By Binseng Wang, principal consultant, BSI Consulting LLC
Despite decades of proven record of managing and maintaining medical equipment safely, effectively, and reliably, clinical engineering (CE) and healthcare technology management (HTM) professionals continue to struggle to receive well-deserved recognition and earn a “seat at the table” for technology planning and acquisition in many healthcare delivery organizations (HDOs).
We are still mostly labeled as basement “wrenchies” who are only called upon when things break down.
Clearly, claiming that we help HDOs comply with accreditation standards or save money by avoiding original equipment manufacturer (OEM) service contracts or time-and-material services is not enough to justify our existence, much less to command due respect. Furthermore, such low visibility does not help us recruit young talent to replace retiring baby boomers like me.
Before exploring how feedback can be helpful, I would like to remind readers of a few ideas for securing recognition that I have explored before.
- Solid return-on-investment (ROI) when comparing CapEx savings to CE/HTM expense. By keeping equipment safe and operational well beyond the “estimated useful life” suggested by the American Hospital Association and other similar organizations, CE/HTM professionals can help save $7.7 million of capital per year for a 400-bed acute care HDO, which translates into an ROI of approximately 24%.
- Reduction of patient revenue loss caused by downtime. OEM service personnel typically cannot reach most HDOs quickly enough to reduce equipment downtime to less than one or two days. By repairing equipment promptly and returning it to service, HDOs can reduce the postponement or cancellation of medical procedures, thus lowering the revenue loss associated with those procedures. Obviously, such calculations are only valid for equipment used in revenue-generating (aka fee-for-service) procedures, not when charges are limited by capitation.
- Improve equipment selection through usability testing. Too often, clinical users are challenged by new equipment in terms of proper use and care. Even though most manufacturers offer on-site in-service training, it is difficult for clinical users to retain that training when the equipment is not used often. The human-machine interface may be quite intuitive for the engineers who designed it and for the clinicians who helped design and test it, but it can still be challenging for those using the new equipment for the first time or during the first few months. While the US Food and Drug Administration has emphasized the need for design teams to adopt human factors engineering techniques (aka usability), this challenge remains. Instead of just asking prospective suppliers to demonstrate their equipment during the selection phase, CE/HTM professionals should insist that suppliers and HDO leadership provide a hands-on demo period for prospective users to “play” with the equipment being offered. Ideally, different brands and models should be available at the same time and in the same location for clinicians to evaluate and grade according to functionality, ease of use and care, and the equipment’s power-on self-test capability. This is also an opportunity for CE/HTM professionals to verify how easy or difficult it will be to perform scheduled maintenance and repairs.
Now, let us see how feedback can improve the planning and acquisition of new equipment. By interacting frequently with manufacturers and their distributors or authorized servicers, CE/HTM professionals learn—sometimes through painful experience—the strengths and weaknesses of each. Furthermore, by witnessing and helping clinical users overcome challenges in using the equipment, CE/HTM professionals know which brands and models have well-designed human interfaces and are therefore less likely to create challenges for the clinical users and sometimes lead to patient harm.
When such experiences are consistently well-documented, they can be used to influence planning and acquisition at the right time and reduce the risk of future problems. It is not enough to buy good equipment; HDOs need to buy well.
Equipment acquisition is almost like marriage: Love alone is not enough to make a marriage last! Unlike drugs, implants, and disposable devices, equipment (reusable devices with a unit cost above $1,000) requires supplies, utilities, cleaning/disinfection, maintenance, software updates, etc, during its lifecycle, which can be as long as 20 to 30 years. Past experience accumulated by CE/HTM teams can help organizations navigate challenging situations more quickly and smoothly.
Some readers or HDO leaders may counter that feedback is not reliable, citing the famous stock market quote, “Past performance is not a guarantee of future returns.” While that disclaimer is valid for financial investments, past performance is usually a good predictor of future performance for both humans and machines, particularly if they can learn from their mistakes and make timely corrections. No single person or machine is perfect or immune from mistakes. The reason we attend schools is because it is much easier and quicker to learn from other people’s mistakes than from our own. The biggest mistake is actually not learning from your own mistakes.
For geeks like me, the best example of feedback is the negative feedback amplifier, patented by Harold Stephen Black in 1927. The introduction of feedback helps electronic amplifiers achieve greater stability, linearity, and frequency response while also reducing sensitivity to electronic component parameter variations caused by manufacturing or environmental factors.
However, feedback already existed much earlier—not just a few hundred or even thousands of years, but likely many millions or even billions of years ago. Just look inside your own body, and you will realize that the reason you are still alive and kicking is because cells and organs have learned how to keep themselves in equilibrium. This phenomenon is called homeostasis, a concept pioneered by Claude Bernard in 1849, with the word later coined by Walter Cannon in 1926. Without homeostasis, cells and organs are sure to perish and be eliminated by natural selection.
Therefore, it should be fairly straightforward to explain to your clinical colleagues that you are not making things up. You are using the well-known principle of homeostasis to help improve the incorporation and management of medical equipment in your institution.
This is similar to the argument I have proposed for justifying your management and maintenance process called evidence-based maintenance. It was shamelessly copied from “evidence-based medicine,” which has been taught in medical schools and practiced by our clinical colleagues for several decades. We should not blindly follow tradition or manufacturers’ recommendations. We need to analyze the results obtained through different maintenance methods (aka alternative equipment maintenance, or AEM) in order to decide which provides the most cost-effective solution while keeping staff and patients safe.
So don’t thank me for suggesting the use of feedback to secure the recognition you deserve. You should thank Mother Nature for it.
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