We are all faced with a common problem: insufficient labor resources. It is a struggle to get through our monthly PMs. It is difficult to meet the known, predictable workload—much less the random, unpredictable maintenance needs and projects, which comprise more than 50% of our workload. So, how can an HTM leader manage these varying demands given the department’s limited resources?

Generally, there are only a couple of choices: Either leave some work undone for an indeterminate time or use the services of an outside company. There are right and wrong ways to utilize outside resources. I will discuss most of the ways to help you make a right decision:

1. Examine the nature of the high workload. Is it a very short-term phenomenon, like the failure of a single infusion pump? Or is the high workload the result of something that is not going away, like a new model of equipment that requires much more work? If it’s short term, the best way may be to consider the use of overtime to put out immediate fires and one-off events. This, however, may not work for a more sustained set of events.

Another factor to consider is whether the item carries significant political fallout if it should be down for any length of time. Often, a powerful individual’s equipment must be given priority service, just because of the nature of the individual.

2. Evaluate the current workload. If it is a light PM month, your decision may be different than if it is a heavy month and around the holiday season, when human resources are typically low. You must include not only the PM workload, but also the current corrective maintenance load, as well as any active project work that involves the department.

3. Ask: “What is the nature of the equipment that makes up the current high workload?” Are there many backups, such as infusion pumps, or very few, such as an ICU monitor, in which a down item requires a room to be closed? Items with few backups should be generally maintained by the fastest possible repair source.

4. Don’t overlook the in-house capabilities. Does your staff have the tools necessary to affect a prompt, quality repair? This not only includes technical skills, but test equipment and service documentation.

5. Consider the labor cost. Is there an outside labor source that can compete effectively with your in-house costs? And how about opportunity costs? Would sending a low-cost item out for repair free up in-house staff to put their skills toward the maintenance of a higher-cost item?

6. Determine which type of outside service is available. Is there a local service person who can come to the hospital to make the repair? Or must you package up the device and ship it to a depot somewhere? Depot repair is typically cheaper, but the labor to process a shipment and check it in when it returns to the hospital can approach the time to make the repair. Note: There are great cost discrepancies between these options.

7. Consider your prior service experience with the available outside service provider. Can they provide a rapid turnaround or response? Are they thorough? Do their repairs prove to hold up? Are they competitively priced? If you are going to have them work in your hospital, can you trust them to speak well of your department to your customers? (Unfortunately, some companies will take advantage of their time alone with the customer to try to badmouth the current in-house service provider to have a shot at stealing the business.)

8. Ask: “Does the use of an outside source for service provide any extra benefits to the hospital, like a warranty or discounted parts?”

9. Consider whether there are any in-house personnel issues that may affect your decision. For instance, are there any vacations on the horizon? Is someone scheduled to be out for a service school?

10. Determine whether your staff is adverse to working on items that are not a part of their daily responsibility. This often happens when an imaging engineer is asked to do in-shop repairs or PMs on lower-tech general medical equipment, like infusion pumps. Often, imaging service is either feast or famine—either there is nothing to do or there is an urgent repair underway. And although it’s tempting to utilize this idle labor for other equipment service, there is often a resistance to this attempt to fill up their time.

The decision to use outside labor is one which makes many biomeds cringe. They see it as a personal affront to their capabilities. But, let’s face it, there are often not enough hours in the day to accomplish everything that is required of us. Choices must be made. And logical, well-thought-out choices benefit everyone involved.

Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE, is a biomedical manager with 40 years’ experience. Questions and comments can be directed to 24×7 Magazine chief editor Keri Forsythe-Stephens at