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Posted By: mammad Familirities lead to monopoly - 19/05/18 2:59 PM
Currently I am doing a procurement for new teaching hospital and now in stage of selecting the brand and model for medical equipment which to be procured and installed.

What I can observed from most of the medical practitioner's feedback is when we presented the brand and model for them to choose, they are more prone to single brand even though there are other better brands which are more economical in term of cost and still in par in term of quality and technology.

One of the reason is familirities. Even we offer a training, they still insist of the brand and model which they are already familiar with.

Is this shall lead to monopoly? Some of the vendor aware on this matter and if their brand fall under doctor's familirities, they will start to increase their price and this will be disadvantage for us a buyer.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 19/05/18 8:08 PM

There are a number of ways of equipping new hospital projects, so it depends on which contractual process you have been saddled with.

The most successful outcomes I have seen were where no physicians or surgeons et al were allowed anyway near the process until way after it was too late for them to muddy the waters! In short (and as arrogant as it may sound), they got what we gave them! whistle

By the way, sometimes a "monopoly" (I prefer the word "standardization") can be a good thing:- all patient monitors from the same manufacturer; all infusion pumps; all the x-ray equipment from the same manufacturer etc. In the last case (x-ray) in particular, the performance of the local servicing agent is usually sufficient to steer in favour of one manufacturer. The same can usually also be said of anaesthesia (and often laboratory) equipment, as well. smile
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 19/05/18 8:19 PM

Originally Posted by mammad

One of the reason is familirities.


Perhaps. But, in my experience there are (were) usually other reasons! whistle
Posted By: mammad Re: Familirities lead to monopoly - 20/05/18 1:18 AM
Originally Posted by Geoff Hannis


The most successful outcomes I have seen were where no physicians or surgeons et al were allowed anyway near the process until way after it was too late for them to muddy the waters! In short (and as arrogant as it may sound), they got what we gave them! whistle



That is why our approached is to get a feedback from physicians or surgeons and to get them informed what they will received when the hospitals operated. We don't want from the last experiences, the equipments is not used due to they was not early informed.

The agreement that we have is under Private Financial Institutions (PFI) which means we as Private company will equipped the hospital with the equipment as well as build the hospital for them. We do have a list of approved and agreed brand with agreed specification for each equipment gazetted in the contract for us to select. For example, there are 2 approved brands for MRI : philips, siemens. With the same agreed specification, we choose Philips (better in price) for example but due to familirities, the end user prefer Siemens. When we studied we found that in other hospital that this end user works, she/he only works with Siemens.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 20/05/18 8:24 AM

Does she/he get asked to justify why Siemens is preferred? Maybe she/he has a good reason! smile

Meanwhile, I am saddened to see that the PFI model has made it to your shores. frown

OK if you're the contractor, of course; but not so good for the tax payer.

So, in this case, my sympathies lay with the end user; they will probably need to fight the contractor all the way in order to achieve a half decent result.

In passing, the process you outline sounds rather odd. Even the old Saudi MOH process was more logical than that!
Posted By: Neil Porter Re: Familirities lead to monopoly - 20/05/18 12:39 PM
Buying through a tender, whereby the end-user does not see the brand or price, only the specification is my preferred method.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 20/05/18 4:06 PM

Mine as well, Neil ... with the proviso of a decent set of specs. smile

To my mind, writing (good) specs is an art ... so that they allow a maximum number of vendors to comply, whilst ensuring that only up-to-date equipment is procured, yet sufficiently generic (creative?) so as not to obviously favour any particular manufacturer or supplier. They should also (like all good writing) be tight, and devoid of any superfluous verbage!

The trouble is (was) that hardly any "clients" were seemingly willing to pay for the time it takes to produce a decent set of specs (that is, not just a cut-and-paste job of someone else's ancient attempts). The only time I got a decent per diem, the gang involved wanted to place Quantity ahead of Quality; they demanded so many specs per day, regardless of equipment type or complexity, and (or) how much research may have been involved. And - they kept adding to the list of details required (first it was typical dimensions, then it was electrical Class and Type), which meant having to go back over old ground, time and time again. I did not stick around very long at that one!

On the topic of "research", back in earlier times, "consultancies" stood or fell on the quality of their Technical Libraries (collection of suppliers' catalogues, architectural text books, standards documents and what-have-you). Some I came across were quite lavish. But now all that is required is a laptop and access to the internet; a level playing field at last, perhaps.

Back in the day, the old Saudi MOH specs became notoriously out-of-date - to an extent that rather wide "interpretations" became the norm. On one project, I actually needed to re-write many of them ... but that was a company hospital using MOH specs (as a way, or so they thought, of cutting costs and speeding up the project - both of which they failed to achieve)! And all that was done whilst trying to limit the amount of Change Order claims made by the contractor. Happy Days!

On another project - for a private hospital - I provided a room-by-room listing free of charge, hoping that we would be awarded the contract for on-site supervision of the construction. We weren't; but that didn't stop the client demanding that I write a set of specs to support the listings I had provided. I declined at that point, as may be well imagined.
Posted By: mammad Re: Familirities lead to monopoly - 21/05/18 1:37 AM
Yeah, he/she did explained but the reason is not technically justified for example image's resolution, system's user friendly etc. which the other brand also fulfilled.

The intentions is not to burden the end user which they have to put a lot of effort in fighting for the brand that they wants. It is more on contractual requirement and process. We do have an agreement (fixed price) and list of approved brand we can choose and propose.

My actual point is end user may need to give a chance for other brands to be selected. If there were a huge gap between two brands, I am understand but with the reason of "not familiar using this brand" is for me not fair. Training and support can be provided. It seems like, if I am a doctor and well trained with brand A, i don't care with other brand which for me may lead in monopoly.
Posted By: Neil Porter Re: Familirities lead to monopoly - 21/05/18 7:19 AM
Geoff, I do my own specifications on excel, modified and updated constantly. using excel allows me to compare all the offers side by side. You must remember though that you are buying the quotation and not the specifications, ensure that the quotation matches the specifications. Apart from the specification AFTER SALES SERVICE is very important.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 21/05/18 9:10 AM

Yes Neil, but who accepts the quotes (bids)? smile

In passing, what's the rule regarding availability of parts these days? How many years from date of purchase? think

I believe it may be better to place a series of overall statements in "General Conditions" to cover such things as:-

1) International standards to apply
2) Mains power specifications
3) Medical gas connections (where applicable)
4) Availability of spare parts
5) Service support
6) Service contracts (where applicable)
7) User training
8) Technical training (where applicable)
9) Provision of technical and user manuals
10) Warranties ... etc.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 21/05/18 9:15 AM

Originally Posted by mammad

It is more on contractual requirement and process. We do have an agreement (fixed price) and list of approved brand we can choose and propose.


If that's what has been agreed to (ie, what the contract says), then everyone should comply - unless someone has the funds required to insist on Change Orders!

On the other hand, surely the end user can propose alternatives? Then it is up to you to agree or disagree as appropriate. Just as long as any such proposals are made in a timely manner (that is, before the selected item has already been approved for purchase). Who knows, they may even suggest something that costs you less!

Where have your specs (specifications) come from, by the way?

Meanwhile, here's another nice phrase that may sometimes be useful:- "Equal to, or better than".

Good Luck! smile
Posted By: Neil Porter Re: Familirities lead to monopoly - 21/05/18 10:27 AM
Geoff, there is a committee appointed and I am on most if not all the biomedical equipment tenders and yes there are terms and conditions as mentioned above, electrical and medical gas are British Standard, FDA, SFDA certificates required among others, we also require manufacturer trained engineers from the vendor.
Posted By: Neil Porter Re: Familirities lead to monopoly - 21/05/18 10:33 AM
Specifications, have come from the manufacturer just remove any reference or particular items that are unique to any manufacturer. If we have a tender for an x-ray machine I will send the specifications to Philips, Siemens and GE to ensure that nothing is biased to one company.

Anything unique that the end-user wants will be re-named in general terms so as not to appear biased.

I have hundreds of specifications on the PC, modified and updated every time a new tender is required, even have room listings for every function within the hospital.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 21/05/18 10:39 AM

Sounds like you're in an influential position there, Neil. smile

But take care ... as you must know, some of those Big Players carry a great deal of wasta. whistle
Posted By: Neil Porter Re: Familirities lead to monopoly - 25/05/18 5:59 PM
Not an influential position, more a position of responsibility
Posted By: Herman Moes Re: Familirities lead to monopoly - 29/05/18 12:49 PM
Wasta
Posted By: Neil Porter Re: Familirities lead to monopoly - 12/06/18 2:17 AM
Geoff, all that is done. Direct purchase is 3 years warranty, tender 5 years. A technical committee is formed to evaluate each tender. After sales service is a major factor in choosing the bids, cowboys still exist here..
Posted By: Herman Moes Re: Familirities lead to monopoly - 12/06/18 5:50 AM
Hi Neil,
Do you also keep track of the life cycle of different brands as depreciation may be different from brand to brand that may affect purchasing strategies?
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 8:15 AM

Originally Posted by Neil Porter

cowboys still exist here..


Good to hear that at least some of the traditions are being maintained, Neil. whistle
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 8:19 AM

Herman, surely depreciation is a notional (accounting) figure that is applied across the inventory ... and one which the esteemed Bean Counters are likely to fiddle about with over the typical lifetime of equipment anyway?

In other words, just pick a number (such as 7% pa), and run with it!

To my (traditional) mind, it is more important to keep a close watch on maintenance expenditure, and the point at which further repair work (for example) becomes no longer justifiable (unless special conditions over-ride).

Anyway, you can always add as many fields as you like! smile
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 8:46 AM

Originally Posted by Herman Moes

Do you also keep track of the life cycle of different brands ...


Do you mean the equipment lifetime (in years)? Surely such a figure is intially planned (estimated, anticipated) ... and is only known for sure "after the event" (once the equipment has finally given up, and has been junked)? And even then may well be a "one off", and not not truly representative across the "brand" - which, in any case, may have "moved on" (or even "up") after the passage of a number of years.

Apart from anecdotal (or personal) bias ... perhaps based on previous experience, or the reported experience of others - as well as perceptions based upon such factors as low (relative) price and what looks and feels like "poor quality" - how can we say initially that one brand is likely to have a shorter in-service life when compared with any other?

Other factors (such as maintenance - or lack of it, availability of parts, service support, user care and attention [or abuse], lack of use [sitting in the stores for most of its life], heavy usage ... and no doubt many more "unknowns") usually apply. smile
Posted By: Neil Porter Re: Familirities lead to monopoly - 12/06/18 8:47 AM
Hi. Herman
It does not matter which brand, 60% of the initial cost is the cut-off point, risk management (which we are still working on) will establish not only the brands but the equipment that is most prone to failure
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 8:59 AM

Yes, Neil; as you know, I'm a supporter of the "Risk-Based PM Model" ... but again, to start with the risk assessment is simply predictive (based upon an informed Best Guess), and in any case usually only sets the initial interval between PM visits. Only after a few - or perhaps, many - PM cycles does a true pattern of equipment reliability emerge.

At that stage, a good PM system allows adjustments to be made - generally reducing or increasing the interval between PM visits accordingly, as well as (possibly) reviewing the Risk Factor(s) settings.

In many situations I have seen (or should I say, suffered) - and, indeed, studied - the PM schedule never reaches that happy state of equilibrium (that is, too few PM cycles on which to base an informed judgement). frown

With PM (and as you know), you have to be in it for the Long Haul. smile
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 9:10 AM

Originally Posted by Neil Porter

60% of the initial cost is the cut-off point ...


You might want to consider making that 60% of replacement cost, Neil. smile
Posted By: Herman Moes Re: Familirities lead to monopoly - 12/06/18 9:20 AM
Thanks Geoff,

I had several discussions with CSSD and Biomeds and too often I hear complains about why the bought that Sh*t product again as the break to often. I aim to make a visibility report that can be clear in costs between brands. Thus based on CSSD and Biomed information an items gets " 0 - 5 stars" based on their work.
Last week example:
A costs 50 K , B 65 K
A lasts 1 years, B 6 years:
A monthly issues, B twice PPM
purchaser buys : A.
Also I want to connect the amount of time required to get parts in connection with "flexible" manufacturers/suppliers that may cost the biomed next to time, a great deal of headache.
Posted By: Herman Moes Re: Familirities lead to monopoly - 12/06/18 9:24 AM
I mean life cycle as in years and uses, depending on the type of equipment.

I had a guy tell me he had the best US in the world, 13 years old, still same probe. But uses it 1 x per 5 -6 months.
Picture has horrible by the way. Future parents will certainly not know from this guy if its a boy or girl.
Posted By: Herman Moes Re: Familirities lead to monopoly - 12/06/18 9:28 AM
Neil,
i agree there, We seek to get biomed more involved through what we want offer. Thus biomed and CSSD become more key - stakeholder rather than the "washing machine" or the "mechanic".
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 9:57 AM

@Herman:- in reply to all your points ... things are obviously a bit "different" where you are.

Hint:- you need more wasta, Mate. smile

Who is the "purchaser"? Follow the money!
Posted By: Neil Porter Re: Familirities lead to monopoly - 12/06/18 10:37 AM
Once the specifications are prepared we will sit with the end-user to modify if required, the technical committee will include the end-user and biomed, a representative from the purchasing department will be there and it is not too difficult to convince them as to the reasons why we are taking the more expensive unit.

As mentioned earlier I will take all the offers and compile them into one sheet to highlight the differences between the offers and to clarify who is not offering the full package as required by the end-user.
Posted By: Herman Moes Re: Familirities lead to monopoly - 12/06/18 10:56 AM
Geoff,

Luckily it was not me losing a job, the wasta issue in our region is highly rated and much more important,
mitigating wasta is very difficult here.Influences by the culture within often separate departments and make it difficult to break through. It often does not align with the "individual goals".
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 11:22 AM

Tell me about it, Herman ... I enjoyed (endured?) something like seventeen years trying (and generally failing) to fight all that armed only with "good engineering practices". smile

Remember, Mate, that you'll never win. So it's best (as I learned in time) - and in order to survive* - to "roll with the flow" as much as you can (that is, without sacrificing your personal principles more than you can bear).

As Neil (as well as a few others we hear from on here from time to time) might recall, we used to call it being "Riyalistic"! smile

* Which I sometimes didn't.
Posted By: Herman Moes Re: Familirities lead to monopoly - 12/06/18 12:45 PM
Hahaha, yes, been here 12 years now, and still don't know the drill, perhaps I have the same "bad" qualities you have trying "good engineering practice".
I do not need to win actually, I stay under the radar and prevent politics. i see a lot of people come and go, all the same "issues", but they are employed and thus report to these. i don't have anyone I need to discuss with. 100% private owned here.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 1:09 PM

About wasta ... assuming that Bahrain follows similar procedures to that larger domain across the Causeway, what matters most of all is the "clout" than could (if need be) be brought to bear by your kafeel ... especially on your behalf. You know, to get you out of jail, and other every-day matters like that.

I once had to represent myself at the Labour Court. Not such an easy undertaking, as you may imagine. But after many visits (journeys, days off work, and what-have-you), and no doubt "impressing" the judge with my "resolve", I finally got a result:- half of what I was owed (by my own beloved Sheikh).

If I had my time again, I would be a bit more choosy ... but back then, at least, it was difficult to know what (or who) you were letting yourself in for. This was especially so in the case of small companies, or Establishments. It was all a bit random. Hopefully these days it may be possible to carry out a modicum of research in advance.

Meanwhile, this link may be of interest. Notice that "Medical Equipment Stores" (shops) are on the list.

I wonder why that is? think
Posted By: Herman Moes Re: Familirities lead to monopoly - 12/06/18 2:38 PM
Luckily here it is still different. Nothing like that, Expats can be investor and have their own company as long as you invest enough. I believe here is still the best location for the entire region. Although is it going a little less every year. and a hell of a lot more expensive, getting close to Dubai pricing now.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 12/06/18 3:00 PM

That's interesting! smile

I wish I had known that "back in the day", Herman.

Am I right in assuming that, once established in Bahrain, you are able to ply your trade (in person, visits to sites and what-have-you) across the GCC countries?

What sort of figure(s) are we talking about (in terms of investment) there, I wonder? think
Posted By: Herman Moes Re: Familirities lead to monopoly - 13/06/18 5:35 AM
Yes,
We plan to expand to the surrounding area, I need to get more marketing on our profile.
I spend in higher 5 digits so far.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 13/06/18 8:21 AM

BHD or USD? think

Either way, that's a lot of feloos ... and certainly way out of my league. frown

Re: marketing. As you know, the name of the game in KSA (and, I should imagine, most of the other surrounding countries) used to be working through a Local Agent. I presume that little has changed in that regard, mainly as it was (for the Agent) such a great money spinner (with exclusive territories, high mark-ups, and all the rest).

But (again, as you must know), there are good, and not so good Agents. Some are very active, others not so much. And see again previous post about wasta.

I used to be (very) aware of the "historical" medical equipment Agents in KSA (and most of their back-stories - many of which were very interesting), but Neil must have the up-to-date picture.
Posted By: Herman Moes Re: Familirities lead to monopoly - 13/06/18 10:39 AM
Geoff, will mail you a first glimpse of our device page, let me know what you think
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 13/06/18 12:35 PM

Why not place a couple of images right here (using the Attachment Manager) so that others can chip in with constructive (hopefully) comments? think

Otherwise, just a quick couple of comments:- at the Asset Management tab, you could remove over-use of the word "Device". Also, the PPM Date needs to be made clear (as in "Next PM") ... and I would add "Last PM" as well. Not sure I would include the Origin column on that form. Neither would I include Supply Voltage there; but what about Location (Room No, etc.)? Not too sure about the (large) "Classification/Type" symbol on the Asset Details form, either; I would just use a simple Class 1 Type B (etc.) myself. Minor point:- on the Asset Management form header you include Type, but not Class (plenty of room). Very minor point:- Year of Manufacturer shows a complete mm/dd/yyyy date (rather than just the year). Other than that, yes; very good! LOL.

All design choices, I understand that. smile

PS: I did notice Moto Guzzi, BTW.
Posted By: Herman Moes Re: Familirities lead to monopoly - 13/06/18 12:50 PM
Good input, thanks on the ppm page ( I did not send) it has the location . but will make links and changes today to the front end.
Large symbol is for the nitwits here that can see pictures but not read.
the Guzzi, yes, test faze hey. good thing i did not show the user list.
O Bin laden,
A Hitler.
Stormy Davis
D. Trump


Will post some pics here in the next few days.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 13/06/18 12:55 PM

All my favourites, then! smilewink

Yes, posting here would be good ... although we realise you may need to spend some time entering dummy data in order to "protect the innocent".

Best use the "correct" thread, though. smile

Nitwits perhaps; but not all Class 1 equipment carries that symbol. tut

BTW, I notice that the Asset Details form has a (drop-down combo-box) field labelled Battery ... and shows what looks like a date. This is good - but what does the date actually imply? I'm assuming "last battery change" in the case shown; but do the fields (form objects) support "hints" (as the mouse hovers over)? Also; how about including battery details (voltage, type, part number etc.)?
Posted By: Herman Moes Re: Familirities lead to monopoly - 13/06/18 1:27 PM
I agree with your symbol note. It adjusts as you fill in the correct class.
The battery date implies installation date, this shows when you drop down, yes all part details come up if you click battery it opens even a picture can be added.
when you click on the last ppm, a full detailed list comes up.
note field, there you can add brand, supplier , etc. 2500 Characters and allows 20 pictures of parts used.
Each PPM ends up in the history, also alarms if you again replace same part again and have to click to approve, you can notes to that also if you wish to add a reason.
Posted By: Geoff Hannis Re: Familirities lead to monopoly - 13/06/18 1:55 PM

Sounds very comprehensive ... looking forward to seeing the PM form. smile

But note the comment about using your original thread.
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