By K. Richard Douglas
Ask any two people, or any 10 people, what is most important to them when purchasing a new car. Some will tell you the color, some want that 630-watt stereo system, others like certain wheels or technology. Then, there is that one person who looks at cost of ownership or historic reliability. That person may also want to know about the length of the warranty, the cost of replacement parts and the cost of insurance.
While some people are satisfied that a new vehicle will get them from point A to point B and do it in style, the practical buyer is taking a deeper dive into which vehicle makes the most sense on a number of levels.
Some buyers will pour over the Consumer Reports surveys on reliability and problem areas while others are oblivious to this information. Yet, with a large purchase, every consideration helps find the best value and greatest peace of mind.
It’s not much of a stretch to relate these varying approaches to the purchase of medical equipment. “Will it provide a clean image of the liver is a much different question than what are the availability of replacement parts?” “Will it provide the accurate amount of medication or nutrients into a patient’s body versus what is its long-term reliability?”
The biomed understands what the clinician requires of the equipment, but the biomed also has a keen sense of what makes that device work, why it will continue to work or break down and how much trouble and cost goes into maintaining it.
Most anything worth knowing something about proves to be more complicated and involved than it seems at first appearance. Making purchasing decisions about medical equipment is a good example. We asked some experts for tips and considerations that can go a long way to making good decisions. We also asked them how they acquired the knowledge to make good purchasing decisions.
And, for the newer members of the HTM team, we asked them what advice they would offer when it comes to purchasing decisions.
These relate to the purchase of capital equipment with a longer life-cycle, a larger price tag and it may require modifications to the facility for installation. Input from the HTM professional is also contingent upon the confidence of clinical colleagues and hospital leadership.
HTM may be in the best position to recommend equipment replacement decisions, knowing the condition of the existing assets better than anyone else.
The Road to Decision Maker
With the unique perspective that HTM brings to equipment selection and negotiation, the myriad considerations that HTM professionals are aware of can bring important considerations to the table.
Someone, representing the HTM department has to have a seat at the table in these decisions and that person must have a roadmap to determine what constitutes the right choice from the HTM perspective. Here are some of those considerations and why these HTM professionals have a seat at the table.
“I developed a good relationship with my supply chain director, and he started to request my insight on future equipment purchases. About two years ago, HTM became an approving authority within our internal capital purchasing application for all medical equipment purchases. Before a purchase order can be issued, the HTM department must approve the request. This has allowed us to weigh in on all equipment purchasing decisions, secure service manuals, and develop a proactive service strategy for the equipment we purchase,” says Ryan Harris, CBET, HTM director at Texoma Medical Center in Denison, Texas.
“We put out a capital recommendations report each year to help executive leadership make the ultimate decision. This report includes obsolete equipment, equipment that is beyond useful life, equipment that has become expensive to maintain, or our involvement with clinical staff to replace lost or additional equipment that is needed to support increased volumes,” says Matt Royal, CHSP, CHFSP, CHEP, CHTM, CLSO-M, CHC, CHFM, CBET, director of biomedical engineering for Eskenazi Health in Indianapolis, Indiana.
Royal says that he also meets with clinical leadership to discuss capital and how HTM can support those requests.
“With the great information we can provide from a CMMS, this is often the justification they can use to help them get what they need. Eventually, they’ve trusted the capital requests go through me and executive leadership has me help them prioritize the capital that is approved. Some capital request processes in health care can be a popularity contest. The information we provide from HTM removes those politics and makes it a more educated decision for executive leadership,” Royal says.
Joshua Virnoche, MBA, CHTM, CBET, director of clinical engineering at JPS Health Network in Fort Worth, Texas, says that he is not necessarily a decision maker as it relates to capital purchases, but instead, part of the decision process.
“To be honest, I kind of weaseled my way into the process. Every opportunity I got, I made mention that we (clinical engineering/HTM) needed to be involved in what type of equipment we bring in. I approached it from both sides in regard to service contracts and in-house service. If we are servicing it in house, we need to a) either know that we are already trained on the equipment and can support it, or b) prepare our staff to support it in-house with a training budget and proactively getting training,” he says.
“If the equipment needs to have a service contract on that, I need to know preemptively so that I can get a POS quote, or shop other vendors for coverage, and have that all lined up before the warranty is up. Continuously reiterating this, plus having the executive support to bring me into the conversation was incredibly important. If I didn’t make it important to me, nobody else was going to make it important to them, to include me in the conversation,” Virnoche says.
Gary Barkov, MS, director of healthcare technology management/clinical engineering support services at Advocate Aurora Health in Downers Grove, Illinois says that his team “doesn’t struggle with being at the table” because his team “manages the entire technology life cycle.”
“System-wide equipment procurement and capital planning activities fall under HTM through their direct management of clinical technology replacement capital and the medical technology acquisition and planning (TAP) department,” he says.
“The AAH clinical engineering leadership team and TAP collaborate with key stakeholders to objectively establish medical equipment standards, forecast replacement needs, analyze utilization, prioritize and allocate funding, and optimize procurement in order to have the right technology in the right place at the best value,” Barkov adds.
Tony Cody says that he is very grateful that his health system technology management department has built such a strong relationship with the organization and the individual hospital leadership. Cody is tech management/ENTECH director in the clinical engineering department at Banner Health in Greeley, Colorado.
“Although it was a TJC standard (EC.02.04.01 EP 1) for a long time that the hospital must solicit input from individuals that operate and service equipment when it selects and acquires medical equipment, the ‘selecting input’ could vary substantially,” says Cody.
“The Banner Health Technology Management Department has earned the trust of the corporation and the health care facilities by delivering excellent service and consistently showing the measurable value of our input. When I joined this team, the hard work was essentially complete. My job is to continue delivering great service, give thorough evaluations of equipment purchases, research equipment standards, be financially responsible and help devise a comprehensive equipment replacement strategy. If I was starting from ground zero then my first step would to be to deliver great service and results in the areas of responsibility, they have already entrusted to me,” Cody says.
Bill McFarland, senior director of materials management at Cambridge Health Alliance in Malden, Massachusetts, says that he has always worked hard to understand “the importance of high touch/high tech in health care.”
“It starts with realizing that it all begins with the patient. For a patient to receive truly supportive patient care, the caregiver needs the time and best tools to deliver care in a safe and efficient manner. With patient care always as the guide, I have tried to work with caregivers to find the safest, most user friendly and economic devices and equipment. It is not easy since each patient’s need can be very specific, but the devices and/or equipment may not be practical or economically feasible to invest in. It is something that is a struggle every day,” he says.
Advice for the Rookies
With their accumulated knowledge and years of providing input into equipment-buying decisions, senior HTM professionals have some advice for the more junior colleagues regarding the process and gaining trust.
“My advice for a person starting out in the HTM industry who wants to have authority on equipment purchasing decisions would be to prove your value to the clinical staff and hospital leadership. It is important that you elevate your HTM program beyond break/fix capabilities. Get involved with nursing and seek out opportunities to help them improve patient care through the use of the equipment that we manage. Bring ideas to them about equipment use that they may not be aware of,” Harris says.
“There may be a device setting to change or an upgrade that we can implement to make their jobs easier. If you can become a resource that they trust for insight and knowledge about the equipment, you will find that they will begin to truly value the opinions of the HTM department and include us in the conversations about selecting future equipment,” Harris adds.
Some of the advice lends itself to the role of a good biomed as much as a good source for buying decisions.
“Be your own advocate. Nobody is going to just assume you need to be there, you need to make sure everyone knows you need to be there. Once you’re involved everyone will understand how much you bring to the table and will begin to ask your insight and opinions. Persistence is key, persistence will allow you to show your expertise,” Virnoche says.
Royal suggests meeting with customers on a regular basis.
“Implement structure on how you do everything. The regular customer meeting builds a trusting relationship because often we are the bearers of bad news when it comes to broken equipment. This news if often much easier when a relationship is established,” he says.
Barkov suggests that the newer HTM professional can learn about purchasing decision making if they “hang close to experienced techs and assist with vendor installations. Ask to attend any equipment planning meetings,” he says.
“If I was starting from ground zero and trying to gain influence with biomedical purchasing decisions then my first step would be to deliver great service and results in the areas of responsibilities, they have already entrusted to me. When an opportunity presented itself that could save the facility financially or help them provide a better standard of care then I would already have one foot in the door,” Cody says.
“I would present my suggestions to the purchasing decision maker in a clear and concise manner. The most important thing is to exceed their expectations at every opportunity and always in their best interest. If you do this consistently then they will trust you as a subject matter expert and your influence will grow,” Cody adds.
McFarland echoes this advice with some general suggestions that will set the newer HTM professional apart as a trusted source.
“I would have three pieces of advice; invest in your people skills; every day you will be confronted with the question: How can we make this happen? You can’t do it alone and you need to be able to work with people on both sides of the table to get it done on a daily basis,” says McFarland.
And with regard to negotiations; “Think win-win. You need to listen to the other side and try to figure out what they need. You both need to know that you walked away from the deal feeling like you got what you needed,” he says.
“Be creative; it is very easy to fall into mental ruts which you will need to climb out of,” McFarland adds.
With HTM at the purchasing decision table, there is a better chance that equipment decisions will consider all factors and prove to be the best choice throughout the device’s life cycle with regards to costs and uptime. Building trust with other stakeholders is part of bringing HTM to the table to begin with.
