IMPROVING OUTCOMES THROUGH ENGAGEMENT OF HEALTHCARE

TECHNOLOGY MANAGEMENT (HTM)

Valdez BravoMay 22, 2015

Welcome

Disclaimer: The views expressed in this presentation are those of the author and do not reflect the official policy or position of the U.S. Government, the Department of Veterans Affairs, or

the Oregon Society for Healthcare Engineering.

About me

• US Army Medical Equipment Repairer (95-03)• Oregon Health & Science University (03-04)• VA Portland Health Care System (04-Present)• Portland Community College (04-06)• Portland State University (06-09)• Army-Baylor Graduate Program in Health and

Business Administration (13-15)

About VAPORHCS

• Built in 1987, 277-bed facility, 12 sites of care across 2 states, 26 counties, 33k square mile area

• Fastest Growing 1A Facility in VHA, serving over 91,000 unique Veterans

• #11 in VHA Research programs ($34M)• Kidney/Liver Transplant programs• Mental health programs with emphasis on PTSD, TBI• Battling homelessness in Oregon and Washington

Shocking, but true …

Questions for the Audience

C-Suite:“A widely-used slang term used to collectively refer to a corporation's most important senior executives. C-Suite gets its name because top senior executives' titles tend to start with the letter C, for chief, as in chief executive officer, chief operating officer and chief information officer.” - Investopedia

Source: http://www.investopedia.com/terms/c/c-suite.asp

HTM: Common titles within HTM include: clinical engineer, biomedical equipment technician, clinical equipment specialist, biomedical equipment specialist, laboratory technician, and imaging technician.

Source: http://www.aami.org

HTM: • Ensures safety, efficacy, and availability of healthcare

technologies

• Strives to minimize healthcare costs

• Works with clinicians and other healthcare professionals to ensure the highest standards and best practices in medical device safety, security, interoperability and functionalitySource: http://www.aami.org

• Challenges Faced by Health Care Systems1

• Challenges Faced by HTM2

• How to Maximize Outcomes3

Today’s Overview

Challenges Faced by Health Care

• An Aging Population• Shortage of Physicians and Nurses• Access• Increasing Reliance on IT systems• Aging Plant and Equipment• Affordable Care Act• Quality Over Volume• Declining Medicare Reimbursement Rates

Driving the Cost of Healthcare“Technological innovations have been the single most important factor in medical cost inflation over the second half of the 20th Century. They have accounted for about one-half of the total rise in real…healthcare spending during the past several decades.”

Delivering Health Care in AmericaShi & Singh, 2012,

Healthcare Technology Management is perhaps one of the only in-house departments that can

mitigate some of the forces driving medical inflation rates.

Contextual Factors Driving Cost

• “The Technological Imperative”

• Market Differentiation

• Physician Preference Items

• Lack of Planning

Challenges Faced by HTM

• Highly Specialized Field• Lack of Understanding of HTM’s Role• Varied Levels of Engagement

Throughout Industry• Growing Requirement for IT Knowledge

and Skills• Restricted Autonomy to Set Local Policy

on Maintenance Procedures

#1 Challenge:

Varied Levels of Engagement Throughout Industry

Causes for Disconnect

• The Technological Divide

• Administrator Education

• The Publishing Problem

• Humility vs. Self-Promotion

The Technological DivideMany Folks Just Don’t Know Exactly What All HTM Does

• Relatively new career• Rise to prominence in the 1970s• A fairly small field• Success means not being called

Administrator EducationWhat are healthcare administrators learning in school?

• Healthcare Delivery• Finance• Economics• Project Management• Healthcare IT

• Not Medical Equipment Management• Not the Role of Clinical Engineering• Not Capital Equipment Replacement Strategies• Not the Benefits of an Engaged Clinical Engineering Department

The Publishing ProblemWhat Clinical Engineers Read (and Publish In):Journal for Clinical EngineeringBiomedical Instrumentation & TechnologyIEEE24x7 Magazine

What Healthcare Administrators Read:Journal for Healthcare ManagementJournal of Healthcare FinanceHealth AffairsHealthcare Executive

Clinical Engineers

Clinical Engineering

Journals

Read By

Healthcare Administrators ✖

Humility vs. Self-Promotion• Biomedical professionals tend to have a humble,

modest nature• Minimizing downtime is the goal Crisis = Failure• When HTM is elevated in the conversation, it may be to explain a crisis• Behind the scenes standard of success; “No

news is good news.”• This perpetuates the lack of understanding• Mechanisms to market HTM departments are not readily available in many systems• HTM Appreciation Week is an opportunity

I Saved Our Hospital $168,000 Last Year!

Engagement Strategies for Healthcare EngineeringDepartments

Time Spent Demonstrating Results

Leve

l of C

omm

unic

ation

Reporting

Working Toward Engagement

Advocating

Partnering

Leading

QUESTIONHow Well Do You and Your C-Suite know each other?

The C-Suite• Do you know the names of

everyone in your C-Suite?

• What are the goals and objectives

of your C-Suite?

• What are your CFO’s concerns?

• What are your hospital’s capital

priorities this fiscal year?

• When did you last meet with the

Chief Information Officer or IT staff?

Adapted from a slide by John-Paul Guimond, 2013

What is the C-Suite’s Perception?• Is HTM viewed as a break/fix service?

• If so, HTM is a commodity that can be outsourced.

• “Located somewhere in the basement …”

• “Biomeds fix general equipment but not the really

high-tech stuff”

• “Engineering guys aren’t financially savvy…”

• “They work hard but they don’t communicate.”

• “I have no idea what those people do.”

Adapted from a slide by John-Paul Guimond, 2013

QUESTIONHow Well Do You and Your HTM Staff know each other?

HTM and Facilities Management• What is the relationship between Facilities and HTM?

• Do you know the names of your HTM manager?

• Is your HTM department in-house or a third party?

• What is the capability level of your HTM partners?

• Is your HTM department successful? How do you know?

• Do you meet regularly, or just during projects?

Key Roles of an Engaged HTM Department

Partnering with HTM

Level 1: ReportingWe all have to report. But how do you do it?• Synthesize data for executive level staff

• Dashboards, Key Performance Indicators (KPIs)

• Avoid using too much jargon; clarify and explain data• Use professional terminology to refer to your department, staff,

and roles

What do you report?• Go beyond the standard metrics• Illustrate cost-savings, utilization, and impact• Align your data with organizational mission, goals, and strategic

objectives• Utilize benchmarks if managing multiple sites• Health device hazards and manufacturer recalls• Customer satisfaction survey results

Level 1: Reporting

Adapted from a slide by John-Paul Guimond, 2013

Level 2: AdvocatingAdvocating is different than whining• Tell your story• Ensure higher-ups are aware of your

situational reality• Illustrate needs and projected

Return on Investment (ROI)• Cost-Benefit Analysis• Highlight savings

• Sell the “WIIFM”• Be persistent yet tactful

Level 3: PartneringEnsure you have a seat at the table• What committees are you on?• Does the C-Suite / organizational leadership

check-in with you before making a move?• Is Clinical Engineering on everyone’s radar?• Do you have equal say in capital equipment

planning, technology assessments, contract decisions, and hospital projects?

Level 4: Leading“What dreams may come.”What if:• Clinical engineering drove change

instead of facilitated it?• Healthcare Technology

Management was effectively used to formulate strategy?

• Clinical Engineering helmed healthcare IT?

• Clinical Engineering was at the C-Suite Level?

Perfect World!

Possible Outcomes

Does Your HTM Department Actively:

• Perform healthcare technology assessments?

• Assist, or lead, capital equipment planning?

• Illustrate the “true” cost of ownership when making

recommendations?

• Lead Systems Integration efforts?

• Partner in project planning? Strategic planning?

• Play a role in the Patient Safety program?

• Manage their own contracts?

• Align with C-Suite goals and objectives?

• Use C-Suite lingo when communicating upwards?

IMPLICATIONS OF MISSED OPPORTUNITIES

ImplicationsMinimized ROI• Poor health technology assessments (HTA)• Premature Asset Replacement• Misguided or Incomplete Buys• Failure to include facility engineering in

purchase decisions, resulting in devices and systems that cannot be installed

• Failure to realize full integration possibilities with existing IT infrastructure

• Failure to achieve optimized performance of medical devices and systems

Minimized Resourcing

• Less likely to get the bodies HTM needs• Less likely to get the schools HTM needs• May not get the equipment HTM needs

AVOIDING MISSED OPPORTUNITIES

Avoiding Missed OpportunitiesStrategies for HTM Individuals• Document, document, document

• For the C-Suite, metrics are everything• Communicate significant savings to your team lead

or manager• Lifelong learning; Continuing education

• Formal (Clinical, Technical, IT)• Informal (Magazines, Websites, Blogs)

• Involvement in professional societies • (OBA, WSBA, AAMI)

• Professionalism• Appearance• Communication• Product

Avoiding Missed OpportunitiesStrategies for CE Departments• Market the HTM department!

• Department Photos• Engaging Intranet Site• National HTM Week• Newsletters• Apparel / Uniforms

• Hire managers with diverse skillsets• Communicate savings and other

accomplishments to the C-Suite• Plug the HTM department into everything;

earn a seat at the table• Visit clinical departments, walk the Gemba• Proactively advise customers on capital

equipment requests at start of FY• Consider hiring a consultant to offer an

objective view of operations

Avoiding Missed Opportunities

What is your reporting structure?• Hospitals are large, hierarchical systems• Communication is always a challenge• Where you are at in the food chain matters• Decision-making can be heavily influenced by which

department you report to• What is the ideal for your organization?

HTM departments reporting through logistics?Through facilities?Through IT?Through nursing?Directly to the C-Suite?

Avoiding Missed OpportunitiesStrategies for the Field• AAMI’s I AM HTM Campaign

• Resources geared towards diverse audiences

• AAMI Presentation in 2013 by John-Paul Guimond• C-Suite Driven Clinical Engineering Operations

• Field should publish How-To Guides for clinical engineering managers; evidence-based technology management?

• Publish in journals/magazines that healthcare administrators read

• Foster professional societies

John-Paul GuimondJPG Consulting LLC

Overcoming Resistance• “We don’t have time to do these things. We’re

supposed to be fixing equipment.”• “I don’t want to be stuck at meetings all day. I’m a

biomed.”• “Would be nice but nobody listens.”• “I like being out of sight, out of mind.”

Departments that perform well, share their successes, educate their system about the breadth of their knowledge and services, and who get involved with decision-making, will have a greater impact on their organization and their own well-being.

Case Study

• HTM Manager A– Reports PM data/repair stats monthly– Avoids hospital boards, meetings; – Rarely leaves office– Minimal presence outside of biomed

realm

Manager A

Case Study

• HTM Manager B– Reports PM, repair data monthly, illustrates cost savings– Uses dashboards, KPIs, visual reports– Plugged into hospital boards/committees– Publishes a department newsletter– Is well known throughout hospital and takes

the time to talk to staff members, both inside and outside of the department

– Maintains clear lines of communication with C-Suite and other stakeholders

Manager B

Discussion

• Who will be more effective in managing their healthcare system’s technology?

HTM Manager A or B?• Who will be better staffed/resourced?• Who adds more value to their system?• Who will be more likely to react to the

changing needs of today’s healthcare environment?

Summary

• The Disconnect Persists Today– No immediate solutions to the technological divide,

publication problem, or lack of healthcare administrator education

• HTM / Engineering must be the ones to advocate and educate

• Each department has a responsibility to itself and to their stakeholders to add value to their system

• The Future is What Healthcare Engineering Makes It– Nobody will lead this change for us– The people in this room need to do it here in Oregon

Resources

• AAMI’s I AM HTM Campaignhttp://www.aami.org/IamHTM/index.html

• Bravo, V. (2014.) Engaging the C-Suite. 24x7 Magazine. December 19, 2014.

• Guimond, J.P., (2013, June). C-Suite Driven Clinical Engineering Operations. Symposium conducted at the annual AAMI conference in Long Beach, California.

• Shi, L., & Singh, D. A. (2012). Delivering health care in America. Jones & Bartlett Publishers.

QUESTIONS?

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valdez.bravo@va.gov