| abstract | - Benchmarking: From a clinical engineering perspective, it may be one of the biggest issues in 2010. Here are the top 10 indicators I use to quickly determine the quality of a biomedical operation. You can calculate numbers and ratios that help drill down to specific causes; however, in the end, several key indicators exist. In fact, after only 10 minutes of conversing with a department manager, I can fairly accurately estimate the quality and vitality of a program. This is my list, but I encourage you to also share your top indicators. Indicator 1: The average cost of all items in the inventory This is an indicator of the accuracy of the inventory and the equipment costs. If the inventory includes all items in all modalities – general, lab and imaging – this number should be approximately $12,000. The director/managershould know this number without having to consult a computer or calculator. Indicator 2: The percentage of items in the inventory with a scheduled PM or EST This number should be in the range of 50 to 65 percent. If it’s higher, the hospital is wasting labor by testing items that don’t need it, either from a patient-safety perspective or from an equipment uptime need. If it’s lower, it’s possible that either the hospital is very aggressive in its risk-ranking and analysis (a good thing), or they’re avoiding testing necessary devices to meet a limited budget (a bad thing). Indicator 3: Whether the inventory includes all laboratory and imaging equipment, as well as items on service contracts An inventory should be complete. Inventorying only those items that you’re currently responsible for is shortsighted and doesn’t help you identify future opportunities. An inventory should include all patient-care equipment and related items. The inventory may even include servers, nurse calls, sterilizers, surgical beds, OR lights, and surgical video devices and controllers. Indicator 4: The number of documented hours per person This is a major gauge of whether your equipment history is complete. If your workers only record 30 percent of their workday, then your equipment history, time to repair, and cost information is woefully lacking. Consequently, it’s useless in calculating the cost of maintenance, productivity or documenting the need for additional staff. Indicator 5: The amount of items in the inventory The manner in which an inventory is created is important. Lumping too many individual items under a single ID number defeats the purpose of an itemized inventory. (An example is a 60-channel telemetry system, which is inventoried under a single ID number, which includes all receivers, displays and transmitters, as well as the antenna system.) I expect a typical 500-bed hospital to have about 14,000 items in the active inventory. If not, they may be missing major areas of the hospital. Indicator 6: The percentage of full-time employees assigned to maintenance and repair As biomeds and imaging engineers, we’re paid to fix stuff. If we have too many people who don’t touch equipment for the sake of repair, we may be wasting precious hospital dollars. Administrative staff, managers, supervisors and directors shouldn’t exceed 10 percent of the total clinical engineering workforce – even less so in a larger shop. Indicator 7: The overall cost value ratio (CVR) The ultimate measure of financial productivity, CVR is the ratio of annualized maintenance cost to the original purchase price of an item. Regardless of hospital size or the quantity of equipment being evaluated, it’s useful to compare the cost of maintaining a single item, a single brand, a single department, a single hospital, a single system, or any combination thereof. Typical ratios range from 4 percent for in-house, to 10 percent for third-party, to 20 percent for manufacturer contracts. A side note: When I refer to in-house, I also include the various independent service organizations that provide comprehensive service to entire hospitals. The cost is usually very close to true in-house cost of service, and sometimes better because of economies of scale and other efficiencies. The cause of maintenance cost inflation is service contracts (usually with OEMs) on individual items of equipment or special modalities. Indicator 8: The number of inventory items with no acquisition cost This is an indicator of the rigorous management of your inventory. An attempt should be made to ensure that every item in the inventory has a cost (price paid) associated with it. This can be easily determined by looking at similar equipment or asking an experienced biomed for their educated guess. The equipment cost drives so many other metrics that the entire system can fall apart if this crucial component is incomplete. Indicator 9: The ratio of in-house-serviced costs to externally serviced items We have a tendency to get lazy over time. As such, we allow increasingly more of our inventory to be serviced by outside persons or companies. It’s important to constantly measure (and trend over time) the quantity of work performed by in-house staff as opposed to outside entities. This ratio is determined by costs, not the number of items. After all, it’s cost that matters most to administration, not equipment counts. Indicator 10: Whether a customer-satisfaction survey is completed at least annually across the entire hospital Perception is reality. And the customer’s perception is the ultimate measure of how a clinical engineering department is performing. Their satisfaction with your ability to provide them with reliable, accurate and safe equipment is paramount. At least annually, every clinical engineering department should ask their customers in writing to rate their performance and make suggestions for improvements. (More informal discussions of these topics should take place much more often.) The written survey results should be compiled, trended, and presented to administration with action items to address deficiencies. Bonus Indicator: The amount of equipment in the shop awaiting repair Finally, I need to speak about using the biomed shop as a storage place for medical equipment. Just walk into your shop right now – what would a nurse or your CEO say if they saw your shop area? Does the appearance inspire confidence and a sense of organization? Or is it a junk heap? Chances are that you have dozens (or hundreds) of medical devices stacked on every available horizontal surface. Are they being actively repaired or simply stored? Do you have work orders on each item, indicating who owns it and why it’s in the shop? Or have they been forgotten? What about the closet? Is it full of equipment? A very useful metric is to perform a weekly count of every patient-care item in the shop and trend it on a large wall chart. For instance, in our 500-bed hospital with 20 technicians and 12,000 items of equipment, the average number at any time is around 100. This is less than 1 percent of the inventory. The goal is to drive down the count every week. If a special “shop cleanup day” is necessary, it should happen as often as necessary. (Note: Friday afternoon is usually a great time.) Summary The ability to cite statistics about their program is another indicator. A good manager/supervisor/director can answer all of these questions without consulting any computer or report. If a program manager seems to know nothing about their program, I have to assume that they don’t actively look at what’s happening on a regular basis. Unfortunately, far too many managers seem to be treading water until retirement. So, are you in-the-know or simply treading water?
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