Creating an in-house clinical engineering program may be more difficult than you think.

Say your hospital has decided to create an in-house clinical engineering department. Management looks for someone to head the project and assigns the job to the maintenance manager or plant operations manager, who seem to have the closest job responsibilities to a clinical engineer. Now, all that project manager has to do is hire some biomeds and an imaging technician, and the hospital has a clinical engineering department, right? Oh, if only it were that easy.

“We have seen so many hospitals create a pretty business plan that outlines why they should create an in-house clinical engineering department, but they have no idea how complicated actually implementing the program can be,” says Joe Hatleli, director of SSM Clinical Engineering Service (CES), St Louis. “What looks good on paper is often totally impractical in practice, especially if the plan is created by someone with no experience in clinical engineering. The project implodes as soon as the first radiology director runs to management saying there is no way they are going to cancel their full-service contracts.”

In his 30 years in the clinical engineering field, Hatleli has seen many hospitals’ plans to establish an in-house department fizzle within the first year of implementation. Hatleli heads up CES, a department of SSM Health Care, an integrated delivery network of 20 acute care hospitals in Missouri, Illinois, Oklahoma, and Wisconsin. In 1994, SSM decided to create a Capital Asset Management System and combine the biomedical shops of their five hospitals in the St Louis region under one corporate department—SSM CES. The biomed staff at each site went from being hospital employees to being SSM corporate employees. Then, imaging and anesthesia technicians were hired to start taking over the maintenance of equipment under full-service contracts. “This was a huge undertaking, and the department is still evolving” Hatleli says. “We learned a lot about what to do and what not to do in that process.”

CES has grown to 10 regional SSM-owned facilities. “Our program has been successful because we have good people who are veterans in this field, and because our management understood that a successful program would take years to implement,” Hatleli says.

Do Your Homework
Hatleli warns hospitals that are considering creating or expanding their clinical engineering program to do their homework up front. “Before you even start hiring BMETs and imaging specialists, you better have a thorough business plan created by someone in the clinical engineering field,” he says. “Only years of experience in the field will give you the knowledge to intuitively identify what equipment can best be maintained by in-house staff and what equipment is better left to the OEMs under full-service contract, or shared agreements or maintenance insurance.”

In the planning stage, Hatleli suggests researching and analyzing the following issues:

  • How much is the hospital spending on total clinical equipment maintenance, and what is the ratio of these costs? This includes service contracts, noncontract vendor labor, parts, and in-house salaries and expenses. If the hospital does not have a general ledger number earmarked just for clinical equipment maintenance, this information can be difficult to gather.
  • What equipment is currently under contract or maintenance insurance that can be maintained by in-house staff? How many staff members will you need to hire, or can existing staff handle the additional responsibilities? Will you hire experienced technicians, or will training be required for existing staff? If so, how much are the training costs (an MRI school can be as high as $35,000)? Consider economies of scale as well. If the hospital has only one CT, the cost of hiring and training staff may not justify the savings, but if it has two or more of the same model, training costs may be justified.
  • What contracts can be renegotiated as shared agreements or put under maintenance insurance? Again training and salary costs need to be factored in.
  • After determining staffing and training needs, what are the start-up costs of the program, including computers, test equipment, salaries, benefits, furniture, and maintenance software? What are the 5-year annual and accumulated savings? Do the savings justify the added risk of an in-house program?
  • What will the organization of the department look like?
  • What accounting practices will be set up to accurately budget and track clinical equipment maintenance costs? Will the clinical departments be billed per service call or will clinical engineering be an allocated cost?

Once the business plan is completed, it’s time to get management’s buy-in. “Make your presentation to the president, CFO, and COO to get their blessings to proceed before meeting with the department directors,” Hatleli says. “This is where some political savvy is needed. Many times, the clinical directors, especially in radiology and lab, have the attitude that nobody other than the manufacturer is qualified to work on their equipment. They also may have built relationships over the years with their vendors and feel a sense of loyalty toward them. They need to be approached with, ‘This is what upper management wants to do.’ ”

Attaining buy-in of the program is a crucial part of the process because opponents can derail the plan at any point without upper management’s support. At this step, you also must make management and customers understand that creating a successful in-house program will take several years and that the financial and service improvements are not instantaneous. If management expects significant savings after the first year, they will view the program as a failure when those savings are not realized.

Implementation Phase
Once the business plan is created and you have the “thumbs up” to implement the program, challenges may still arise. “No matter how great your plan is, you can’t plan for everything, and adjustments and compromises will need to be made,” Hatleli warns. “The clinical equipment maintenance program affects a lot of people, and so you are going to have a lot of people with an opinion on how it should be done. You can’t communicate enough to the people it will affect, and they need to know what’s going on every step of the way.”

The implementation phase involves:

  • Creating a department policies and procedures manual, which contains everything from dress code to preventive maintenance (PM) procedures to quality measurements of the program.
  • Finding a location for the shop that is large enough for workbenches and storage, is accessible by elevator, and meets all regulatory safety standards.
  • Recruiting qualified staff—the program is only as good as its technicians.
  • Purchasing test equipment.
  • Selecting and purchasing a maintenance database to keep maintenance records on your clinical equipment, tracking PM due dates, completion rates, and productivity of technicians, etc.
  • Creating service training plans for technicians.
  • Renegotiating or eliminating high-priority vendor contracts.
  • Setting up repair request procedures and educating customers and staff on how to properly place a service request.
  • Ensuring that the new department is properly following all government regulations regarding procedures and documentation.
  • Continuing to meet regularly with customers to get feedback and fine-tuning the program as needed.
  • Reporting financial and service successes to upper management.

These to-dos for creating an in-house program are just the beginning of the tasks and procedures that must be performed, which may be why more hospitals have not taken that step. However, if done properly, a well run in-house clinical engineering program can save the hospital a significant amount of money, improve service levels, and increase the life and reliability of the equipment. A poorly planned program will leave hospital staff demanding they want their service vendors back, and all that work will be for naught.

Heidi E. Horn is regional manager of retail operations and sales, SSM Clinical Engineering Service, St Louis.