By the Book

How do you know what to do when you are asked to work on a device you have never seen before? Some of us will start by asking the users to demonstrate what they were doing when they noticed the problem, since that’s one of the quickest ways to find out where the power switch is. Others will ask their peers what they know about it. Some will methodically go in search of the user’s manual or service manual or any similar document related to the expected utilization and performance of a device. There are a few who will refuse to even look at it because they have not been formally trained on that specific item, and will place a call to the vendor of choice.

Out of all of the above-mentioned options, is there one that is the best? I believe they are all viable, and any one may result in a successful outcome for the situation. Alternatively, any of the approaches could prove to be wasted energy. It has been my experience that no one solution fits every time, and any one of the above approaches could be a good place to start. Based on what we find after we have gotten started, we then make necessary and appropriate adjustments to our processes as we move forward. The end goal, after all, is to be successful in resolving whatever the issue was to begin with, for the best support of the health care technology and the caregivers.

Now the next question: How do you know you are doing the right things every time you work on a device that you are familiar with? It is natural for most technicians to develop a consistent, routine set of actions for certain pieces of equipment or systems, and then to pass those habits on to new technicians as part of their training process. Often, that may be some slightly modified version of the original recommendations from the device manufacturer. Does that mean we are doing things incorrectly?

I don’t believe it means that at all, but I realize I may have a different interpretation than some people when it comes to the phrase “doing it by the book.” I will try to explain using a couple of examples to support my rationale. I have a great appreciation for logic, common sense and learning from the past in order to achieve better outcomes in the future. I am also very aware that technicians entering this profession in recent years are faced with a whole different set of circumstances compared to the things we “old guys” have experienced. The things we have learned during our years in this profession and the concrete rules that have been in place the entire time may not prove to be the most appropriate for the technicians, and the technology, of today and of the future.

I realize you may be wondering what triggered this particular rant of mine, so let me clue you in. I am totally baffled by the recent statement issued by CMS, requiring health care organizations to follow manufacturer recommended inspection intervals on certain types of equipment. There are many published studies that clearly explain that variations in inspection strategies, based on documented service histories, have not resulted in any increase in equipment failures. Nor is there evidence to indicate that changes in inspection intervals correlate to patient related safety events. Where is the logic? CMS has decided to reduce reimbursements to health care organizations based on patient perceptions of quality (HCAHPS scores), and now they are dictating that our statistically validated processes are not sufficient for supporting the health care technology.

Instead, they have specified that we must follow manufacturer recommendations for inspection intervals, when there is no consistency and no oversight of those recommendations to begin with. This is one instance where doing things “by the book,” meaning accepting the CMS statement without argument, is totally contradictory to logic and common sense, and allows no opportunity to add value by acting on what we have learned from the past.

If we follow that thought a little farther, we get to the point of answering the second question from above, about how we know if what we are doing is right or not. We can determine that, especially if we are not literally following every step of the book, by looking at the end product of our efforts. If an organization elects to incorporate adaptations that allow you to vary from an originally specified process, and you evaluate the end result of the process after the changes, then you are doing an assessment of the effectiveness of the modified process. There was a new concept thrown out a few years ago called Continuous Quality Improvement. Do any of you remember when there was a big push in health care to find ways to achieve improved outcomes by studying the things we do and looking for ways to improve? That improvement may be indicated by attaining better patient outcomes, reducing costs, improving customer satisfaction or similar gains in any number of measured parameters. We can demonstrate that our efforts toward reducing costs by expanding inspection intervals have not caused any other quality measure to drop. We know we are making a positive difference because we measure the outcomes and make adjustments accordingly.

If the technology is not “out of service” as often, for us to be doing useless tests and measurements, then it is more readily available when needed for patient care, possibly even improving patient and staff satisfaction. If we are not stressing the equipment to the full range of performance as frequently, then it is not wearing out as fast and does not need to be repaired or replaced as often. That reduces the cost of ownership of the equipment, another improved outcome for our health care organizations.

Hmm, if the equipment does not need to be replaced as often, perhaps that had a negative effect on the manufacturers, so they in turn looked for the root cause of that problem. I know it is just speculation on my part, but do you sense any correlation between the financial pressures faced by equipment manufacturers in this economy, and the push by CMS to force us back to following the manufacturer recommendations? Manufacturer recommendations are a good place to start, but why should we not seek to continue to improve? How is it acceptable that CMS can dictate when and what amount they will or will not pay for the services our facilities provide, and at the same time prevent us from improving our efficiency in the way we manage our technology? Please read more details if you’re interested, and share your comments and concerns via this link. Perhaps together we can influence revisions. http://www.aami.org/news/2012/012412.press.cms.html

One sidebar point, by the book… The term Management can either be used to describe a role or a function. In the context of the Healthcare Technology Management profession, the word “management” is intended to describe the function performed by those in this profession, regardless of the specific role of any individual. Management functions include: defining goals, establishing strategy, developing plans, coordinating activities, determining what needs to be done and how it will be done, motivating, leading, and monitoring activities to ensure they are accomplished as planned (taken directly from the book Management, by Robbins and Coulter, 2007, Pearson Education Inc.). Thankfully, these functions are routinely performed by all individuals within this profession. Because of that, we can make a positive difference for the patients who rely on our health care facilities. Thanks for all of the continuing feedback!

Karen Waninger No comments