We need to rewrite departmental policies and procedures to emphasize safety over maintenance.

Based on the argument that we have always been safety specialists, and maintenance is simply one of the methods we have used to achieve our safety goals, we contend that the legacy of CEs and BMETs will be safety in medical technology. If safety is our real goal, how do we modify our maintenance culture to refocus on safety and place maintenance in its proper assistive role? We would like to suggest some ways.

To begin, we must recognize that a culture of any kind has tremendous inertia. Since the publication of To Err is Human: Building a Safer Health System, by Janet Corrigan, Linda T. Kohn, and Molla S. Donaldson, in 2000, we have been witnessing a slow but continual change in individual attitudes and in the safety structure and processes in health care. Although a national vision and plan for change have been established, it will be many years before every health care professional and system will have accepted them. Our maintenance culture exists in a relatively small population, but the industry is still resistant to change.

A safety legacy provides a goal and a broad vision for change, but not the practical steps. The first steps for change must lie in a debate of the issues. We recommend discussion of the following three questions:

1) Are the arguments sound that we should be identified as safety specialists in technology?

The arguments that we have presented are a beginning of the discussion. Is there any argument that a maintenance culture is more valid than a safety culture? What other arguments favor our change to safety specialists in technology? These arguments need to be spotlighted and discussed.

2) If a change is agreed upon, what cultural changes are required?

A primary cultural improvement will change the attitudes and beliefs of CEs and BMETs from one that "we are maintainers" to "we are safety specialists who actively support and advance safety in technology." This change alone will remind individuals in the profession that they are safety specialists and they should constantly strive to improve patient safety in technology. Educational institutions must add course content to emphasize the safety outcomes that result from maintenance efforts. Other changes must include image changes in CE and BMET support programs, along with the education of clinical health care staff as to our safety duties and responsibilities.

3) What practical form should the cultural changes take?

We believe that a departmental name change should be implemented. For example, medical equipment risk management programs or medical equipment safety management programs are better descriptors of our collective efforts. Functional safety (maintenance) is only a part of our efforts. Equipment selection, prepurchase evaluations, clinical evaluations, receiving inspections, clinician training, and technology retirement are mostly safety issues and not maintenance issues. We need to rewrite departmental policies and procedures to emphasize safety over maintenance. Staff should be educated to meet the safety obligations of these broader tasks. Departmental promotions should reflect the safety nature of the staff's activities. Requests for additional staff should emphasize that advancing patient safety is a prime purpose of new hires. Any search for new employees should emphasize the need for safety-minded CEs and BMETs. Intradepartmental reports should specifically include any increases or advances in safety efforts. Awards should emphasize advancements in patient safety, whether large or small, whenever made by technical staff members.

On a broader front, educational institutions should also emphasize the safety nature of the field and its various safety tasks. Authors of books should include more chapters focused on the different types of safety issues encountered by the profession. Professional conferences should emphasize the safety issues along with solutions. Certification questions should be revised to emphasize the nature of the profession's safety activities.

The cultural translation from maintenance to safety will not be easy. However, the change will better portray our obligations and duties to continuously improve patient safety in health care technologies. The ultimate benefactor will be our customer—the patient.

Douglas Dreps, MBA, is regional director, Mercy Clinical Engineering Services, St John's Mercy Health Care, St Louis, Mo; Marvin Shepherd, PE, FACCE, is an independent safety consultant for Devteq Consulting, Walnut Creek, Calif; and Bruce Hyndman, MSBE, PE, is director of engineering services and safety at Community Hospital of Monterey Peninsula, Monterey, Calif. They are also members of the Biomedical Advisory Committee (BAC). For more information, contact .