Maintenance magic: A thoughtful approach to biomedical services delivers big savings
August 03, 2018
by Sean Ruck
, Contributing Editor
Wesley Reid, CBET/CHTM, is a healthcare technology manager and also an enlisted member of the U.S. army. While the military is well-known for its disciplined approach to challenges as well as its formal structure, Reid’s work as the HTM during his time at Tripler Army Medical Center in Honolulu put a disciplined, structured approach to maintenance cost reduction on full display.
Reid joined the army 18 years ago right out of high school. He trained in biomedical equipment repair and that training has served him and the U.S. Army well. When Reid came to Tripler, he saw a lot of business-as-usual and on closer examination, he discovered an issue that method created. “I saw the amount of one-time service requests coming through for my approval. Being a technician, it was apparent to me it was something we could keep in-house,” he recalled.
So Reid put down the paperwork for a moment and took some time to show the technicians how to do the repairs that could and should have been handled in-house. But it wasn’t just some quick briefs – the department looked to improve overall training for the military and civilian technicians tasked with servicing the Army’s medical equipment. The training was extended to middle-managers to help empower them, and also to operators, in order to ensure they were using equipment as recommended to reduce needless wear and tear.
When Reid joined Tripler, the budgeting didn’t necessarily provide room for big changes at first. “We have to project our budget by July. To do that, we look at the previous year of contracts, personnel, training, average parts costs per month, and some projects in order to make our forecast. To reduce costs, the first thing we focused on was increasing the training of our technicians and we started saving thousands – 10, 20, 30, 40 thousand a month,” he said.
Another key decision was to bring more people into the discussion regarding the purchasing decisions for capital equipment. Previously, a project manager would have been assigned to manage the installation and other details after a contract was signed. Reid wanted to bring them in earlier. “What we did, when we got any contract to review, we’d review the procurement requests with the project manager before they went out, because they’re the ones that will be working on the project after the contract is live.”
If, upon review, the project manager saw any issues – like a needed modification that wasn’t detailed in the contract, for example – the contract was revised before pen was set to paper, while the negotiation power was still in the hands of the team at Tripler. Reid recounted a specific instance of where careful review and consideration of a procurement order paid off big. In that case, the order was for a diagnostic mammography unit for a satellite clinic. “But we have those machines at Tripler. So what they really needed was a screening machine,” said Reid. If the order had just been rubber-stamped, they might have spent twice the amount they needed to spend (potentially hundreds of thousands) to meet their needs. “So taking 30 minutes or an hour to review these procurements saved a lot of money and helped to make sure we were getting the right equipment or avoiding problems before the contract was in place,” he said.
He gave another example – something as simple as a sterilizer going to a dental clinic. “If you assumed that a clinic has a central steam supply and it doesn’t, and you’ve ordered a sterilizer that doesn’t have a boiler, you’re going to be stuck until you get a boiler for it,” Reid said.
There were some growing pains during the overhaul of the department. For one, leadership was chasing a metric of work order completion and as long as the backlog was kept under control, the situation was accepted. However, with about half of the equipment over-aged, the work orders were piling up. The situation was untenable, but solutions were found. “My boss, Deanna Hughes, who was also a biomed, she and I came up with a strategic plan to replace nearly 70 million dollars’ worth of equipment in the hospital.”
Although it was a hefty price tag, in the long run the cost was offset by reducing repair costs and downtime. It did create more work in the beginning, as systems were installed and technicians and operators received training on the new systems. Which led to another observation by Reid, “Going forward, I think we would look into contracts for temporary technicians for a year or so to keep on top of the work log if we were bringing in that much new equipment.”
And the result? A more efficient maintenance process, better-trained technicians, new equipment and a reduction in the maintenance budget of more than five million dollars per year.