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Setting up EBME Department #73797
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rsysmexk Offline OP
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Hello folks,
I've just started a new role in a Hospital (JCI Acredited) where I've been tasked to set up the Biomedical Department. Can the more experienced of you provide me with your experience on what needs to be done and also advise me on what what mistakes not to make!
I've a wealth of experience as a contract biomedical engineer, where I've set up contract Biomed functions in Hospitals that managed the equipment as a 3rd party so I know the amount of work lies ahead of me. I've participated in JCI Audits before where I've had to assist the hospital during the audit, so I know the detail of what is expected in relation to their audit requirements.
But for those of you who have set up EBME departments, I'd be interested in hearing your experience of what you did and what you would avoid doing if you had to repeat the job again?
Cheers!

Re: Setting up EBME Department [Re: rsysmexk] #73798
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Geoff Hannis Offline
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Hopefully this will be an interesting thread (like ones we used to have in days gone by).

In my own experience what matters most is "the blokes"; that is - the quality of the biomed techs you have on your team.

Oh, and don't be tempted to put all your files in the Cloud!

Good luck! smile

Re: Setting up EBME Department [Re: rsysmexk] #73799
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Dustcap Online content
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Sounds like a great project.
My first thought is a robust and suitable asset management system that will be able to accept GS1/ UDI numbers and also the prospect of any future RFID systems. Some good test equipment, some good tools, and as Geoff points out-the techs are the most important part. Look at whats being asked of you, within two years you'll be asked to do more! This could be in the way of in house devices that are already on manufacturers contracts or it could be nearby services that will want your services.
Make good networks with IT staff and discuss any incoming or future projects.
Most of all ensure you have a suitable workshop with a kettle and fridge!


30 years since the Chernobyl disaster and yet we still have no super heroes or zombies.
Re: Setting up EBME Department [Re: Dustcap] #73800
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Geoff Hannis Offline
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Yes; you need a good "database" (and a kettle is essential) ... but also a good set of Policies and Procedures (although these could - and should - be developed over time).

But to my mind the Big Thing that I have seen many biomed departments fail to really get to grips with is simply:-

"Remembering who your customers are"!

Or - put another way - the real reason you are there!

You need to get into the habit of taking time out to visit the user departments every day. One or two each day, if you like. Or better still (if the hospital isn't too big), stride around your complete domain every couple of days (as I always liked to do). Take a regular mid-afternoon break and get out there! smile

In short, maintaining "good relations" with user staff should be a high priority. And I mean face-to-face, and not (as I have seen) just by email.

Stuff like that - "the user interface" - is the real difference between being a visiting service engineer and being in (or running) an in-house biomed department. There is more to it than just "fixing the kit"; and even more so these days.

I have known a fair number of techs in my time who were good at one, but not the other (and vice-versa); they tended to fall into one camp or the other - but in the in-house situation, we really need both attributes. smile

Re: Setting up EBME Department [Re: rsysmexk] #73802
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Steveddie Offline
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One of the questions that often gets asked by the modern generational wing within our department is a clear definition of why? The proverbial statement of purpose. I think we are there to protect the trust first, and by that, we make sure what should work should, whats needed to be available is and to put things in place so that what we can do to keep the prior two is most likely. And do so £££ savy.

What’s the core purpose of your new set up?

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Re: Setting up EBME Department [Re: rsysmexk] #73804
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Great advice lads (especially the kettle bit!). The hospital were recently purchased by a huge hospital group who like to control things internally (hence my appointment) and not rely on contractors maintaining the equipment in a manner that I find is second rate and not good enough in my opinion. I will be able to draw on experience from other hospitals in the group so that I don't need to "reinvent the wheel" when it comes to generating documentation for JCI/quality purposes, but my past life (a long time ago) as a test engineer for an aerospace company thinks that I can improve on whatever they can supply, I'm here to make this place better for the patients and staff that occupy the facility.

@Geoff, I'm the only Biomed in the hospital, but I will be working in tandem with the facilities team. I will be generating the process documentation for these fellows to work with. The guys have a great team spirit, are enthusiastic and are definitely willing/able. I am planning on being as paperless as possible, I don't see the point in having hoards of files and binders if all that is needed, is available electronically (environmentally friendly too). I'm not the hiding away type who tries to do as much as possible in the dungeon that is usually the Biomed department, I like to get out and meet the "customers" as it makes the rapport connection that inspires confidence in what I want to achieve. There's a young demographic of staff in the facility who appreciate assistance and are willing to accept change for the better. I've contracted in places where there was an older demographic, who don't like change to how things have been done for years, that was always an uphill battle.

@Dustcap, the hospital gave me "carte blanche" on test equipment, even for future plans. I've spec'ed the kit that I need and they've ordered it. The asset management system is an upgraded I.T. system that has a lot of capacity for development. Excuse my ignorance, but does GS1 or UDI cover all/most med equipment labels?

@Steveddie, the hospital have been getting second rate support from contractors/OEM's in the past. I've witnessed it 1st hand. "Yes of course we will be there tomorrow", then they either call to reschedule for some reason, or worse, just don't show up. I'm there to provide the level of support that they deserve and to crack the whip on OEM's. I've worked in the In-vitro diagnostic market (which is a cut throat sector) and I'm planning on including non conformance penalties in SLA's in order to improve their performance. It really annoys me that SLA's are signed and then the OEM's don't deliver...

Re: Setting up EBME Department [Re: rsysmexk] #73805
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Geoff Hannis Offline
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What? You don't have a dungeon? whistle

Otherwise, it sounds like you've "got it made, in the shade", as it were.

It's great that you're starting from scratch, thereby avoiding the usual process of having to un-pick the mess left by others!

It sounds to me like you have an opportunity there to be part of an integrated Technical Services Department (rather than the usual separate Biomed and Facilities set-ups, and all the turf wars that generally engenders) - this could (should) also include IT, in my opinion.

But you need to be sure that the "asset management system" is in fact suitable for biomed needs (which generally differ from those of Facilities). In short, you need a decent biomed PM regime.

Regarding the young and (versus?) old demographics ... yes, what you say can be the case; but don't forget that the perceived "resistance to change" by the Old and Bold is probably based upon the sorry experience of having many (endless, and often futile) "changes" foisted upon them over the years. To my mind, the basics of providing decent in-house biomed services - especially a programme of properly conducted PM - have remained much the same since the Dawns of Biomed, and this is likely to continue to be the case.

Other than that - yes; I like your attitude (and spirit) - well done, and keep it up! Be sure to come back to us and let us know how you got on. smile

OK ... a couple of questions for you:-

1) How big is the hospital (how many beds etc.)?
2) How big is your inventory (items of equipment to support)?
3) How much of it is on contact with an outside agency?
4) Have you gone for any particular line of test kit (Fluke)?
5) Who do you report to (Facilities)?

Yes; "paperless" is good. Many of use have tried to implement it for many years (as in, thirty at least). With all the magic kit that is available these days, there is really no reason (or excuse) not to adopt this approach - especially when starting with a clean sheet of paper (see what I did there?).

Re: Setting up EBME Department [Re: rsysmexk] #73806
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1) How big is the hospital (how many beds etc.)? 100 bed
2) How big is your inventory (items of equipment to support)? I haven't completed the site audit yet, but it could be in the region of 1500.
3) How much of it is on contact with an outside agency? 30%
4) Have you gone for any particular line of test kit (Fluke)? Mainly Rigel.
5) Who do you report to (Facilities)? Chief Financial Officer

Re: Setting up EBME Department [Re: rsysmexk] #73807
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Geoff Hannis Offline
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Thanks for the info.

Sounds like you really need two biomeds, then.

If you plan (and/or hope) to be in it for the long term, after recruiting a colleague, whenever the opportunity arises I would look to be taking as much kit back in house as possible. In such manner are Empires created! LOL

Back in Ye Old Days we ran 100-bed hospitals with two biomeds. We managed all the kit in-house, and only called in* "the company" when unable to clear a job ourselves. Mainly on equipment such as the big autoclaves, the main x-ray sets, and some of the lab kit. That is, no contracts as such. Down-time sometimes suffered a bit, but it was a cost-effective approach back then (and back there) in those simpler times. Those were the days!

At larger sites we did everything at 1st. line (and were the "first responders" no matter what), but had contracts with outside service providers for some of the 2nd. line work (such as six-monthly PM on the main x-ray sets and certain lab instruments, monthly visits for dialysis ... and so forth). That way we had a bit of leverage ("first shout") if the kit broke down, and also a modicum of preferential treatment regarding availability (and cost) of spare parts. We found this to be the most cost-effective approach, whilst also keeping down-time on critical items within reasonable bounds (not that we ever stopped the radiologists moaning, of course).

Bottom line is that you need to look at every piece of kit within your domain and ask yourself the question:-

"How am I going to maintain that"? think

In each case you need to consider not only PM, but also how to get it repaired (in-house preferred, of course) if necessary. This process will also lead you to establish what resources you need - test equipment etc. But also parts:- will they be readily available, which items should I stock for ready use, and so forth. But in doing all that, don't forget the most valuable resource of all:- time (or if you prefer - man-hours - a point often glossed over, in my experience).

Biomeds are lucky in the range of test equipment that is available these days. I have nothing against Rigel, and have used a fair amount of their kit over the years, but if "cost was no object" I would have gone for Fluke - on grounds of the large range of test kit they offer (due to having bought up so many of the smaller companies), as well as their apparent policy of continuously rolling out new stuff! And (and a Big One, in my opinion) ... their gear works (links with) Ansur (which they now own as well).

Lastly, as you're just starting out - if I were you I would try to change the Chain of Command ... to come under the Hospital Engineer (Facilities Director, whatever) or better still, my own favourite, the Nursing Director. You know it makes sense! smile

* Although, to be honest, we had pretty good tech support (back-up) from within our own "company" resources.
In fact that was where I myself hid away.

Re: Setting up EBME Department [Re: rsysmexk] #73820
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rsysmexk Offline OP
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Referring to your statement about "managed all the kit in-house". Did you have OEM training on all the kit or did you generate your own service procedures? If you generated your own procedures, what did you base them on? ECRI guidelines?
As much training as I've had over the years, there's still a lot of equipment for which I won't have training on, so my plan is to reach out to the OEM's with training requests (although I'm sure that many will be reluctant to offer it as they know that I will be reducing their service contracts) and if they don't provide the training, then I'm going to follow ECRI guidelines mixed with the technical manual instruction that I have or can get.
Do OEM's have an obligation to provide technical assistance/manuals to site services if requested? I've always wondered if they do? Your thoughts or knowledge would be appreciated?

Re: Setting up EBME Department [Re: rsysmexk] #73821
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Geoff Hannis Offline
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I was really reminiscing about a different era there - one where we were trained in general terms to be able to tackle any equipment we were likely to encounter. And back then there was always a lot of kit that needed fixing. Sadly, I don't expect any young techs to be trained in such a fashion these days; and with kit in general being more reliable, perhaps there is no longer the need. frown

Yes, I used to be a great admirer of ECRI stuff - but, to be honest, some of my own "experiences" pre-date ECRI!

But yes, in general I always used to generate my own procedures - that is, department policies and procedures, and PM procedures (as well as writing my own software). Yes, those were busy times; but (as you can no doubt tell) I was always a great supporter of the "doing stuff in-house" (ie, myself) approach. Although, to be honest, in those pre-internet days, and in semi-remote locations, there wasn't really too much choice if you wanted to crack on and get the work done.

Regarding OEMs' attitudes to training - no doubt almost all of them would be glad to take your money, but whether there would be any "depth" to the training may be a different matter. In practical terms, you're probably better off just jumping in and effectively learning on the job. Nothing beats actual experience!

As to the OEMs' obligations to provide manuals and what-have-you ... that is best dealt with (included) when purchasing the kit in the first place. After all, they're likely to say "yes" to almost anything when they can see that Purchase Order is about to be signed! whistle

The only OEM course I can remember attending was at EMI Medical (anyone else remember them?) back in 1980.

Re: Setting up EBME Department [Re: rsysmexk] #73822
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@Geoff, have your procedures ever been through a JCI audit? How did they stand up when audited? I know from previous experience that they (JCI) seem to like ECRI more than the OEM's procedures, due to the fact that they think that OEM procedures are generated when the equipment enters the market and that they don't really evolve from birth.
Personally, I think that ECRI procedures aren't great, due to the fact that they are a one-4-all approach for every OEM's equipment. Hence, my approach for using ECRI bits and adding the OEM detail where I deem required.

Re: Setting up EBME Department [Re: rsysmexk] #73824
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Geoff Hannis Offline
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I assume you are referring to I/PM (Inspection/Preventive Maintenance) procedures - rather than department Policies and Procedures.

Let's call them PMP's (Preventive Maintenance Procedures) - I always developed them to suit the circumstances (organisation, location, capabilities of local tech manpower, likely time available, what was achievable in reality etc.) - a "common sense" approach, you might say. I was never bothered by outside agencies, and the only times anyone from "the Ministry" (or whomever) deemed to visit they were generally only interested in what (if any) kit was out of order.

But I should point out that my "previous lives" were usually at places that had never even heard of PM, let alone practised it or seen it carried out. We rarely had a full set of manuals (and in my Tech Support role I used to spend a great deal of time trying to source, and then distribute - copy - them to the various hospital sites). I recall one occasion when a visitor called my procedures "sophisticated"; I understood him to mean "unnecessary" - or at least "more than they were used to"! Those were Pioneering Days!

My PMP's were, therefore, always "appropriate" - and to my mind, at least, equal to or better than any others I have seen (and I have seen a few)! By the way, I always balanced the PM schedule over time as well. For example, it was no good coming up with a Grand Plan to PM everything in a 350-bed hospital every six months if you only had two techs!

Yes, I agree that ECRI PMP's can be a bit OTT. Let's say "verbose". I always preferred a "terse" style, myself. But they are (were) as good a place as any from which to make a start (especially if you had nothing else). I should imagine that JCI and similar bodies probably like them because they are "American".

By all means incorporate guidance where contained in service manuals. Some folk would say that procedures there should be the only ones you should follow. I disagree, on the grounds that the quality (and the format) of procedures provided can vary considerably from OEM to OEM - some are well over the top, whilst others hardly bother at all. I like to say that we should "respect the manual"; but what we want here is consistency.

So yes, develop your own ... with emphasis on "develop"; they need to evolve as necessary, as you suggest, rather than being "cast in stone" (for all to admire, but probably never use).

Bottom line is that it sounds like you're on the right track. smile

Re: Setting up EBME Department [Re: rsysmexk] #73825
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Geoff Hannis Offline
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Setting up a new biomed department takes a lot of time and effort ... especially if (as is the normal case) you are trying to provide a service (not to mention fixing kit) at the same time.

When it comes to building up a set (library) of PMP's, I have always found it best not to get too carried away (at least at first). "Do something simple, rather than do nothing complicated"!

If setting out from scratch, start off "on the nursery slopes" by following (what may - or rather, should - be) a simple "generic" PMP (see Angus). Then as you go around doing your actual PM work, for each type of equipment encountered you can add (develop) a more refined PMP if necessary.

But at this stage still keep things generic - a PMP for all ECG recorders, another for all suction pumps etc. Then, over time (PM cycles) you can develop more specific PMP's as found necessary in light of experience (not to mention repair records).

At first you need to decide upon reasonable PM intervals considering the type of kit in question (where it is used, how many there are, how critical it is - what we usually refer to as the "risk factor"); and estimate the time needed to carry out each PMP bearing in mind the need to balance the whole programme over time (eg, a year). But in the longer term you should also consider lengthening or shortening the interval between PM visits; but that is "another story". smile


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