Clinical Engineering Services Research Articles

Evaluation and optimization of CES performances: application of Pareto principle to KPIs

In recent times the approach to health care has been mostly influenced by the growing number of biomedical equipment used in hospitals, which needs the presence of the Clinical Engineering Service (CES).
 The aim of this work is to suggest a methodology to improve the performance of a CES through the application of Pareto principle to main Key Performance Indicators (KPIs). The methodology is applied by focusing on the use of KPIs that represent a quantifiable measure of achieving goals set by an organization. In this study five KPIs are considered: Uptime, MTTR (mean time to repair), PPM (percentage preventive maintenance), MTBF (mean time between failures) and the COSR (cost of service ratio). The first three indicators express the measure of CES efficiency in ensuring regular maintenance.
 The first step consists in retrieving data related to work orders for the years 2015-2016 on 6000 installed devices, carried out by a management software. The second step is to get the results through the use of an environment for numerical calculation and statistical analysis.
 In order to identify the main critical issues that may be present, three indicators (Uptime, MTTR and MTBF) are analyzed by applying the Pareto principle (i.e. 20% of the causes produce 80% of the effects). Considering the totality of work orders, therefore, it is possible to concentrate on only 20% of them in order to focus on a small group to understand the correlations between them. Identifying these characteristics means identifying the main critical issues that are present, on which action must be taken, and which affect 80% of the overall behavior. The COSR and PPM indicators, instead, suggest distribution models that allow to focus attention on the most critical devices.
 In conclusion, the way to analyze the results is obtained, when possible, by applying Pareto principle. Therefore, a CES will be able to focus on a few causes of poor performance. The achievement of these results could allow the standardization of the method used, enabling it to be applied to any healthcare system.

Feature: Beating the COVID-19 Surge: How Allina Health Doubled Its ICU Capacity in Eight Weeks.

Feature: Beating the COVID-19 Surge: How Allina Health Doubled Its ICU Capacity in Eight Weeks.

Cost analysis of medical device spare parts.

Objective:To establish estimation method on budget management of medical device spare parts and to evaluate the cost of medical device spare parts in affiliated hospitals of Istanbul Public Hospital Unions (PHUs).Methods:While this evaluation was performed, the relationship between paid cost for spare parts according to technological development level of device groups and total inventory value was used. Spare part cost analysis was carried out by using the normalized weighted arithmetic average method. Cost analysis of medical equipment spare parts of Istanbul PHUs was performed by using the data retrieved from Ministry of Health Business Intelligence Decision Support System for spending of spare parts in 2015.Results:The medical device spare part groups were categorized based on technological development. Among 1 to 6 PHUs, the cost ratios were acquired for high, middle, low and simple technology group as 17.31 – 40.08%, 29.14 – 43.36%, 22.62 – 27.44% and 8.16 – 11.89%, respectively. The ratio between the spare part and total inventory costs for 1-6 PHUs were calculated as 1.66%, 2.87%, 3.03%, 3.31%, 2.57% and 4.69% respectively. Expected rates based on normalized weighted method were obtained as follows; 5.76%, 4.67%, 5.31%, 4.87%, 4.34% and 4.27%.Conclusion:The expenditure analysis and budget planning for medical device spare parts in PHU could be predicted more accurately by taking into consideration the expected rate calculated by the normal weight method. In additon, the importance of Clinical Engineering Service Units in management of medical devices has been determined.

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Workplace crises: keys to prevention and planning.

Workplace crises: keys to prevention and planning.

Inspiring Others on the Job: What Makes a Great Leader?

<i>Inspiring Others on the Job:</i> What Makes a Great Leader?

Managing Recalls: Responsibility, Adaptability Are Key to Effective Process

Managing Recalls: Responsibility, Adaptability Are Key to Effective Process

Avaliação econômica da implantação de um serviço de Engenharia Clínica em hospital público brasileiro

A Engenharia Clinica e uma area com atuacao nos Estabelecimentos Assistenciais de Saude, desenvolvendo atividades baseadas nos conhecimentos de engenharia e de gerenciamento aplicadas as tecnologias de saude. Nesse contexto, este trabalho relata os impactos economicos da aplicacao de tecnicas de gestao em Engenharia Clinica num hospital publico brasileiro de grande porte e referencia em alta complexidade - Hospital de Clinicas da Universidade Federal de Uberlândia. Trata-se de uma pesquisa quantitativa, onde foram consideradas questoes economicas e de qualidade, suportada por pesquisa documental. O levantamento de dados baseou-se em relatorios e documentos administrativos do hospital do periodo de 2001 a 2010, referentes a recursos humanos, indicadores de servicos, indicadores de qualidade, custos com pecas e contratos. Dentre os resultados encontrados, destaca-se a reducao de aproximadamente 20% nas manutencoes corretivas e sua estabilizacao ao longo do tempo, mesmo em face de um elevado aumento do parque tecnologico da instituicao. No montante global de gastos com contratos, observou-se uma reducao de cerca de 65% no periodo avaliado. A economia gerada pela gestao em Engenharia Clinica para a instituicao foi de aproximadamente R$ 2 milhoes em 2010, e a economia acumulada no periodo de 2001 a 2010 foi de R$ 7,6 milhoes. Concluiu-se, que a gestao em Engenharia Clinica na instituicao possibilitou uma reducao significativa nos custos por meio da formacao e capacitacao de uma equipe propria, da reducao dos custos com contratos e melhor planejamento das manutencoes. Tais resultados demonstram a importância de um servico de Engenharia Clinica para a melhor gestao de custos e das tecnologias em hospitais, sejam eles publicos ou privados.

Health technology management: A database analysis as support of technology managers in hospitals

Technology management in healthcare must continually respond and adapt itself to new improvements in medical equipment. Multidisciplinary approaches which consider the interaction of different technologies, their use and user skills, are necessary in order to improve safety and quality. An easy and sustainable methodology is vital to Clinical Engineering (CE) services in healthcare organizations in order to define criteria regarding technology acquisition and replacement. This article underlines the critical aspects of technology management in hospitals by providing appropriate indicators for benchmarking CE services exclusively referring to the maintenance database from the CE department at the Careggi Hospital in Florence, Italy.

Using 80001 to Manage Medical Devices on the IT Network

Healthcare technology today is considerably different than it was 20 to 40 years ago. Yet, much of what is done by healthcare technology managers in support of medical technology has not changed. The tools and procedures still used by most clinical engineering services have evolved little to address some of the unique challenges posed by new healthcare technologies that are at once more pervasive, more complex and more susceptible to failures that may have catastrophic consequences for patients and healthcare operations. Just how has the healthcare technology landscape changed?

The Roundup

The Roundup

The Roundup

The Roundup

Clinical Engineering and Central Service Departments Collaborate in Crucial ‘Dance’

Clinical Engineering and Central Service Departments Collaborate in Crucial ‘Dance’

TMC Corner

A video created by AAMI's Technology Management Council (TMC) that promotes the biomed profession as a career option has been viewed more than 3,600 times in just five months on the popular video-sharing site YouTube.The video, which debuted in February, features TMC leaders Dave Francoeur and Ken Maddock discussing the benefits and opportunities of the biomed profession, and how to enter it.“When you check in to a hospital as a patient, you probably take for granted that the medical equipment that surrounds you will work properly,” Maddock, vice president of clinical engineering and telecommunications services at Baylor Health Care System in Dallas, says in the video. “But most people don't realize that there are skilled professionals responsible for ensuring that the technology performs safely and effectively.”The video is available on AAMI's student website (www.aami.org/student/videos.html) and on other video-sharing websites such as Vimeo.For more information on the TMC, visit www.aami.org/tmcconnect.

TMC Corner

A new video developed by AAMI's Technology Management Council (TMC) promoting biomedical careers is now available at AAMI's student website at www.aami.org/student.The video features TMC leaders Dave Francoeur and Ken Maddock discussing the benefits and opportunities of the biomed profession.“When you check in to a hospital as a patient, you probably take for granted that the medical equipment that surrounds you will work properly,” says Maddock, vice president of clinical engineering and telecommunications services at Baylor Health Care System in Texas. “But most people don't realize that there are skilled professionals responsible for ensuring that the technology performs safely and effectively.”The video has been praised by many in the profession as a valuable recruitment tool that also sends a good message about the profession. “It may be the most positive statement about biomedical engineering that I have ever seen in over 45 years,” says Frank Magnarelli, an independent biotechnology professional.

TMC Corner

It's a Friday morning in October, and Dave Francoeur and Ken Maddock are walking down the hallway at Baylor Health Care System in Texas—nothing unusual for two veteran biomeds.But this isn't any ordinary day. Francoeur and Maddock—two leaders of AAMI's Technology Management Council (TMC)—are “on location” being followed by a camera crew filming a new five-minute video to promote the biomed field as a career option.The video, which is being developed by the TMC and produced by CTI Productions, features Maddock and Francoeur speaking about what a career in biomed entails and how to get involved. It will be available on AAMI's new student website, www.aami.org/student.Francoeur, vice chair of the TMC, says the video is a great “way to potentially reach lots of individuals who might not ever have the opportunity to hear about our great profession.”In particular, the video may have special appeal to high school students, who lack an awareness of the biomed profession. “The video targets students who are voracious consumers of web-based and social networking tools,” says Maddock, vice president of clinical engineering and telecommunication services at Baylor. “Making a video available to students in a comfortable way will increase awareness of the field.”The video may also help sway parents, who “are often led to believe that sending their child to a community college to get a two-year degree in a field such as biomedical equipment technician (BMET) is not good enough, and that only a four-year education has value,” says Lynda Wilkinson, program coordinator of electronics engineering technologies for North Seattle Community College. “A good video showing the level of training and the career opportunities will be wonderful.”Two new resources are now available to provide additional guidance to AAMI members on information technology (IT) integration issues.The first is a questionnaire that provides guidance to hospitals on integration issues; and the second is a comprehensive document listing IT standards and guidance documents. Both resources are available to all AAMI members through the CE-IT Community at www.ceitcollaboration.org.The questionnaire—called the Medical Device Integration Matrix—contains dozens of specific questions that healthcare facilities could consider asking vendors with respect to medical device integration.The matrix is divided into 10 sections including topic areas such as vendor information; a decision chart; and issues affecting security, network, hardware, software and interface, human factors, service support, training, and documentation.Within the matrix, each section includes a number of specific questions that a healthcare facility could ask a vendor. For example, in the system support category, questions pertain to whether the vendor provides loaner equipment, the type of onsite and remote support that is offered, and the onsite response time provided.The matrix—which was developed by the CE-IT Community's Integration Working Group—serves as a reminder to hospitals to ask questions about certain components in a system, says Linda Chan, information services manager for New Jersey-based Virtua Health Information Services, and a member of the Integration Working Group.“Each hospital will have its own standards on what the answer should be,” Chan says. Vendors also can use an accompanying decision tree to submit responses to the questions.The second new resource developed by the CE-IT Community is a 26-page document that provides a comprehensive listing of applicable IT references, resources, and standards.The document—titled “Medical Device Integration: Reference, Resources, and Standards”—includes seven chapters listing general IT references, key interoperability organizations, reference documents, Food and Drug Administration (FDA) documents, FDA recognized standards, informative standards, and relevant journals.The document—which is intended for clinical engineers, system integrators, and IT professionals—provides a glimpse into an engineer's point of view, says Rick Schrenker, systems engineering manager for Boston-based Massachusetts General Hospital and a member of the Requirements Working Group which developed the document.The resource can help in the development of requirements for systems and vendors. “We couldn't write requirements because they are often organization specific,” Schrenker says. “Those of us who were familiar with doing requirements came up with the idea of providing people with references that would help them develop requirements for say high-intensity systems.”The document is intended to be a living document, which will be updated periodically as standards and resources are developed or revised.Both resources were developed by the CE-IT Community—a collaboration among members of AAMI, the American College of Clinical Engineering (ACCE), and the Healthcare Information and Management Systems Society (HIMSS). The CE-IT Community was created in 2008 to develop resources, best practices, and network opportunities to advance CE-IT interests. For more information, visit www.ceitcollaboration.org.

Leaders Share 2009 Goals, Priorities

Editor's note: A new year always brings a set of new challenges, and this year those challenges are particularly serious. Recently, BI&amp;T asked a number of medical technology professionals to share their goals and priorities for 2009. Here's a sampling of their responses.“ Our top priority is to continue working to improve our processes. This is always a top priority and does not change from year to year. We also want to continue our work to improve coordination and communication of our biomed team with the information systems (IS) network/server/application support teams and focus on biomed education on the support of networks. Because of the proliferation of interconnected medical/imaging devices to information systems, this is imperative.The biggest challenge I see us facing this year is dealing with the growth of our system. As a system it is necessary to grow into specific areas to ensure that we will maintain financial viability, but getting the resources necessary to handle the additional work associated with this growth is especially difficult in the current economic climate.”Kenneth Maddock, Corporate Director, Biomedical Technical Service, Baylor Health Care System, Dallas“ Our biggest priority has—and always will be—to provide safe and reliable clinical equipment for our patients. But we have another priority in 2009 that wasn't so pressing in years past: to find new ways to control and even reduce costs to assist the health system in these challenging economic times.Our goal is to provide as much of the maintenance in-house as possible, which has the added bonus of quicker responses and reduced costs.”Heidi E. Horn, Vice President, Clinical Engineering Service, SSM Integrated Health Technologies, St. Louis, MO“Since I'm moving out of my leadership role, my top priority is succession implementation. Succession planning should be high on everyone's priority list all the time. It's often neglected. Every leader should always have in mind who he or she is grooming to step into their role.But the big priority is connectivity of devices to networks and complying with IEC/CD2 80001, Application of risk management for IT-networks incorporating medical devices 80001. These issues will heavily impact us soon, and we need to be getting them on the radar screen of the hospital and healthcare system leaders.Second, but really an equal first, will be how we will cope with the certain substantial financial impact of the imploding economy. I suspect it'll be back to the 90s. But, back then, we had some reserve. Now we don't. Somehow life will go on, but it won't be pretty.”Jeffrey B. Cooper, Ph.D., Director, Biomedical Engineering, Partners HealthCare System, Inc., Boston

A Numbers Game-Benchmarker Beware

Corporate Director, Clinical Engineering Services McLaren Health Care 420 Ballenger Hwy, Flint MI 48532 [email protected]

Making the Most of Service Manuals

Some were outdated, some were missing, and some never arrived. So he took matters into his own hands. Poulsen posted a message on the Biomedtalk listerv asking colleagues nationwide to help him compile a list of service manuals available online. With the information he’s collecting, he intends to create a website that links directly to manuals on manufacturers’ websites. The site is expected to launch later this year, providing one more resource for medical technology professionals in search of up-to-date information on the devices they service. Service manuals are a popular topic among biomedical equipment technicians (BMETs) and clinical engineers (CEs), and their concerns run the gamut—including availability, price, and quality. Often the most high-tech equipment comes with one printed manual that can quickly be lost or become outdated with software or other upgrades. Second-hand or donated equipment often comes without the original manuals, which may be unavailable if the manufacturer no longer supports the device. Poulsen, a senior biomedical technician with Biomedical Technologies in New Jersey, is not alone in his concerns about service manuals. In the last two years, nearly 500 messages have been posted on the listserv about these critical documents. “Service manuals are our life-blood. They are one of the core documents with any device or system,” says Andrew Currie, director of clinical engineering services at Johns Hopkins Hospital in Baltimore, MD. “If you can’t get access to the technical documents, this sometimes introduces an insurmountable hurdle in the effort to do cost-effective work and may reduce the overall in-house department value.” Making the Most of Service Manuals

Economic and ethical considerations in managed care.

The growth of managed care has had a significant impact on the way hospitals provide medical services, the relationships between hospitals and physicians, and the relationships between providers and patients. This impact arises primarily from the economic constraints that managed care places on the provider. As hospital employees or contractors, and as consumers of health care services, clinical engineering personnel need to understand the effects of managed care on the hospital and the physician. Beyond general information, this knowledge can play a useful role in understanding the impact of managed care on the acquisition and use of medical technology, and the increasing role that clinical engineering can play in guiding investment in, use and maintenance of hospital medical equipment. Ironically, this potential for increased value occurs at a time when clinical engineering services and departments themselves are under increased scrutiny for their more measurable costs and value.