Some may call him a bit of a renegade, but Fennigkoh always moves forward—with patient care in mind

By Laurie Bonner

The connection between running and a career in biomedical engineering might not be immediately obvious, but for a young Larry Fennigkoh, one led to the other. “Having run track and cross-country in high school, I became fascinated with the body, how it worked, why it occasionally didn’t, and its physiology,” he says. “Combined with a tinkering interest in techy things, especially chemistry and electronics, since grade school, I thought how cool it would be if electronics could somehow be combined with medicine.”

But it wasn’t until his sophomore year in college, after he attended an IEEE meeting in the early 1970s, that Fennigkoh learned about the then relatively new field of biomedical engineering. “Talk about being hit by lightning!” he says. “Moses came down from the mountain, the seas parted, and in that moment—that epiphany—I knew exactly what I was meant to do.”

About a year later, still a student, Fennigkoh attended an AAMI meeting. “It was at this meeting that I learned of an emerging subspecialty being referred to as ‘clinical engineering,’” he says. “Well, that just threw more gasoline on the fire. I eventually graduated and started my first hospital job in 1975 and it has been a fabulous and wild ride ever since.” 

His career finally off and running, Larry Fennigkoh, PhD, PE, CCE, worked in a series of clinical engineering positions at Lakeland Hospital in Elkhorn, Wis.; the University of Nebraska Medical Center in Omaha; and Aurora St. Luke’s Medical Center in Milwaukee. He has also worked along the way as a consultant, lending his expertise in biomedical engineering to forensic investigators, lawyers, insurance companies, and the like—and he always found time on the side to teach: at the University of Nebraska, at Marquette University in Milwaukee, and at the Medical College of Wisconsin.

Since 1998, Fennigkoh has been imparting his enthusiasm for the field to others as a professor of biomedical engineering at the Milwaukee School of Engineering. More than 20 years later, he says he “still believes that there is just something incredibly fascinating, noble, and, in a way, morally mandated of using and applying technology to serve others and help heal the sick.”

Over the course of his career, Fennigkoh has racked up a number of accomplishments and accolades, and in 2017, he was inducted into the American College of Clinical Engineering’s (ACCE’s) Clinical Engineering Hall of Fame “in recognition of his pioneering work in developing a medical device inventory inclusion algorithm that significantly reduced the maintenance and regulatory burden for many of the nation’s hospitals.” The ACCE also cited his “application of human factors principles in device incident investigations and the reduction of medical error.”

24×7 Magazine asked Fennigkoh to discuss his career, his accomplishments, and what the future holds, for himself and for the profession. Here’s what he said.

24×7 Magazine: Your work in establishing “risk-based criteria” for preventive maintenance is often cited as one of your seminal accomplishments. What were the problems that existed, what challenges impeded progress, and how did you approach working toward a better way?

Fennigkoh: I’m not sure when or how the “risk” modifier became associated with and attached to what was originally and simply intended to be a quantitative method for determining which medical device categories should be included in a preventive maintenance and equipment control program—especially since risk was only one of its components. Basically, points from an ordinal scale were assigned to each device category based on its function (2 to 10), risk to the patient (1 to 5), and maintenance requirements (1 to 5). 

If their total exceeded a specific threshold, the device category (for example, infusion pumps) was deemed to be critical enough to warrant inclusion in the inventory, our formal PM program, and keeping detailed maintenance history records. If the total score fell below this threshold, these devices (such as otoscopes and tube rockers) were effectively ignored and allowed to run to failure.

The primary motivation for developing such a system was to take on and challenge the Joint Commission and try to justify why we were no longer going to comply with their then-requirement of inspecting every medical device every six months. Within our department and seemingly many others, this simply was not a practical and doable requirement.

The challenges to making such a change, and a very real “risk” to me was in getting reprimanded or fired for willfully (and with a bit of malice aforethought) defying an established Joint Commission requirement. In virtually every one of my early presentations on this inclusion system, we were criticized for deliberately choosing to not PM and ignore these benign devices—despite our overwhelming and growing evidence that said we could.

What remains most ironic—but to their credit, however—the Joint Commission learned of our system and asked us to write a case study paper for one of their Environment of Care publications. Brigid Lagerman (née Smith) also worked extensively on this analysis and coauthored our original paper for this publication. Once published, and especially in a Joint Commission document, the merits and methodology of our inventory inclusion model seemed to have received their de facto stamp of approval, and the [movement] just took off from there.

24×7: Openly defying a Joint Commission requirement was a career-threatening risk. Would you do it again or would you try a different tactic? What advice would you offer to someone today who wanted to challenge an onerous regulatory requirement?

Fennigkoh: Well, it surely wasn’t a decision made lightly or just because we were having trouble staying in compliance, but rather one preceded by years of struggle, anecdotal similarities and accounts from peers around the country, and just the frustration of spending so much time on what appeared to be technical boondoggle. Doing so was also an ongoing and obscene insult to my very skilled staff and a waste of their precious talents. 

It wasn’t until the availability of computerized maintenance management systems around the mid 1980s, however, that allowed us to interrogate, analyze, and ask questions from the thousands of equipment history records that we now had in a relational database. As these data and subsequent analyses strongly confirmed, many of the more benign devices (such as otoscopes and tube rockers) virtually never had anything wrong with them, let alone needing to be inspected every six months. It was these data and analyses that encouraged and gave us the confidence to proceed. 

If I trusted the data and their analyses, then yes I would do it all over again. While I might now be a bit more tactful and politically sensitive, the obligation I felt to our staff and the profession was much greater than my need to be in compliance with any—and especially, in this case, such a seemingly arbitrary—regulatory requirement.

In the end, all of us have a professional responsibility to fix what is broken or at least continuously try to improve upon what we have, even when it is a scary and unpopular thing to do. So, when your gut and science are in alignment, I say just go for it. Real and good science is always true, even if others don’t believe it.

24×7: From your own perspective, what other career achievements would you cite as your proudest accomplishments? And why?

Fennigkoh: While I had a number of tremendously rewarding positions in three different hospital systems, along with countless challenging and rewarding consulting projects, earning an MS and PhD along the way, the greatest “achievements” were the many precious relationships I developed with fellow employees, students, and colleagues. It was from these people—not the stuff, places, or positions—that I was able to learn, grow, and share the most.

There was simply nothing more heartwarming and fulfilling than seeing my staff and co-workers having fun outside of work, yet also doing whatever was necessary to get the job done. They and so many other like-minded and dedicated biomed souls have been and remain the silent warriors of our profession—the true heroes of HTM.

24×7: Reading into your background, it’s easy to find comments like “Dr. Fennigkoh is an icon in our industry” and “Larry is a legend in the field.” How do you respond to such praise?

Fennigkoh: Well, in addition to being touched to my very core and flooded with a near tear-jerking sense of gratitude, it also feels a bit out-of-body, like “Who are they talking about…?”

24×7: OK, that last question was on the light side. But what we’d really like to know is this: You clearly are an accomplished individual. How was your approach to your career challenges different than others (that is, how and why did you succeed, when others didn’t or couldn’t)? What advice can you offer to others who face problems and need to overcome serious challenges like you did?

Fennigkoh: That is a question that I have yet to fully understand, let alone answer myself. Basically, I really don’t know! The closest that I’ve been able to come seems to be related, in part, to having been blessed with finding my passion and veritable calling so early on. Accompanying all of this was also an increasingly rigid (or stubborn?) and near sacrosanct belief in the value and importance of what we and the entire hospital-based HTM community were collectively trying to do—that is, to maintain, manage, and support healthcare technology in the absolute best, timeliest, safest, and most cost-effective manner possible. It was this belief that gave me the guidance and strength to persevere and, if necessary, push, shove, or (as a last resort) bulldoze. 

This same passion, however, also had its downside, which I didn’t come to fully appreciate until much later in my career. The intensity that served me in so many positive ways also frequently clashed with the brutal realities of hospital politics and power structures. Contrary to what I was taught, expected, and believed as an engineer, the scientific method, indisputable facts, the “Golden Rule,” and the physical laws of the universe did not always prevail. In fact, many times they never even mattered! More often than I now care to remember, I ran head-on into political clashes with physicians, nurses, and administrators.

In retrospect, I really could have used (and only briefly had) a trusted and seasoned mentor who could have guided me through those organizational minefields and radioactive personalities. It wasn’t so much that I was ignorant of these political realities, but more of a misguided resolve that I simply did not want to play in this sandbox.

If I could offer any advice to new or aspiring HTM leaders, it’s this: Don’t shy away from acquiring an organizational and political awareness, tolerance, and skill set for functioning in this space. Doing so is not a sellout or a betrayal of your technical roots or first love. The skills associated with working the politics and working the technology are not mutually exclusive—you don’t have to give up one to nurture the other. Finding a trusted mentor to learn from, whether it be your boss or others within your organization, is crucial because these skills simply can’t be learned from a book.

24×7: Looking forward, what are the most significant challenges you see for this profession today as well as in the years to come?

Fennigkoh: As many others in our community have already identified, and especially those HTM managers currently in the trenches, the continuing and growing shortage of skilled BMETs and CEs is of growing concern. This shortage, however, makes it even more critical than ever for all HTM programs to seriously drill down and reassess what they are doing and why they’re really doing it. Suspend, at least temporarily, the notion that it is because of some regulatory requirement. 

Instead, ask these questions: “Would we be doing this if no one or outside agency said we have to? Does it technically make any sense? And is it really improving patient safety or device reliability?”

24×7: What will today’s healthcare technology professionals (and students) need to do to prepare themselves for the future?

Fennigkoh: Given the rate of change across virtually all technologies—and medical, in particular—it’s becoming next to impossible to stay even remotely current, let alone train people to be so once they enter the workplace. Despite this rapid change, however, what have remained constant are the engineering, biological, and physiological principles upon which most of our related change is based. As such, getting and maintaining a solid foundation in these principles becomes one of the best ways to prepare ourselves for the future.

It is also in the understanding of these fundamentals that you’re now prepared and able to teach yourself new things and remain reasonably current. Granted, electronic circuits will continue to shrink and become increasingly sophisticated, but the governing principles, laws, and theorems of DC, AC, and electronic circuits are not going anywhere, nor is our cardiovascular system changing anytime soon.

With the growing and evolving sophistication of wearable technologies, deep learning, and the expanded capabilities that will accompany 5G networks, blood chemistry and vital sign monitors of the future may become completely implantable. How will you be able to do a PM or safety test on these? Regardless, most if not all the underlying principles will remain constant. The preparation for getting certified is also a great way to start reinforcing or relearning these fundamentals.

24×7: What is the most important message you would like to impart to today’s HTM professionals?

Fennigkoh: Especially for those working in hospitals, please stay ever mindful of how incredibly dependent our caregivers and their patients have become on our technology. This means treating every service call as though the device is being used on your own child or family member. It means preparing for and getting your head around becoming invisible—which is precisely what happens the better you become. Essentially, detach from the normal expectation of being rewarded for doing great, important work—most of which will go unnoticed. If you love what you do and fully understand why you’re doing it, the rest won’t matter.

24×7: What’s next for you in your own career?

Fennigkoh: I retired from full-time teaching in May 2019, but I’m still active in a part-time, adjunct capacity and hope to continue [this role in the future]. My passion hasn’t diminished and my path hasn’t changed—only my desire for a slower pace.

I also immensely enjoy attending and participating in our regional and national HTM meetings. It remains an absolute blast seeing so many of our “founding fathers” and dear friends still actively engaged—and it’s especially [rewarding] to see so many of my former students advancing the cause and doing great work as well. I’m not yet sure what this next phase will look like, but if it continues to be fun and meaningful, that’ll be my sign to honor the original gift and keep it going.

Laurie Bonner is associate editor of 24×7 Magazine. Questions and comments can be directed to [email protected].