Who Drank My Wine?

Abstract

I was, at the same time, happy and sad reading the two Final Word editorials in the July/August issue of BI&T. I was happy because it has been almost a decade since the subject of benchmarking has been discussed among clinical engineering (CE) professionals. I was sad, however, to see that suspicions and skepticisms, as well as misunderstandings, are still so prevalent among our colleagues.In spite of agreeing with the positive aspects that Ken Maddock pointed out, I am afraid that I have to disagree with his choice of title (“Glass is Half Full”). While we have been arguing with each other over benchmarking minutia (what is the right definition of inventory, how to count work orders, which expenses should be included or excluded, etc.), hospital administrators and chief financial officers have long since gone ahead to benchmark CE using whatever measures they—not us—believe are correct. Today, almost every hospital participates in one of the benchmarking projects offered by a number of “performance solutions” consulting companies and each one of these companies has created some type of benchmark for CE services. In other words, our “wine” has already been consumed by others while we are busy fighting each other!For example, I recently reported at the 29th Canadian Medical and Biological Engineering Conference held in Vancouver, BC, a preliminary analysis of CE “measures” collected by Solucient LLC, one of the leading performance improvement companies. To my surprise, over 170 hospitals (among the over 850 subscribers to Solucient's Action O-I® database) have been reporting CE- and technology-related data for numerous years. More surprising even is the fact that in spite of all the well-known and discussed concerns and disagreements among CE professionals on how to measure each indicator, a fairly clear picture of what is happening with medical technology adoption and management has emerged.For instance, most hospitals have about 13 pieces of capital equipment per staffed (not licensed) bed and invest about $3,000 for each patient discharge, regardless of hospital size or teaching nature. Typically, a hospital spends per year about 4% of its total capital equipment investment to maintain it. The annual total CE budget (including labor, parts, service contracts, etc.) is generally less than 1% of the hospital's annual total operating budget (thus our “invisibility” to the C-suite). Furthermore, the amount of CE FTEs hovers around 2.6 per 100 staffed beds or each CE FTE covers about 520 pieces of capital equipment. Obviously, these are “averages” and not benchmark goals for others to aspire to, but they seem to provide useful insights and “rules of thumb” for healthcare administrators and CFOs.Perhaps more alien yet to the CE community is the direction healthcare benchmarking has taken. Instead of using “capacity” metrics (e.g., beds or pieces of equipment), hospitals are adopting “operational” and “output” metrics such as patient days and discharges as the denominators. This trend reflects the realization that hospitals are production sites that should be measured by their operations and output rather than capacity, as well as the fact that most reimbursements nowadays are for cases (diagnostic related group—DRG) or amount of patient covered (“capitation”) rather than equipment used or procedures performed.While I am not sure suspicion and skepticism are the fundamental reasons for our lack of consensus (e.g., while scientists are required to have similar professional traits, they seem to agree on most fundamental laws of nature), I think Boyd Hutchins is right in pointing out that CE professionals are likely to remain for sometime in the dungeons fighting themselves and invisible dragons before realizing that the sun is shining above and there are numerous other challenges and opportunities waiting for us above ground (e.g., licensing the profession, assuming broader roles, or simply going fishing).