A health care system’s advanced clinical engineering program yields major savings.
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| David M. Dickey |
Purchase decisions on new patient care technology are always going to be a critical component of a hospital’s ability to provide the best care and to attract the best clinicians and staff. However, the actual purchase is only one facet of medical technology ownership. The typical process requires a needs analysis, installation planning, clinical user training, warranty service management, clinical effectiveness and patient safety assessments, life-cycle cost-of-ownership planning, and ongoing service and support management.
Faced with the decision on how best to plan for and control life-cycle cost and utilization of biomedical equipment, McLaren Health Care, Flint, Mich., decided to take a fresh look at managing the overall cost of ownership, implementation and deployment of its medical equipment. Internal discussions among senior management led to the creation of a corporate clinical engineering program, known as McLaren Clinical Engineering Services (MCES).
Centralized Management
Before MCES was launched in 2002, McLaren Health Care’s direct patient care delivery network consisted of five hospitals, multiple freestanding clinics and a home health care division. For the most part, medical equipment was serviced by three separate clinical engineering programs, along with a host of vendors who maintained specialty equipment via multiple service contracts. Service budgets—approximately $7,698,000 in total for medical equipment support—were decentralized, with limited central management or oversight of vendor agreements. The biomedical staff’s service capabilities were generally concentrated on basic clinical equipment, such as monitoring, ventilators, infusion devices, anesthesia machines and dialysis, with the majority of technical support for high-end systems provided by manufacturers. Based on an analysis provided by a clinical engineering consultant, McLaren developed a corporate clinical engineering program whose annual cost would be allocated with no markup to the hospitals served.
McLaren executive leadership endorsed a three-year business plan that included the following eight program goals and objectives:
1. Create a new staffing model to include corporate clinical engineering management, degreed clinical engineers, biomedical technicians dedicated to each site, shared service equipment specialist staff to rotate between sites, and a central call center and business office to provide financial management of the program and to process all service requests.
2. Centralize and consolidate clinical engineering budgets to capture all medical equipment service costs, with the ability to provide an annual financial report on how all support costs could be distributed to all departments served. This would replace an existing interdepartmental charge-back model.
3. Centralize management of all vendor services and related contracts. Evaluate existing contracts for effectiveness and identify those that could be cancelled and replaced by expanding in-house staffing and service capabilities.
4. Enhance departmental equipment inventory and failure rate reporting.
5. Standardize medical equipment management plan and program policies.
6. Expand professional clinical engineering services to include product evaluations, equipment failure investigations and educational support to clinical staff on safe use of technology.
7. Reduce annual cost of equipment service from 6.75 percent to 5.1 percent over the first three-year period, then achieve an annual program budget of 4.9 percent.
8. Generate a first-year program net cost saving of $540,000.
First-Year Success
To generate first-year results, McLaren rapidly implemented key pieces of the new biomedical engineering program. The first step was to consolidate three separate clinical equipment inventory databases and standardize on one software system for tracking all costs, inventories and maintenance services. Then, we developed new job descriptions and pay structures that were competitive with equipment manufacturers. We cancelled some existing vendor service contracts and renegotiated others. Finally, we launched a central call center and configured the telecommunication systems to allow for individual hospital calls to ‘biomed’ to automatically route to the new dispatch office.
MCES’ first-year program results far exceeded expectations. The year-end cost-of-service ratio (total program cost, divided by equipment purchase cost) achieved was 5.74 percent, which generated a net cost savings of $1,176,791. Since then, annual financial results have shown a consistent reduction in the annual cost-of-service ratio, except for 2005, during which total program expenditures exceeded budget due mostly to the high cost of imaging glassware replacements. When looking at a five-year performance model, based on our initial cost-of-service ratio as compared to actual results, total cost avoidance has been estimated to be close to $11 million.
Now in its sixth year of operation, MCES staffing has grown to 51 FTEs to accommodate McLaren’s eight hospitals and growth in clinics. As we prepare for fiscal year 2009, total clinical equipment inventory—more than 34,000 pieces—is estimated to be worth $273 million. Our staff’s services have expanded beyond what many clinical engineering programs are called upon to provide and include technical support and management of radiation oncology systems, rigid and flexible scopes, analytical laboratory systems, imaging systems, cardiology/ultrasound picture archiving and communications systems, all sterilization products and surgical instrument repair and sharpening.
Growing Scope
In the past, clinical engineering programs have routinely been responsible for not only maintaining patient care equipment but for ensuring compliance with equipment related-components of various state, Joint Commission, American Osteopathic Association Healthcare Facilities Accreditation Program and other regulatory agencies. But a “repair and maintenance” program is no longer adequate given the complexities of today’s medical technology. The additional components of a program that provides services beyond repair and maintenance are not as easily quantified, especially when considering the other professional activities that a properly staffed clinical engineering program participates in, such as:
- Providing new technology assessment and equipment planning
- Coordinating equipment trials and product evaluations
- Performing vendor product comparisons and verification of technical specifications
- Coordinating clinical equipment installations
- Educating clinical staff on the use of medical equipment
- Planning for clinical equipment life-cycle replacement
- Performing incident investigation for devices implicated in medical errors
- Planning for equipment deinstallation and redeployment of physical assets
- Managing vendor warranty services
- Performing failure mode and effect analysis
- Providing real-time problem-solving for complex equipment interactions
- Participating in patient safety, disaster planning and other internal committees
As our program grows to meet our ever-increasing technology base, so will our need to hire additional staff to provide direct service on the equipment, and to also provide additional clinical engineering services. Our program model allows for easy expansion both horizontally and vertically to accommodate increases in the geographical areas we serve. Also, as it becomes increasingly difficult to define the difference between biomedical and information technology, we see a need to expand our working relationship with our IT departments.
Link to Quality
Given the amount of new and replacement technology that our health care system will purchase in the future, the MCES program model allows us to minimize our life-cycle cost of ownership and maximize the effective and safe use of medical systems, devices and instruments. This systemwide approach to clinical engineering has contributed to the standardization of processes, which has improved quality of care. With the impact that the safe and effective use of technology has on patient care delivery, it is extremely important for hospitals to ensure that they have the clinical engineering resources required to adequately service and support all aspects of medical technology management.
David M. Dickey, CHC, CCE, is corporate director, McLaren Clinical Engineering Services, Flint, Mich., and a member of the board of directors of the American College of Clinical Engineering Healthcare Technology Foundation. For more information on clinical engineering, contact the American College of Clinical Engineering or the ACCE Healthcare Technology Foundation.
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