved, ask questions, and keep their finger on the pulse of their customers. Do not let your customers forget you are there to support them. Technicians need to market themselves and constantly remind their customers of their expertise and experience. Establish a rounding plan, sit in on clinical procedures, and keep the lines of communication wide open.
Technicians need to invest in themselves so that they continue to add skills and credibility to their toolbox. A common opinion of obtaining certifications (such as CBET) or continuing academic studies is, “It’s not going to increase my ability to fix this stuff.” This narrow perception feeds the model of clinical engineering as a repair depot and ignores the need for technicians to develop not only their technical abilities, but also their clinical understanding, business acumen, and critical thinking skills to drive the hospital’s technology assessment and acquisition process to a whole new dimension. With the advent of network-focused technologies like PACS, EMR, and remote access, additional training and network certifications are becoming unavoidable.
A formal technology assessment and acquisition program is necessary to ensure that standards of care are being met through fiscally responsible and technically informed decisions. If your hospital is not there yet, help them open the doors for clinical engineering leadership in this essential and critical process. Develop a marketing plan! If your hospital is already there, remember the path to continuous quality improvement never ends.
Matt Dummert, MS, BSEE, is an imaging modality specialist with Universal Hospital Services, Edina, Minn. For more information, contact .
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