David Dickey: Look Beyond the ‘Sacred Cow’

In my previous blog post, I wrote about how the continual focus on measuring and reporting on the number of scheduled inspections (preventive maintenance, or PMs) is a “sacred cow” that needs to be put out to pasture. In this blog post, I’ll show you some better places where we in healthcare technology management (HTM) should be spending our time.

To evaluate my claim, I looked at PM outcome data at our hospitals for the past two fiscal years. I found that 97% of completed inspections (average of 17,735 per year) uncovered no equipment defects or problems. That comes after expending an average of 50,030 hours of PM labor per year to complete. While performing these inspections can and does serve to validate that nothing was wrong with the equipment at the time of the inspection (and, yes, we could put a sticker on it to tell the user that the device was safe to use on that day), performing this sacred-cow task does not tell or guarantee anyone that the device will not fail (or be used incorrectly) in the future.

While performing equipment repairs and scheduled maintenance has historically been the main focus of all equipment management programs, many HTM professionals have, over recent years, rightfully shifted their focus to other important initiatives, such as supporting clinical alarm management initiatives; working with our IT and risk management colleagues on device and data security; implementing and supporting device electronic medical records integration; supporting clinical staff education; refining HTM performance cost analytics models; getting more involved with technology planning; and participating in customer satisfaction and patient safety initiatives.

Yet, most inspectors typically don’t ask us about these activities. They, unfortunately, still tend to focus on scheduled inspection numbers, and more recently on the use and testing of extension cords and multiple power plug adapters.

However, HTM involvement in areas more directly associated with patient care and safety can certainly be argued to perhaps be a better use of our talent and time. That said, I believe that the time has come for the HTM profession to say goodbye to the “sacred cow” and focus on benchmarks and reporting tools that can help quantify how the implementation, management, and focus of our medical equipment management plan (MEMP) impacts patient care outcomes, safety, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

Going forward, HTM leaders should put more emphasis on developing new metrics for quantifying the effectiveness and quality of our medical equipment management programs. What is the intended or expected outcome or goal of your MEMP? I propose these:

  1. Clinical equipment is safe to use, available when needed, and does not compromise patient care or cause contribute to injuries or death.
  2. Users of equipment know how to safety use equipment for their intended purpose, which allows them to provide patient care adequately.
  3. Combined, issues surrounding availability and operational status of clinical equipment, along with the ability of the user to properly utilize the equipment, should not result in an increase in the patient’s length of stay (LOS).

In other words, shouldn’t we be prepared to answer the following two questions on future inspections:

  1. Has your management or implementation of the hospital’s MEMP contributed to, or caused, any patient injuries or death?
  2. Has your management or implementation of the hospital’s MEMP resulted in any increase in patient’s LOS? (Big HCAHPS score impact)

Aren’t these questions more useful than:

  1. What is your PM completion rate?
  2. Are they done on time?
  3. Where’s the sticker?

To my knowledge, there is no published data showing any direct correlation between PM completion rate to patient injury, death, or LOS. Same issue with our latest challenges in getting scheduled inspections done on time. Does a PM being late by 30 days have any impact on patient care outcomes? How about 60 or 90 days late? I think I hear a sacred cow mooing!

David M. Dickey is Vice President of McLaren Health Care Clinical Engineering Services in Grand Blanc, MI.

2 thoughts on “David Dickey: Look Beyond the ‘Sacred Cow’

  1. I always enjoy disruptive thinking and just continuing a practice without thinking about its value leads to complacency. However the other mantra that comes to mind is, “If it ain’t broke, don’t fix it.”

    While doing thousands of inspections of items that are working seems to be wasteful, the act of doing the inspection and compelling health care workers to look for potential hazards is of value. Doing gemba rounds and just “showing up” can be very productive.

    The AEM concept does allow for using other metrics than just annual inspection, however, the burden of collecting baseline data, managing repairs and reporting can be more work rather than less. There have also been some revealing AEMs that have resulted in more frequent inspections, rather than fewer.

    So, I’ll conclude by agreeing that sacred cows are to be avoided. Continue to assess and ask the core questions about outcomes, satisfaction, risk avoidance and efficient use of resources.

    Cows do produce milk…milk can be consumed immediately…milk may be separated into cream…cream may be mixed with sugar, fruit or nuts and transformed via a thermal process and mixing into ice cream. Ice cream when topped with syrup, bananas and whipped cream becomes a Sunday! So, check your calendar to find out if it is a holy day or a holiday or skip the analysis and enjoy the dish!

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