By ECRI
ECRI’s annual Health Technology Excellence Award competition provides insight into exceptional technology management initiatives undertaken at health care organizations around the world. ECRI bestowed the 2024 Award on Clínica Imbanaco (Cali, Colombia) for its multiyear effort to improve how health technology is managed at its facilities, with the goal of becoming a pioneer of health technology management best practices in its region.
“For our organization, it is essential to learn every day from the best global practices in patient safety.” Those words from Karent Muñoz Salazar, head of clinical engineering for Clínica Imbanaco S.A. (Cali, Colombia) – combined with her organization’s demonstrated commitment to facilitating better strategic management of health technology to improve patient safety, enhance processes and reduce costs – illustrate why ECRI selected Clínica Imbanaco as the 2024 winner of its Health Technology Excellence Award.
Clínica Imbanaco in Cali, Valle Del Cauca, Colombia. Photos courtesy of Clínica ImbanacoClínica Imbanaco has implemented multiple initiatives over the past several years to expand the capabilities and upgrade the quality of its health technology management function.
“What struck us about the work being done at Clínica Imbanaco is that the projects weren’t just one-time efforts. They reflected a culture of wanting to continuously improve how health technology is managed,” explained Scott Lucas, ECRI’s vice president of device safety. “Their work shows a real desire to elevate the health technology management function within their region to meet or exceed international standards.”
The following are a few examples of their work.
From Corrective to Proactive Maintenance
Corrective maintenance is a reactive measure. A problem occurs, then staff need to identify the cause and restore the equipment to normal operation. This approach can be costly in terms of time and money, and it can put patients at risk, subjecting them to harm if the problem is not discovered before the device is used in their care.
The proactive management of medical technologies, by comparison, is intended to help prevent future device failures. Clínica Imbanaco implemented several measures to reduce its reliance on corrective maintenance (repairing devices after they’ve failed) in favor of a more proactive approach.
This initiative included the following measures:
- Identifying and classifying medical equipment risks, the probability of failure, and the potential impact of failure, and then using that information to define maintenance and training strategies for the equipment. For the risk assessment process, the organization developed a “heat map” to classify the probability and impact of device failures for various clinical processes, ranging from acceptable risks (low probability, low impact) to unacceptable risks (high probability, high impact).
- Training users on the safe use of medical technologies and, importantly, evaluating the effectiveness of that training (using the Kirkpatrick methodology).
- Adhering to a robust preventive maintenance program. Regular device inspections and maintenance (e.g., lubricating and adjusting components, replacing worn parts) can prevent failures and breakdowns.
Collectively, these efforts helped reduce corrective maintenance expenditures, increase preventive maintenance compliance rates, and improve patient safety.
Medical Device Calibration
An inaccurate measurement from a medical device can lead to inappropriate care decisions. So access to a timely and reliable source for medical equipment calibration is a key technology management consideration for any care provider.
In many regions, health care organizations can contract with an outside organization to perform this function. That can be a challenge in Colombia. According to Muñoz, only four health entities in Colombia have accredited metrology laboratories. Further, calibration services are expensive, are not readily available in all locations, and can be of inconsistent quality (or not conducted in accordance with the country’s regulations). Clínica Imbanaco reports that it repeatedly experienced delays in the process, resulting in medical devices not being available.
To address this challenge, Clínica Imbanaco established, and achieved accreditation for, an in-house metrology laboratory. This effort required a significant investment, as it involved infrastructure adjustments, equipment maintenance, proficiency testing, internal audits, consulting and training for the team of professionals formed. Achieving accreditation from ONAC (Organismo Nacional de Acreditación de Colombia) under the guidelines of ISO/IEC 17025:2017 was key to providing assurance that medical devices would be calibrated according to the organization’s standards and available when needed.
Evidence-Based Technology Selection
Consideration of an intracranial and extracranial surgery system for treating cancer patients illustrates the organization’s embrace of an evidence-based technology assessment process. A multidisciplinary technology assessment team was formed to establish selection criteria, evaluate the prospective models against those criteria and make an evidence-based selection decision.
Clínica Imbanaco’s assessment followed the GRADE methodology to evaluate the certainty of the evidence; this approach helped the organization make clinical practice recommendations and decisions about new or emerging technologies systematically. Questions were framed in the PICO format, defining the population, intervention, comparator and outcomes to be studied. (The comparator, in this case, involved comparing the technologies under consideration with the alternatives currently available for managing the health condition.)
The team’s analysis considered factors such as the system’s ability to fulfill a clinical need, the features and capabilities of the systems under consideration, preinstallation conditions and testing, and economic and operational factors (e.g., cost, warranty information, expected life, service schedules). This process helps the organization identify new or emerging technologies that will meet clinical practice recommendations in a cost-effective manner.
Other Initiatives
Following are a few of the additional projects that Clínica Imbanaco has implemented in recent years to improve how health technology is managed:
- Establishing a clinical alarm management program. Efforts included assessing clinical workflows, adopting a patient assessment process to facilitate early detection of patient decompensation, and upgrading medical technologies and alarm communication systems.
- Implementing smart infusion pumps with dose error reduction system technology to reduce medication errors.
How to Apply for the 2025 Award
To apply for the 2025 Health Technology Excellence Award, which is open to members of any ECRI program, visit https://ly.ecri.org/HTE_Award. Applications consist of a short essay describing an initiative that improves patient safety, reduces costs, or otherwise facilitates better strategic management of health technology. ECRI will accept applications through the end of January 2025.
