Introduction

Healthcare technology procurement, use, maintenance, and management policy is a serious issue recognised by research undertaken worldwide. Some of the critical literature discussing 'healthcare technology issues' come from the National Audit Office, the National Patient Safety Agency, the Medicines and Healthcare Products Regulatory Agency and the World Health Organisation.

Old Healthcare technology is being used within many healthcare organisations, with no replacement planning, and a lack of standardisation across individual technology groups. This leads to technology being bought only when it is beyond economical repair, creating a pool of devices in the Hospital that fulfil the same function but have been bought from a variety of suppliers. Many devices in use are more than ten years old and already past their useful life. This issue happens as a result of poor planning, multiple budgets, multiple purchases by different budget holders, and limited or unplanned funding. As long as there are multiple budgets, then device users will continue to have individual choice and the risks will remain.

Procurement and EBME managers must work together to understand this issue and find policy solutions that improve use and availability, thereby leading to fewer incidents and lower costs. Device users, such as nurses and doctors, need equipment that they are trained to use safely, is up-to-date, and functions well. EBME managers, engineers and technicians also want standardisation, and want users to be trained because with standardisation they could carry less spare parts and become more expert in repairing devices, thereby reducing down-time.

Moreover, with trained users there would be fewer callouts to equipment that is not at fault. EBME engineers often discuss the number of calls they receive because users do not know how to use the equipment correctly and therefore 'think it is faulty' rather than there being an actual fault.  Governance managers are also concerned about meeting inspection standards from the CQC. To achieve this, they work with internal stakeholders to ensure that healthcare technology management policy is inclusive not only of the internal requirements of the hospital (such and procurement conduct, user training and maintenance), but must also meet external regulatory requirements from the CQC and other government agencies. Therefore, it is the responsibility of a wide range of healthcare professionals to bring together their joint knowledge to develop policy that leads to best practice.

Multiple budget lines

As illustrated below, there can be many wards and departments with their own budget lines for equipment. The current state of device procurement does not easily allow for equipment standardisation that can reduce costs and risks. Users of equipment at the Hospital have a great degree of choice when buying devices. This would be understandable if they were buying something for their personal use, but when it comes to thousands of devices being used across the hundreds of departments and wards it becomes both a financial and a patient risk.

If purchase requests are analysed and authorised by the Medical Devices Committee to improve standardisation, hospitals can develop strategies for filtering purchase requests; the preferred future state for device procurement policy should be a planned process in accordance with best practice guidelines.

This would mean that all wards and departments would have their equipment budget lines removed and put into a central budget that the medical devices committee could use in a planned way to buy devices strategically for the Hospital, as in the figure below, preferred future state of device procurement.

The purpose of healthcare technology procurement policy is to reduce risk, give better access to newer technology whilst reducing the costs through improved acquisition, and improved productivity. The government should agree a technology procurement policy on which a code of conduct must be met by the health services in general.

These may cover areas such as:

• Investment planning, replacement planning
• User training
• construction of facilities, commissioning works
• healthcare technology maintenance
• safety
• the environment
• quality management.

The environment and sustainable development

The carbon footprint of the NHS - from the NHS Sustainable Development Unit

As can be seen from the research done by the NHS Sustainable Development Unit, procurement has a 50% impact on greenhouse gas emissions. In October 2020, the NHS became the world’s first health service to commit to reaching carbon net zero, in response to the growing threat to health posed by climate change. The “Delivering a Net Zero Health Service” report sets out a clear ambition and two evidence-based targets to achieve this.

Ensure medical devices procurement planning drives down CO2 emissions:

• Buy medical equipment with low carbon manufacturing footprint
• Buy medical equipment that can be updated, rather than replaced
• Improve utilisation of devices (less assets bought = less CO2)
• Buy devices that capture / recycle anaesthetic agents
  • Common anaesthetics produce greenhouse gas emissions at a rate 2,500 times higher than carbon dioxide.

Do you have a medical equipment procurement policy and plan?

Organisational policies are the ‘bedrock’ of any healthcare organisation. They are the rules by which the staff carry out their professional practice. Explore existing policies and decision-making processes to align with the ambition to get to net zero, and ensure procurement policies are robust and monitored.

Issue supplier policy advice to ensure companies providing services & products minimise their environmental impact and support your drive to reach net zero.

Delivery will require ongoing, targeted investment and an aligned financial policy with equipment replacement plans (and agreed decision-making processes). Initiate incentive schemes and remove disincentives to drive change.

Issues around poor standardisation, poor utilisation, poor access to modern technology and reducing risk of misuse of technology can only come about through a concerted effort from all stakeholders in healthcare.

Healthcare technology procurement policy should guide healthcare practitioners to procure technology in a strategic manner, rather than the current 'make do' mentality that actually increases risk, and cost, whilst reducing efficiency.