L-R: Joe Palmieri, field service specialist II (rear of photo), and Ian Barrett, field service specialist II, perform a PM on a special procedures room.
Four car trips during a typical work day is not unusual for biomeds at Mercy Health Partners of Southwest Ohio (MHP SWO), a Cincinnati-based group that encompasses six hospitals under the Catholic Health Initiatives (CHI) umbrella. Most health systems with multiple facilities train technicians or specialists at each facility, but MHP officials took a different route.
Traditional setups work well, but entrenched silos readily form—not so at MHP. “What makes us special is that we train one person, and that person is the expert across the region,” explains Jim Meyer, regional director, MHP SWO, CHI clinical engineering, Cincinnati. “That is a rarity in our field.”
Meyer calls the strategy “regionality,” and he freely acknowledges that the workflow is far from the traditional methods that have served biomeds well for decades. The confidence to buck tradition stems from rigorous analysis. In short, the numbers back him up.
Taking care of just over 24,000 devices with one regional director, three lead technicians, 10 BMETs, and seven specialists has yielded a cost-to-value ratio of 3.65%. Since training is justified based on all like devices spread out over six hospitals, biomeds are rarely, if ever, denied the chance to expand their skills. “If you look at our number of technicians and specialists and compare it with our number of devices, we are pretty low,” Meyer says. “The average is about 1,200 devices per technician. We all tend to the small things, help each other out, and shift the workload around.”
Meyer believes strongly in the regional strategy, while acknowledging that geography, administrative will, and timing all contribute to eventual success. The three elements came together in 2008 when MHP SWO became the fourth Catholic Health Partners (CHP) region to transition to CHI clinical engineering. At the time, 16 employees brought a whopping 276 years of MHP service to the table.
Meyer’s arrival brought new managerial energy to the six Cincinnati-based acute care facilities where biomeds tended to a wide variety of devices, including 15 MRIs, 16 CTs, and eight cath labs. “Our service contract percent of budget is 47%,” Meyer says. “This is a major factor contributing to our cost/value ratio of 3.65%.”
These days, lead BMETs divide supervisory responsibilities, while remaining employees all tackle regional responsibilities based on skill and experience. “Our technicians and specialists are not confined to a specific facility, which avoids duplication of training and costs,” Meyer says. “We logged more than 7,000 miles traveling between facilities in 2010. This approach created efficiencies and the ability for our region to continually manage costs as the region grows.”
L-R: Scott Goodman, BMET II, and Jim Meyer, regional director, perform a PM on a ventilator.
The first 16 months of the initiative yielded a 97.1 program quality evaluation rating and a 4.33 customer satisfaction score out of a possible perfect five. From there, the numbers only got better as employees settled into their roles.
In all, 12 members out of a staff of 20 are considered part of the regional team that goes from hospital to hospital as needed. While these well-trained individuals are ready to travel the familiar road to sister facilities, sharing advice through the telephone is also a common practice when a relatively easy fix is called for.
Scott Goodman, BMET II, is the “anesthesia/ventilator guy,” but he often describes basic repairs to technicians at other sites. “We share information, and they can do a little first look and see if it can be easily handled within,” Goodman says, who has spent his entire 15-year career at MHP. “Small leaks within the patient circuit are an example of relatively easy fixes.”
Typically, anesthesia physicians will catch these small flaws, or they may have concerns as the case goes on. When this happens, clinicians usually ask Goodman to look at the anesthesia machine when the case is done. If Goodman’s presence is ultimately required to finish the job, he can respond quickly.
Miles Ahead
Most hospitals are on the so-called highway “loop” that spans downtown Cincinnati and its suburbs. Joe Palmieri, field service specialist II, occasionally goes to outpatient centers even farther from the main or “home” hospital—going from the eastern side of the MHP service area to the edge of Indiana, a distance of 40 to 50 miles.
Palmieri takes care of all the gamma cameras (22 across the region), and that requires multiple trips per week—occasionally completing the loop in an 8-hour span and ending up back where he started. “With nuclear medicine, all the departments do a periodic quality assurance in the morning,” Palmieri says, who has also spent his entire 18-year biomed career with MHP. “I prioritize which ones are going to go first, which depends on patient load.”
According to Meyer, MHP’s lab specialist ends up doing the most traveling, with 20 to 25 trips per month not uncommon. Fortunately, all driving is reimbursed at the current federal rate of 51 cents per mile. In case a biomed forgets to keep track, established mileage charts among facilities—and even modern GPS units—keep an accurate count.
Far from a nuisance, time on the road is often viewed as a respite to get some air, listen to the radio, and take a quick time-out. “I do not mind the driving at all,” Goodman enthuses. “It does give you a break from the monotony of being in one facility. I go to multiple sites, and it gives you a bit of time to catch your breath and get out and see some of your other customers.”
Despite all that time on the road, workers’ compensation costs are no higher for MHP biomeds, and car insurance rates are not affected. After 3 years and not so much as a fender bender, all biomeds are encouraged to use caution and never rush from job to job. “You always have traffic,” says David Dunn, lead BMET. “On the opposite side of town there is no real highway, so you are going through bumper-to-bumper traffic. It really comes down to these guys are willing to work together and make the commitment.”
On the road again: Scott Goodman, BMET II, heads to his car to travel to another hospital.
Optimum Patient Care
Hitting the road so often requires a “traffic cop” of sorts, and at MHP the man for the job is Dunn. Meyer established the role to take the scheduling burden off of his biomeds. “These guys have so many responsibilities they have to manage that I wanted to remove that responsibility and place it on somebody else,” Meyer says. “If they have concerns with scheduling or difficulties with backup, I don’t want them scrambling to find backup. I just want them to do what they do best, and that is take care of customers.”
Fortunately for Dunn, the culture of cooperation is so entrenched that directing traffic usually takes care of itself.
“It’s more of a role than a position,” Dunn says, who has 23 years’ experience as a biomed, 17 of those at MHP. “I see it more as facilitating these guys. Things can come up when somebody is going to school, a vacation, or sudden illness. That is when we usually need to backfill people. When we do send somebody to training school, that person knows his general duties and PMs are being taken care of while he is gone.”
Effectively planning PMs across the region is now part of a well-oiled set of procedures, with every specialist adhering to a strict schedule. Ian Barrett, field service specialist II, is responsible for the region’s CTs and MRs. In a break with the one-person-per-device workflow, Barrett shares duties with one other specialist due to sheer numbers—16 CTs and 15 MRs.
To ensure optimum patient care, Barrett coordinates with his counterpart, as well as the appropriate clinicians. “We want to keep those patients being scanned as much as possible,” Barrett says, yet another employee who has spent his 27-year career on the job at MHP. “That is good for patients and beneficial for revenue. We work around patient/clinician schedules quite a bit. We do PMs on Sundays if necessary, or in the evenings. We usually have a set PM every other month on CTs and MRs, and we get them done in a timely fashion because we are flexible. We are not called out when we are doing a PM, because calibrations can take hours, and we need time to do it properly.”
Meyer negotiated shared service contracts for MR and CT, an arrangement also shared by other vendors. MHP biomeds do all PMs and most of the repairs, with occasional problems requiring manufacturer personnel. “Our talent is such that most of the time we are going above and beyond the shared support agreement,” Meyer says. “It is difficult for us to lower the contracts to a lower level of support, because clinical engineering is involved on the capital side as well. As we negotiate really good service contract pricing, we sometimes hamstring ourselves because it is more difficult to lower the service levels—because that contract would actually be more than what we are currently paying.”
Joe Palmieri, loading tools into his car, occasionally travels to outpatient clinics 50 miles away.
Nationwide Trend?
Will the freeway flyer method catch on in the biomed world? According to Meyer, it depends on organizational goals and how the department is set up. MHP was already regionalized, with goals based on rigorous stewardship of resources.
If the specialty workload is already too much at one facility, it’s unlikely that biomeds can spread labor to other hospitals. When the regional workflow began, all the biomeds first had to find a way to deal with numerous demands at their “home base” hospitals. It took work, but everyone made the adjustment.
“You don’t want to let your own department down at the home-base facility, so you have to manage those tasks,” Dunn says. “Once you get on top of those duties, you must be willing to jump in that car and go help your teammates on the other side of town.”
Active training and support through strong leadership fosters an independent streak that allows Meyer to confidently give his employees the latitude they need. “We all look to each other as being individual leaders, and with that comes quite a bit of responsibility,” Meyer says. “Regionality requires responsibility, and proper training breeds confidence and competence.”
Regionality leads to more and better training because one biomed can affect so many sites. “We have six sites, and if we worked to train people for an individual facility, we would have six people going to training school for anesthesia or ventilators,” Meyer explains. “It would be difficult to justify that, so we train one person to take care of anesthesia across the region. The training may be expensive, but we can show the amount of money we can save.”
The tactic ultimately lowers the cost-to-value ratio because more anesthesia machines purchased eventually leads to more revenue. Meanwhile, regionality lowers outside service costs. “We can affect so many different devices bringing work in-house across the region,” Meyer adds.
Multiple facilities become an asset in the regionality model. Systems with one or two hospitals may, for example, have only one to three balloon pumps. In this situation, it is not cost effective to send a full-time employee to training because it is too expensive. Add on that fourth, fifth, or sixth hospital, with perhaps 10 balloon pumps, and it starts to make economic sense.
Another example at MHP is digital mammography. “I know a lot of individual hospitals that have one or two digital mammo devices, and they have them on full service contract because they are very expensive,” Meyer says. “In our region, we have 15 of them. We can take them in-house, and across the year we save hundreds of thousands of dollars. When you pool all those resources together and start adding up all these devices, you can attack it in a creative way that reduces that cost-to-value ratio.”
Generating an effective stewardship report puts the icing on the cake and satisfies the CFO. Meyer accomplishes this through a proprietary equipment management database program. Stewardship is reported every month, up through the CHI clinical engineering chain, as well as to the MHP financial team.
“We have created a spreadsheet, and we can pull that activity summary report into the spreadsheet, and from that spreadsheet we can pull out costs by individual control number,” Meyer explains. “We can list the control numbers for all of the mammography machines, input all the activity summaries from every month. At the end of the year, we can see exactly how much money we spent on each device and compare that to a contract cost or to a cost/value ratio that we set up individually for that device.”
Effective stewardship brings clinical engineering into the good graces of the CFO, but Meyer is quick to point out that the database and regional strategy all go back to a focus on the patient. At the heart of that focus is training.
“Some CE departments may want to limit training because they view it as a cost,” Meyer says. “These guys bring unsolicited training requests to me. Training is justified by being a good steward of resources. Since I have been here, we have not had one training request turned down. We make an impact across many facilities, and in the end it is the patient that benefits the most.”
Greg Thompson is a contributing writer for 24×7. For more information, contact .
