From one CE or BIOMED manager to the next, you can find great variances in deciding whether to use in-house technicians, an independent service organization (ISO), or an original equipment manufacturer (OEM). Some departments call the vendor at the first sign of trouble, and others hesitate to use outside assistance until absolutely necessary. I recently caught wind of a director of a large hospital system who strives never to have another outside vendor in his system again. That director hired a biomed with experience in advanced sterilization products to work on Sterad plasma sterilizers, which is one of the first items in a hospital to typically get outsourced to the OEM. While it is fiscally responsible to explore in-house training opportunities, I have seen a recent emphasis on doing as much in-house as possible, even if it sacrifices customer service.
Most of the equipment in a hospital can be serviced successfully by qualified in-house biomed or clinical engineers; this percentage can vary, but I would say somewhere between 70% and 90% in–house, and 10% to 30% outsourced to the OEM or an ISO.
Ideally, a service delivery plan is in place for every piece of equipment in the hospital, spelling out who is financially responsible for the equipment—the hospital, a contracted ISO like Aramark, or a service contract with the OEM. It also explains who takes care of any service and how the work order will be escalated from a first-look, in-house technician to the OEM.
Three things to consider when creating a service delivery plan are expense, expertise, and customer satisfaction.
One option is to train the in-house technicians on the specialized equipment and use a third party or the OEM as needed on a time and materials basis. This option depends on the quantity of the particular equipment in question, and if there are proprietary test equipment, parts, or software that the vendor will not sell. Service schools can charge from $200 to $10,000 or more for 1 day to 2 weeks or more of training. Specific test equipment that can’t be used on anything else may need to be purchased for thousands of dollars.
Most of the time the experts are going to be employed by the manufacturer, though occasionally an item can be serviced as well or better in-house or by using a third party. The inherent problem with training in-house technicians to do specialized work is that they cannot afford to be as specialized as the OEM, or even a third party. An in-house tech can be asked to work on several hundred different models of equipment throughout the course of a year. Many OEMs I have worked with have fewer than 10 models they work on. Every day when they go to work, they find new problems and nuances with their particular equipment. An in-house tech trained by the OEM could leverage the OEM technical support team, but many times an OEM field technician knows more about the equipment and typical failing points than the technical support line. The OEM technician also has quick access to the engineers who developed the equipment. Clinical engineering or biomed shops frequently try to specialize their techs by department or equipment type, such as respiratory or surgery, but this does not come close to the specific knowledge an OEM possesses from his or her day-to-day experience on a limited number of models.
In some areas of the hospital, lab and imaging in particular, the technicians who operate the equipment strongly desire to have the OEM looking at a down piece of equipment. I have seen a work order progress from an in-house tech to verify the problem, an ISO to try and save money, and finally, the OEM is called, because the ISO and in-house tech do not have access to proprietary software. During this progression, the customer suffers a lengthy downtime that could have been avoided.
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I certainly use the in-house option when appropriate, but we cannot forget the strengths of specializing. Business 101 classes across the United States teach that specializing makes the human race more efficient. In the end, the best solution is to consider expense, expertise, and customer satisfaction when choosing how to service specialized equipment.
Tim Huffman is clinical engineering manager, Clarian North Medical Center, Carmel, Ind. For more information, contact