David Dickey: Saying Goodbye to a ‘Sacred Cow’

Historically, every hospital has always had a written medical equipment management plan (MEMP), which is used to define and outline the organization’s responsibility and actions they take to properly acquire, utilize, and maintain the equipment used to provide patient care. This MEMP document defines the roles and responsibilities of the equipment users as well as those responsible for maintaining the equipment and forms the basis of all of the activities that are required as a means to demonstrate to the various inspection agencies that their equipment is safe and effective in supporting their patient care needs.

Regardless of whether the program is implemented using an in-house or an outsourced group, it is the hospital management’s responsibility to periodically review the overall goals, effectiveness and performance of their program. This is typically done via establishment of metrics (indicators of performance), leading to periodic reporting (quarterly and/or, annually) presented to a hospital safety, environment of care, or other oversight committee or executive staff member.

At McLaren Health Care, we standardized this annual report (about 15 years ago) and have always reported familiar program operational metrics: program cost, equipment inventory, repair activities, number of scheduled inspections, and more. While these metrics are important to measure, they, by themselves, do not answer the following question:

“Is your MEMP effective and of high quality?”

I have come to the conclusion that many of the historically used metrics typically measured and reported by healthcare technology management (HTM) departments actually have very little to do with quality or effectiveness, especially the preventive maintenance (PM) completion-related number. Those are just numbers based on counting completed tasks! If a surgeon completes all his scheduled cases on a given day, is he or she an effective surgeon? Perhaps, but that tells you nothing about the effectiveness of the surgery.

Likewise, if HTM completes 100% of scheduled inspections on time, but the equipment fails after we put it back into service, is our scheduled inspection program “effective?” Completing scheduled inspections on time or late is not inherently a measure of effectiveness, defined as “the degree to which something is successful in producing a desired result.”

Shouldn’t the expected outcome of your scheduled inspection program be somehow linked to equipment failure rates, or better yet, to patient care outcomes and/or safety?

During three previous presentations I have given on this topic, I asked the audience how they define and measure effectiveness and quality of their MEMP? So far, I’ve received more than 30 different responses on how each of these metrics are defined by HTM program managers. That tells me that HTM practitioners have yet to define and standardize on measures of a MEMP program’s quality and effectiveness.

Our continual focus on measuring and reporting on the number of scheduled inspections (PMs), I believe qualifies as being a “sacred cow.” While everyone in the HTM profession should understand the original intent of scheduled inspections, perhaps the main reason why we continue to put such a high programmatic focus on it is because our inspection agencies keep asking us to do so.

While we have made progress in being allowed (and able) to justify reducing our scheduled PM workloads over the years via Alternative Equipment Maintenance (AEM) program implementation, I suspect we are still wasting a great deal of time performing inspections and procedures on medical equipment for no other reason other than the OEM manual says so. Don’t get me wrong, I am all for performing scheduled inspections and PM on equipment that truly needs it, especially if it can be shown to impact patient safety, length of stay or patient care outcomes.

Other than that, what’s the value in continual emphasis on this “cow?”

In my next blog post, I’ll discuss where we in the HTM profession should be focusing our time and effort instead.

David M. Dickey is vice president of McLaren Clinical Engineering Services in Flint, MI.

7 thoughts on “David Dickey: Saying Goodbye to a ‘Sacred Cow’

  1. I would think the evolution of the MEMP should focus on equipment reliability/uptime and “use” errors (and user damage)…..basically is the item available when needed (and its working correctly) and do the users know how to use it? Everything else becomes the ‘tactics’ it takes to support the reliability and uptime as part of an active AEM program that incorporates active service events into its calculations to ensure items are being looked at (PM’d) at the appropriate intervals (or if even needed) to reduce age-related unplanned failures and maximize value of the equipment (Cost of ownership, ROI, and clinical productivity/revenue production per clinical user metrics). This addresses patient safety, cost, and ensures stewardship of resources…..

    • Hi Mark, have you modified your MEMP to include aspects of reliable, uptime, and use errors and more metrics along these lines? This is what we’re looking at and if there is something you can share, I’d appreciate it.

  2. Dave, I love the outlook presented here and totally agree. While I don’t disagree on presenting the numbers around PM completion, recalls, RPTs, repairs, etc. I think we need to move a step further and actually show the hospital leadership as well as committee leaders the true values of these numbers, which is, how it impacts our ability to support safe and reliable patient care. This is going to be a big culture shift for internal and external regulators and stakeholders. In addition to the culture shift, there needs to be thorough education and understanding for HTM leaders presenting these metrics to the different committees and leadership forums. We need to do a “smarter” job at showcasing the value we bring to the organization through an effective medical equipment management program and plan. I would love to see what’s coming in your next blog and any collaboration we can do as an industry to make this shift happen!

  3. Nice Blog Dave. Now how do we start changing the thought process of governing bodies? Writing up HTM’s can be done but take a lot of time to initiate and have to be so specific that I feel some HTM shops will feel it is easier just to continue down the same trudged path. Due to a shrinking work force, more equipment, and tighter restrictions from manufacturers HTM’s are going to have to adopt new methods moving forward to be able to keep the Patients safe and hospital equipment running safely. We all know that a PM is only good as long as the unit is in our sight. The next nurse, aide, technician to touch it could break it and we are looked at as the bad guys even though it was working fine when we completed that PM a half hour ago.

  4. So, while a PM schedule for a device may not be technically justifiable, Is there a more “legal/defensive/proactive” reason for doing annual PM on clinical equipment ? Is “Due Diligence” – being able to tell caregivers we check their equipment at least annually a good thing?

  5. Very well said Dave and totally agree. In addition of letting go of the percentage PM completion metric – and nearly as blasphemous if not more so – I would also encourage eliminating much of the unnecessary and useless PM inspections as well; doing so, however, will require a rather bold paradigm shift within the HTM community and – especially – some collective courage (and risk) to take on the regulators. Since PM inspections have become so tightly bound and nearly ( but incorrectly) synonymous with patient safety, trying to reduce the former attacks the very sanctity of the latter. Nonetheless, thanks for keeping us thinking about such things!

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