Saving money and lives by implementing Healthcare Technology Management (HTM)
The NHS is struggling to fund replacement of Healthcare technology. This is an issue recognised by all NHS Acute Hospitals. From my research across multiple NHS Acute Hospitals it is clear that Hospitals are ‘making do’ with old technology and this impact’s on patient care and increases costs.
Hospitals have always faced fundamental questions of patient safety, care, and budgetary concerns. There has been increasing recognition recently of the serious issue of medical devices management, covering the areas of procurement, training, maintenance, and governance. Procurement conduct for these organisations can be redefined thereby making training, maintenance, and governance easier to achieve, thereby reducing risk and cost.
Poor procurement leads to variation and ultimately higher risk to the patient. This is recognised by research carried out by the World Health Organization.
Improving practice in procurement will inevitably reduce cost and also assist in improving practice in the use and maintenance of equipment. In summary, good procurement reduces the variety of equipment types, enabling user training to be more effective, maintenance to be more effective and economies of scale to be achieved, thereby reducing costs. Another added benefit is that risks associated with the use of equipment can be reduced, making it a safer environment for patients.
The overall outcome of this strategy is the improvement of Healthcare Technology management within a governance framework that meets the needs of the patients, regulators, and the management of the organisation. I have found that the use, maintenance and governance of medical equipment are reliant on a central issue, namely procurement practice. HTM Procurement practice makes training, maintenance and governance easier to achieve, thereby reducing risk and cost. To do this requires structured procurement teams with proper skills and tools (technology groups information, internal database of vendors and prices, etc.), and strong relationships with OEMs and vendors (establishing lists of approved suppliers).
Healthcare Technology Asset Management services include: Acceptance Testing, Installation, Maintenance, Repairs, Setting up of equipment, Reporting, Help Desk, Remote Diagnostics, Modifications, Software Upgrades, IT Integration, Decommissioning and Disposal.
User training, a key element for improved patient care
International data shows that user errors are one of the main causes of incidents involving medical equipment. Training of users is, therefore, a fundamental element for the correct and safe utilization of medical equipment. Moreover, skilled users make better use of their equipment, increasing productivity and reducing failures and maintenance needs. That’s why user training is a key component of HTM.
HTM is a concept based on my own academic research, and that carried out by other reputable organizations including the NAO; NPSA; MHRA, and the World Health Organization.
Lack of funds to buy healthcare technology
Hospitals do not have the funds to replace aging assets that would enable delivery of improved service. Even with support from charities, the NHS fleet is aging rapidly. A flexible but planned approach to equipment replacement is needed and could lead to standardisation benefits such as:
- Easier user training / better use of technology
- Safer and improved services for patients
- Faster diagnosis and therapy
- Less complications
- Early discharge
- Safer and improved services for patients
- Easier/cheaper Maintenance
- Newer equipment is more reliable / less breakdowns / more uptime
- Less spare parts usage
- Economies of scale
- More economic
- Improved utilisation with improved training and maintenance
- Less equipment needed
- Improved use of technology software leading to admittance avoidance and early discharge (potentially freeing up emergency beds leading to more income generating elective work / easing bed pressures / avoiding cancellations)
In the UK, The total NHS medical equipment inventory has an estimated replacement value of £5billion *NHS Supplies. (£3Billion of this replacement value is portable devices).
NHS Hospitals must manage their Healthcare Technology - which includes the equipment, consumables, user training, maintenance and regulatory compliance.
Evidence shows that there is an increasing issue that Healthcare Technology is not being replaced because of lack of funding. In many NHS organisations, more than 40% of equipment is already past its recommended life.
This means there is a need for investment in Healthcare Technology but a lack of government funding. The NHS total asset values is approximately £5Billion with £2.2billion of fixed capital equipment, and £2.8billion of portable equipment.
My research has also shown that more than 30% cost savings may be achieved by adoption of professional Healthcare Technology Management. Various government agencies such as the National Audit Office and the Medicines and Healthcare products Regulatory Agency recognize that the NHS does not manage technology in accordance with best practice and have issued advice on how to improve.
Poor technology management is leading to an estimated investment backlog for equipment replacement in excess of £2billion in 2015, with increased risks to patients and increased costs due to the old technology being less efficient and reliable than new technology.
The current NHS ‘make-do’ methods of buying Healthcare technology ‘as required’ in an attempt to save money actually leads to less standardization, significant age variance (of similar asset groups) making bulk buying difficult, ultimately leading to higher costs, and higher risks to patients. The current annual investment required for healthcare technology across the NHS is approximately £500 million.
The National Patient Safety Agency recognizes that NHS equipment is very poorly utilized with many devices lying idle. Improving utilization of technology can reduce the volume of assets needed and thereby reduce costs by up to 30%, resulting in a significant reduction in the investment required to replace devices and software. If the NHS improves technology management it can successfully reduce cost by standardizing and maximizing utilization.
Healthcare Technology Management includes areas such as: Procurement (Replacement planning), Consumables Management, Service Delivery, Decontamination, Equipment Library, User Training, Telehealth platforms (with 24 Hour Call Centre support), thus providing a complete technology platform for a busy NHS Trust.
The key objectives for Healthcare Technology Management (HTM) are the following:
- Financing and managing equipment replacement
- Current and Future Cost Management
- Reducing overall costs
- Reliable Equipment Replacement Forecast
- Optimization of cash flow
- Improve the Patient Care Experience
- Increase Patient safety through standardization
- Reduce unnecessary hospitalization through home warding (Telehealth)
This approach can also deliver significant savings on equipment maintenance costs. The total annual savings that could be delivered across the NHS is estimated to be above £100 million per year.
The final goal of HTM is to enable hospitals to provide better care for their patients at the same time reducing the costs related to health technology management of at least 30% compared to their current yearly expenditures. This can be achieved through the reduction of portable assets stockholding, improved investment planning and reduced procurement costs, reduced expenditure on consumables, improved utilisation of Healthcare Technology, reduced stockholding of associated spare parts, better user training, etc. The following picture summarizes the basics of HTM, starting with Procurement to include all lifecycle aspects including training equipment users, maintaining devices and managing compliance.
Ultimately, adopting a profession approach to HTM meets the regulatory standards for medical devices management, guides best practice for medical devices management policy, leads to the improved practice through improved management.