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Hi to all,

I'm working alone as Bio-medical Equipment Technician in 120 bed Capacity hospital and next year were going to expand up to 200 capacity. We have 450-500 working equipment for now, half of them are maintain by outsource. If we have our bio-medical test tools, How many technician i need to work with me?

Delfin
Hi Delfin, welcome to the forum.

One of the things that tends to define the workloads is not just how many beds but also how many theatres there are. Can you tell us that info?

There is also the question of how experienced people are but that's a bit more difficult to define.

Thanks, Dave
Posted By: RoJo Re: Bio-medical Engineering Improvement Plan - 20/06/13 9:47 AM
Also the type of hospital.
One I worked in only had a couple of hundred beds but as it was a specialist cardiac centre with a large ITU the was a lot of complex equipment. So just going by numbers is not a simple process as Dave has said.
If you are coping now and the number of beds is going up by two thirds you need two thirds more staff.
Robert

Welcome to the forum, Delfin. smile

Are you planning to take on the full commitment (that is, cancelling any outsourcing)? If so, you will need four techs if you hope to do a decent job (with properly conducted PM, and all the rest).

Back in my planning maintenance days I developed various methods of establishing (guessing) how many techs are likely to be needed in various scenarios.

Once (as in your case) the hospital is already up and running it should be easier to quantify the man-hours required "simply" by working out how many hours it takes to PM each item of equipment ... and then adding in some more man-hours for the other (many and various) tasks that biomeds get involved in.

But, rather that waffle on about this and that method - trust me, the "result" will be more or less the same ... that is, a total of four biomeds of average capability (able to act independently, without supervision ... etc.) - one Senior Technician and three Technicians.

By the way:- how have you been managing so far ... are you able to operate a PM programme (for instance), or are you just "fire fighting" (responding to calls from user staff, equipment breakdowns etc.)?

I suspect I'm right in assuming that the stuff you currently have outsourced is the more "difficult" kit. So how do you propose to gain the necessary expertise needed before you are able to take on that burden (if that's what you are planning to do)?

I wonder if what we're really looking at here is a (another) case of senior management hoping to make substantial savings, without realising the full extent of the true costs involved in reforming their tech support strategies? think

Anyway ... Good Luck. And feel free to come back with more information (as long as you don't mind the candid - but hopefully realistic - responses you are likely to receive)! whistle

It's all down to man-hours. A single tech, regardless of capability, can only sustain so many hours of work per day (week, month, year).

It takes time to PM each piece of kit, be it a nebulizer compressor, or a CT scanner.

It also takes time to repair kit, order parts, attend meetings ... and all the rest (including travelling, if required). smile

When planning, for every item of equipment on your inventory (not number of beds, operating theatres ... or anything else) you have to ask the question:- how many hours is it going to take me to support* this piece of kit (eg, per year)?

Then you work out how many hours your techs are actually available for work each year. When you do the summing calculation you will find that you really need twenty blokes! LOL

Time is all we have (any of us). And there is never enough of it. frown

* Even if it's only managing service contracts (monitoring contractors) ... it still takes time.
Posted By: Roger Re: Bio-medical Engineering Improvement Plan - 20/06/13 1:22 PM
Well said my dear friend, Geoff.

Man-hours is the way to determine the estimate number of headcount for your institution.

Also the type of work scope like PM,CM, Commissioning, Specifications, etc. Your main scope should form towards PM and CM for your entire equipment listing with minimum involvement in specifications and commissioning depending on how actively the hospital is embarking on a replacement programme or new services.

Take for example a Defibrillator which needed 4 PM a year and each full PM takes about 2 hrs. You have a base quantity of 10 units. Then the total number of hours needed for defibrillator would be:

4x2x10 = 80 hours

A certain percentage (for the entire equipment list) would have to be factored for corrective maintenance (CM). Breakdown or equipment failure are hard to predict especially when they are new. You need to add this figure to the total PM hours to make up the total man-hour required.

You will arrive at say "Z" hours

"Z" hours divided by the number of hours per annum needed for 1 headcount say "X" hours

Total headcount needed = Z/X.

Cheers!


Which brings us to the next lesson (aimed not only at our new friend in Western Visayas, but everyone else who aspires to progress beyond the mere "fire fighting" model of tech support):-

The absolute need to maintain good records. smile

At the very least:- records of work carried out (job reports).

Then, you can quickly, and with some accuracy, estimate how much time is spent on CM (and, hopefully, PM as well) simply by analyzing the previous years (ten years, whatever) job reports.

You don't even have to use a computer. A simple ruled log-book, if properly drawn up and diligently maintained for all work carried out, will suffice.
I'd guess that a 200 bed hospital may have 4~5 theatres and, with the right training, two technicians should easily cover all repairs and PPM's. If there are 1000 pieces of equipment that's only approximately 2.5 units each per day.
Quote:
two technicians should easily cover all repairs and PPM's.


Absolutely, two should be quite sufficient unless it was a highly specialised hospital (cardiac for example). If it is a general med/surg, two would be comfortable I would have thought.

......and, if I ever found one of my staff taking 2 hours to PM a defib they would be looking at, at least, a serious telling off for being very slow or if they persisted, a new employer.
Are we talking about 9-5, 5 days a week with a rotating on-call system? I would go for 4 technicians to cover holidays and if required sick leave.
Thanks.. I appreciate all of your comments guys.
Hopefully our work load will be,
5 anesthesia machine
5 vaporizers
12 defibrillators
21 patient monitors
2 ctg
35 infusion pumps
4 electrosurgical units
10 O.R. Lights
10 pulse oximeters
4 autoclave machine
234 mix with BP App, Nebulizer, ES TENS,O2gauge, suction machine, scales and other minor equipment.
Imaging equipment will be left for 3rd party.
we are an ISO certified hospital. Thanks a lot..

delfin

What about the lab(s) ... also physio, neonatal; and dental?

Do you (or will you) have a full PM programme, Delfin? think
Thanks to all of you,
I am the only one in charge of all biomedical equipment under maintenance dept., i'm working both on technical and management in biomedical section, I also have PM program for all of our functioning machine, and I divided in 3rd party and inhouse,..
For this year I decided to proposed a test tool and manpower to accommodate all of PM and CM of our hospital. and the only thing I am confused on manpower to adjust our Investment compare in Hiring 3rd party. If its possible the machine left for 3rd party is our Imaging. By the way were ISO certified, I hope to here another comment from you. Thanks to ebme
In man hours I think were going to adjust the PM frequency in a minimum required depending on the equipment.
In our lab I only have Cenrifuge and thermometers there most of the equipments thre are tie-up for other supliers.
we don't have dental here, only for private clinics and not own by the hospital. I have also 3 In incubators, radiant warmer and photo therapy units.

When (or if) you get the time, I suspect you need to carry out an accurate survey of all the equipment in your hospital, Delfin.

For each item of equipment, you need to ask:- "how am I going to support that item" (and how long is it going to take)? In each case you need to assess its condition, and also jot down an estimate of how long (and yes, how *often) it will take to carry out PM.

Based upon your assessment of the condition of each item, you should be able to make a reasonable guess about how long you are likely to spend on repairs (initially, at least). You may even find stuff that is broken and (or) unused that may not be worth repairing. But (obviously) the aim is to have everything well maintained and under control.

As you go around making your inventory (or "Asset Register") of maintainable items, you should also make a list of anything you shall need to support each item (manuals, test equipment, parts etc.).

Only when you have good (accurate, reliable) data available can you really sit down and make calculations that will (hopefully) be taken seriously by senior management.

Although your "equipment count" looks a little low to me, at this stage I would still suggest four technicians!

I suspect that our good friends Dave and Paul are looking at things from a "maintenance contractors" point of view, rather than that of an in-house biomedical engineering department. That is, they are forgetting the thousand-and-one other "little jobs" that in-house biomeds get roped in - or "volunteered" - to carry out. "Supporting" the clinical staff ("hand-holding") comes immediately to mind (and how long does that take!). I have been in places where the real work only started once the departments (wards etc.) had fallen quiet, and everyone else had gone home! whistle

And (as Neil has reminded us) you have to consider "real world" factors such as sickness, courses, staggered hours (to provide "shift" cover), on-call ... and (even) - days off! smile

* At first, I would start out with 180 days (every six-months) as a default PM frequency. With 90 days for critical (high risk) stuff like defibs, anaesthesia machines and ventilators. See how you get on with that, and then adjust (extend) the periods later if you can (that is, once all equipment has been brought under control).
No Geoff, the view was/is that of a full service "in house department" quite able to deal with all aspects of the tasks required no matter what. Are we really saying that one person could not hold the fort while the other was sick or on leave? I think they probably could.

To have four staff at a hospital of that size would be unnecessary. All you would have is four bored people.

All I can say is that I suspect that you and I must have had different experiences of hospitals outside the cosy confines of the "Western world", then Dave. whistle

Also ... I suspect that Delfin will only get the one chance to make his "pitch" to senior management.

If he goes for two, then he shall be creating a hostage to fortune (aka making a rod for his own back). But if he goes for four (and gets approval for that), he should be comfortable in the medium to long term, secure in the expectation that he shall be able to handle whatever gets thrown at him during the years ahead.

If he goes for four, and has to make concessions, he can always give way and drop to three ... but if he goes for two, what bargaining power is he left with? think

In passing, in all the hospitals I have even known (or even visited), I have never come across a bunch of bored biomeds. It has invariably been the reverse ... a few good guys being run ragged. Except, of course, in the ones where biomedical engineering was set up by Yours Truly (that is, done properly). frown
I'm sorry, I thought we were being asked for the reality of the situation not the starting point of negotiation with senior management. How silly of me, I must have misread the original question (or not........ as the case may be).

Well, Delfin's original question has been qualified to a certain extent by his subsequent posts ... but sometimes we have to "read between the lines" a little, do we not?

But, unless I get a chance to visit his location (which is very unlikely to happen), and survey the hospital myself (and thereby establish the actual situation), it's difficult to offer definitive advice.

Failing that, I would need accurate data, plus an idea on what the "risks" associated with each equipment type are considered to be (leading to "how many PM's per year" ... and all the rest).

Meanwhile, as I say, I would have to stick to my guns (and "rules of thumb" that have worked well enough in the past) and continue to suggest four. smile

As a historical note, I hope my memory serves me well if I say that I recall we had three techs at the famous G-100 (general 100-bed hospitals) out in Saudi Arabia 20-25 years ago. A Senior Tech and two Techs ... plus a clerk (computer operator - storeman - general helper, whatever). And we certainly had more than five techs at certain well-known private hospitals (of 200 beds or so) "out there" that I could name. Similar situations (to Delfin's) I would have thought, except that in the case of "our" G-100's they also had "the company" (me and my gang) to back them up. smile
I continue to suggest two. If it wasn't for leave and possible sickness then based on the list of equipment given one man could easily cover it in my opinion.

My own feeling is that we don't yet know the full story, Paul. smile

There are two many unknowns.

For instance, what if (as I suspect), "4 autoclave machine" turn out to be full size steam autoclaves (with integral electrical steam generators, if I know anything about it)? Are you OK on kit like that?

Actually, it's a good thing there are four of them (whatever they are), as at least the "heat is off" (literally) when one, or even two, are down (out of order).

And - although we have heard about (as yet undefined) kit in the lab that's "outsourced", as well as the imaging kit - in theory at least that still has to be managed; as well as (I suspect) at least some sort of involvement at 1st.Line.

The trouble with having just the one biomed is (as we all must know) when the guy is busy - as he will always be - it doesn't take much for him to become swamped once the kit starts going wrong. Surely we've all "been there"?

And the novelty (privilege?) of being permanently on-call wears off after the first six-months or so, let me tell you.

No, the "jury's still out" on this one, as far as I'm concerned. whistle
I'd be surprised if it was four "full sized" autoclaves for only a 100 bed hospital. I know autoclave validation can take days but if you're a one man operation or even a two man team you go of and do other things whilst waiting, a concept that some people don't understand.

Having looked at the equipment list provided I estimated no more than 20 man weeks to cover it all and that's being very generous but for the reasons I've explained you have to have two men.

I go off the information I'm given, if it's wrong then there's not a lot I can do about it!
For those that are suggesting two biomeds I would suggest that you do a complete time and motion study of your own facilities and reduce your staff to the bare minimum. You will never have any 'bored' biomeds to contend with. Can we assume that in your COSY "Geoff's words" WORLD only one equipment breaks down at any given time as it would be a nightmare if a few pieces of equipment broke down at the same time!
Ok, rather than go round and round in circles, can we have a look at a real world example and, those who are interested, let us know what level of resource you think would be needed for such a site.

Attached is the asset list from one of the sites that we look after. It is 130 beds, has five theatres, two day surg procedure rooms, a small ICU (fairly low level but they are licensed to ventilate), birthing suite with special care nursery and general medical, surgical and rehab wards. We provide a full biomed service (both PM and repair) for all the assets listed. We are not involved with the CSSD or imaging (except an EST on the listed II). We do the "area testing" for body and cardiac areas also the testing of "gas therapy" assets (not listed but I can provide if anyone is interested in the detail). Gas therapy includes regs, flow meteres, twin-o-vacs, blenders in maternity, wall outlet testing and of course the manifolds.

All assets are tested 12 monthly except defibs, vents, anaesthetic machines, SCN cots and manifolds which are tested 6 monthly. Where required (vents, anaesthetic machines and maniflods) kits are fitted 12 monthly.

So, what level of resource would you consider necessary to support this site? Once opinions are expressed I will reveal what the level is and I promise to be honest about it (in fact if anyone wants, I'll PM the "answer" to Huw now so that he can reveal all when the time comes, but really, I promise to be honest about it).

It may be of interest to know that I have just looked at the "compliance stats" for this site and we currently sit at 95% in date for PMs.

Ok, over to you guys


Attached File
Asset list.xls  (871 downloads)



No doubt you will be expecting a reply from me (and as everyone knows, I hate to disappoint) ... but I just don't have the time to do a proper analysis right now, Dave. By "analysis" I mean breaking it down into man-hours.

However, straight off the top of my head, and using my usual "rule of thumb" (based simply on the number of maintainable items listed), I would go once again for four techs.

Specifically, a Senior Technician and three Technicians.

If that figure doesn't gel with the actual number of techs deployed, that will most likely be due to you not doing PM often enough (that is, my default PM interval is six months). smile

By the way, these days most of my time is spent fiddling about with data, so I am always on the look-out for "real world" inventories (of biomed maintainable assets) - parts stock lists as well. If anyone has some nice data that they don't mind sharing (.xls format preferred), please feel free to bung it together with an email. Confidentiality is always respected (and thanks again to those who have already sent some stuff).
Two.
Interesting setup, reminds me of somewhere. Two techs what do people think of that number?

There is another way of running delfin's department, guess how many techs a MES might put in and you might get a shock!

And Geoff one answer to the problem of on-call is just don't do it and buy extra equipment.
Still on 4, Dave, for your site who does the management of the site? As the overseeing company do you supply techs to cover leave, sickness etc. Do you pay overtime to complete tasks that require extra time (ppm on unavailable equipment)

Originally Posted By: Chris Watts

... one answer to the problem of on-call is just don't do it and buy extra equipment.


We're (well, we were) talking about a (private, charity, faith-based?) hospital in the Philippines, Chris. So somehow I doubt that simply throwing money around (in the NHS style?) is really an option. whistle

Originally Posted By: Chris Watts

Two techs what do people think of that number?


... it's not enough. Unless we are now talking about some sort of "Boot Camp" situation; a place where we send fresh young techs to "test them out" - put them under a bit of pressure in order to "stress them out a bit" (towards a nervous breakdown, early grave ... or whatever). Sounds like fun!

Meanwhile, can you convince us with a clue about how you arrive at that figure? think

In case anyone was wondering, my own first approximation (ancient yes, but I've yet to be convinced that it's not still valid) "rule of thumb" from Ye Olde Days is simply:-

2 Techs : AR of 600 entries : 100 beds

Where "AR" stands for the number of maintainable items on the Asset Register, and the beds figure is only used if no other information is available. In other words, it's the amount of kit that is given the most weight. I'm pretty sure I've used this on here before:- yes, here it is.

Notice that the AR figure doesn't simply include "everything", but just items for which planned maintenance is applicable or a foreseeable requirement. smile
I'd have to agree with you on that Geoff but if you don't include the team leader that's how many there are in my section. If anything if two does work as long as no one goes off sick.

I must admit when there was three people I did have to read a good book, but I personally would say you need techs working at 60% capacity but I do know other places where they either work at lower or higher.

Problem is some MES companies would actually say that the right number of techs in a small hospital like this would actually be Zero. Instead of actually having anybody on the ground you have one clerical person who just packs the faulty equipment into boxes and ships it either directly to the manufacturer or to their head office where a small number of techs work on multiple sites equipment.



There are many ways of supporting equipment, and (as I have said a few times before), in theory it doesn't matter how kit gets maintained just as long as it does (that is, everything is covered). But surely by now we all agree that there is more to in-house biomedical engineering than just repairing the kit once it breaks down (like getting off your idle butt and walking around the user departments, rather than sitting there reading a book, for instance)!

And anyway, that last "model" you mentioned is undoubtedly the worst of all the options. There are many reasons, but here are just three:-

1) Nurses et al don't get the direct support they need
2) Fixed equipment cannot be sent off (so will still need to be visited)
3) The dispatcher becomes a tyrant! frown
Originally Posted By: Geoff Hannis
But surely by now we all agree that there is more to in-house biomedical engineering than just repairing the kit once it breaks down (like getting off your idle butt and walking around the user departments, rather than sitting there reading a book, for instance)!
Yes Geoff I'm sure there is , but you'll probably find those departments have done all that and had to stop for fear of doing next years ppms before that happens.

I'd still say three or four was the right numbers even if the department has spare capacity for sickness and emergencies.
Quote:
We're (well, we were) talking about a (private, charity, faith-based?) hospital in the Philippines,


Where do you get the idea that Delfin's hospital is a private, charity or faith based hospital Geoff? I can see nothing in the posts that says it is. I do hope that you are not making unwarranted assumptions again tut

Delfin, could you please clarify if this is this the case (not that it makes that much difference)?

Thanks.

It makes no difference at all to the "calculations" ... but whatever the foundation of Delfin's situation is, I doubt that it's awash with funds.

That comment was made in response to Chris suggesting that "one answer to the problem of on-call is just don't do it and buy extra equipment"! frown

Once again it has been demonstrated that my own experiences as a hospital biomed and those of many of our fellow correspondents on the forum must have been during a different era, at different places (if not on different planets). whistle
Poor Delfin must be totally bemused at this point.
Then again how do we not know that Delfin's hospital doesn't have the spare capacity already? I notice five anaesthesia machines and imaging equipment is covered by a third party, how many of those is going to fail out of hours? It depends on what type of work the hospital does, if it's a small community hospital it might not need on call. (also note distinction between private clinics and the hospital, so it doesn't seem to be a private hospital)

Also how do we know that a UK hospital is awash with money? Apparently there's more hospitals in worse conditions.

Originally Posted By: Neil Porter

Poor Delfin must be totally bemused at this point.


Yes, Neil. I agree. whistle

I noticed that Delfin looked in at the forum a few hours ago, yet hesitated to make a reply ...

However, I think that his original question has been answered:- he shall need a total of between two to four in-house techs; so he can take his pick. Three?

@Delfin: if you have an equipment list already prepared on your computer (in whatever format - but .xls is easiest) I would be happy to take a look at it. And even load it up into the latest - and soon to be issued [I hope] - version of the TaskMaster equipment maintenance management database program, then email it all back to you. That's the best I can do. smile

@Chris: do any of the guys at Weston ever get on here? No doubt we could offer them a few tips as well. But somehow I doubt that "biomed" is the root of the problem there (or at any other of the disgraceful situations we hear about so often these days).
Yes, I agree with Neil here as well.

@ Delfin, in concert with Geoff, if you want an alternative view you are also welcome to send me (PM me) a copy of the asset list and I will have a look. An alternative view might be useful.

For those of you who had a look at the asset list I uploaded, the answer is ................ 0.6FTE.

Yep, that's correct, one person, 3 days per week.

Well ok, that's not the entire story, as well as the 3 days a week of one person, we also provide specialist support for anaesthetics machines and manifolds from our gas specialist and management support from yours truly.

Gas support probably amounts to a week or two per year (in total) and management support to perhaps one day per month (reports, meetings, answering questions etc etc etc).

Now, in fairness, this is not a "stand alone" hospital but part of group that is serviced by us. As such we can provide holiday cover etc. But, to think that a hospital the size of the one Delfin is talking about would need 4 people is, frankly, ludicrous. As I said in an earlier post, even with this level of support we run at 95% PM compliance.

Before anyone says "but you don't do XYZ" pls check my earlier post. This is a full service biomed support arrangement (within certain limits).

Honestly, 4 people?, you jest me thinks (except I know you don't). Two would be quite sufficient to cover all the work and, with a little cooperation, provide leave cover etc, etc for a hospital the size of the one being asked about by Delfin.

Originally Posted By: DaveC in Oz

... if you want an alternative view you are also welcome to send me (PM me) a copy of the asset list and I will have a look. An alternative view might be useful.


Yes. The more the merrier. smile

OK, I don't want to prolong the debate (?) ... but (as I suspected) yours is not really a like-for-like comparison there, Dave (if you don't mind me saying).

That's why, instead of vaguely talking about "number of techs", to do this stuff properly you (we, they) have to screw it all down to man-hours. That (as you must know, Dave) takes a fair bit of work (and my ancient spreadsheets from the Lotus 1-2-3 era haven't been dusted off for a while).

There are a lot of "ground-rules" (variables) at play as well. For instance, in your case, how many man-hours get factored in for the support provided by the company? And how many FTE's would the numbers crunch out at if the customer insisted on more frequent PM? think

We also don't know about the condition of the kit. Delfin mentions "working" equipment; so I guess that means that some of it isn't. "Reading between the lines"? Yes.

Delfin also mentioned that he works alone. So I think we're safe in assuming zero support, except when he calls upon outside companies (which, I suspect, he doesn't do lightly). Meanwhile, your 0.6 of a guy will be well trained, fully equipped, well supported (and all the rest), no doubt.

Anyway ... jesting? No, I know that you're not. But there again, neither am I. Those "examples" I mentioned earlier actually happened; with much success (both operationally and contractually) I might add.

But (in closing):- MES (visiting contractors, whatever) versus in-house (employees of the hospital). Two different approaches; equally valid, equally effective (you might say), but different mind-sets (and I've done both myself). Chalk and cheese. whistle
Quote:
but (as I suspected) yours is not really a like-for-like comparison there, Dave.


How so Geoff?

Quote:
For instance, in your case, how many man-hours get factored in for the support provided by the company?


As I said, smallish amount for "gas man" speciality and some from myself. Not that much really.

I'm a bit busy right now (and have already spent too much time on this one), Dave.

It's not like-for-like for some of the reasons I've already mentioned. In short, it's not just about the kit ... but also what we might call the general circumstances.

All I can suggest is that you get your company to branch out beyond your shores, visit Delfin's hospital, and make a proposal to the management there.

How's that? think

Meanwhile, excuse me Mate, but I have work to do.
Dave, who does the management side (your company)and 1 guy doing 3 days a week, does that mean there are times when you have to wait 4 days to report a fault? Are there any patients at this hospital as it appears that all the equipment due for PPM is readily available, not a real world situation as far as I am concerned.
Well being part of a group is going to effect things there greatly Dave. If you remember rightly Geoff it use to be Bristol and Weston health authority and it also only required 1 or maybe two people driving up from Bristol to look after it. Only when it was treated as a stand alone unit was that number too little. Also yes condition of equipment also plays an important part.

If you think four is frankly ludicrous you should see some other hospitals this size, my colleague went on a training course to another trust recently and hasn't stopped talking about how many people they had!

Another way at looking at all this is to take a look at situations with large commitments (many items of kit, and more than a few techs) and zoom the numbers down to suit smaller situations.

Enjoy the perusal! smile
..private, charity, faith-base, I think it could be mostly alike with our hospital. Because our hospital is a non-stock non profit type of hospital (but not own by the Government)
thats why i'm here.
what ever suggestion and comments u made still be very useful to me.

Hang-in there, Delfin. And don't forget to keep us updated. smile
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