EBME Forums Forums Management Medical Equipment Management The Zero-Budget Department

Ooops, misread the thread - Oooer.

Over here as opposed to over there us clinical eng techs are responsible for the equipments functioning. It's not just a case of fixing but also managing. Going the zero budget route makes you no better than any external service vendor, whose opinion/advise may not always be impartial. At least with an in house department you should get an almost immediate responce. That's what we aim for. Zero budget; I can almost hear the GE's of this world rubbing their hands with glee.

(As I think I may have mentioned before) Zero-Budget does not mean out-house (is that the phrase for non-in-house?). In fact we are really talking here about Zero-Budget In-House Providers of Biomedical Engineering Services! All the services that Das has mentioned should be included, of course. Can’t see what that’s got to do with GE et al, unless they can provide a like-for-like full biomed service (which, if held to a properly drawn-up contract, I expect they could manage as well as anybody else). In actual fact (and in the real world), it doesn’t actually matter who provides the service, as long as it is properly managed. In my book, there should be a clearly stated maintenance plan for every bit of kit (ie, how is it to be maintained?), but we all know that there are a number of options available in each case. Rest assured, Das, that equipment management does indeed fall within the remit of biomed departments in the UK (and, frankly, I can’t image where you got hold of the idea that things could be otherwise)!

Geoff

Presumably the department would require start up capital to acquire its test equipment and rent space. It would also be needed to bridge the gap before income started flowing otherwise you would never manage to get anyone in post. You would need deep pockets.

What would happen if equipment users ran out of money or had budgets frozen and income dried up for the last few months of each year. You would have to have quite a markup to accumulate enough on account to bridge that gap.

A lot of people like running a small business. I've done a little of that myself and found it dreadfully stressful. The financial risk was an additional considerable burden on top of the organisational responsibilities and plenty of damn hard general donkey work and in the end it was a huge money loser.

What happens if it turns out the technical staff can't run a business adequately. Who pays if it goes belly up and where do the departments get their service backup in that event.

In the event of an incident who pays for the legal representation and possible costs? Anyone fed up with their house?

Given the awful disorganisation of the NHS in general I wouldn't want to rely on NHS management to draw up contracts for such a department and getting external legal support would be a task in itself.

As you may guess this idea doesn't appeal to me and I think only a masochist would voluntarily do it.

All the best

Marc

Billy’s got the right idea! Fancy having a go, Mate?

But have I been unlucky, then, in the places I have worked? Have you guys been able to instil some degree of “pride of ownership” in nursing (etc.) staff for the equipment provided for them at the tax-payers’ expense? What I see everyday is a careless disregard for equipment and the amounts of time, effort and money involved in maintaining it.

My tack is to do whatever they want, and then bill them for it! After a while, even Nurse Diesel will modify her brutish ways if she’s hit in the pocket often and hard enough (…and before I’m pounced upon, and roundly vilified, rest assured that [personally] I do more than my fair share of “goodwill jobs”)!

I can but only agree with your comments about NHS management, Marc. In reality, contactors often act as a banker, providing services on credit, as it were. Frankly, many NHS clients are taking the p*ss! Contractors are always fully insured, however (how many in-house shops are?).

Independent Service Organisations (ISO’s, as they are known in the USA) should be (and usually are) able to give impartial advice, Das. Just as long as they are, in fact, independent. Spin-off’s from OEM service departments must have conflicts of interest, however hard they try. So look for an ISO, rather than an OEM!

We are getting way off the original intent of this thread now, but I’ll finish off with this final comment about service providers – the real difficulty in building biomed ventures is in finding, and then retaining, quality people to do the work! And Marc is right, it is not easy, it is high-risk, and simply may be “not worth the candle”!

If ZB were a good idea all EBME departments would be either 1. fully funded for all the work they carry out by recharging departments and getting all the income generated and paid within a short time or 2. have a large deficit each year for all the departments who can't or won't pay.
If it is the first option then it would not matter about ZB as if the department is fully funded why have several extra accountants chasing thousands of invoices from different departments.
If it is the second option then welcome to the real world were staff shortages, unfunded equipment not being maintained and no test equipment are the norm.
Put simply it does not matter what system is in place if proper funding of the EBME service is available.

Was under the impression that some hospitals/trusts had outsourced their clinical engineering to companies like GE & Drager and that the engineers were then employed by those companies. Forgive me if I am wrong. Not been in UK for 11 years now and when I was I worked for Drager & the RAF.
My main point is that when outsourced there is no longer the impartial view. What happens when a new piece of equipment is required in such a circumstance? Does it go to tender? Are the tenders evaluated along with trials of equipment, or dies equipment get supplied by the company supplying the in/out house service?

I'd just like to bring this subject back to the fore...

Has anybody attempted this recently? And does it really work?

Any comments welcome!

A few years ago the idea of the ZB was looked at here.Basically decided that there was too much effort for very little (if any) gain.
Finance were initially looking at this excercise but soon got cold feet when the amount of traffic (workload) was shown to them and examined closely.Fully understanding our department was the first thing to have them realise, i think.

In esscence going ZB here, appeared to be only shifting work around. IMO the costs are the costs at the end of the day and if you have no commercial gains (profit) to make then a good level of service to the customer at the best value is what they want.
Ebme depts are best placed to lead on best value,(we should know most of the angles), so it seems rare that an end user will take on negotiations to find their own suppliers/repairers etc. which would totally flout Trust equipment management policies anyway.

Over the years, I have only come across the odd person that has wished to do this, but it seemed for one reason or another that often they were not around too long. Not sure if this was linked in anyway ?

One recent change has seen users being asked to authorise 'expensive' repairs for their equipment.This in itself has led to delays in repairs being carried out, but to be fair this was part of a bigger financial overhaul across our organisation. Things run fairly smoothly now the system is bedded in.
(so that's my comment)

Many years ago a friend who worked in a zero budget department was asked by a business manager if he really needed to order the expensive spare part. Being an amiable chap he went away, brought the ventilator back to the office and asked the manager if thought he it was really needed and it was worth spending the money.
I have worked in a department where all spares were authorised by the user department. Who ever that was. As they had lent the equipment to someone else who broke it but it was registered to yet another department
What does this add but hassle in trying to find the correct person to sign the requisition and a delay in getting spares and the equipment back in to use?
Do the people authorising the money know if we really need to order something or maybe we order spare parts just for fun.
Robert