EBME Forums Forums Management Medical Equipment Management The future of ebme

One question, which is the more economical, (as that is the criteria that "management" will be looking at)including quality of service is better, more in-house services with integrated structures, training,management decisions etc. or more out sourcing, because as you say 'if they ask what you can do better', if you offer an alternative business plan then the EBME department could only get stronger.

External MES's usually make good profits else they would not be in business. OK maybe not vast but they do pretty well because they have good business setups and usually end up supplying the medical equipments too.

For the record I am (was) in-house and support internal EBME departments all the way. I am currently taking a short break from EBME work though to gain some valuable project management experience but hope to get back into it when the right opportunity comes along.

Good question though to ask - How many people on here are in house or from external MES services. I bet our competition gain a lot from this site.

Neil, If EBME departments were more involved in managing the out sourcing then that will make the department more cost effective or stronger as you put it. AS opposed to seperate departments (usually nursing managers) holding individual contracts, if EBME managed these we would be able to combine them to get a better service and or price. Even go to other third parties and get them to bid against each other for the business......it only gets better.

So John - When is this talk you are doing and where?

David, I was not saying you should manage the out-sourcing I was saying that if you offered the "management" a different option you could manage in-house without out-sourcing. Extra personell with more responsibilty in all areas of the medical equipment, purchasing, contracts, tenders etc.

"Our competition"? ... it's not "us and them", you know. Or have I misunderstood, and this forum is run for the benefit British NHS EBME departments, after all?


... hardly sounds like good management to me. Plan? What plan? Hint:- it's time to hire some fertile young minds.

I think we can safely say that, in terms of scope of equipment maintained, UK NHS EBME departments cover a lot less than you and I would have been used to looking after, Neil.

For example, and generally speaking, most EBME departments don't touch x-ray, neither do they get involved in the laboratories (usually the biggest department in terms of numbers of bits of kit, as we know). Nor, for that matter, CSSD kit (or even laundries)! In recent years, however, there has been a massive upsurge in the numbers of electric beds, air-beds, patient lifters and stuff like that. Plus all the stuff forked out to the "Caring Community" (eg, nebulizer compressors, CPAP devices and all the rest). All of which needs to be maintained, of course. Meanwhile, some places "do" anaesthesia kit, whilst others contract it out. Similarly with dialysis.

Think "general biomed" and you will have grasped the picture. Some unkind souls use the term "pump boys" to illustrate the point!

I have found that NHS biomed departments work to high standards, generally only fitting original manufacturer's parts. "Repairing" kit (in the way that some of us older blokes were used to) is also discouraged. They also usually have lots of nice test equipment, a full shelf of manuals, and seemingly have little or no difficulty in purchasing spares. Stock control of parts etc. (in the way I know it) is virtually non-existent, in my experience (perhaps I've just been "unlucky").

The ethos of electrical safety (testing) is almost universal, but (believe it or not) I have seen places where hardly any attempt at properly conducted PM is made. But (and to be fair), other places have nice written PM procedures that are religiously followed. So, it would seem that the approach to inspections and PM varies. One place I know was constantly in excess of 95% of the moving target (of PM's complete), whilst another reckoned they were four years behind with their PM! Don't ask me why.

The guys seem to be able to get on manufacturer's courses without too much difficulty. Some places do "on call", whilst many don't (and are strictly "nine to five"). Techs get "time off in lieu" if required to work late for whatever reason. As an "outsider" (outcast?) myself, and looking from the outside in, I reckon they get a good deal (don't forget the pension at the end of it all). But despite all this, there seems to be a continuing problem with attracting good new people into the departments, and many of them are definitely "aging" (mellowing?), as has already been mentioned.

Frankly, I have seen a lot of (what I would have to call) poor leadership in NHS EBME departments. "Lions led by donkeys" may well be true at some places. And some are not what you would call "a happy ship". All to do with group dynamics, as people would have heard me say before. And, as you know Neil, good techs need (deserve) good leadership.

Meanwhile, there has been never ending meddling by the government over the years, with an effort to introduce weird concepts like an "internal market" within the NHS. So we have become used to wards having their own equipment budget, for example. I have myself come across hospitals where (disgruntled) ward managers have allocated maintenance contracts to service providers outside of the EBME department. One can only assume that they weren't happy with some aspect of the service on offer in-house.

Other places I have been have put great emphasis on moving away from "hand-holding" and getting user departments to take (more) responsibility for their equipment. It can be argued that, in theory, it should not matter how, or by whom, equipment technical services are delivered, just as long as the user is satisfied in all respects (that is, as long as a quality service is delivered). So Mark et al are right to feel nervous about the possibility of "outsiders" taking over their patch!

Lastly, the Equipment Library (that is, the shared - or pooled - equipment store, the service it provides, and the staffing it requires) has become commonplace in the larger NHS hospitals. In my opinion, this has been "a great leap forward", and is bound to become the norm, I should imagine. Notice though that the Library idea is in direct contradiction to the "wards owning their own kit" model. Probably due to a different government think-tank genius being available for the briefing on that day, I suspect.

Geoff, just a few more area's to cover eh! bet you never had to upgrade medical clinics for the Navy, I got 9 Frigates to upgrade, Dental, Radiology, Theatres and the funniest of all on two of the ships 6-bed isolation wards (yes 6 beds in each ward hope they all have the same illness!!!)

The poor ol tech can only do what his/hers management allows/want them to do.

All roads lead back to management.

How do these MES guys charge for talking to people. A lot of my time is spent reassuring staff - chatting.

I help the estates guys out - you scratch my back and I'll scratch yours.

Is there a lot of chargeable 'extras' with these MES guys?

You may get a better managed service from MES but it comes with quite a few 'out of contract' costs.

Cheers
Mark

Oh yes, it's management's job to manage (as I have said many times before). But that doesn't mean that the techs should just sit there moaning. If the manager falls short in some regard, challenge him (her)! If not, then one of these days you may well end up out of the cosy job you thought was yours for ever. Never mind the sensibilities involved ... they (the managers) will be on the big bucks. I'm not. Are you? As John Sandham says, be proactive! Or (as I like to say), lead, follow, or get out of the way!

And further to "giving away secrets" ... here are a couple from the other side (surely it works both ways?). Actually, they are not secrets at all, just the application of common sense.

Again as I have said many times in the past, all any of us has is time. So the smart (and mythical) "MES guy" charges for his time. Regardless of whether he is servicing kit or reassuring (advising) staff ... or attending meetings, or whatever.

The mindset (can we call it the "Estates approach"?) where every hour in the week has to be logged against some job card or other has never been appropriate for biomed work, in my opinion.

Another "secret" is that the MES contract has to be well written. Only then will any "chargeable extras" be known about upfront. With a well-written contract, there should not be any surprises! Otherwise, if and when the MES guy is required to carry out work not mentioned in his contract, he has the right to charge for that, especially if extra resources need to be brought to bear (and quite rightly, too). Back to management, yet again.

At the "signing of the contract" stage, the ball is in the Trusts' court. If the requirement is that (MES) staff need to be recently trained on any or all kit, that needs to be put in the contract (but you can expect to pay more). If the MES guy is to be held to designated response times, that has to be made clear too. Want on-call cover? Then bung it in. A 24x7 on-site service? By all means, Sir. But can you afford that? Etc., etc. It's like a menu, you select what you want, but the more you go for, the higher the bill at the end. It's hardly Rocket Science, is it?

The smart "MES guy" also needs to charge at commercial rates (that is, not some half-arsed, wishy-washy in-house figure dreamt up somewhere). He has to operate in the Real World, and has to absorb real-world prices. To put it bluntly, if you are to succeed in business, you need to charge the maximum the market will bear. Note here that some Agencies bill for Bank Nurses at around £ 60 an hour (note also that I personally have never billed at much more than a third of that ... but there again, I'm not smart)!

Here is yet more free advice for in-house biomed services (but it's the same as always):- adopt the "Zero Budget" model, and bill (the wards etc.) for everything. That's everything. Equipment maintenance (servicing, fault investigation, repairs, inspections, PM, parts used etc.), consumables, advice, training ... and all the rest. Yes Mark, you should end up with a better service being provided. But don't forget that when you bill for time, someone has to actually put in those hours!

A band of bothers sharing technical info - that we are.

Sharing information that may be deemed to be commercially sensitive - nah, not with MES lurking around the corner.

We, NHS bods, must realise that we are now subject to market forces.

Them and/or us?

Cheers
Mark

Everyone is subject to market forces. It's just that you guys have traditionally been insulated from them!

And, as for sharing information ... some others (such as myself, for example) prefer to be entirely open, upfront and forthright in their dealings. Why not? And anyway, I must admit to wondering what "commercially sensitive" information you're actually referring to.

Are we not, after all, talking about the maintenance of public assets held in government hospitals, here? So why the need for secrecy?

Regarding contractors margins, I would have thought that cost plus ten per cent sounds about right. You could do the same. But, to be honest (of course), I doubt very much that you guys have any real idea about what your costs actually are!