Julia has since completed her MSc thesis which gained a very high mark and has received good feedback from those involved in managing medical equipment libraries.

Her thesis can be found here Health Informatics PhD and MSc theses

Also, we have had a paper accepted based on this work: Werth, J. & Furniss, D. (To Appear). Medical Equipment Library Design: Revealing Issues and Best Practice Using DiCoT . To Appear at International Health Informatics Symposium (IHI 2012), Miami, Florida, Jan 28-30.

Thanks to those who were able to help with this project. If you had further comment on the work or ideas of how to take it forward I'd be happy to hear from you.

Care to explain what Distributed Cognition for Teamwork (DiCoT) is all about (in two paragraphs, or less)?

Distributed Cognition for Teamwork (DiCoT) is a method that we use to help us understand how a 'system' works e.g. like a control room, a lecture theatre, a call centre, or in this case a medical equipment library. There is often a lot going in these contexts which makes it challenging to understand when you're not an expert. This method helps us focus on five specific areas: 1) the way tasks are done, 2) the way the room is laid out, 3) the artefacts that are used in the system, 4) the way people are organised, and 5) the way the system has developed and evolved over time.

The 'Distributed Cognition' part refers to theory that says a lot of our thinking is shaped by how the environment is organised, and that we manipulate the environment to improve our thinking. For example, everyday we use PostIt notes, shopping lists, diaries, alerts and reminders to help us perform - we might even need to write numbers down on a piece of paper to perform a calculation if it's too complex to do in our head.

The 'Teamwork' part refers to the fact that there are normally multiple people in a system that work together to perform broader goals. For example, in a study we did in the London Ambulance Service control room you have many call takers that filter information, which passes on to one of the sector desks where an allocator makes a decision about what ambulance will attend what incident, then a radio operator will contact the ambulance to communicate details of the incident.

DiCoT helps us see how information changes and moves around these different contexts, between people, artefacts and bits of technology. We essentially want to understand the system better and suggest improvements.

"The Hospital as a System" was an idea that we picked up on back in 1987.

A year later once we had our "hospital team" in place, that's how we used to lay out new hospitals in a certain well-known Desert Kingdom. With great success, I might add.

And not a PhD (or even a BSc, come to that) in sight!

"Circulation studies":- hospital kitchens and laundries are two areas that spring immediately to mind. Nothing mind blowing there. Just a modicum of enthusiasm, keen observation, a vivid imagination, a clue about how hospitals operate, a sense of scale ... and an ability to count, really. Plus common sense, I suppose I should add (although we were generally able to take that for granted, I'm pleased to say).

The idea of "Equipment Libraries" had yet to take hold, but I wouldn't see that as too much of a mental challenge, myself. To be honest, I don't really see why some folk apparently have such problems in setting them up. Once again, it's really just a numbers game. Back to circulation studies, in fact.

Haha... [laughs]... if only we had more like you then we'd have great medical equipment libraries up and running in all sorts of different hospitals everywhere, with a little bit of common sense and imagination, all soon after 1987 as well maybe

Some things are more obvious in hindsight. I guess medical equipment libraries may fall into this category. Julia's research found that there were specific drivers which led to the idea of centralised device management. Since we now have the idea of the equipment library I look forward to these practices evolving with experience, design and improved technological support. I like to think the paper will draw more attention to the current state of some equipment library practice so knowledge can be shared and researchers might turn their attention to it to do more research and so some positive interventions can be made.

I wouldn't want the details of the DiCoT, and references to 'system' and 'team', to detract from the explanation of how some medical equipment libraries operate at quite a detailed level e.g. the use of a T-card system which was novel to one large library we were working with.

I don't see how setting up a library is just a numbers game? You need a space (clean and dirty areas), staff, maintenance systems, administrative systems (some paper and some computer), procedures, plans for provision of service out of hours (evenings and weekends), you need buy-in from staff throughout the hospital and the service has to be such to maintain trust. This all seems much more than numbers to me. (All these things will vary given the size of the hospital you are in and the sorts of devices the medical equipment library is tasked to manage).

Could you explain a bit more about circulation studies and the focus on counting and perhaps I'll understand your perspective better? Perhaps a reference to an example of a circulation study.

As Geoff stated clearly 'common sense' is the answer not baboon management speech.

Thank you, Neil.

@Dominic: Shared Equipment Stores (or Pools) are hardly a new idea. Anyone who has worked in a real engineering environment will surely remember handing over their tally tag(s) at the workshop (or factory) stores in exchange for the loan of a special tool etc..

But for some daft reason, shared equipment stores in NHS hospitals have become known as "Equipment Libraries". Why is (was) this? Well, perhaps that's another area for study. But my guess is that the folk who started the first one (where was that?) had never worked in industry, but had borrowed a book from the local Library a couple of times over the years.

With respect, the criteria you mention (re:- setting up a library) are blindingly obvious, I would have thought. No Rocket Science there, then.

How is it a numbers game (you ask)? Well, first of all you need to sit down for half an hour with paper and pencil and work out how many infusion pumps et al your "Library" is going to need ... (all the "Equipment Libraries" I have encountered never seemed to have enough).

Examples of circulation studies? There could be many and various (all of which would take time, and indeed, inclination). But at the risk of repeating myself ...

Lastly (and on a personal note), I always found consulting on New Hospital Projects to be (what I would call) "easy work". Drawings, and simple pencil and paper calculations, in the main. Plus, of course, databases (my own particular forte). And then, later on:- inspections and such. Although such work was often drawn out and tedious, is was (and is) nothing compared to electronics design and fault finding (especially when the kit is urgently needed by user and patient).

Yes, some things are more obvious in hindsight. That's why Version 3 (of anything really) is the one to go (wait) for! However, it's one thing examining what has already gone on, and making comments and recommendations (ready for "next time", we presume), but it's quite another doing what we might call "pioneering work" (based upon first principles - and yes, common sense) in the first instance!

Thanks Geoff,

We haven't focused on numbers at all, and not really interested in this aspect. We're interested in the operational details i.e. how the workplace is organised. I followed your link through to circulation studies but there was only a list of areas for where one might do such a study, and not an explanation of what one was. Have I missed this or is it missing? Also, is there a specific circulation study on equipment libraries that we can see?

I still think there is merit in pooling collective wisdom, experience, and best practice. I see this forum as a way that this is achieved, where lots of people share knowledge and practice. Some people in industry have given positive feedback on the paper - I guess it is more useful for those that are new to Equipment Libraries or want to find out details of how others organise their library. Sharing collective wisdom and best practice stops everyone doing pioneering work independently.

Yes, I like to think that I'm big on "spreading the word", myself.

I'm pretty big on collaboration, and sharing the wealth (of experience, information) as well.

But sadly, I don't always have too much time for in-depth studies, explanations and worked examples these days ... since I'm no longer being paid for my efforts.

Your point about "reinventing the wheel" is valid, and well taken. But what if a guy struggling on in splendid isolation actually comes up with a "better way"?

In other words, if Pioneer H comes up with (or already has come up with) a better way than Pioneers A,B,C et al, are we to be too proud to adopt it (assuming, of course, that we eventually come to hear about it)?

Back in the days I was referring to (that is, the pre-internet etc. era, and usually in semi-remote locations), we didn't really have a whole lot of choice. Problems were presented, or they arose ... we got on and sorted them out.

Lastly, fundamentally I'm not entirely "sold" on the idea of "Equipment Libraries" by the way. It may not be the panacea that some would have us believe. Let's start by asking the question:-

"What's wrong with Wards and Departments having (and hopefully, looking after) their own kit"?

Earlier on you mentioned "drivers". To be honest, I suspect that one of the main drivers behind "Equipment Libraries" in the NHS is that someone thought (and no doubt continues to hope) that they may get away with having only seventy-five infusion pumps (say), rather than a hundred. The bottom line being, as usual it's all about money. Saving a few bob.


It's the whole point of it! Eg, having sufficient serviceable infusion pumps (for example) available when called for.

Surely "how the workplace is organised" is a secondary consideration? When it comes to "Equipment Libraries", any old back room that has become vacant can be pressed into service (and generally are). At the end of the day, it's only a store ... albeit usually (hopefully?) with a few extra power sockets.