Healthcare Technology Management Research Articles

Determinants in the number of staff in hospitals’ maintenance departments: a multivariate regression analysis approach

To date, there are no broadly accepted or accurate models to determine appropriate staffing [levels] for clinical engineering departments (CEDs). The purpose of this study is to determine what the determinants of the staffing levels are (total number of full time equivalents (FTEs)) in CEDs in healthcare organisations. In doing so, we used a cross-sectional exploratory approach by using a multivariate regression model over a secondary source of data information from the AAMI Benchmarking Solutions—Healthcare Technology Management database. Two hundred and one healthcare organisations were included in our study. Our study revealed that on average, there are almost 14 biomedical technicians (BMETs) per clinical engineer and one FTE per 1083.72 devices (SD 545.69). The results of this study also revealed that the total number of devices and the total technology management hours devoted to these devices positively affects the number of FTEs in a CED, whereas the hospital complexity, measured by healthcare organisation patient discharges matters inversely. The most important factor that matters in the number of FTEs in CEDs was the total technology management hours devoted to devices. A value of explained variance (i.e. R2) of 85% was obtained, indicating the strong power of the prediction accuracy of our multivariate regression model.

Benchmarking Comparison Between Zhejiang Province and American Hospitals

Clinical engineering (CE) has evolved rapidly over the last 30 years in China. Among the 34 provincial-level administrative units within China, the Zhejiang province is 1 of the most advanced in terms of healthcare technology maintenance and management. To determine Zhejiang’s current stage of development and opportunities for further improvement, a comparison of the performance of its CE departments was made against hospitals in the United States. Data were collected from 22 Zhejiang hospitals and compared with those from 270 acute-care hospitals in the United States collected by Truven Health Analytics. To provide a background for CE benchmarking, comparisons were first made between China and the United States and then between hospitals in Zhejiang and the United States. CE benchmarking comparison was made in 3 categories: (a) operational, (b) financial, and (c) productivity. Within the operational category, the total annual amounts of repairs and scheduled maintenance events were compared versus total equipment amount. Within the financial category, the total CE expense was compared versus total number of operating beds, total equipment amount, total equipment acquisition cost, and total hospital operating expense. Within the productivity category, the total CE full-time equivalent was compared versus total number of operating beds and total equipment amount. These comparisons showed that (1) although the equipment inventory in Zhejiang tends to be much smaller than in the United States for hospitals of comparable amount of operating beds, the amounts of repairs and scheduled maintenance events per total equipment amount are similar; (2) the total CE expense, although apparently lower in Zhejiang than in the United States versus total operating beds, is comparable versus total equipment amount. The cost of service ratio is much lower in Zhejiang than in the United States, but the total CE expense is comparable versus total hospital operating expense; and (3) the CE full-time equivalent is significantly lower in Zhejiang than in the United States versus total amount of operating beds but much higher versus total equipment amount. The fact that repairs and scheduled maintenance are similar in Zhejiang and the United States shows that CE leaders are managing equipment in a comparable manner. Most of the differences found in the comparisons were traced to a few factors. First, the average length of stay in China is substantially higher than in the United States, which explains why hospitals in Zhejiang tend to have more operating beds but fewer pieces of equipment. Second, labor cost is significantly lower in China than in the United States, thus allowing Zhejiang hospitals to employ more workers than their American counterparts. Third, there is significantly difference in the cost of living between China and the United States. Fourth, healthcare is financed in different ways in these 2 countries. Finally, being public entities, Chinese hospitals are managed and operated in a different manner than American hospitals are, which are mostly private, albeit nonprofit, organizations. For example, most CE departments in Chinese hospitals are also directly responsible for medical equipment procurement. Nonetheless, it is interesting to note that hospitals in both areas spend roughly 1% of their total operating expenditure for CE. These results suggest that CE in Zhejiang is comparable with that in the United States in terms of managerial excellence, but there could be some room for improvement in financial management, technical expertise, and productivity.

Understanding Higher Education Accreditation for the HTM Field.

Steven Yelton, PE, AS, BSEE, is a professor in the Electrical Engineering Technologies Department at Cincinnati State Technical and Community College in Cincinnati, OH. Email: steven.yelton@ cincinnatistate.edu Over time, the healthcare technology management (HTM) field has seen an expansion in the education credentials for certain positions. However, getting a college degree can be challenging for many professionals, even with extensive experience in the field and a previous college degree. One problem is that accreditation mismatches may exist between institutions, which often is a surprise for employees and employers. A thorough understanding of institutional accreditation is critical for successful career development. To begin, here is an important fact: Every one of the thousands of colleges and universities in this country is accredited (with a tiny number of exceptions, mainly religious schools). Accreditation is designed to ensure academic quality, ensure public confidence, and most importantly, serve as a gatekeeper for federal financial aid (Title IV funds). Because many students use financial support to pay for college, institutions need accreditation for enrollment to start to happen. An accreditation credential granted to institutions is associated with one of two bodies: the Council for Higher Education Accreditation (CHEA) or the U.S. Department of Education (USDE). CHEA is a nongovernmental organization that recognizes five regional groups (Accrediting Commission of Community and Junior Colleges Western Association of Schools and Colleges, Middle States Commission on Higher Education, Higher Learning Commission, New England Association of Schools and Colleges Commission on Institutions of Higher Education, and the Southern Association of Colleges and Schools Commission on Colleges) surveying about 3,000 schools. Colleges or universities with this accreditation type are deemed “regionally accredited.” Academic credits earned at one of the schools are transferrable to another regionally accredited school. (Of note, while regional accreditation ensures the transfer of courses between institutions, it does not guarantee that courses will meet the specific degree requirements.) The transfer of courses between institutions is a complicated and challenging process that also involves program accreditation (discussed later). A database of regionally accredited schools is accessible at www.chea.org. Approximately 85% of colleges have regional accreditation, including all public (state or federally supported) institutions. The other accreditation credential option comes from one of about 52 private agencies. The USDE has provided “deemed status” to this diverse group to accredit colleges and universities, many of which are faith-based (e.g., Association of Advanced Rabbinical and Talmudic Schools) or focused on specialty training (e.g., Accreditation Commission for Acupuncture and Oriental Medicine). Institutions accredited by one of these We Hear You! Our Complete Standards Collection Is Now Digital. Includes the current version of every standard and guidance document

Making Wireless Work: A Look at What Hospitals Are Doing.

Three events in January 2016 did a terrific job of capturing the essence of wireless technology in healthcare today, putting the expectations, innovations, and problems in the limelight. In glitzy Las Vegas, more than 150,000 people flocked to CES (formerly the Consumer Electronics Show) and the colocated Digital Health Summit. An equally engaged crowd of 1,000+ health information technology (IT) and healthcare technology management (HTM) professionals gathered in Cleveland for the IHE North American Connectathon.

Blazing New Trails: How Women Are Making Inroads into HTM.

Stephanie Stephens, MA, is a freelance writer, producer, and multimedia expert. Email: stephanie@ stephaniestephens. com Although no one is saying that the field of healthcare technology management (HTM) is a “boys’ club,” the truth is that this specialized workforce is populated by more men than women. That tends to be true of most technical jobs, but the tide is slowly but steadily changing, as four powerhouse women will attest.

Necessity of Clinical Engineers to Improve Present Health Technology Management in Developing Countries

<p>Developing countries such as Bangladesh, Nepal, Bhutan, Indonesia and so many could not introduce clinical engineering professional (CEP) in health technology management (HTM) science. As a result, they could not establish the safe health technology management. Conversely, CEP has been introduced by developed countries in HTM for about last 35 years long and thereby established a safe health care system. We noticed the continual problem in the health care management system. To overcome this continual problem, we think that clinical engineering professional is very much necessary to proper implementation of health technology management in developing countries in order to ensure the safe health care system. CEP will train to HTM personnel and a safe health care management will be established in developing countries. The modern medical technology will be involved by the proper practice of HTM and CEP. This pioneer professional will keep the whole HTM with good functional condition. Therefore, we conclude that introducing of CEP is badly necessary to improve the existing unhealthy HTM as well as health care system of the developing countries.HTM personnel will understand the necessity of CEP as well as health care planners. This paper will guide to the existing personnel of HTM and help them to understand the importance roles of CEP. Among these counties, the health care technology management system seems to very problematic. Continually, it is observing that the health care technology management performance is twisting with the increase of sophisticated medical devices. Authors firmly believe that an excellent benefit can be obtained by introducing skilled clinical engineers in the health services of developing countries as Bangladesh. </p>

Current Status of Skilled Clinical Engineer in Developing Countries

With the rapid development of medical technology for the last 30 years the clinical engineering practice was introduced in developed countries. But in developing countries, such as Nepal, Bangladesh, Malaysia and so many, this profession is totally a new concept. The medical equipment in the most developed countries is maintained by the clinical engineers whereas in developing countries like Nepal, Bangladesh and Malaysia are maintained by unskilled professional. A series of publication indicate that a lot of sophisticated modernized costly medical equipment could not be kept in a safe and optimum functional condition through the traditional short-trained electrical/mechanical engineers. This paper explores the importance of clinical engineering practice in developing countries of south Asia and its benefits for healthcare service. In this paper, authors propose a novel method for clinical engineering practice for the developing countries to sustain safe use and economical maintenance. This method will not only increase the clinical engineering practice but also help to get optimum feedback through clinical engineers. It should be noticed here that the different developed countries are producing and introducing clinical engineers in health care technology management in different ways, but those methods seem to not be suitable for the developing countries like Bangladesh based on the country contexts. The proposed method will change the health services top level managers and users of the medical equipment. It is ascertained that the performance of the health care technology will be improved by introducing this professional in the hospitals. This study will be much worthy to produce and introduce clinical engineers in order to improve the existing performance of healthcare services in developing countries like Bangladesh significantly.

Health-care technology management: developing the innovation skills through implementing soft TQM among Lebanese hospitals

The objective of this research is to determine the influence of implementing soft total quality management (TQM) on the innovation skills (INS) of employees in Lebanese hospitals. A quantitative methodology was applied through conducting a cross-sectional survey among the employees and health-care professionals at 13 accredited hospitals in Lebanon. The respondents agreed that they were implementing the soft TQM principles and practicing the INS. However, the results showed that soft TQM influenced INS through people-based management (p < .05) but not through continuous improvement (p > .05). The major contribution of this research is centred on its empirical part since there is a lack of empirical studies in the field of health care in Lebanon. In addition, the shift from the hard side to the soft side of TQM contributes significantly to the academic literature as well as the methodological part especially in terms of using structural equation modelling analysis. This study was limited because of lack of participation especially from the public health sector in Lebanon. Thus, future studies are recommended to extend the research geographically and include more hospitals from both private and public sectors.

Using athletics to grow stronger on the job.

A job in healthcare technology management (HTM) is anything but “8 to 5.” You’re committed to doing the best job possible— before, during, and after work. But you also need to “have a life,” and stay well, right? In his book, “Leading the Life You Want: Skills for Integrating Work and Life,” author Stewart D. Friedman suggests that the work-life concept is actually “a misguided metaphor.” “The idea that ‘work’ competes with ‘life’ ignores the more nuanced reality of our humanity,” writes Friedman, who is the practice professor of management at the Wharton School of Business of the University of Pennsylvania. “It ignores the fact that ‘life” is actually the intersection and interaction of the four domains of life: work or school; home, or family; community or society; and the private realm of mind, body, and spirit ... Conflict and stress aren’t inevitable. Harmony is possible.” In pursuit of your own harmony, learn how your well-rounded peers have made peace with the 24/7 aspects of life in the faster lane and have used fitness to cope and thrive.

Patient safety and healthcare technology management.

Patient safety and healthcare technology management.

Assessing risk in the Kaiser Permanente clinical technology program.

The Kaiser Permanente Clinical Technology (KP ClinTech) program consists of 10 autonomous healthcare technology management (HTM) teams across the enterprise’s seven geographic regions, as well as a relatively new national leadership team. Although the organizational reporting relationships and budget resources vary across regions, the KP ClinTech program is on a journey to function as a unified service: One ClinTech (Figure 1). The national team provides vision and strategic direction and facilitates the consensus process necessary to address the challenges of variation in process, procedure, and performance. The regional operations teams work to fulfill the vision and strategy. In late 2012, Kaiser Permanente (KP) introduced an integrated risk management (IRM) program to address the increasing complexity in the healthcare industry and regulatory environments. Healthcare reform, individual state involvement, and tight budgets further complicated efforts to assess and manage the enterprise’s risk. The IRM program provided a more efficient and effective way for leadership, operations, and risk management units to come together to identify requirements for operational processes, apply common criteria to prioritize risks related to those processes, and implement coordinated risk assurance activities for priority risks. In late 2013, the decision was made to sponsor an initiative to implement IRM within the KP ClinTech program. The expenditure of resources required to move forward with the initiative was justified by the interregional process design and reconciliation activities, as well as the magnitude of risks associated with implementation, use, and support of medical technologies. Of note, Technology Management Solutions (Trumbull, CT) was selected to carry out the first phase of the IRM process.

Evolution of a risk-based approach to effective healthcare technology management.

Evolution of a risk-based approach to effective healthcare technology management.

Courses help foster network-savvy HTM professionals.

Courses help foster network-savvy HTM professionals.

Workplace crises: keys to prevention and planning.

Workplace crises: keys to prevention and planning.

In times of trouble.

When I was in the newspaper business, every day involved a crisis or 10.I clearly remember my earliest workplace crisis. As a new writer fresh out of college, I arrived for my first day on the job just as the veteran reporter who was assigned to mentor me was busy being fired.Then there was that late election night in 2000 when the downstairs presses were speedily printing the next day's news with the massive “Gore Squeaks In” headline. Ouch!Or that beautiful Tuesday in September when those same presses were commandeered to print out a hastily produced supplement announcing the horrific events of 9/11. Newspaper people who thrive on adrenaline and chaos were able to communicate, collaborate, and push through with a focused determination that I have rarely seen since.Crises, big and small, happen. Workplaces aren't immune to them.My crises may have delayed people from getting their news on time. How healthcare technology management (HTM) professionals handle themselves in an emergency, on the other hand, could mean life or death. They are key cogs in the patient care machine and, as such, must be able to handle themselves in times of acute crisis.In this month's issue, writer Stephanie Stephens talks to experts in the HTM field about how to avoid and navigate workplace catastrophes.The cover story delves into ventilator technology, and issues that may arise while helping critically ill patients breathe. Crises can—and do—happen with these complex machines. Knowing the basics, including battery maintenance and data and alarm management, is crucial, and it becomes even more so when the technology is used outside the clinical setting.Now, if only working through an on-the-job dilemma was as easy as pretending it doesn't exist. Then busy people like us could keep quoting Henry Kissinger when faced with the possibility of one.“There can't be a crisis next week. My schedule is already full.”

Healthcare technology management: department plays role in transforming 21(st) century sterile processing.

Healthcare technology management: department plays role in transforming 21(st) century sterile processing.

Ask George.

In this column, BI&amp;T features questions and answers between AAMI members and George Mills, director of the Department of Engineering at The Joint Commission. Become part of the discussion and ask questions about those subjects that matter to you the most. You can submit your Joint Commission question at this link: www.aami.org/tmcconnect/askgeorge.html. Or to join AAMI's Joint Commission e-forum, which is open to all AAMI members, visit www.aami.org/tmcconnect/discussiongroups.html. Some of the questions and answers may have been edited for space, style, and clarity.What's in a name?Many times when I am speaking to a group of … That's the problem I have. Am I speaking to a group of clinical engineers? A group of biomedical engineers? A group of BMETs? I have wrestled for years with what title to use in referring to those who manage medical equipment. I can talk to other healthcare groups and generalize pretty easily. When talking about the Environment of Care, I can say to “those of us in facilities…” or “those of you in safety or security …” and everyone is comfortable with this. But I always hesitate when addressing those who manage medical equipment.So recently at a meeting hosted by AAMI [Future Forum III] we had about 25 of us in one room plus AAMI staff. At one point the discussion came to the various titles used. I had thought that “healthcare technology management” would replace the different titles, but I was informed this was really more of an umbrella term for the field. After a lengthy discussion, we landed on the following definitions, which I plan to use in all future articles and speaking engagements (although I plan to default to BMET when unsure of the audience).Stryker takes care of our universal instruments, cleaning and setting them up, along with cleaning and wrapping the cameras, light cords, and scopes in the Sterile Processing Department (SPD). Our requirements are that you need to be certified to work in SPD. According to Stryker, its staff is trained, but not certified. Is this something that I can get in trouble with The Joint Commission?The Joint Commission would expect you to follow your policies and requirements. Currently, you would not be compliant with your own policies, and likely a finding would be written at HR. What I would suggest is that you re-visit your organization requirements related to certification, to ensure this is necessary. If you conclude that certification is needed to assure the quality outcome, then either your vendor will need to meet your requirements or you may need to replace the vendor.Our institution is addressing the Sentinel Event Alert on alarm safety. One of the strategies suggested is to assess whether the acoustics in patient care areas allow critical alarm signals to be audible. Can you provide guidelines on how to accomplish this?This was an issue identified in the previous 2003/2004 National Patient Safety Goal—the inability of staff to hear the patient alarm. The solution then was to physically audit the care environment, working with nursing to adjust the alarm levels or create alternative notification systems. For some, this meant tying alarms into smartphones or pagers. For others, this was accomplished by interfacing with the units nurse call system. Include in the assessment the physical characteristics associated with the occupied space and related equipment.In our hospital, we have small refrigerators in some patient rooms. These are for that patient and family members only. Is it required by TJC to monitor the temps, etc., per PC.20.02.03 EP 11?The Joint Commission would expect that your organization conducts a risk assessment to determine if monitoring was needed or appropriate. Typically, we do find policies that include patient and patient family orientation including use and cleaning of the refrigerator.

The complexity of clinical alarm systems.

Healthcare technology management (HTM) is ideally suited to take a leadership role within healthcare organizations on the subject of clinical alarm systems, because technology issues are a major part of the overall alarm picture. In order to do so, they need to be an excellent knowledge source on the subject. If an HTM department is currently only marginally involved in clinical alarm systems, I strongly encourage it to use the information gained from this article to become part of the core team. Because the clinicians need to live with consequences of clinical alarms decisions on a daily basis, they should be the ultimate decision makers. There has been a lot of attention given to the subject of clinical alarm systems since the 2011 Clinical Alarm Summit was convened by AAMI, the U.S. Food & Drug Administration (FDA), The Joint Commission (TJC), the American College of Clinical Engineering (ACCE) and ECRI Institute. The AAMI Foundation’s Healthcare Technology Safety Institute (HTSI) has spearheaded follow-up work on the issues raised by the summit, and has set up an online resource page at www.aami.org/htsi/ alarms that is definitely the best and most complete collection of resources on the subject. If you are not familiar with this website, you need to be. If you haven’t visited the site recently, you need to—additional resources and webinars are being added continually. Healthcare leadership’s interest in alarm systems increased when TJC published a National Patient Safety Goal paper on the subject. The purpose of this article is not to try and summarize all of the great work being disseminated on clinical alarms. Instead, the purpose is to sift through the blizzard of information on the topic and highlight those parts of the overall picture that others may have missed as they address clinical alarm systems. Hopefully, the selections will help clarify issues and/or stimulate important discussion, rather than simply adding to the blizzard.

Association Roundtable

Insights and advice from leaders of local and state biomedical associations“In 2014, we heightened focus on our website as a central location for information relating to HTMA-MW. Not only is it the place for members and corporate partners to join our group, but a place for them to find out what we are planning and have already accomplished. Since most of our meetings take place in a university auditorium, we have used the technology available to both record the audio of the meeting for podcasts and the video to link through our site for those who cannot make it to the meetings.”Chris C. Coleman, President, Healthcare Technology Management Association of the Mid-WestWhen managing a biomedical association and an associated conference, it is very important to have an up-to-date one stop shop for information and communication among team members. Information that is synchronized over Wi-Fi between personal computers and mobile smartphones is important. Google has tools we need such as gmail, a drive for document storage, a calendar to schedule meetings, and a contact application to create group lists for members, the biomedical engineering community, and vendors. This further enables website administrators to post the most current public information as needed to increase activity.Matthew Savoie, President, Biomedical Associations of Wisconsin“CABMET has spent the last couple of years investing resources into our website. By upgrading our website, we have been able to streamline many of our operations. We can electronically send out our newsletters and other items to our members. All meeting information and member information can now be found on the website. This has allowed us to save time and resources by going green. We are also accepting membership dues and study group payments through PayPal, which has greatly reduced the time spent logging check and cash payments. In conjunction with accepting payments online, parties interested in attending the study group can register and participate in the webinar through the website. This has allowed our study group to continue to grow and help people from around the world with their certification goals.”Richard Marshall, President, Colorado Association of Biomedical Equipment Technicians“The Georgia Biomedical Society uses a membership management software package to manage the organization's website, membership database, and e-mail sending. Online membership applications and payments for dues and events are features used to be more effective and efficient. We also use card swipe for accepting payments, conference calls, and ebash for communicating with members.”Horace Hunter, Executive Director, Georgia Biomedical Instrumentation Society

Healthcare Technology Management (HTM) of mechanical ventilators by clinical engineers.

Mechanical ventilator failures expose patients to unacceptable risks, and maintaining mechanical ventilator safety is an important issue. We examined the usefulness of maintaining mechanical ventilators by clinical engineers (CEs) using a specialized calibrator. These evaluations and the ability to make in-house repairs proved useful for obviating the need to rent ventilators which, in turn, might prove faulty themselves. The CEs' involvement in maintaining mechanical ventilators is desirable, ensures prompt service, and, most importantly, enhances safe management of mechanical ventilators.