Paul Kelley: Of Crabs, Crawdads, and HTM

Have you ever seen a bucket of crabs or crawdads? You can put them all in the bucket and not worry about any escaping because as one tries to crawl up and out of the bucket, the others grab it and pull it back. It’s akin to a mindset of, “If I can’t have it, neither can you.” While there are many exceptions, I often feel that this mentality applies, unfortunately, to the HTM community.

Too often, we’re holding ourselves back, pulling ourselves back into the bucket, instead of moving ahead and taking advantage of new opportunities.

Our field started with many tinkerers with a can-do attitude. It has morphed over the years, but the fiercely independent streak still survives. We have seen it with the debates over certification (and licensure) and the move to name the field healthcare technology management. Some people don’t like change. Others will always believe that they are right and everyone else is wrong. Others may be intrigued, even excited, by the prospect of change, but they lack a professional foundation and support, so they are afraid to take a chance, worried that it may wind up shutting them out of the field that they love. In the end, such thinking can leave us like the bucket of crabs or crawdads; nobody moves ahead.

So how can we change? To start, we must embrace new ways of thinking.

Lean principles call for “standardized work.” This concept means everyone doing something does it same way. This approach reduces waste, including mistakes.   Something else to keep in mind is the aphorism, “Don’t let perfect be the enemy of good,” which means it is better to implement something good, even if it has some flaws, than to analyze an idea to death in an endless quest for the perfect solution.

Both of these concepts have relevance to our jobs today and our futures tomorrow. Our field is being attacked because we do not have consistent standards. Regulators and lawmakers can sometimes cast a critical eye at the HTM field, asking about the basis, or the supporting data, for our practices and policies. Many other healthcare fields make changes that are “evidence-based” and are rejecting some practices that have been “traditional.” We should be doing the same thing.

There are several initiatives in the works that are striving to move the HTM field forward, and I hope you will get involved. Here are a few opportunities:

  • There are several standards being developed now for the HTM community. They include one focusing on healthcare technology acquisition and another seeking to develop a common vocabulary for medical equipment management programs and processes.
  • AAMI’s Technology Management Council (TMC) has task forces with focuses on career development, regulatory matters, standards development, and promoting the field. The TMC also has two committees meeting on reliability-centered maintenance (RCM) and supportability (including competence).
  • Education is another challenge. Some schools with HTM programs are closing. Those that are up and running would benefit by hearing from the professionals on the frontlines. You could volunteer to be a teacher, guest speaker, or take on interns.
  • Getting certified by the AAMI Credentials Institute (ACI) is a great way to demonstrate your credibility and commitment. If you are already certified, volunteer to get involved by writing questions.

If you don’t like the direction any of these items are heading, get involved! If you do like their direction and you support them, get involved! Together, we can help each other get out of that bucket and move the HTM field forward—and stop acting like crabs and crawdads.

For more information or to find out how to get involved with the TMC, contact Patrick Bernat, director of healthcare technology management at AAMI, via email at or by phone at (703) 525-4890, ext. 1268. To learn about volunteer opportunities in general at AAMI, please visit this volunteer page.

Paul Kelley, CBET, is director of biomedical engineering, the Green Initiative, and asset redeployment at Washington Hospital in Fremont, CA. He is a member of the AAMI Board of Directors.

3 thoughts on “Paul Kelley: Of Crabs, Crawdads, and HTM

  1. Hi Paul Kelly. I am getting involved. I have been to my statehouse, lobbying in support of pending right-to-repair legislation, testified in in front of committees at the statehouse and even in front of the FDA last October.

    A lot of things may be holding us back, but without “right to repair” we are dead.

    Right to repair is the most serious issue our industry is facing. IMHO, our industry, needs to actively support and promote right-to-repair legislation across the nation.

    This past week, I had a 24VDC power connector that became erratic on a surgical display. I called the OEM to ask them for some tips on opening the unit and checking the connector. The OEM tech on the phone said, “You can’t repair OUR equipment; you have to send it to us here in California.” (The disdain in his voice was palpable over the phone.) I asked for a copy of the factory service manual, telling him that TJC/CMS now requires us to have them and that TJC/CMS has adopted NFPA-99 which says he must provide them. He replied, “I have never heard of them; our manuals are proprietary.” I asked, “Can’t you just help me one tech to another? I have an MD that needs this first thing in the morning.” He said, “If you can get me a PO#, I can give you an RMA and we can turn it around in a couple weeks.” Yada yada yada.

    This was over repair of a video monitor with a loose 24VDC power connector. Examples like this are becoming far too common. On the bright side, I was able to get an X-ray of the unit, see where the screws were hidden under a plastic overlay, open it up, fix the connector, and get the display back in service before I left that night.

    As you are on the AAMI Board, can you ask AAMI to start actively promoting the right to repair? I know in the past AAMI was neutral in this due to the membership also including OEMs, but since you are writing about what is “holding us back,” I think right to repair has sit right up front at the table.

    Your thoughts?
    J Scot Mackeil CBET Quincy Ma.

  2. After 9 years of promoting a standardized system developed by biomeds to improve the access to medical equipment user manuals ( AAMI 2016 Tampa ), I would like to suggest we add “support” of biomeds who step up to the plate to solve issues courses and committees can’t and don’t solve.

    NFPA99, the TGA, the MHRA, and every single code, standard, and bulletin related to medical equipment user manuals, user information, and the details on safe use mandate these should be available to staff 24/7, yet 70% plus of the organizations I come into contact with ignore these codes.

    If use error and user error are not a problem in your organization, I would suggest you share your experience and strategy with the world. The people I come into contact with remind me on a daily bases that it’s an issue; however, we have now moved on from electrical testing and stickers to cybersecurity. I think many of us will agree the first 2 offer very little value in terms of patient safety in 2017 (and currently an obsession in Australia).

    I often hear the HTM argument that use and user errors are related design issues and are compared to the layout of car foot pedals etc. Not to dispute that obvious fact, it’s interesting to see that one of the arguments for introducing driverless cars is that most accidents are related to human error.

  3. Two comments:
    (1) Everyone doing things the same way is only good if that way has been proven to be better than the other ways, under all circumstances. Simply agreeing doesn’t make it right.
    (2) The counter to “perfect is the enemy of good” is “good enough is the enemy of better.” Satisfaction with just getting by is not a lofty goal.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s