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Healthcare Technology

Ground Zero Perspective

By

Peter Terence D’CruzAllied Physics Sdn Bhd

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Ground Zero Perspective• Medical Technology Service Industry - Career

Choice and Maintaining an Edge• Politics of Equipment Management• Equipment Management and Options• Maintenance of Medical Equipment-Points and

Pitfalls• Customer Service - Why Customer Service

Matters• Negotiating skills

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Medical Technology Service Industry - Career Choice and

Maintaining an Edge

How is it now ? HOW ?

Is this career recession proof ?

What is the Future ? CE ?

WHY ?WHEN ? What is the pay like ?

How do I keep up ? Oh - alamak !

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Politics of Equipment Management

Border disputes between Biomedical Engineering and Facilities Engineering are sometimes the cause of disservice to the patients.

• EEG from quality of power feeding it.• Anesthesia Machine from the wall gas outlet.• Dialysis System from the water and plumbing.• Imaging Equipment from air-conditioning.

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Equipment Management

Options

• Vendor Service

• In-house Service

• ISO - Independent Service Organization

• Depot Service

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Vendor ServicePROS• Eager to provide good

service• Available in country• Good Parts supply• Easy upgrades and

field corrections

CONS• Lack of Multi modality

service back-up teams • Mergers effect service• Parts price uncontrollable• Are we ever sure the part

needs replacement?• Insist on same level

service coverage for all

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In-house Service

PROS• Fast Service and easy

access• Ownership • Better coordination

with internal staff• Easier implementation

of quality systems.

CONS• Not possible to have

experts in all systems• Lack of manpower• Overloaded with work,

meetings, audits, ISO • Budget constrains • Danger of finger

pointing matches

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Independent Service ProvidersPROS

• Vendor neutral

• Fixed overhead

• Flexible approach to service needs of each equipment /customer

• Value added services frees hospital to provide Clinical service

• Customer can impose guarantees and penalties

CONS• Parts supply• Access to passwords

and S/W• Conflict with in-house

service

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Depot Service - 4th Party

PROS

Low cost

Super communication

Quick turnaround time

No commitment

CONS

Over promise on time, speed and quality

Unable to figure exact user complaint

Lost in transit

Damaged in transit

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Asset Management• Asset take-up - Equipment History Analysis• Field Service Software• Avoiding Problems• PM,CM,BM• Mac Gyver, Sparky, Mr. Knowall• “GUD” Report Writing• Ways to Defeat Time Robbers• Useful Skills - Customer Service• Useful Skills - Negotiating

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Asset take-up - Equipment History Analysis

The asset take-up must at least identify :

• Type of equipment, Model,Age,Cost

• Manufacturer

• Spare parts used and cost

• PM, CM, BM records

• Location in hospital

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Field Service Software

• Document what your department does and what it needs from the software package.

• Select the software that most closely answers your needs

• Then change your process to fit the software - don’t change the software to fit the business, or you run the risk of the original developer not supporting it due to the the extent of modification.

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Field Service Software

Buying Software without getting fired.• Functionality - Does the software do what you

want it to do?• Technology - Does the software run on your

computer and interface with other systems?• Vendors - Does the vendor have a good reputation?• Cost - Not just software, but training, add-ons and

integration.

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Avoiding Problems

• Recommend comprehensive up-front training when new equipment is purchased.

• Teamwork approach, a good collaborative model. Instead of chasing each other’s problems and getting nowhere.

• Plan prior to purchase,make sure everyone understands what is being done and what kind of support can be expected.

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Avoiding Problems• If users are rotating through and every body takes

care of the equipment, it means there is no ownership, they may not be familiar with it and you end up with more failures.

• As devices become lighter and their housing is changed from metal to plastic, it becomes sensitive to RF and must be shielded properly

• Little ripples and brownouts can cause problems. Use line monitors for at least 2 weeks to analyze.

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Mac Gyver, Sparky, Mr. Knowall

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“GUD” Report Writing

Examples of bad report writing:

Problem found - problem fixed

No problem found

Replaced xxx PCB - system tested OK

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Ways to Defeat Time Robbers

• Too Many PMs -Utilize a risk-based maintenance management system to reduce unnecessary preventive maintenance on minor equipment. IV pumps, may be put on annual maintenance with justification. Others may be removed from the PM schedule based on risk criteria, with reference to available standards in the country

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Ways to Defeat Time Robbers

• Unbalanced PM Workloads - Although repair calls cannot usually be anticipated, preventive maintenance work can be scheduled and balanced to maximize staff time. One should begin with known holidays, annual leave, ISO audits, scheduled installations, available manpower together with some contingencies

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Ways to Defeat Time Robbers

Excessive hunting-time - Reduce time spent looking for equipment. Frequent inventory reviews may help. Do not allow tech staff to close WO as ‘Item not found’. This practice will give a false WO closure rate.

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Ways to Defeat Time Robbers

Too much paperwork - Laptop computers or PDAs should be widely used to reduce paperwork time, data-entry errors, etc.

Unexpected repair workloads - Selectively outsource like demand service or depot service to tide over such loads

Tiada Tools - Invest in tools, technical library, communication eqpt

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Ways to Defeat Time Robbers

No parts - Have suppliers commit on parts supply even after the warranty period. Invest on fast moving parts and store them locally.

Missing tools - Engineers spend a lot of time looking for tools that are misplaced or ‘borrowed’ . GET A LOCK for your tool bag !

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Ways to Defeat Time RobbersReinventing the wheel - There is little that your

predecessors has not thought of in the service of biomedical equipment. Go through the internet, AAMI, ASHE,AHA, ECRI or JCAHO have lots of standards that will get you started.

Not enough training - Good training saves troubleshooting time, increases customer confidence of your capability- willing to pay for good service.

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Ways to Defeat Time Robbers

No Priorities - Be willing to say no to projects that will take too much off at the expense of PM and other maintenance activities.

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Ways to Defeat Time Robbers

This is a request from your mothers - Clean up you workplace! If you can’t find the part tools or manual, you can’t use it. If it is broken it won’t get better sitting there, get rid of it! A clean organized workshop is a pleasure to work in - and you can invite Mom down to visit.

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Useful Skills

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Useful Skills - Customer Service

Customer service

Matters because every body:

• Wants to stay in business

• Wants to stay in your job

• Wants to be someone people think of positively

• Good customer service = commercial survival+job security+good self-image

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Useful Skills - Customer Service

Customer expectations

• Often set by other industries like banks, hotels, airlines, fast food outlets, etc. You are not just competing with other hospitals.

• Evolving and growing more demanding, so you can never sit back complacently. Your standards of customer service always need to be on an upward curve.

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Useful Skills - Customer Service

The Silent Complainer

Most dissatisfied customers don’t tell you:

• They tell their friends

• They ‘goreng sikit’

• It eventually turns into a real horror story - you may even attract hostile press publicity

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Useful Skills - NegotiatingNegotiating

• Negotiating takes place when two or more people,with differing views come together to attempt to reach an agreement on some issues. This may be a one of event or part of an on-going relationship.

• Persuasive communication (bargaining) is about getting what you want.

• Negotiation is about getting the best possible deal

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Useful Skills - NegotiatingLike all forms of communications, negotiations are never simple. Keep in mind the overlapping processes

0204060

Communication

Negotiation

PersusiveCommunicationTime ofinteraction

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Useful Skills - NegotiatingTypes of Negotiation

1. Distributive

Sometimes called ‘win/lose’ arises when the parties are in conflict. Each sees the objective as beating the other. Negative tactics are used.

2. Integrative

Sometimes called the ‘win/win’ situation where the objective is to gain agreement

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Useful Skills - How to Negotiate

• Identify equipment needs - Know a system’s capabilities and buy accordingly. If the basics are enough, avoid additional features, even if the price looks attractive.

• Allocate time - Devote at least two to three months to gather information on the equipment and the market

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Useful Skills - How to Negotiate• Get educated - Pick up brochures from

vendors, surf the web and visit trade shows for the latest in medical equipment.

• Shop around - Gather quotes from at least three vendors. Analyze all cost, including parts and supplies and operational expenses after warranty.

• Stick to necessities - Vendors may sweeten the deal with additional software and hardware.

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Useful Skills - How to Negotiate

• Hold firm on the price - If the price isn’t within the budget, go to the next vendor. There’s always room to negotiate.

• Shop towards the end of the year - The best chance for a good deal is at the end of the company’s fiscal year. Better discounts may be available to meet sales quotas.

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Thank you

“Remember 99 percent of the problems are caused by people who make excuses”

-George Washington-